It’s an extremely stressful time right now.
Having bipolar disorder means living with challenges most other people don’t face, like needing to regularly manage bipolar triggers to make sure you don’t have dramatic mood changes. Bipolar triggers are individual, and the way you react to those triggers can depend on the form of bipolar disorder you have. Some people may be prone to manic episodes, where they feel excited, irritable, or energized, while others experience more depressive episodes, the National Institute of Mental Health (NIMH) explains. It’s also possible to have milder manic periods, known as hypomanic episodes, or to have mixed episodes that involve both manic and depressive symptoms.
The ongoing global pandemic is stressful for anyone, but it can be particularly difficult for people living with bipolar disorder because experiencing periods of high stress is one of the major risk factors of having a bipolar episode.
“Any kind of significant stress can potentially trigger either kind of episode,” Jed Magen, D.O., associate professor and chair in the Department of Psychiatry at Michigan State University, tells SELF.
There are some common situations (like stress) that trigger mood episodes. But again, people may have their own specific triggers, so it’s best to identify yours with the help of a doctor if you can. That said, here are some ways that you can prioritize your health right now.
1. Allow yourself to grieve if you need to.
Many people are grieving the loss of human connection, jobs, and loved ones during the pandemic. Acknowledging your feelings can be overwhelming, but is an important part of the grieving process, says Dr. Magen. And especially if you have a loved one who is severely ill from COVID-19 or have lost someone close to you to the virus, Dr. Magen recommends allowing yourself the space to experience your feelings. “Recognize that you are going to be emotionally devastated for some period of time like anyone else,” he says. However, he adds, support is crucial to help prevent an episode—and to help your overall mental well-being. “Friends, other family members, a therapist can all help,” Dr. Magen says.
However, accessing this support is not always easy during the pandemic for various reasons. If you’re not already seeing a therapist, consider looking into counseling sessions to help you process your grief. You can ask your insurance provider for recommendations if you have coverage. Or, you can research therapists in your area who specialize in bipolar disorder and ask if they accept sliding-scale fees. Many mental health professionals are using video chat or phone calls to conduct appointments during the pandemic, so you don’t need to physically go into an office. (Here is what you should know about scheduling medical appointments during COVID-19.) Additionally, some hospitals offer virtual bereavement groups for family and friends who lost a loved one due to COVID-19. For example, Kaiser Permanente Los Angeles Medical Center hosts weekly sessions. These are not a replacement for mental health services with a professional who understands bipolar disorder. However, it may be helpful to attend a bereavement group in conjunction with counseling.
2. Schedule regular check-ins with yourself.
Regular life stress didn’t just magically disappear after COVID-19 arrived. Add in the nuances of the pandemic and it’s a lot to deal with. Given that COVID-19 is still a fairly new virus, there’s no clear picture yet to link bipolar episodes to pandemic-specific stress. But, generally, stress of any kind can trigger manic and depressive symptoms in bipolar patients, according to the Cleveland Clinic.
This is why it’s particularly important to think about how you’re feeling and look for any differences in mood or behaviors. Understandably, the ongoing stream of awful news may trigger anxiety, and you may experience a range of emotions or have trouble sleeping depending on what happened on a given day. But scheduling a daily-check in with yourself can help you identify important behavior shifts, such as going to bed later, and possibly help you avoid an episode. Sleep is a particularly important behavior to monitor because just one night of poor sleep can lead to a manic episode, according to the University of Michigan Medical School.
After checking in with yourself, you might want to talk to your psychiatrist or therapist about how you’re feeling so they can help you determine the best way to take care of yourself right now. They might suggest more regular therapy sessions or changing your medication, depending on your particular needs. And now is not the best time to cut back on therapy or to stop taking any medications you use to manage bipolar disorder. Staying on prescribed medication and sticking with your treatment regimen is crucial to managing triggers, David J. Miklowitz, Ph.D., author of The Bipolar Disorder Survival Guide and director of the Max Gray Child and Adolescent Mood Disorders Program at the UCLA Semel Institute, tells SELF. That being said, this is a difficult time financially for so many people. If you’re having a hard time affording therapy or medication, you may have more accessible options. You can search for therapists who offer reduced-fee sessions on websites like Open Path and Thero.org. If that isn’t an option, you can find federally-funded health centers through the Health Resources & Services Administration database. Many of these offer sliding scale or even free care. And you may want to consider joining an online support group, which connects you with others who can understand your specific concerns. You can find one specifically for people with bipolar disorder through the Depression and Bipolar Support Alliance. It’s not a replacement for seeing your own dedicated mental health expert, but it may help.
When it comes to medication, some pharmaceutical companies have assistance programs to help people pay for medications. Check with your manufacturer to see if there is one for your particular prescription. If you qualify for Medicaid, you can contact your state’s Medicaid office to see if you’re eligible for any prescription assistance or discount programs in your area.
3. Talk to your support system daily.
Right now, a lot of us feel lonely and isolated, which makes it important to maintain relationships in a physically distanced, safe way, especially for people with bipolar disorder. It can be helpful to have supportive friends and family who can help you identify and monitor triggers. If you can, identify a check-in buddy you trust and know well and whom you can talk with at least daily, the University of Michigan Medical School advises.
Of course, there’s phone and video chat, but an app like Marco Polo can also be helpful because it allows you to send a quick video message whenever you really need to talk. Your buddy isn’t required to be available when you send the message. Rather, they can view your video when they’re free and send their own video response.
Aside from helping you monitor symptoms, people with bipolar disorder who talked to more than one friend or family member within the past two weeks felt like they were in control of their condition, according to a 2019 paper published in the Psychiatric Rehabilitation Journal. What’s more, research from 2017 published in Clinical Psychology & Psychotherapy found that social interaction can help people with bipolar disorder stop negative ruminative thoughts and even help prevent a major mood episode from happening.
4. Limit your alcohol intake.
It may be tempting to relax with wine after a stressful day, but alcohol and drugs are direct triggers for bipolar episodes, according to the Mayo Clinic. There are a few reasons for this. “The main thing is that drugs and alcohol can interfere with medications used to treat bipolar disorder,” Dr. Miklowitz says. Mixing alcohol or drugs with mood stabilizers—like—lithium or antipsychotic medication can make the prescriptions less effective, he says. And while drugs and alcohol may feel good when you take them, regular or excessive use may come with longer-term consequences, like more mood episodes, Dr. Miklowitz says.
If you’re seriously tempted to drink alcohol, Dr. Miklowitz recommends trying to put yourself off for an hour after the urge starts. “There’s some value to delaying responses,” he says. “Sometimes that craving will go away in an hour.” It can be useful to establish boundaries with the people around you who are drinking if you feel tempted to join in. If you live with others, this might be difficult during a pandemic when people in your home don’t really have other places they can safely socialize or drink. But try to have a conversation with them about why it’s important for your mental health. “At a minimum, you have to try to be clear that you don’t want them drinking around you,” Dr. Magen says.
If you find that you’re regularly thinking about alcohol, then Dr. Miklowitz recommends looking into a support group like Alcoholics Anonymous. “That support can be really helpful right now—and many groups are online,” he says. If you’re seeing someone like a therapist, they may also be able to help you work through this or point you in the right direction. And if you’re not, it could be all the more reason to try to find someone to talk to.
5. Come up with a plan to sleep consistently.
As we previously mentioned, good sleep is vital for managing bipolar disorder. Research has found that lack of sleep increases the risk of a bipolar episode, particularly manias. “We don’t have a very good idea exactly what is going on in the brain, but we know from patients that poor sleep is bad for people with bipolar disorder,” Dr. Magen says.
And, Dr. Magen points out, lack of sleep can be a vicious cycle for episodes. “Decreased sleep can trigger manic episodes in which you then have less sleep, so you get a reinforcing cycle,” he says.
If pandemic stress is interfering with your ability to sleep, then it’s important to try to figure out specific strategies to minimize the particular factors involved, even though it can be tough. For example, if you’re worried about the number of COVID-19 cases in your city, consider limiting the number of times you check local case counts, or even temporarily blocking certain sites that you normally go to for that information. Or maybe you’d benefit from adding meditation or other mind-relaxing exercises to your daily routine. The specific strategies can be dependent on the cause of your specific stress.
If you can’t pinpoint what’s behind your sleep issues, Dr. Miklowitz recommends doing your best to make sure you’re following the rules of good sleep hygiene. According to the Centers for Disease Control and Prevention (CDC), those include:
1. Going to bed at the same time each night and getting up at the same time each morning, including on the weekends.
2. Making sure your bedroom is quiet, dark, relaxing, and at a comfortable temperature.
3. Removing electronic devices, including TVs, computers, and smartphones, from your bedroom.
4. Avoiding large meals, caffeine, and alcohol before bedtime.
5. Being physically active during the day—this can help you fall asleep more easily at night.
“All of these can be very useful,” Dr. Miklowitz says. With that said, pretty much everything is harder these days. Even top-notch sleep hygiene isn’t necessarily going to make pandemic stress stop interfering with your sleep. So if you’re still struggling to sleep after troubleshooting on your own, ask your primary care physician for a referral to a sleep medicine doctor. They should be able to offer up a more tailored treatment for you. Alternatively, your psychiatrist may be able to safely prescribe a medication to help you sleep.
6. Maintain consistent caffeine intake, if any at all.
And we’re back to another vicious cycle. Being stressed out and sleeping less can cause you to turn more to caffeine to try to help you stay awake during the day. But higher levels of caffeine can trigger an episode.
A systematic review of 17 studies on bipolar disorder and caffeine published in the journal Bipolar Disorders last year found that drinking higher quantities of caffeine was linked to more manic, hypomanic, and mixed symptoms. The researchers weren’t entirely clear why this occurred, but said it could be due to an impact on your sleep patterns (which could then indirectly lead to a manic episode), or an impact on how well your body metabolizes your medication when consuming caffeine. Avoid taking in more caffeine than usual, even if you’re tired, says Dr. Miklowitz. Then, try to focus on good sleep hygiene for your next bedtime.
We’re living in an extremely unsettling time, and it’s understandable that you might have trouble managing bipolar triggers. If you feel like you’re struggling, speak to a medical professional who can help you decide whether it's time to try a new treatment plan.
Originally appeared on Self US | Author Korin Miller