Living with Bipolar Disorder: What to Expect

Having a support system is critical for successfully managing bipolar disorder.

But you may be unsure who to tell about your diagnosis — and how. Because people’s reactions can vary widely and some people may not understand, it’s best to be selective.

Of course, both personal and professional positive experiences abound. For example, some people who share their diagnosis with their boss find it helps them feel at ease at work and even perform more effectively.

If you’re working with a therapist, you can try talking to them about the people you’d like to tell and how to go about it.

“To help you decide on disclosing, consider these questions,” says Elizabeth Brondolo, PhD, a psychologist and co-author of “Break the Bipolar Cycle.”

• What are my concerns around sharing?
• How might sharing be harmful?

“When telling others, be direct and share some information about bipolar disorder,” Brondolo says.

If you’d like to educate your employer about bipolar disorder and ways to support your specific needs, you can direct them to useful resources such as this one from the Job Accommodation Network (JAN).

Treating bipolar disorder typically involves meds and therapy. So if you can, it’s helpful to see both a mental health professional and medical doctor who specialize in bipolar disorder.

Medications may include mood stabilizers, such as lithium — the most commonly prescribed bipolar disorder med that’s considered a first-line treatment for bipolar disorder.

Types of therapy may include:

• Cognitive behavioral therapy (CBT): In CBT, a therapist helps you detect symptoms before they escalate, reduce unhelpful thought and behavior patterns, and manage your stress.
• Interpersonal and social rhythm therapy (IPSRT): IPSRT is used to help you develop and maintain regular routines, such as keeping a consistent sleep and eating schedule.

As with any type of treatment, obstacles come up. Thankfully, you can effectively navigate these challenges.

Challenge: Finding it difficult to accept the diagnosis

It’s common for people with bipolar disorder (and other mental and physical conditions) to find it difficult to accept a diagnosis at first.

But the more someone resists the diagnosis, the longer treatment can be delayed.

“What can help is to think about the kind of evidence you need to be convinced,” says Monica Ramirez Basco, PhD, clinical psychologist at the University of Texas at Arlington and author of “The Bipolar Workbook.”

It can also help to educate yourself about bipolar disorder and talk to others who are living with the condition, though it can look differently from person to person.

There are three main types of bipolar disorder:

• Bipolar disorder I: episodes of mania and sometimes depression
• Bipolar disorder II: episodes of hypomania (a less severe and shorter version of mania) and depression
• Cyclothymic disorder: symptoms of hypomania and depression without meeting criteria for a full mood episode

To learn more, check out these organizations and blogs:

• Depression and Bipolar Support Alliance (DBSA)
• National Alliance on Mental Illness (NAMI)
• Healthline’s list of bipolar disorder blogs

Challenge: Wanting mania to stay

For many people, mania feels pleasurable — even intoxicating — so you may not want those feelings to go away.

Some people stop treatment in hopes mania will continue. This is especially true after recently experiencing a depressive episode, since you might’ve felt exhausted, worthless, and hopeless and are eager not to feel that way again.

In the beginning, mania feels good because you’re ecstatic, excited, energized, and confident. You feel like you can do anything.

But manic symptoms can quickly go from excessively upbeat and energetic to impulsive, unwanted behaviors.

Some untreated manic episodes may even lead to psychosis, which includes experiencing delusions or hallucinations.

To work through this, consider how mania affects you — listing both the pros and cons. In Basco’s experience, most people will decide it’s worth it to continue treatment.

Challenge: Using substances

Bipolar disorder and substance use often co-occur.

Some research estimates that up to 60% of people with bipolar disorder will develop a substance use disorder at some point in their lives.

A 2013 review found that 45% of people with bipolar disorder also have alcohol use disorder.

It can sometimes feel like these substances are helping you cope — however, using them may interfere with your treatments and actually make symptoms worse.

Substance use can:

• mess with your sleep
• trigger episodes of mania or depression, or worsen symptoms during one
• interfere with medications like mood stabilizers, which may involve danger of overdosing, effects on your heart, or liver damage

While quitting isn’t easy, it’s one of the best things you can do to reduce your symptoms and cope.

If you have one, talk with your treatment team. Together, you can come up with a plan that meets you where you are.

Need help? You can also reach out to SAMHSA’s National Helpline at 800-662-4357 for treatment referrals and information.

To maximize your medication’s effectiveness and overcome common medication challenges, you can try some of these tips:

Know it takes time

It’s natural to want the first medication or combo of meds you try to work. But many people often take multiple meds before finding the best combination for them.

This can definitely be frustrating, but you’re not alone in this trial and error. And, this process will help you find what meds work well for you in the long run.

Communicate with your treatment team

Finding the right treatment plan — including that “just right” mix of meds — is a collaborative process where you and your doctor work as a team.

Before starting new medications, it’s helpful to ask your doctor the following questions:

• Why are you prescribing this particular medicine?
• What side effects might I experience, and how can I minimize them?
• What does a reduction in symptoms look like?
• What other changes may I expect?

Monitor progress

Keeping track of your progress on a daily basis can provide you with helpful info on just how effective your medication is. This information can also be useful to have during your doctor’s appointments.

To monitor your progress, psychiatrist and professor Melvin McInnis, MD, suggests keeping a daily diary of:

• moods
• quality of sleep
• energy levels
• symptoms

You can record symptoms on a scale of 1 to 10, or use a self-report questionnaire, such as the Beck Depression Inventory or the Patient Health Questionnaire.

There are also many apps for people with bipolar disorder, which may include mood and symptom trackers.

Take medication consistently

“Missing doses or fiddling with how much you take can reduce the effectiveness of your medication,” says Basco.

Stopping altogether may cause discontinuation symptoms or lead to a recurrence of symptoms.

It will really help to be consistent with your meds — even if you’re feeling better (which means the medication is working).

Still, if you’re unhappy with side effects or lack of symptom relief, talk with your treatment team. Together, you can find ways to reduce side effects or find a new medication.

Find helpful tools

Forgetting to take your meds is common for everyone, whether living with bipolar disorder or another health condition.

Thankfully, more and more tools exist to help remind you.

For example, you may use a pillbox and set reminders on your phone. There are plenty of good medication reminder apps you can try.

You might want to pair taking your medication with an everyday task or time, such as eating breakfast or before getting out of bed.

Connect with a support group

Support groups can be useful for swapping tips on taking meds or getting around side effects.

Look for in-person groups or find online communities:

• bpHope
• DBSA
• Daily Strength

It can sometimes feel like bipolar disorder mood episodes come out of nowhere. But there are some common triggers that may bring on symptoms:

• stressful events may cause both manic and depressive episodes
• sleep loss may cause mania, including traveling to a different time zone, pulling an all-nighter, and going to bed late
• seasonal changes, such as springtime for mania and fall and winter for depression

Here are some tips for dealing with common triggers:

Make stress reduction part of your routine

Consider some of these tools for reducing your stress:

• Start your day with a guided practice from a meditation app.
• Use breathing techniques throughout the day, such as deep breathing or progressive muscle relaxation.
• Take regular breaks to stretch your body.
• Journal daily to process your feelings and explore what you’re grateful for.

When stressors do occur, lean on your practices, along with your support system.

Prioritize sleep

One of the biggest things that can help improve sleep is to try waking up and going to bed at the same time every night.

You can also turn your bedroom into a sanctuary — making it easier for you to fall asleep faster. Consider some of these simple fixes, which can go a long way:

• keeping your bedroom cool and decluttered
• using soft, clean sheets
• wearing comfortable pajamas
• diffusing calming lavender essential oil
• using a white noise machine or listening to a calming bedtime story for adults

If improving sleep on your own hasn’t worked, talk with your treatment team. It’s possible that you could have a sleep disorder. Thankfully, there are many solutions to treat sleep issues.

Know your limits

Consider reflecting on the type and number of commitments you can take on realistically without getting overwhelmed — and without disrupting your sleep schedule in order to complete tasks.

Try to limit projects and activities to a reasonable number, saying no when you can.

Plan for travel

Given the unpredictable nature of travel (and often changing time zones), it’s critical to plan ahead. This can include:

• booking flights that work around your sleep schedule, such as not super early or super late
• bringing extra medication to account for longer travel
• anticipating specific issues and coming up with solutions

Know your own triggers

“In addition to common triggers, every person has a unique set of stressors,” says Basco.

“At first, triggers may seem arbitrary,” says Brondolo, “but you can learn to anticipate episodes by:”

• thinking through why a previously simple task is now a stressor, considering the reasons it was so unnerving for you
• keeping a daily record of your moods and symptoms to help you spot early signs so you can get help quickly

Sometimes, you can do all the “right” things, and episodes still happen. To be prepared, you and your treatment team can create a plan to reduce symptoms and find relief faster.

Also, try to be kind to yourself — remember, this is not your fault, but the inherent nature of a chronic illness.

Managing bipolar disorder and overall well-being means caring for your emotional, physical, and spiritual needs. In short — practicing healthy habits and self-help strategies helps you feel healthier overall.

Here are just some of the ways you can start:

Eat nutritious foods

While research on whether diet and nutrition play a role in treating bipolar disorder has increased, scientists still point out that well designed, long-term, and large scale studies are lacking.

Still, eating a balanced diet may help you feel better in general and may increase your sense of control and coping.

Adding fruits and vegetables to your daily meals is a simple way to boost your overall wellness. Plus, some foods contain nutrients that may be particularly helpful for managing symptoms of mania or depression.

Move your body

Exercise has plenty of physical and mental health benefits — from reducing anxiety and stress to promoting better sleep.

However, some research has suggested that while exercise can ease hypomanic symptoms and aid sleep for some people with bipolar disorder, for others, it can worsen mania.

Pay attention to how exercise personally affects you, and which physical activities are most beneficial and enjoyable. For example, you may find that practicing yoga, biking, and hiking are best for you.

Think tasks through

Tasks that seemed simpler in the past may be tougher now, partly because of the strain bipolar disorder puts on information processing.

For instance, if you’re a student, you may find it more difficult to take exams.

“Before tackling a task, rate its difficulty from 1 to 10,” suggests Brondolo. “If the task is over a 4, consider what it is about the task that trips you up, and anticipate what you need to do to complete it successfully.”

Recognize your own courage

Managing a complex condition like bipolar disorder isn’t easy. Acknowledge your hard work every day.

Consider leaving yourself words of encouragement or reminders of recent accomplishments on sticky notes in noticeable places like your bathroom mirror, fridge, or front door.

You can even take a photo of the notes and make it the lock screen or background photo on your phone.

Practice self-compassion

Whenever you find that you’re criticizing yourself, try to do the opposite. Have compassion for what you’re going through, and remember that other people with bipolar disorder are going through something similar.

For a tangible practice, try the self-compassion break from researcher Kristin Neff, PhD, which you can revise to reflect what resonates with you:

• Say, “This is really hard.”
• Say, “I’m not alone.”
• Put your hands over your heart and ask yourself, “What do I need to hear right now to express kindness to myself?”
• You might follow up with “I forgive myself.”

Cut back on caffeine

While the relationship between caffeine and bipolar disorder isn’t entirely clear, this 2020 review suggests it might lead to manic symptoms.

Researchers speculate that this may be because caffeine is a stimulant, interferes with sleep, or affects the metabolism of lithium and other medications.

Consider reducing your daily caffeine intake and see how you feel. Maybe switch to decaf drinks and consume more water.

If caffeine negatively affects you but you’re struggling to cut back, talk with your treatment team.

Thoughts of suicide are common in bipolar disorder, particularly during deep depressive episodes and mixed states (when a person is energized but agitated and depressed).

If you or someone you know is considering suicide, you’re not alone. Help is available right now:

• Call the National Suicide Prevention Lifeline 24 hours a day, 7 days a week at 800-273-8255
• Text “HOME” to the Crisis Textline at 741741

If you’re not in the United States, you can find a helpline in your country at Befrienders Worldwide.

Bipolar disorder may be a challenging condition, but you can effectively manage it and lead a full, healthy life.

Don’t be afraid to discuss any concerns you may have or challenges you may be facing with your treatment team and trusted allies.

Together, you can work out how to maximize medication, minimize triggers, and optimize your treatment plan.