Monday, November 7, 2022

About me

(This post was first posted on 8 February 2008)

About Me
=========

Hello! Thank you for visiting this blog, dear Reader. Let me share with you a little about myself and God's mercies to me.

My name is Nancie. I am a Chinese Christian living in Singapore. I was led to seek and know the Lord Jesus Christ as my personal Saviour and Lord in 1990 through the instrumentality of two of my ex-colleagues Michael Sing and Daniel Hee when I was working at SATS, Changi Airport, Singapore. My life was radically changed when I became a Christian. I went through many challenges just like everyone else, and have been wonderfully upheld by the Lord Jesus Christ through all the ups and downs in the changing scenes of my life.

In December 2001, I had a severe relapse of asthma and was hospitalized. In year 2002, I took 2 months leaves to recuperate at home. It was during that period of recuperation at home that the Lord used many encouraging Christian articles, sermons and books to minister to me. I was greatly uplifted by the reminders of God's love and faithfulness. The result of it was the design of a website to upload some of my favourite articles and sermons to share with others.

Thank God for the excellent medical care for my asthma by Dr Phoa Lee Lan from Tan Tock Seng Hospital in mid 2002. As I am suffering from mild-persistent asthma, I have to be on low dosage of maintenance medication life long. Now my asthma is under good control.

In Dec 2006, I had a severe relapse of clinical depression. At first I was diagnosed as having Major Depression. But because of the extreme mood swings I experienced, I was diagnosed in late March 2007 to be prone to Bipolar Disorder also known as manic-depressive illness, a brain condition that causes extreme mood swings from very happy or high moods (hypomania) together with lots of energy and creativities and then to very low and depressed moods (clinical depression) with very low level of energy, constant tiredness, etc. During the worst times, I experienced feelings of hopeless and worthlessness to the point of having suicidal thoughts at times. Thank God for preserving me.

I think I have experienced these extreme mood swings since around 1990 ie for over 30 years. But I can only remember more clearly of the 10 or so relapses over the 18 years prior to my diagnosis. These are relapses that occurred just before I became a Christian and then the years after. I could remember them more clearly now because my life was changed significantly after I became a Christian. I have very little memory now of my younger days without Christ.

These episodes in the first 18 years usually lasted for a few months. Different from the normal ups and downs we all experience every now and then, Bipolar Disorder's symptoms are very severe. It is a long term medical condition just like diabetes and hypertension that needs to be carefully managed throughout a person's life.

Through this severe relapse in end 2006, I was led to seek medical and counselling help for the first time, besides praying and reading God's Words plus some other helps. I thank God that after so many years of roller coaster rides with extreme mood swings, I have finally understood the reason behind them. To know that I suffer from this brain medical condition and that it has a name for it, is helping me to learn to manage it better with various resources the Lord Jesus Christ has provided so that I can live for the glory of God and be able to serve Him more effectively.

The medication, by God's grace, is helping to stabilise my mood and enable me be more functional, so that I can continue to seek and serve God. I thank God for Dr Pauline Sim of LP Clinic, Dr Tham and  Dr Chan Lai Gwen of Tan Tock Seng Hospital for their valuable helps in treating my condition.

I am very thankful and indebted to my first Doctor at LP Clinic, Mt Elizabeth Hospital ie Dr Pauline Sim Li Ping. She is a very compassionate, kind and encouraging Doctor. She always assure me that I will get well and not to be discouraged.

She taught me how to recognize early symptoms of relapses, what I can do to get better, how to adjust the dosage of medicine and other matters. She said she wants me to be the co-therapist and know what to do instead of panic or run to the hospital during relapses. Under her guidance I am able manage better.



Currently, I am being followed up by Doctor Chan Lai Gwen at Tan Tock Seng. She  is also a very excellent, kind and compassionate doctor. She works patiently with me as I learn to understand how to manage my condition.

She taught how to recognize early symptoms of relapses, what I can do to get better, how to adjust the dosage of medicine and other matters.

In January 2007, I have received professional help from a group of counsellors who are trained to manage brain disorders such as bipolar, clinical depression, OCD, etc etc and my Pastor also counselled me on spiritual matters. The professional counsellors are trained to use Cognitive Behavioural Therapy (CBT) which is a form of counselling with a focus on understanding how our thoughts affect our behaviours. Bipolar alternates between 2 extreme mood swings ie. mania and depression, and our thoughts and behaviours are shaped by these mania and depression episodes which can at times be very confusing. CBT helps to make sense of some of these confusions, and help to pick up skills to manage these mood swings so that one can be more functional.

I am thankful to God for provided me with a team of very compassionate, kind, understanding and encouraging Christian counsellors at Counselling and Care Centre, Singapore from Jan to Apr 2007. My sessions with my counsellor, Sarah (and her team), were most fruitful and encouraging. Through her counselling sessions, I embarked on a new journey of self-discovery, of knowing God, myself and others better. The benefits I derived from my sessions with Sarah continues to help me as I journey on. I am grateful to Ruth for her counsellings and encouragments between May to June 2007, when she took over from Sarah.

From July to August 2007, I was helped by Dr Spencer Lee and Yvonne Ying of Association of Christian Counsellors of Singapore. Now I am helped by my Pastor's prayers and counsels, and that of some of my elders and brethren in my church, besides doing my own reading and researching on the internet to understand this condition and how best to manage it. I am deeply indebted to the above persons for their valuable prayers, counsels, encouragements and kindness during my most difficult times.

I am now learning to look to God and learning to use a combinations of available means which our Lord has graciously provided to cope with this brain condition. You can read more about these coping means/strategies from the category "My Coping Strategies" on my blog.

With God's help, I am hoping to share my journey of understanding this brain condition and God's mercies to me with you, dear Reader. If you know of anyone suffering the symptoms similar to that of my condition, please do pray for him/her and let him/her know that it is a medical condition that can be treated. Do advise him/her, if possible, to seek professional and medical help, counselling help, some natural remedies and other helps. Do not hesitate to tell him/her about this blog.

Just click on the links in the "Label" box on the right to read my postings.

I thank God for my family Church and some friends - for all their prayers, encouragements, support and kindness. In particular, I am indebted to my dear Pastors ie Pastor JJ Lim, Pastor Linus Chua and my brethren in my church ie Pilgrim Covenant Church  for their unconditional love, prayers, supports, concerns and kind love gifts which enable me to recuperate away from work and also to providentially work on this blog. I realized these are tokens of God's love, mercies and faithfulness to me in this difficult trial. These give me the courage to press on, to look to God daily, and to seek and serve our Lord as He enables me. I am thankful to God for His mercies and lovingkindness to me despite my many sins, failures and weaknesses.

I found it helpful and therapeutic to verbalise my thoughts and feelings and share it with others who can benefit from it. It is my prayers that, God willing, this blog with all its information will be used by our Lord to help others, particularly those who are afflicted in like manner and for their loved ones and friends, just as God has used many information available on the internet for my benefit and comfort as I seek to understand my illness and manage it so that I can live for Him and serve Him.

May the testimonies of God's love and faithfulness, through all the changing scenes of life, will continue to bring glory to Him and some comfort and encouragement to His people.

To God be the glory!

"My flesh and my heart faileth: but God is the strength of my heart, and my portion for ever." Psalm 73:26

Warm Regards,
Nancie

(First posted on 8 February 2008)

Comments:
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4 comments:

Sunday, August 17, 2008 1:46:00 PM

I really appreciated reading how God is working in your life.

Please pray for me, as I will for you!

Love,
Kate.

Reply: Sunday, September 28, 2008 5:32:00 PM

Thanks, Kate. I am remembering you in prayers. Praise and thank God for His goodness and mercies. 

Warm regards,
Nancie

Monday, October 13, 2008 10:30:00 AM

My dear friend Nancie, You are a testimony of God's love & faithfulness and YOU ARE MORE THAN ABLE & MORE THAN A CONQUEROR! Indeed, the strength of your heart and your portion is God even when Bpd & your heart might fail you, He will not!
You have shown us the mercies & goodness of Our Lord as you share with us your story of wellness & your struggles to maintain functioning as close to normal. You have shown us all that it entails to have a complete package of balance with a well qualified team of medical & spiritual counselors.
You demonstrate how wonderful it is to have support of many: loved loves, family, friends & church!
Again this echoes of how necessary it is to share this MISSION with others while serving you as therapy
as you express yourself, your thoughts, your feelings so it benefits others who are suffering
like manner! It benefits us all.
I pray you receive continual encouragement from others as you walk through this with God beside
you! Thank you for allowing us to
view your beginnings to the present![I think this was one of your first posts, right?]

Reply: Monday, October 13, 2008 7:45:00 PM

Peggy, thank you for your encouragements! Yes, this is one of my earliest post :)

All praise and glory be to God for His mercies to me and the way He is enabling me to cope and live for Him and serve Him. Take care!

Warm regards,
Nancie


(This post was first posted on 8 February 2008)


Thank God for His mercies and faithfulness

(First posted on 21 Feb 2008)

This morning, the Lord brought the following verse to my mind:
"It is of the LORD's mercies that we are not consumed, because his compassions fail not. They are new every morning: great is thy faithfulness." Lamentations 3:22-23
I am thankful to God for His mercies and faithfulness throughout my life. As I considered afresh how He provided and led me through this part-time job assignment that just ended, I am once again amazed by God's love and mercies to unworthy me.

When I was first diagnosed with proneness to bipolar disorder (manic-depressive illness), it was a relief to me. I finally understood my confusing past where I have experienced some 10 or 11 episodes of severe depression that usually lasted between 3 months to 6 months or sometimes longer. I struggled to get through each day. I used to wonder what sins have I committed that I have to go through these punishment time and again. Whenever I am well, I do love the Lord, love His people and love to serve Him. It must be a great sin that landed me into severe depression each time, that was what I thought. Yet during such an episode of severe depression, no amount of soul-searching, repentance and cries can bring about deliverance. It was usually 3 to 6 months later that I began to get better and more functional. I thank God for preserving me through those very very difficult times and now finally enabling me to understand why.

My diagnosis helped me to realize that my severe and prolonged depression episodes are due to my proneness to bipolar disorder which is a medical condition that can be treated. No doubt various factors, internal and external, has brought about a relapse in depression. Most of the time could be due to stress and overstraining as I am some kind of a perfectionist in my character and though I have tried hard to change, it is not easy. So unknowingly I sometimes set rather high expectations of myself or goals that are unrealistic and I am doomed to fail in my own eyes when I don't meet up to those high expectations. These often happened unknowingly as I always strive to do my best. I just can't seem to understand my limitations and how much I can really do. This has something to do with the other side of bipolar ie. hypomania. Whenever I am well, I am usually on the hypomania side. Which means I have more energy, more ideas, more creative, more talkative, more friendly and tend to take on more projects than I can handle (without realizing it) and sleep/rest less. I also will be so engrossed or occupied with various things that I neglect exercise, breaks, recreation, hobbies and sometimes regular meals or healthy meals. After weeks or months of such hypomania, a severe depression will surely follow for another 3 to 6 months or so.

My diagnosis helped me to realized that bipolar can happen to anyone. And thank God for preserving me through those very difficult times in the past and delivering me each time. Each experience, confusing though they were, have been used of the Lord for my eternal good. Through every prolonged depressive episodes, I was thrown completely upon the Lord. I have no one else to turn to. No one understood what I was going through. I thank God that through those times, He led me to seek and search His Words and Truths to understand the importance of a right relationship with Him and the great work of sacrifice our Lord Jesus Christ has done when He laid down His life on the cross for us to redeem us from sins and eternal damnation. I thank God that these Truths became very precious to me through my darkest days. I wanted to know what I must do to be saved. During a depressive episode, all my thoughts and feelings became distorted and not functioning properly. I often couldn't feel my love for God, His Word or His people. Actually, I can't feel aright generally, but I didn't realize it. I thought I was surely not a sincere believer and probably even a reprobate. So through each difficult experience, I learn afresh to look unto Jesus the Author and Finisher of our faith, to seek Him afresh and to know His love and forgiveness. So those very difficult times became great blessings as the Lord sanctified me, drew me closer to Him and enable me to experience His love and faithfulness experientially. God is very real to me because of these difficult experiences. Now I understand why the Psalmist said in Psalm 119:71:
"It is good for me to be afflicted; that I might learn thy statutes."
It was through my afflictions that I understand the true meaning of some of God's Words and promises.

But my diagnosis also brings about some difficulties. In the past when I was looking for a new job, I have had difficulties finding one due to my asthma condition. It is a requirement to declare my health condition in the job application form. There were times when I was rejected because they said my asthma condition is very serious as I am on long term medication. They didn't want me to be a liability to them. Actually, my asthma is not very serious. It is mild and persistent, and that is why I have to be on long term medication as I will be in danger of sudden asthmatic attacks that can lead to sudden death otherwise. But as long as I continue with my medication, I am fine most of the time. I only get asthmatic attacks during very very cold weather in December as it rains heavily in Singapore during that time. Or if the office's aircon is too cold, I will feel uncomfortable too. But I have made it a point to wear my sweater and so in the recent years, I have very few attacks. But even then it is so difficult to get a job because of my asthma.

God in His faithfulness, provided a job for me through my good friend, Dr Chin Ming Shu, who is a child psychologist helping children with special needs such as autism, dyslexia, speech delay, etc. Ming Shu is a Christian and a very kind friend. I was with her for the next 4 years plus until I left the job recently when I was severely depressed and could hardly work. At that time, providentially she had to scale down her work to attend to some family matters. I am thankful to God for Ming Shu's kindness to me over the years as she allows me flexibility in terms of my working hours and work. And she lightens my load whenever I went through depressive episodes. Being a child psychologist, she understood depression. So she never condemn me and she sympathized and prayed and encouraged me during such distressing time. I survived a few episodes while working with her and it was because of her kindness that I was able to continue working despite my depression. It was also through her promptings that I finally sought medical help in Dec 2006, and now able to manage my condition better with medical plus other helps. Thank God!

End of last year when I started to look for a new job, I encountered the same difficulties where my health declaration is involved. Now I have to declare not only asthma, but that I am on medication for manic-depressive illness or bipolar disorder. Once I declared that, I don't hear from them anymore. Mental illnesses is still very much a stigma in Singapore. But I thank God that through my friend, Grace, that I was offered this part-time job recently. And because it was a part-time assignment, I was not asked to fill up any application forms. So no one know about my medical condition and I was not rejected because of that. Thank God! Truly with Him all things are possible. Great is His mercies and faithfulness.

As I pray, look and await God's provision of another suitable job, I thank God for the assurance in my heart that He will provide for me in His time despite the great difficulties. I pray that He may enable me to once again testify of His goodness and mercies in His next provision of a job, and that I may continue to know Him and serve Him in my new job. Meanwhile, I really appreciate this little break once again :-).

"My soul, wait thou only upon God; for my expectation is from him." Psalm 62:5


Sunday, November 6, 2022

About Bipolar Disorder (Manic-depressive illness)

This article is taken from the website of National Institute of Mental Health (NIMH). NIMH said "NIMH publications are in the public domain and may be reproduced or copied without the permission from the National Institute of Mental Health (NIMH). NIMH encourages you to reproduce them and use them in your efforts to improve public health. Citation of the National Institute of Mental Health as a source is appreciated."

Introduction Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in a person's mood, energy, and ability to function. Different from the normal ups and downs that everyone goes through, the symptoms of bipolar disorder are severe. They can result in damaged relationships, poor job or school performance, and even suicide. But there is good news: bipolar disorder can be treated, and people with this illness can lead full and productive lives.

About 5.7 million American adults or about 2.6 percent of the population age 18 and older in any given year,1 have bipolar disorder. Bipolar disorder typically develops in late adolescence or early adulthood. However, some people have their first symptoms during childhood, and some develop them late in life. It is often not recognized as an illness, and people may suffer for years before it is properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person's life.

"Manic-depression distorts moods and thoughts, incites dreadful behaviors, destroys the basis of rational thought, and too often erodes the desire and will to live. It is an illness that is biological in its origins, yet one that feels psychological in the experience of it; an illness that is unique in conferring advantage and pleasure, yet one that brings in its wake almost unendurable suffering and, not infrequently, suicide."

"I am fortunate that I have not died from my illness, fortunate in having received the best medical care available, and fortunate in having the friends, colleagues, and family that I do." Kay Redfield Jamison, Ph.D., An Unquiet Mind, 1995, p. 6. (Reprinted with permission from Alfred A. Knopf, a division of Random House, Inc.)

What Are the Symptoms of Bipolar Disorder? Bipolar disorder causes dramatic mood swings—from overly "high" and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression.

Signs and symptoms of mania (or a manic episode) include: • Increased energy, activity, and restlessness • Excessively "high," overly good, euphoric mood • Extreme irritability • Racing thoughts and talking very fast, jumping from one idea to another • Distractibility, can't concentrate well • Little sleep needed • Unrealistic beliefs in one's abilities and powers • Poor judgment • Spending sprees • A lasting period of behavior that is different from usual • Increased sexual drive • Abuse of drugs, particularly cocaine, alcohol, and sleeping medications • Provocative, intrusive, or aggressive behavior • Denial that anything is wrong

A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present.

Signs and symptoms of depression (or a depressive episode) include: • Lasting sad, anxious, or empty mood • Feelings of hopelessness or pessimism • Feelings of guilt, worthlessness, or helplessness • Loss of interest or pleasure in activities once enjoyed, including sex • Decreased energy, a feeling of fatigue or of being "slowed down" • Difficulty concentrating, remembering, making decisions • Restlessness or irritability • Sleeping too much, or can't sleep • Change in appetite and/or unintended weight loss or gain • Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury • Thoughts of death or suicide, or suicide attempts

A depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.

A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Thus even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression.

Sometimes, severe episodes of mania or depression include symptoms of psychosis (or psychotic symptoms). Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there) and delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person's usual cultural concepts). Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one is the President or has special powers or wealth, may occur during mania; delusions of guilt or worthlessness, such as believing that one is ruined and penniless or has committed some terrible crime, may appear during depression. People with bipolar disorder who have these symptoms are sometimes incorrectly diagnosed as having schizophrenia, another severe mental illness. It may be helpful to think of the various mood states in bipolar disorder as a spectrum or continuous range. At one end is severe depression, above which is moderate depression and then mild low mood, which many people call "the blues" when it is short-lived but is termed "dysthymia" when it is chronic. Then there is normal or balanced mood, above which comes hypomania (mild to moderate mania), and then severe mania.

In some people, however, symptoms of mania and depression may occur together in what is called a mixed bipolar state. Symptoms of a mixed state often include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. A person may have a very sad, hopeless mood while at the same time feeling extremely energized.

Bipolar disorder may appear to be a problem other than mental illness—for instance, alcohol or drug abuse, poor school or work performance, or strained interpersonal relationships. Such problems in fact may be signs of an underlying mood disorder.

Diagnosis of Bipolar Disorder Like other mental illnesses, bipolar disorder cannot yet be identified physiologically—for example, through a blood test or a brain scan. Therefore, a diagnosis of bipolar disorder is made on the basis of symptoms, course of illness, and, when available, family history. The diagnostic criteria for bipolar disorder are described in the Diagnostic and Statistical Manual for Mental Disorders, fourth edition (DSM-IV).2

Descriptions offered by people with bipolar disorder give valuable insights into the various mood states associated with the illness:

Depression: I doubt completely my ability to do anything well. It seems as though my mind has slowed down and burned out to the point of being virtually useless…. [I am] haunt[ed]… with the total, the desperate hopelessness of it all…. Others say, "It's only temporary, it will pass, you will get over it," but of course they haven't any idea of how I feel, although they are certain they do. If I can't feel, move, think or care, then what on earth is the point?

Hypomania: At first when I'm high, it's tremendous… ideas are fast… like shooting stars you follow until brighter ones appear…. All shyness disappears, the right words and gestures are suddenly there… uninteresting people, things become intensely interesting. Sensuality is pervasive, the desire to seduce and be seduced is irresistible. Your marrow is infused with unbelievable feelings of ease, power, well-being, omnipotence, euphoria… you can do anything… but, somewhere this changes.

Mania: The fast ideas become too fast and there are far too many… overwhelming confusion replaces clarity… you stop keeping up with it—memory goes. Infectious humor ceases to amuse. Your friends become frightened…. everything is now against the grain… you are irritable, angry, frightened, uncontrollable, and trapped.

Suicide Some people with bipolar disorder become suicidal. Anyone who is thinking about committing suicide needs immediate attention, preferably from a mental health professional or a physician. Anyone who talks about suicide should be taken seriously. Risk for suicide appears to be higher earlier in the course of the illness. Therefore, recognizing bipolar disorder early and learning how best to manage it may decrease the risk of death by suicide.

Signs and symptoms that may accompany suicidal feelings include: • talking about feeling suicidal or wanting to die • feeling hopeless, that nothing will ever change or get better • feeling helpless, that nothing one does makes any difference • feeling like a burden to family and friends • abusing alcohol or drugs • putting affairs in order (e.g., organizing finances or giving away possessions to prepare for one's death) • writing a suicide note • putting oneself in harm's way, or in situations where there is a danger of being killed

If you are feeling suicidal or know someone who is: • call a doctor, emergency room, or 911 right away to get immediate help • make sure you, or the suicidal person, are not left alone • make sure that access is prevented to large amounts of medication, weapons, or other items that could be used for self-harm

While some suicide attempts are carefully planned over time, others are impulsive acts that have not been well thought out; thus, the final point in the box above may be a valuable long-term strategy for people with bipolar disorder. Either way, it is important to understand that suicidal feelings and actions are symptoms of an illness that can be treated. With proper treatment, suicidal feelings can be overcome.

What Is the Course of Bipolar Disorder? Episodes of mania and depression typically recur across the life span. Between episodes, most people with bipolar disorder are free of symptoms, but as many as one-third of people have some residual symptoms. A small percentage of people experience chronic unremitting symptoms despite treatment.3

The classic form of the illness, which involves recurrent episodes of mania and depression, is called bipolar I disorder. Some people, however, never develop severe mania but instead experience milder episodes of hypomania that alternate with depression; this form of the illness is called bipolar II disorder. When four or more episodes of illness occur within a 12-month period, a person is said to have rapid-cycling bipolar disorder. Some people experience multiple episodes within a single week, or even within a single day. Rapid cycling tends to develop later in the course of illness and is more common among women than among men.

People with bipolar disorder can lead healthy and productive lives when the illness is effectively treated (see below—"How Is Bipolar Disorder Treated?"). Without treatment, however, the natural course of bipolar disorder tends to worsen. Over time a person may suffer more frequent (more rapid-cycling) and more severe manic and depressive episodes than those experienced when the illness first appeared.4 But in most cases, proper treatment can help reduce the frequency and severity of episodes and can help people with bipolar disorder maintain good quality of life.

Can Children and Adolescents Have Bipolar Disorder? Both children and adolescents can develop bipolar disorder. It is more likely to affect the children of parents who have the illness.

Unlike many adults with bipolar disorder, whose episodes tend to be more clearly defined, children and young adolescents with the illness often experience very fast mood swings between depression and mania many times within a day.5 Children with mania are more likely to be irritable and prone to destructive tantrums than to be overly happy and elated. Mixed symptoms also are common in youths with bipolar disorder. Older adolescents who develop the illness may have more classic, adult-type episodes and symptoms.

Bipolar disorder in children and adolescents can be hard to tell apart from other problems that may occur in these age groups. For example, while irritability and aggressiveness can indicate bipolar disorder, they also can be symptoms of attention deficit hyperactivity disorder, conduct disorder, oppositional defiant disorder, or other types of mental disorders more common among adults such as major depression or schizophrenia. Drug abuse also may lead to such symptoms. For any illness, however, effective treatment depends on appropriate diagnosis. Children or adolescents with emotional and behavioral symptoms should be carefully evaluated by a mental health professional. Any child or adolescent who has suicidal feelings, talks about suicide, or attempts suicide should be taken seriously and should receive immediate help from a mental health specialist.

What Causes Bipolar Disorder? Scientists are learning about the possible causes of bipolar disorder through several kinds of studies. Most scientists now agree that there is no single cause for bipolar disorder—rather, many factors act together to produce the illness.

Because bipolar disorder tends to run in families, researchers have been searching for specific genes—the microscopic "building blocks" of DNA inside all cells that influence how the body and mind work and grow—passed down through generations that may increase a person's chance of developing the illness. But genes are not the whole story. Studies of identical twins, who share all the same genes, indicate that both genes and other factors play a role in bipolar disorder. If bipolar disorder were caused entirely by genes, then the identical twin of someone with the illness would always develop the illness, and research has shown that this is not the case. But if one twin has bipolar disorder, the other twin is more likely to develop the illness than is another sibling.6

In addition, findings from gene research suggest that bipolar disorder, like other mental illnesses, does not occur because of a single gene.7 It appears likely that many different genes act together, and in combination with other factors of the person or the person's environment, to cause bipolar disorder. Finding these genes, each of which contributes only a small amount toward the vulnerability to bipolar disorder, has been extremely difficult. But scientists expect that the advanced research tools now being used will lead to these discoveries and to new and better treatments for bipolar disorder.

Brain-imaging studies are helping scientists learn what goes wrong in the brain to produce bipolar disorder and other mental illnesses.8,9 New brain-imaging techniques allow researchers to take pictures of the living brain at work, to examine its structure and activity, without the need for surgery or other invasive procedures. These techniques include magnetic resonance imaging (MRI), positron emission tomography (PET), and functional magnetic resonance imaging (fMRI). There is evidence from imaging studies that the brains of people with bipolar disorder may differ from the brains of healthy individuals. As the differences are more clearly identified and defined through research, scientists will gain a better understanding of the underlying causes of the illness, and eventually may be able to predict which types of treatment will work most effectively.

How Is Bipolar Disorder Treated? Most people with bipolar disorder—even those with the most severe forms—can achieve substantial stabilization of their mood swings and related symptoms with proper treatment.10,11,12 Because bipolar disorder is a recurrent illness, long-term preventive treatment is strongly recommended and almost always indicated. A strategy that combines medication and psychosocial treatment is optimal for managing the disorder over time.

In most cases, bipolar disorder is much better controlled if treatment is continuous than if it is on and off. But even when there are no breaks in treatment, mood changes can occur and should be reported immediately to your doctor. The doctor may be able to prevent a full-blown episode by making adjustments to the treatment plan. Working closely with the doctor and communicating openly about treatment concerns and options can make a difference in treatment effectiveness.

In addition, keeping a chart of daily mood symptoms, treatments, sleep patterns, and life events may help people with bipolar disorder and their families to better understand the illness. This chart also can help the doctor track and treat the illness most effectively.

Medications Medications for bipolar disorder are prescribed by psychiatrists—medical doctors (M.D.) with expertise in the diagnosis and treatment of mental disorders. While primary care physicians who do not specialize in psychiatry also may prescribe these medications, it is recommended that people with bipolar disorder see a psychiatrist for treatment.

Medications known as "mood stabilizers" usually are prescribed to help control bipolar disorder.10 Several different types of mood stabilizers are available. In general, people with bipolar disorder continue treatment with mood stabilizers for extended periods of time (years). Other medications are added when necessary, typically for shorter periods, to treat episodes of mania or depression that break through despite the mood stabilizer.

• Lithium, the first mood-stabilizing medication approved by the U.S. Food and Drug Administration (FDA) for treatment of mania, is often very effective in controlling mania and preventing the recurrence of both manic and depressive episodes. • Anticonvulsant medications, such as valproate (Depakote®) or carbamazepine (Tegretol®), also can have mood-stabilizing effects and may be especially useful for difficult-to-treat bipolar episodes. Valproate was FDA-approved in 1995 for treatment of mania. • Newer anticonvulsant medications, including lamotrigine (Lamictal®), gabapentin (Neurontin®), and topiramate (Topamax®), are being studied to determine how well they work in stabilizing mood cycles.

• Anticonvulsant medications may be combined with lithium, or with each other, for maximum effect. • Children and adolescents with bipolar disorder generally are treated with lithium, but valproate and carbamazepine also are used. Researchers are evaluating the safety and efficacy of these and other psychotropic medications in children and adolescents. There is some evidence that valproate may lead to adverse hormone changes in teenage girls and polycystic ovary syndrome in women who began taking the medication before age 20.13 Therefore, young female patients taking valproate should be monitored carefully by a physician. • Women with bipolar disorder who wish to conceive, or who become pregnant, face special challenges due to the possible harmful effects of existing mood stabilizing medications on the developing fetus and the nursing infant.14 Therefore, the benefits and risks of all available treatment options should be discussed with a clinician skilled in this area. New treatments with reduced risks during pregnancy and lactation are under study.

Treatment of Bipolar Depression Research has shown that people with bipolar disorder are at risk of switching into mania or hypomania, or of developing rapid cycling, during treatment with antidepressant medication.15 Therefore, "mood-stabilizing" medications generally are required, alone or in combination with antidepressants, to protect people with bipolar disorder from this switch. Lithium and valproate are the most commonly used mood-stabilizing drugs today. However, research studies continue to evaluate the potential mood-stabilizing effects of newer medications. • Atypical antipsychotic medications, including clozapine (Clozaril®), olanzapine (Zyprexa®), risperidone (Risperdal®), quetiapine (Seroquel®), and ziprasidone (Geodon®), are being studied as possible treatments for bipolar disorder. Evidence suggests clozapine may be helpful as a mood stabilizer for people who do not respond to lithium or anticonvulsants.16 Other research has supported the efficacy of olanzapine for acute mania, an indication that has recently received FDA approval.17 Olanzapine may also help relieve psychotic depression.18 • If insomnia is a problem, a high-potency benzodiazepine medication such as clonazepam (Klonopin®) or lorazepam (Ativan®) may be helpful to promote better sleep. However, since these medications may be habit-forming, they are best prescribed on a short-term basis. Other types of sedative medications, such as zolpidem (Ambien®), are sometimes used instead. • Changes to the treatment plan may be needed at various times during the course of bipolar disorder to manage the illness most effectively. A psychiatrist should guide any changes in type or dose of medication. • Be sure to tell the psychiatrist about all other prescription drugs, over-the-counter medications, or natural supplements you may be taking. This is important because certain medications and supplements taken together may cause adverse reactions. • To reduce the chance of relapse or of developing a new episode, it is important to stick to the treatment plan. Talk to your doctor if you have any concerns about the medications.

Thyroid Function People with bipolar disorder often have abnormal thyroid gland function.4 Because too much or too little thyroid hormone alone can lead to mood and energy changes, it is important that thyroid levels are carefully monitored by a physician.

People with rapid cycling tend to have co-occurring thyroid problems and may need to take thyroid pills in addition to their medications for bipolar disorder. Also, lithium treatment may cause low thyroid levels in some people, resulting in the need for thyroid supplementation.

Medication Side Effects Before starting a new medication for bipolar disorder, always talk with your psychiatrist and/or pharmacist about possible side effects. Depending on the medication, side effects may include weight gain, nausea, tremor, reduced sexual drive or performance, anxiety, hair loss, movement problems, or dry mouth. Be sure to tell the doctor about all side effects you notice during treatment. He or she may be able to change the dose or offer a different medication to relieve them. Your medication should not be changed or stopped without the psychiatrist's guidance.

Psychosocial Treatments As an addition to medication, psychosocial treatments—including certain forms of psychotherapy (or "talk" therapy)—are helpful in providing support, education, and guidance to people with bipolar disorder and their families. Studies have shown that psychosocial interventions can lead to increased mood stability, fewer hospitalizations, and improved functioning in several areas.12 A licensed psychologist, social worker, or counselor typically provides these therapies and often works together with the psychiatrist to monitor a patient's progress. The number, frequency, and type of sessions should be based on the treatment needs of each person.

Psychosocial interventions commonly used for bipolar disorder are cognitive behavioral therapy, psychoeducation, family therapy, and a newer technique, interpersonal and social rhythm therapy. NIMH researchers are studying how these interventions compare to one another when added to medication treatment for bipolar disorder.

• Cognitive behavioral therapy helps people with bipolar disorder learn to change inappropriate or negative thought patterns and behaviors associated with the illness. • Psychoeducation involves teaching people with bipolar disorder about the illness and its treatment, and how to recognize signs of relapse so that early intervention can be sought before a full-blown illness episode occurs. Psychoeducation also may be helpful for family members. • Family therapy uses strategies to reduce the level of distress within the family that may either contribute to or result from the ill person's symptoms. • Interpersonal and social rhythm therapy helps people with bipolar disorder both to improve interpersonal relationships and to regularize their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes. • As with medication, it is important to follow the treatment plan for any psychosocial intervention to achieve the greatest benefit.

Other Treatments • In situations where medication, psychosocial treatment, and the combination of these interventions prove ineffective, or work too slowly to relieve severe symptoms such as psychosis or suicidality, electroconvulsive therapy (ECT) may be considered. ECT may also be considered to treat acute episodes when medical conditions, including pregnancy, make the use of medications too risky. ECT is a highly effective treatment for severe depressive, manic, and/or mixed episodes. The possibility of long-lasting memory problems, although a concern in the past, has been significantly reduced with modern ECT techniques. However, the potential benefits and risks of ECT, and of available alternative interventions, should be carefully reviewed and discussed with individuals considering this treatment and, where appropriate, with family or friends.19 • Herbal or natural supplements, such as St. John's wort (Hypericum perforatum), have not been well studied, and little is known about their effects on bipolar disorder. Because the FDA does not regulate their production, different brands of these supplements can contain different amounts of active ingredient. Before trying herbal or natural supplements, it is important to discuss them with your doctor. There is evidence that St. John's wort can reduce the effectiveness of certain medications.20 In addition, like prescription antidepressants, St. John's wort may cause a switch into mania in some individuals with bipolar disorder, especially if no mood stabilizer is being taken.21 • Omega-3 fatty acids found in fish oil are being studied to determine their usefulness, alone and when added to conventional medications, for long-term treatment of bipolar disorder.22

A Long-Term Illness That Can Be Effectively Treated Even though episodes of mania and depression naturally come and go, it is important to understand that bipolar disorder is a long-term illness that currently has no cure. Staying on treatment, even during well times, can help keep the disease under control and reduce the chance of having recurrent, worsening episodes. Do Other Illnesses Co-occur with Bipolar Disorder? Alcohol and drug abuse are very common among people with bipolar disorder. Research findings suggest that many factors may contribute to these substance abuse problems, including self-medication of symptoms, mood symptoms either brought on or perpetuated by substance abuse, and risk factors that may influence the occurrence of both bipolar disorder and substance use disorders.23 Treatment for co-occurring substance abuse, when present, is an important part of the overall treatment plan.

Anxiety disorders, such as post-traumatic stress disorder and obsessive-compulsive disorder, also may be common in people with bipolar disorder.24,25 Co-occurring anxiety disorders may respond to the treatments used for bipolar disorder, or they may require separate treatment. For more information on anxiety disorders, contact NIMH (see below).

How Can Individuals and Families Get Help for Bipolar Disorder? Anyone with bipolar disorder should be under the care of a psychiatrist skilled in the diagnosis and treatment of this disease. Other mental health professionals, such as psychologists, psychiatric social workers, and psychiatric nurses, can assist in providing the person and family with additional approaches to treatment.

Help can be found at: • University—or medical school—affiliated programs • Hospital departments of psychiatry • Private psychiatric offices and clinics • Health maintenance organizations (HMOs) • Offices of family physicians, internists, and pediatricians • Public community mental health centers

People with bipolar disorder may need help to get help. • Often people with bipolar disorder do not realize how impaired they are, or they blame their problems on some cause other than mental illness. • A person with bipolar disorder may need strong encouragement from family and friends to seek treatment. Family physicians can play an important role in providing referral to a mental health professional. • Sometimes a family member or friend may need to take the person with bipolar disorder for proper mental health evaluation and treatment. • A person who is in the midst of a severe episode may need to be hospitalized for his or her own protection and for much-needed treatment. There may be times when the person must be hospitalized against his or her wishes. • Ongoing encouragement and support are needed after a person obtains treatment, because it may take a while to find the best treatment plan for each individual. • In some cases, individuals with bipolar disorder may agree, when the disorder is under good control, to a preferred course of action in the event of a future manic or depressive relapse. • Like other serious illnesses, bipolar disorder is also hard on spouses, family members, friends, and employers. • Family members of someone with bipolar disorder often have to cope with the person's serious behavioral problems, such as wild spending sprees during mania or extreme withdrawal from others during depression, and the lasting consequences of these behaviors. • Many people with bipolar disorder benefit from joining support groups such as those sponsored by the National Depressive and Manic Depressive Association (NDMDA), the National Alliance for the Mentally Ill (NAMI), and the National Mental Health Association (NMHA). Families and friends can also benefit from support groups offered by these organizations. For contact information, see the "For More Information" section at the back of this booklet.

What About Clinical Studies for Bipolar Disorder? Some people with bipolar disorder receive medication and/or psychosocial therapy by volunteering to participate in clinical studies (clinical trials). Clinical studies involve the scientific investigation of illness and treatment of illness in humans. Clinical studies in mental health can yield information about the efficacy of a medication or a combination of treatments, the usefulness of a behavioral intervention or type of psychotherapy, the reliability of a diagnostic procedure, or the success of a prevention method. Clinical studies also guide scientists in learning how illness develops, progresses, lessens, and affects both mind and body. Millions of Americans diagnosed with mental illness lead healthy, productive lives because of information discovered through clinical studies. These studies are not always right for everyone, however. It is important for each individual to consider carefully the possible risks and benefits of a clinical study before making a decision to participate.

In recent years, NIMH has introduced a new generation of "real-world" clinical studies. They are called "real-world" studies for several reasons. Unlike traditional clinical trials, they offer multiple different treatments and treatment combinations. In addition, they aim to include large numbers of people with mental disorders living in communities throughout the U.S. and receiving treatment across a wide variety of settings. Individuals with more than one mental disorder, as well as those with co-occurring physical illnesses, are encouraged to consider participating in these new studies. The main goal of the real-world studies is to improve treatment strategies and outcomes for all people with these disorders. In addition to measuring improvement in illness symptoms, the studies will evaluate how treatments influence other important, real-world issues such as quality of life, ability to work, and social functioning. They also will assess the cost-effectiveness of different treatments and factors that affect how well people stay on their treatment plans.

The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) is seeking participants for the largest-ever, "real-world" study of treatments for bipolar disorder. To learn more about STEP-BD or other clinical studies, see the Clinical Trials page on the NIMH Website http://www.nimh.nih.gov, visit the National Library of Medicine's clinical trials database http://www.clinicaltrials.gov, or contact NIMH.

For More Information Bipolar Disorder Information and Organizations from NLM's MedlinePlus (en EspaƱol)

Addendum to Bipolar January 2007 Aripiprazole (Abilify) is another atypical antipsychotic medication used to treat the symptoms of schizophrenia and manic or mixed (manic and depressive) episodes of bipolar I disorder. Aripiprazole is in tablet and liquid form. An injectable form is used in the treatment of symptoms of agitation in schizophrenia and manic or mixed episodes of bipolar I disorder.

If you have questions regarding these guidelines and use of NIMH publications, please contact the NIMH Information Center at 1-866-615-6464 or at nimhinfo@nih.gov.

Updated: 01/24/2007 

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Thank God for the above helpful article.

By God's grace,
Nancie
12 Feb 2008


Friday, November 4, 2022

Coping Skills for Bipolar Disorder

Dear Friends, 

Thanks for stopping by. 

Thanks for your prayers and encouragements. Thank God for sustaining and strengthening me daily. I am still experiencing fatigue and tiredness. 

I am looking to God daily and continuing to learn to pace myself. I have been doing exercise regularly and cut down on some activities. 

I am not able to do active blogging but hope to post some helpful resources that can encourage and help you and my readers. I do missed all of you very much and you are in my thoughts and prayers! 

I found a helpful article on Coping Skills for Bipolar Disorder and thought it might be useful to you and some of my readers. Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in a person's mood, energy, and ability to function. 

Different from the normal ups and downs that everyone goes through, the symptoms of bipolar disorder are severe. They can result in damaged relationships, poor job or school performance, and even suicide. But there is good news: bipolar disorder can be treated, and people with this illness can lead full and productive lives. 

From my personal experiences, I have found that it is important to accept the reality of my condition, to learn to understand the limitations as well as the advantages of it, to learn to manage it and live a productive life, by the grace of God, through all the resources that are available. I am thankful to God that since my diagnosis, He has provided me with many helps and resources to many my condition and my condition is under better control. He is enabling me to live a meaningful and productive life despite various limitations of my condition. I look forward to each day that I can walk with God and serve Him, and His people. The following article is taken from the website of Bipolar Focus:
Coping Skills for Bipolar Disorder

Step-by-Step Coping:

  1. Find a good doctor
  2. Become an expert
  3. Manage your illness
    • mood charting - what it is and why it's helpful
    • managing medications
    • a healthy lifestyle helps recovery
  4. Plan for a crisis
  5. Find a community
    • United States Support Organizations
    • Online Support Groups and Newsgroups
    • International Support Organizations
  6. Practical matters - work, school, and federal aid issues
  7. Other Resources - coping with mania, depression, and life with bipolar disorder

When we give lists of symptoms and medications for people with bipolar disorder, the entire thing can seem disarmingly simple. But anyone who has been there knows that there is nothing simple about accepting and living with a chronic illness, and it's just as important to address the emotional and practical issues of bipolar as it is to know the diagnostic criteria and treatment guidelines. Those with other chronic diseases like diabetes, cystic fibrosis, or multiple sclerosis go through a similar process of grieving, accepting, learning, and adapting - and through this, begin healing and recovery.

A helpful outline to guide a healing and recovery journey is described in the acronym TEAR:

T = to accept the reality of loss. There are things that will be different after a diagnosis of bipolar, and it's important to recognize these things rather than denying or hiding them.

E = experience the pain of the loss. You are allowed to grieve what you feel has been lost with the onset of this disease, both from your own life and the lives of others. You are allowed to mourn previous goals and aspirations that must be altered to this new reality.

A = adjust to the new environment without what was lost. Whatever was lost with your diagnosis doesn't constitute the whole of your person. The core of you is still the same, and knowing about your illness now allows you to re-adapt to this new context of life.

R = reinvest in the new reality. Explore, create, engage, and live as the person you are, managing your own life and your illness as part of that life.

Below are some articles and resources that we hope will help you in your own life.

1) Find a good doctor.

Even if you already have your diagnosis, your doctor will be your ally and partner in treatment and recovery. It's important to have a doctor you can speak openly with, who will listen to you as an equal and acknowledge your expertise on your own body, who will offer helpful suggestions and be invested in your recovery. Below are some resources on what to look for in a good psychiatrist and/or health care provider, and how to find one in your area.

2) Become an Expert.

Putting a name to what used to be a vague collection of debilitating symptoms puts you in control. Knowing your disease as intimately as you can gives you the tools to manage it effectively, rather than it managing you. It can also make your situation seem much less frightening when you can understand and recognize what is happening in your own body. Here are some resources to get you started.

3) Manage your Illness - mood charting and meds.

One of the best coping strategies, suggested by professionals and patients alike, is using a mood chart to track your own episodes and symptoms. A mood chart can be a preventative tool to help identify early warning signs for relapse, a record for physicians and family to help assess the efficacy of different medications and treatments, and a therapeutic tool to organize a person's daily routine and improve awareness of the illness.

The simplest method of mood charting is rating your mood (at the same time each day) on a scale of 1-10, with one being very depressed and ten being absolutely elated. A good place to keep a record is on a wall calendar or in a daily diary. Other methods involve more elaborate charts, and a more detailed rating scale (see the links below). Some people work better with graphs, others with numbers, others with writing lists of words or paragraphs to describe their feelings. The overall goal of the charts is to have a reliable and consistent record of how greatly your moods flucuate over a period of time, so develop the method that is easiest for you to achieve this goal.

  • Mood charting resources:
    • The Mood Diary - gives an explanation of how to use the mood chart, and has a blank and a completed example available for downloading (pdf files).
    • A Mood Chart System - a patient describes how he developed a personal system that worked for him, including examples.
    • Mood Charting for Children - the Child & Adolescent Bipolar Foundation provides examples and resources for charting your child's moods, and eventually helping him/her to track it themselves.

Another excellent coping strategy is learning how to manage your medications effectively. The first thing to do is know about what you are taking - ask your psychiatrist what symptoms your medication is treating, how long it might take to work, how much and how often you should take it, what you should do if you miss a dose, what side effects you might have and what you can do about them, and anything else that is on your mind. Keep track of your own medication information - names, dosages, how it makes you feel, what symptoms it makes better or worse - in a journal or diary. Having this information will help both you and your doctor find the medication regimen that works the best for you, and allow you to adjust it effectively as needed.

It can be an extremely frustrating trial-and-error process to finally find a medication that works for you. Please be patient and give the medications adequate time to do their job. Most people won't feel better right away - it can take four to six weeks for a drug to get into your system and start noticeably helping. In the meantime, you can help yourself by trying some of the suggestions on this page, or finding a support group to help you through difficult times. By all means work with your psychiatrist to switch medications if you are unhappy with your current one; however, try to be realistic about what medications can and can't do, and consider the relative benefits of staying on one versus trying to adjust to a brand-new one.

Simplify your medications as much as possible by putting them in separated daily pill boxes (you can purchase pill organizers with seven separate compartments, one for each day of the week), taking them at the same time each day, or taking them with a daily vitamin pill or something else that you do religiously. If you have a lot of trouble remembering, ask family members/roommates to help, or ask your doctor about the possibility of switching to long-acting injectable medications instead of pills.

Help your medication do their job by keeping healthy habits in your daily life.

4) Plan For a Crisis

Your mood charts (see above) will help you recognize what particular symptoms or behaviors tend to precede a manic or a depressive episode. Having a plan ready for relapse situations will help you get the care you need, and make sure other practical matters are taken care of, even if you are in a place where you can't effectively make decisions. One of the most difficult aspects of bipolar to deal with is the seductiveness of mania - many people don't seek help during a manic episode because they are feeling on top of the world. However, even though they can't recognize it, they still present a danger to themselves or others via reckless acts, excessive spending, uncontrollable behavior, etc.

You can take some precautionary steps while you are stable to help get through a crisis situation as smoothly as possible. Put the following information (along with anything else that might be helpful) into a "crisis plan" folder, and distribute it to your doctor, your family members, and other trusted people who can help you.

  • Make a list of people you trust (close family members, friends in the area, etc) who know about your disease and are willing to help you. Have their names and phone numbers together on a "crisis alert list"
  • List the names and contact info of your psychiatrist, general practitioner, case worker, or any other professional that helps you manage your illness.
  • Write out the particular signs that indicate a manic or a depressive episode, to help others recognize when you need help. (See some of the early warning signs compiled by bipolarsurvivor.com to use as a guide in making your list).
  • Make another list of all your medications, what dose you take, and what side effects you experience. Note any medications you are allergic to or do not want to take under whatever circumstances.
  • Leave directions for the care of your house, your pets, your plants, etc., in case you are hospitalized.
  • Write down your insurance plan information
  • Leave the names and numbers of family members and/or employers that need to be contacted in case of an emergency or an extended hospital stay.
  • Leave any detailed instructions of what kind of care you do and do not want to recieve if you are unable to make your own decisions (the legal document for this is called a psychiatric advanced directive).

5) Find a Community

Having a supportive community is important for anyone, but particularly for someone dealing with a chronic illness. A support group of friends and peers can relate to what you go through like no one else can, offer support or a sympathetic ear, and give practical advice and solutions for difficulties as they come up. For the times when you are not feeling particularly social, an online discussion group or chatroom is a great option to keep yourself connected with others.

National U.S. support groups for people who have mood disorders:

Online Support Community:

International Support Organizations:

6) Practical Matters - work, school, and federal aid issues:

7) Other Resources - coping with mania, depression, and life with bipolar disorder:

Take care and hope you have a great weekend!

   
  My friend took this lovely picture at Saipan. This is one of my favourite verse:

Cause me to hear thy lovingkindness in the morning; for in thee do I trust: Psalm 143:8

Warm Regards,
Nancie
(First posted on 9 March 2009)

How carers or friends can help - Part 1

Marja is sharing about "A lonely Place" in depression. The loneliness and disconnectedness we, who are prone to depression or bipolar depression, can feel at times when we go through depression, is possibly the worst part of the whole experience of depression.

I can identify with Marja's feeling as I often felt that way too whenever I go through depression. I am not able to feel love in any way. And that is extremely painful as I am someone who feel very deeply and love deeply whenever I am well. How I long to love and be loved though I can't feel it because during depression the chemical in our brain has become unbalanced and not able to send the right messages to our brain. So I can't think and feel aright.

Marja wrote on her Blog "Roller Coaster":

I need a friend who will listen to me and just be with me for a while, without making me feel bad about being the way I am. I need a friend who will not tire of sticking with me as I work my way out of the hole I'm in. I need a friend who will love me, no matter how ugly I feel. I need someone I can count on. I need someone who will remind me that God is there. Read more of Marja's sharing....


No man is an island. We all need family and friends in our life to make us a complete person and for us to live a meaningful life. Recently, I shared about my struggles with the issue of "What is the meaning of Life" whenever I go through severe depression. The lack of ability to know and feel the love of God, the love of my family, church brethren and friends, makes me feel life is so meaningless and it is so difficult to go on day by day. I felt as if I am left on a obscure island, isolated from the world and living a life that is utterly useless, and there is no way out of it at all. I am doomed to face the extreme loneliness and helplessness every day. I yearned for human contact but there is none because no one knows how to get onto that island. If someone tried hard enough, maybe they can come on a boat and they might find me. But no one seems to be trying. In my own distorted mind and inability to feel, even God seems so far away. I know He is there and I longed for someone to just give me that assurance again. The loneliness, pain and hopelessness one can feel during a severe depressive episode is beyond description. And another very difficult part of it is that it goes on for days, weeks, months and for some people even years. Day in day out, night in night out, week in week out, etc. You have to go through it yourself to know how it is like. But I sincerely pray that my family and friends will not need to go through these experiences themselves in order to pray and encourage me.

Many times it was the thought of God and my aged mother which prevented me from ending my own life. Note: If you are reading this article and you undergoing severe depression with suicidal thoughts or tendency, please stop reading and seek help immediately! There is help for depression. It can be treated. Don't suffer alone. Reach out and call someone! If you are in Singapore, you can contact these people in Singapore.

During severe depression, I often wonder how to carry on in such a utter pain, misery and loneliness? Who will understand and who will help? Thank God that He is with me and Marja, and all of His other precious children whenever we have to go through severe depression. No matter how we are not able to feel God's love and presence during that time, He never leave us nor forsake us. He is very near to us and it is He who is sustaining us. For underneath us is His everlasting arms. True, during depression I just couldn't feel anything of God's love or presence with me, but that is only because at such a time the chemical in my brain has become distorted. When I am better or well, I will know once again His everlasting love and mercies, which has been unchanging.


Marja's sharing reminded me of a question a dear church friend, Wee Chin, who just asked me yesterday on how she can help me if she notices that I am either a little manic or depressed besides praying. I thank God for her willingness not only to pray for me but also to help in some ways. Several months ago, my brother-in-Christ, Chee Yean, asked me the same question after I shared with him about my experiences with bipolar disorder especially my severe depressive episodes which often lasted for 3 to 6 months or longer.

DBSA and other mental/psychological health sites have many useful articles for sufferers and carers/friends of person with bipolar disorder (manic-depressive illness) or depression, etc. As these articles are on public domain and meant to help us, I will try and post some of these articles on my blog by and by, for our prayers and help.

The following is taken from the website of Depression and Bipolar Support Alliance (DBSA) :

Family and Friends' Guide to Recovery From Depression and Bipolar Disorder

When a friend or family member has an episode of depression or bipolar disorder (manic depression), you might be unsure about what you can do to help. You might wonder how you should treat the person. You may be hesitant to talk about the person’s illness, or feel guilty, angry, or confused. All of these things are normal.

There are ways you can help friends or family members throughout their recovery while empowering them to make their own choices.

The Five Stages of Recovery

It can be helpful to view recovery as a process with five stages. People go through these stages at different speeds. Recovery from an illness like depression or bipolar disorder, like the illness itself, has ups and downs. Friends and family who are supportive and dependable can make a big difference in a person’s ability to cope within each of these stages.

1. Handling the Impact of the Illness
Being overwhelmed and confused by the illness.

An episode of mania or depression, especially one that causes major problems with relationships, money, employment or other areas of life, can be devastating for everyone involved. A person who needs to be hospitalized may leave the hospital feeling confused, ashamed, overwhelmed, and unsure about what to do next.

What friends and family can do:

  • Offer emotional support and understanding.
  • Help with health care and other responsibilities.
  • Offer to help them talk with or find health care providers.
  • Keep brief notes of symptoms, treatment, progress, side effects and setbacks in a journal or personal calendar.
  • Be patient and accepting.

Your loved one’s illness is not your fault or theirs. It is a real illness that can be successfully treated. Resist the urge to try to fix everything all at once. Be supportive, but know that your loved one is ultimately responsible for his or her own treatment and lifestyle choices.

2. Feeling Like Life is Limited
Believing life will never be the same.

At this stage, people take a hard look at the ways their illness has affected their lives. They may not believe their lives can ever change or improve. It is important that friends, families, and health care providers instill hope and rebuild a positive self-image.

What friends and family can do:

  • Believe in the person’s ability to get well.
  • Tell them they have the ability to get well with time and patience. Instill hope by focusing on their strengths.
  • Work to separate the symptoms of the illness from the person’s true personality. Help the person rebuild a positive self-image.
  • Recognize when your loved one is having symptoms and realize that communication may be more difficult during these times. Know that symptoms such as social withdrawal come from the illness and are probably not a reaction to you.
  • Do your best not to rush, pressure, hover or nag.

A mood disorder affects a person’s attitude and beliefs. Hopelessness, lack of interest, anger, anxiety, and impatience can all be symptoms of the illness. Treatment helps people recognize and work to correct these types of distorted thoughts and feelings. Your support and acceptance are essential during this stage.

3. Realizing and Believing Change is Possible
Questioning the disabling power of the illness and believing life can be different.

Hope is a powerful motivator in recovery. Plans, goals, and belief in a better future can motivate people to work on day-to-day wellness. At this stage people begin to believe that life can be better and change is possible.

What friends and family can do:

  • Empower your loved on to participate in wellness by taking small steps toward a healthier lifestyle. This may include:
    • Sticking with the same sleep and wake times
    • Consistently getting good nutrition
    • Doing some sort of physical activity or exercise
    • Avoiding alcohol and substances
    • Finding a DBSA support group
    • Keeping health care appointments and staying with treatment
  • Offer reassurance that the future can and will be different and better. Remind them they have the power to change.
  • Help them identify things they want to change and things they want to accomplish.

Symptoms of depression and bipolar disorder may cause a hopeless, “what’s the point?” attitude. This is also a symptom of the illness. With treatment, people can and will improve. To help loved ones move forward in recovery, help them identify negative things they are dissatisfied with and want to change, or positive things they would like to do. Help them work toward achieving these things.

4. Commitment to Change
Exploring possibilities and challenging the disabling power of the illness.

Depression and bipolar disorder are powerful illnesses, but they do not have to keep people from living fulfilling lives. At this stage, people experience a change in attitude. They become more aware of the possibilities in their lives and the choices that are open to them. They work to avoid feeling held back or defined by their illness. They actively work on the strategies they have identified to keep themselves well. It is helpful to focus on their strengths and the skills, resources and support they need.

What friends and family can do:

  • Help people identify:
    • Things they enjoy or feel passionate about
    • Ways they can bring those things into their lives
    • Things they are dissatisfied with and want to change
    • Ways they can change those things
    • Skills, strengths and ideas that can help them reach their goals.
    • Resources that can help build additional skills
  • Help them figure out what keeps them well.
  • Encourage and support their efforts.

The key is to take small steps. Many small steps will add up to big positive changes. Find small ways for them to get involved in things they care about. These can be activities they enjoy, or things they want to change, in their own lives or in the world.

5. Actions for Change
Moving beyond the disabling power of the illness.

At this stage, people turn words into actions by taking steps toward their goals. For some people, this may mean seeking full-time, part-time or volunteer work, for others it may mean changing a living situation or working in mental health advocacy.

What friends and family can do:

  • Help your friends or family members to use the strengths and skills they have.
  • Keep their expectations reachable and realistic without holding them back.
  • Help them find additional resources and supports to help them reach their goals step-by-step.
  • Continue to support them as they set new goals and focus on life beyond their illness.
  • Help them identify and overcome negative or defeatist thinking.
  • Encourage them to take it easy on themselves and enjoy the journey.

People with depression or bipolar disorder have the power to create the lives they want for themselves. When they look beyond their illness, the possibilities are limitless.

What you can say that helps:

  • You are not alone in this. I’m here for you.
  • I understand you have a real illness and that’s what causes these thoughts and feelings.
  • You many not believe it now, but the way you’re feeling will change.
  • I may not be able to understand exactly how you feel but I care about you and want to help.
  • When you want to give up, tell yourself you will hold of for just one more day, hour, minute - whatever you can manage.
  • You are important to me. Your life is important to me.
  • Tell me what I can do now to help you.
  • I am here for you. We will get through this together.

Avoid saying:

  • It’s all in your head.
  • We all go through times like this.
  • You’ll be fine. Stop worrying.
  • Look on the bright side.
  • You have so much to live for why do you want to die?
  • I can’t do anything about your situation.
  • Just snap out of it.
  • Stop acting crazy.
  • What’s wrong with you?
  • Shouldn’t you be better by now?

What to find out:

Contact information (including emergency numbers) for your loved one’s doctor, therapist, and psychiatrist, your local hospital, and trusted friends and family members who can help in a crisis

Whether you have permission to discuss your love one’s treatment with his or her doctors, and if not, what you need to do to get that permission.

The treatments and medications your loved one is receiving, any special dosage instructions and any needed changes in diet or activity.

The most likely warning signs of a worsening manic or depressive episode (words and behaviors) and what you can do to help.

What kind of day-to-day help you can offer, such as doing housework or grocery shopping.

When talking with your love one’s health care providers, be patient, polite and assertive. Ask for clarification of things you do not understand. Write things down that you need to remember.

Helping and getting help

As a friend or family member you can provide the best support when you’re taking care of yourself. It helps to talk to people who know how it feels to be in your situation. Talk with understanding friends or relatives, look for therapy of your own, or find a DBSA support group.

DBSA support groups are run by people, families and friends affected by depression or bipolar disorder. They are safe, confidential, free meetings where people can learn more about depression, bipolar disorder, and how to live with the illnesses.

One father of a daughter with bipolar disorder says, “DBSA support groups help take a lot of stress out of your life. As a family member, you have to be as prepared as possible, and accept that things will still happen that you aren’t totally prepared for. DO all the research you can. Build a long list of dependable resources and support people, so when a situation arises, you know where to turn and how to take the next step. This really helped my family when we needed it.”

A mother of a son with depression says, “When you are in the middle of a situation, it’s hard to see what’s happening, but when you sit in a support group meeting across from someone who is going through the same things, it gives you perspective.”

Depression and Bipolar Support Alliance (DBSA) has a complete section with information for family and friends to help a loved one on their recovery to wellness.


Thank God for Marja's "Living Room" ministry which is a Support Group for people with mood disorders.

Regards,|
Nancie
March 2008