Just Diagnosed as Bipolar. What Next?

So you recently got diagnosed with Bipolar Disorder.
What should you do next?

The answer to that could fit an entire book. But here are some pointers.

I’m going to assume that you ended up at a psychiatrist either because over time your life had degenerated into a bit of mess, or that you had done stuff that was sufficiently, er, awesome that your family insisted that you see a psychiatrist. In either case, I’m assuming that (1) the daily organisation of life is in a bit of shambles right now, (2) that you have a lot of stuff to catch up on or fix because lots of things have gone wrong in the last few months, (3) that you don’t exactly understand what your diagnosis of bipolar means, but you know you are not crazy.

Let’s start with the last one first.
Bipolar Disorder is a physical illness, just like an ulcer is a physical illness, or like diabetes is a physical illness.

We can call it a mental illness because it is happening in your brain, but that just determines location, just as we can say an ulcer is an abdominal illness because it is happening in your abdomen. Mental in this case does not mean imaginary.

Right. So what you were diagnosed with is a physical illness.  Since you need to understand what it is like, it’s handy to have comparisons. It turns out that the features of the illness bipolar disorder are similar to the features of asthma or to diabetes. Be careful of what I am saying here. I am not saying that bipolar disorder is related to either asthma or diabetes. What I am saying is that they share very general commonalities.

These commonalities are:

  1. If you have it, you probably have it for life. You generally do not get better from asthma or diabetes or bipolar disorder.
  2. But that’s ok, because in all three of these illnesses, you can take actions which minimise their effects so that the quality of your life is pretty good. The actions may include
    1. Taking medication,
    2. Adjusting the way you do some of the things you currently do
    3. Avoiding some things you currently do or might want to try.
    4. Adding in some new things to your daily activities
  3. In all three cases, you need to be aware of the symptoms to look out for when things are going wrong, and you need to learn to monitor yourself for these symptoms. And you need to know what to do when the symptoms appear.
  4. In the case of bipolar disorder and diabetes, one of the symptoms of the physical illness is a change in your moods. If you deal with the underlying physical problem, the moods right themselves.

So. Your diagnosis is for a physical illness which messes with how you feel. You aren’t crazy. You aren’t imagining things. You are not creating problems out of nothing to get attention or irritate other people.

If someone says your are making things up, it’s like them saying ‘Oh, you are making diabetes up. Your diabetes is just in your mind. Get your act together and snap out of it.’ Any comments like that are medically nonsensical, show a thorough lack of understanding of the illness, are insensitive to you, and most annoyingly, don’t really help you at all.

Right. So I’ve hopefully made you feel a bit more comfortable about being bipolar. So what do you actually do next.

Step 1: If your life is currently in a mess, stop stressing over the things that need to get done.

Well, ok, your life will still be a mess. However, the only way you can sort it out is piece by piece. You will probably have about 3-10 things which have gone critical and you need to deal with immediately, but you’ll still only be able to sort them out one by one.

Make a list of the critical items. Then start dealing with item 1 on the list.  Try to not fuss about the items you aren’t doing. You will get to them.

If you worry about the tasks you are not doing, chances are you will begin to feel panicky.  Worse, you may feel as if there is too much to do and you can’t possibly cope. In either case, your feelings may trigger you to fall into depression or into doing nothing at all. So the plan is to try to avoid worrying or stressing about things which are not done.

Great. I’ve said this, but it is surprisingly hard to do. But try.

Here’s something to think about that might help. If whatever you are worrying about hasn’t been done for a while, another day or two will usually not make a difference. If there are no critical deadlines, you can not worry about it for the next day or two.

Step 2: Ask for Help in sorting out Critical Tasks.
It may be that you want to sort out one of the things that needs to be done, but you are embarrassed that you are so overwhelmingly late about it. Or you might not feel like you are ready to deal with people or strangers. Or you might feel like the person on the other side will laugh at you or shout at you or criticise you in some way.

Believe it or not, how you are feeling is an aftereffect of the depression. The sensation of not wanting to deal with people is often an indicator that you might still be slightly depressed. You will eventually learn to cope with low levels of this feeling and get your stuff done, but in the early stages – like for the next 6 months or so – it is perfectly reasonable to ask people to help you.

Good people are parents, siblings, or good friends. They will ask why you can’t do it for yourself since you will look perfectly competent to them. Your response can be something like “I know I should, but I’m still slightly depressed and it feels as if the people on the other side will shout at me. It’s making it impossible for me to pick up the phone (or visit the office, or….). I’ve been told this happens with the mood swings. I need your help. As my moods get better, I’ll be able to do it myself.”

They’ll look at you funny, but they’ll probably help. If the situation requires your presence, ask them to come with you and be the person talking to the customer representative.

Step 3: Start plotting your moods. If you don’t know what is happening to you, you can’t fix it.
You’ll need either (a) An appointment book which has 1 day per page or (b) a notepad. Either works. I used to use an appointment book, but now I use a notepad.

If you haven’t already, see the link on Setting up a Mood Chart for more information on how to chart your moods. You can use the Signs of Mania,  and the Signs of Depression in determining your mood for the day.

Yes, the stuff you write will be scrappy and messy. Yes there will be days with no entries or partial entries. That’s normal.

It will take anywhere from about 2 weeks to about 1 month to get data that is useful in allowing you to make decisions or choices. Persevere.

Step 4: Take your meds.
They may or may not work, but it’s a good place to start. You can check this link on why you should take the medications.

Note that us bipolar persons have a terrible record of consistently taking medications. I strongly recommend that you ask someone living with you, or someone you see everyday, to be in charge of giving you the meds and making sure you take them.

There is no such thing as personal responsibility here – if we are depressed, we simply won’t be able to get our act together to take them.

Step 5: Ask family or a friend or two to act as your social interface.
This is related to step 2. Just as you would ask someone to help you sort out some of the critical tasks, it is handy to have one or two people to help you sort out the whole set of complications with friends and family.

It would be handy to have a family member who can tell others ‘They’ve been ill for the last two weeks (or six months, or…), that’s why you haven’t seen or heard from them” or “I’m sorry they couldn’t make dinner (or family gathering, etc.), they’re ill”.

If you have a friend who can do the equivalent for you with friends meeting, that would be useful.

If you are working, it can also be handy to have someone who will call in to say you are ill when you don’t make it to work.

Note that all of these arrangements have to be set up ahead of time. There will be times in the future when you won’t make it to a close friend’s party, or Thanksgiving dinner, or to work. In the first few months after diagnosis, you will very frequently miss these things. Having someone who can smooth things out a bit for you will make your life substantially easier when you do reconnect with these people.

Step 6: Just because you are diagnosed, you will not magically get better in two weeks.
This is a reminder to you. Things will get better, but it will take a while for you to get the hang of managing the moods. This is going to be measured in months, not weeks. And there will be setbacks. All of this is normal and not you being incompetent.

Assume it will take you the better part of 2-3 months after diagnosis to at put a stop to the process of your life unravelling. Yes, life will keep getting worse for a while after diagnosis. And then it will take more months to get things back onto something that you think is an even keel.

You will get frustrated and annoyed by the setbacks and length of time things are taking. That’s normal. But even as you do, have a little part of your mind thinking – “well, this is what I was told to expect.”

While you might be willing to accept that learning to cope will take time, your family will expect you to be back to normal quickly. You will probably find it annoying to have friends and family members who assume that now you are diagnosed and taking the meds, things are all hunky dory and back to normal . Meanwhile you’ll be struggling to keep thing afloat. Very annoying.

If you feel like shouting at these people, your response should at least include something like “I’ve am really ill and I’m recovering. My research indicates that having a depression episode (meltdown, nervous breakdown, etc.) is like have a major injury and takes months to heal. I may look physically ok, but that doesn’t show the real problems. I would really appreciate if you could stop assuming that I am back to normal.”

Step 7: The meds may not work very well.
The meds may not work very well. My calculations seems to indicate that there is probably a 66% chance that what the doctor gives you first will not work properly. Expect to be experimenting with drugs for a while. Check this link for my thoughts on drugs.

Step 8: You are in charge.
Now that you know that you have a physical illness, you can do something about it instead of wondering what the heck is happening to you. But here’s the important thing – it’s gonna be up to you to steer your course.

The doctors and psychiatrists and others are going to be resource people along the way, offering good advice and experience, but you are going to have to be the one deciding what to do next. Because you are the one who is going to see your illness every hour of every day, you are in the best position to make decisions.