Things That Sabotage Bipolar 1 Disorder Treatment

Setting up a care plan for a mental health condition such as bipolar 1 disorder can be challenging. And sometimes, despite the best intentions, it can be hard to follow that plan exactly.

Part of the reason is because the manic episodes — periods of high energy, activity, and risky behavior that last at least a week, according to the American Psychiatric Association — of bipolar 1 disorder can interfere with your ability to stick to treatment. So can the depressive or hypomanic (shorter periods of higher energy that are less severe) episodes.

To prevent bipolar 1 disorder episodes, including mania, you can try to avoid or minimize some habits that may affect your treatment. Here’s what to keep on your radar — and what you can do to take back control.

1. Not Taking Medication as Directed

“Mood disorders, including bipolar 1, are some of the most treatable conditions we see in medicine,” says John Zajecka, MD, a professor of psychiatry and behavioral sciences at Rush University Medical College in Chicago. “There is no reason why people can’t be in charge and in control of their moods and illness and live normal, happy lives.”

Key to this, though, is taking your medication regularly. “[It] is imperative,” Dr. Zajecka says. When it comes to keeping your mood stable, he notes, “It’s not a good idea to try to manage without medication.”

That said, you may not want to take medication during an episode of hypomania or mania (when you may feel you don’t need it) or during a depressive episode (when you may feel as though no medication will help you).

Sometimes, the side effects of the medication can deter people from taking it. Other times, people simply forget about it. If either is the case for you, talk to your healthcare provider. There are many medication options for bipolar 1 disorder, and there may be ways to tailor your regimen so it fits your lifestyle better or reduces side effects. If you don’t feel your doctor is taking you seriously, Zajecka recommends seeking a second opinion.

2. Not Sticking to a Sleep Schedule

Good sleep is crucial in bipolar 1. “Keeping this illness under control requires good sleep hygiene,” Zajecka says. When you’re sleep deprived, you’re more likely to “cycle up” into hypomania or mania. On the other hand, too much sleep can cause you to “cycle down” into depression, he says. Over time, you should notice a pattern in your moods based on your sleep.

Unfortunately, being aware of the importance of sleep can itself pose a challenge, research suggests. You may have anxiety about bedtime, because you know that a lack of sleep can trigger a relapse into mania, but this anxiety can make it more difficult to fall asleep.

Working with your therapist or doctor to develop strategies, such as journaling or setting an earlier “worry time,” can help lessen rumination so you can get to sleep. Prioritizing sleep hygiene, such as setting consistent sleep-wake times and creating a wind-down bedtime routine, is also helpful, the researchers say.

3. Not Asking Trusted Loved Ones for Help

Your healthcare provider may be fully focused on getting an episode of mania or depression under control, “But the next step should be, ‘How do we prevent further cycles?’” says Zajecka. That’s where trusted people in your circle can help.

As a patient, you should have two people to turn to when you recognize your mood is cycling: someone on your healthcare team, such as your therapist, as well as a family member or friend who knows your history with bipolar 1 disorder. This person has a responsibility to be open and up front. Zajecka explains that they should be able to gently name what they see going on. For instance, “I hope you don’t mind, but I notice you’re going on a spending spree, and I’m worried about you.” They can then help connect you with your doctor or therapist, if needed.

“You don’t want to be alone in this,” Zajecka says. For more support, he also recommends the Depression and Bipolar Support Alliance, which is a patient-run advocacy group. “This is a phenomenal source of information, and they have so many support groups,” he says.

4. Not Keeping a Mood Journal or Life Chart

When it comes to monitoring your mood, Zajecka recommends to all of his patients that they measure their mood daily. “This seems to be one of the early predictors of where their mood may be going,” he says.

A life chart, as Zajecka calls it, comes in handy to pinpoint how environmental and lifestyle behaviors influence your mood. “People will learn patterns and learn how to manage their illness better,” he says. At the end of the day, spend three to five minutes describing your mood; you should also note whether you exercised, drank alcohol, got enough sleep the night before, and took your medications.

5. Not Focusing on What Makes You Feel Good

While it’s important to recognize the patterns or behaviors that make bipolar 1 worse, it’s also helpful to find the patterns that make you feel good.

You shouldn’t “feel as if [you’re] being put under a microscope about what’s wrong,” Zajecka says. “Rather, let’s reinforce what’s working in the right way.” For instance, if you notice that your mood cycles (dips into depression or heightens into mania) at certain times of the year (for example, connected to fall or spring), then you can really home in during those times on the lifestyle habits that make you feel great, such as getting good sleep, eating a healthy diet, or sticking to your exercise routine.

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