When Moods Change Dramatically

He sat there, propped up on one elbow, slouched in his seat. He looked like a deflated elf, his round eyes sunken in their sockets, his skin a gray pallor. “I don’t know what happened”, he said. “Two months ago I was on top of the world. There was nothing I couldn’t do. My wife says she can’t understand how I was able to function on three hours sleep and still have boundless energy. I never felt so good in my life. Now, it all seems beyond me. I feel stuck like I’m on a roller coaster, and I’ve become glued to the bottom of a high ride, a bottom I can’t seem to shake. I’d rather not be alive if it means living with this sense of hopelessness and futility. What’s wrong with me? I can’t stop crying.”

I hear this story in various degrees and shades of emotion all too often. My client is talking about mood changes that seem to have a life of their own. They stem from no particular losses or grievances, which might explain his sense of acute melancholia. What further complicates this picture is the alternation of moods, the ever irrepressible highs of boundless energy, the sharp drop into apathy. What is happening here?

There are several variations and explanations through which we can understand dramatic mood changes. Are we, for instance, talking about a swing in mood from our normal, everyday “OK”state into a depressive state? Or, is there also the presence of sharp spikes in energy characterized at its extreme by a grandiose, inflated sense of self? As well, there are degrees of intensity to take into account.

The sinking into despair is what is termed a clinical depression. It may occur in response to a crisis or significant life event, run its course over a matter of weeks or months, and in time recede into the past. Sometimes there may be no apparent stressor. What we have recently come to understand is that there may be a chemical imbalance triggered by some kind of stressful occurrence. Depression appears to run in families.

Of further concern is the fluctuating of mood between intense “highs”called manias along with a cycling into depression. This is termed manic depression or, bipolar disorder. In its extreme it can be highly debilitating and like depression, lethal. Mania can result in acute thought dysfunction, impairing a person’s ability to think logically. As well, one may become involved in highly questionable schemes, financial &/or personal, resulting in financial repercussions, promiscuity and brushes with the law.

There are milder versions of heightened mood fluctuations termed cyclothymia and hypomania. Cyclothymia is a fluctuation or cyclic alternation of mood, without the intensity of its more severe cousin, bipolar disorder. Hypomania is a heightened state of energy - filled expansiveness less severe then mania. It often feels enhancing with a sense of productiveness, while having less of a downside, at least on the surface. Mania and hypomania are quite seductive. They often involve such a sense of powerfulness and confidence, that one becomes caught in expansive well being, the abrupt deflation of which seems all the more cruel. Like other mood disorders, there appears to be a genetic link (it runs in families).

Our understanding of the causes and biochemical underpinnings of dramatic mood shifts has increased in the last 20 years. We know that once established, mood disorders are more likely to persist and grow worse. This is called “Kindling.” Studies show that the sooner a mood disorder is treated, the greater the chance for a complete recovery. Virtually,75% of those affected can be treated successfully, either with complete cessation of symptoms or a significant reduction.

What does one do when he finds himself in a dramatic mood change, or more commonly, when he sees a friend or family member in the throes of one? Mood disorders are often discounted by those afflicted. How do we come to know that what we are seeing is dysfunctional, and what do we do? Here are some thoughts on how you can help:

• Recognize symptoms early on by noticing changes in sleep, appetite, grooming, belligerence and isolating behavior.

• Maintain a supportive atmosphere. Avoid confrontation through speaking calmly in the face of agitation. Project an attitude of concern.

• Fill in for the patient’s lack of emotional control by overcoming denial, yours and theirs. Often a family meeting is helpful. Be sure to point out strengths to help gain common ground.

• Set boundaries and limits; it’s important to let a family member or friend know there is a structure, a support to make up for their lack of control. Reduce their sense of turmoil.

• Join a support group. Being connected with others who share your concern helps normalize your situation. It also serves as a source of advice and knowledge, often from others who have trod the same road as you.

• Seek treatment. Today there are medications and treatments that can dramatically change hopelessness into hopefulness. A combination of medication and psychotherapy has been found to be the most effective, successful combination in treating mood swings. Seeking treatment helps reduce isolation and a sense of stigma.

One final thought--thousands of people die from suicide every year. What is especially sad about this fact is that mood disorders are treatable. Don’t be a statistic. Be a survivor.

Manic Depression - Renewing Courage

Manic Depression affects its victims in insidious ways. It weakens resolve and undermines the spirit. It agitates the ability to concentrate and focuses the individual afflicted on the edge of social norms, a place where he is vulnerable to the loss of mental health. This is not particularly unique as many illnesses follow a similar course. So it is that many bouts with illness are universal. It is from this perspective that I offer the following: the struggle to maintain stability, the sensitivity of human dignity, and the drive for courage.

Courage, which is about living dreams daily, is not just about physical courage, but mental courage as well. It is about persistence, not taking no for an answer. Reaching a goal is a daily decision to pursue that goal. It is resisting intimidation and focusing quietly without fanfare.

We all hear stories of tenacity in the face of odds. They speak to us everyday: the businessman who strives to improve his business, the worker who works three jobs to support his family; the individuals with a serious illness who focus on life and refuse to be victims. They all display examples of courage.

Dana was deemed mentally retarded at a young age, five years old. His reactions were slower then other children his age. While being termed slow, he was not without grace. He had a way about him. He found comedy in everyday activities. When he made a mistake, he would laugh at himself. Though pensive about his performance at school or in a group activity, he would look back at the milestones in his life with a sense of wonderment: graduating high school or working his first job. While some collect stamps or baseball cards, Dana collected people, those who had helped him overcome the obstacles of life. Though he wouldn’t be able to define the word, Dana had gratitude. As an adult, he recollected stories of the help he received: the third grade teacher who taught him how to read, the coach who encouraged him to swim, the counselor who helped him choose a vocation, his parents who never let him feel disabled.

Today, Dana works at a major metropolitan hospital as an x-ray technician, a job he has held for over 20 years. He has also had a long-term relationship with a woman for twenty-six years. But Dana is not without his fears. A recent bout with anxiety had him question his ability to continue in his job. Over time this receded. Like all of us, his relationship sometimes has discord, which offers challenges to overcome. In spite of it all, Dana displays a resilience which could make all of us envious. He shows courage in the everyday sense of the word, perhaps not the physical heroics of the battlefield, but the daily struggle to fulfill a promise to himself to be the best at whatever he does, living out his goals one day at a time. Dana should be a lesson to us all. Life is a drama lived out on a stage.

For those with bipolar disorder, like many of my psychotherapy clients, Dana’s story is instructive. Never miss a chance to do your best. As for those out there who have never experienced a manic episode or a clinical depression, but struggle daily with their loved ones who have, take heart at the dramatic unfolding of a life lived and the small but not inconsequential victories achieved. What is already stated for a friend or loved applies to us all. Courage is about the attitude we bring to the things we do. It would seem that at some point we find common ground, both client and family alike. Sometimes, what is true for one is true for all.

Am I Crazy – the Bipolar Dilemma

Incorporating manic behavior into a recovery-belief system is a dilemma, perhaps the ultimate bipolar dilemma. What is good in our lives is often tinged with the excessive and grandiose things we think and believe that stay and linger long after an episode has us sidelined.

Am I crazy, or is there a place in our lives for a variation of what is often viewed as a delusion or fading vision of positive afterthought? Often, it is the stigma of being deemed crazy that forces us to let go of our more upbeat selves. How can we hang onto what feels at the time of an episode like a fairy tale existence, yet has the underbelly of manic excess, which ultimately drags us down? Is it possible to sustain some semblance of hope and acceptance, or am I just plain crazy?

As every stereotype has the value of truth captured within it, so grandiosity and seduction have their valued qualities. Often, black and white thinking, the antithesis of open examination, has us discard our more creative selves in favor of stability and survival. Do we need to discard it all for the sake of sanity? A lot depends on regaining some
self-respect after an episode leaves us hollow and bereft.

There is a recovery period after an episode, a time when we may question ourselves or find it difficult to understand how we could have followed a line of thought and action to such an excess. Eventually, we come to a place of balance, recognizing what’s gained from “a brilliant madness.” Recovery is about second chances. Leaving the door of insight and openness ajar can help us retain what has value from even the most extreme and chaotic impulses.

The next time you are ready to throw away every grit and particle of an experience because of remorse over letting yourself go emotionally and intellectually, remember to glean from your memory the biochemical facts of your diagnosis. Gather in what felt true and what touched your heart. There is no need to judge yourself harshly. Be kind to yourself and from that place evaluate your extremes. Discern what mania offered you in the light of day and embrace those elements of true caring. Question what you cannot sort out and put it aside for the time being. Fullness of thought sometimes only comes with time.

Learning to live with only partial understanding can lead us to fuller insight at a later time. From mania can evolve a fuller recovery, and THAT’S NOT CRAZY.

A Work Ethic for the Recovering Manic Depressive

There is much lost in initiative when one is struck with mental illness. Drive dries up like autumn leaves cast adrift by the wind. Caught in a mental maelstrom, one is often imprisoned in the world of the mind. The enduring quality of mental aberration often leads to a paralysis of activity and action. The best-trained and raised with an attitude of productivity often become enmeshed in a net of mental stricture which leaves one immobile and uninspired. Stamina is lost.

Recovery takes work, and success takes tenacity. How do you cultivate an ethic of work that will carry you through the successes and failures of creating a life, when motivation seems to have left you behind? Not only is mental illness fraught with inaction and faintness of heart, but its course over time leads to a loss of vitality and a lack of impulse to act. With this in mind, here are some ideas to help carry you through:

Never take no for an answer. When in treatment, don’t be discouraged by early failures. Turn frustration into persistence.

Angry at the rejection of a job application? Allow your anger to be channeled into positive action. Depressed at the daily lack of routine? Allow your melancholy to form a response. Shy and withdrawn after an episode of mania leaves you unsure of yourself?

Sit and let the discouragement wash over you. Use it as an expression of impotence. When you get done with feeling sorry for yourself, make a resolution to fight back. You are not a failure.

Read books and attend lectures that promote hope and a positive image. Take your life one day at a time. Make a list of daily tasks to complete, and do your best to complete them. Gauge your ability to persist as you go through your list. Acknowledge that your ability to persist will vary from day to day. Over time, your ability to pursue a goal will fluctuate. Accept this as you accept the need to push yourself.

Though anxiety may be your opponent, never let it define you. Learn from your struggle with depression and anxiety. Know you are more than your illness and don’t let others (professionals included) define you. When all seems lost, rest. Rest as long as you need.

When you lose hope, allow time for hope to return. In the end, motivation will surface, perhaps slowly and in small pieces. Let it move you. Eventually it will come.

Like a muscle atrophied after disuse, hope and tenacity must be toned and retrained. Be patient with yourself. Know you are more than your illness. The ethic of work is in your attitude. It is to that you must apply yourself. And so, a work ethic is born or recovered.

Creativity and Bipolar Disorder

As an adolescent I spent my free time writing songs. I loved to sing, and for a long time I was part of a combo consisting of several other musicians. Several years later, while making my living as a silversmith, I experienced my first manic episode. With all of this creativity, I fit the mold of those creative artists who have bipolar disorder. Because of a high correlation between the two, it is no surprise.

It is often acknowledged that those with major mental illness have a creative side to their persona. A look at artists of any era reveals a high percentage of co-occurring mental illness, most often depression and mania. Studies reveal the incidence of creative talent is higher in those with bipolar disorder than the public at large. What can account for this? The answer is, we don’t know.

In my psychotherapy practice where I specialize in treating this mood disorder, I see a large proportion of artists and musicians who struggle with their creativity. In the wake of severe mood shifts these talented people have a difficult time balancing their personal lives with their mental health needs. Their dilemma in dealing with out of control, emotional fluctuations is eerily similar. How can they create in the face of mood shifts, which can either send them into a manic frenzy of racing thoughts and out of control emotions or into depressive lows that have them vacant of inspiration?

Added to this confusion is the issue of medication. Quite often the creative types I see value their manic side, where for them their inspiration comes in the throes of mania. Their dilemma is how to balance their need for creative expression with the need to deal with the everyday tasks of normal living. Often, this dilemma gets played out in their medication regimen. The common complaint is wanting to have enough medication to keep them stable, yet not so much that their inspiration is stifled. Some artists would rather live with the dysfunction mania brings than face the shut-off of emotion, which leaves them bored, depressed and vacant of the color and magnitude of boldness they need for self-expression.

There are no easy answers here. Out of control and without medication only leads to chaos, including crisis in relationships and other staples of a healthy life. Yet, stifling a creative side leads to a lack of zest and the feeling you cannot express a side of yourself that is a part of who you are .The common complaint is, “we only live half a life.” What’s to be done for people tormented with the inspiration of a creative vision, yet who are handicapped when they try to express it? Such is their struggle.

We assume those touched with creative expression are lucky to have talent and to lead a charmed life, able to bring forth new ides and new creations. Yet, often it is not so easy for them. In the wake of mental illness their lives are burdened by their talent. In the end, we are all a work in progress trying to find a balance. It is, however, doable.

Tips to Balance a Creative Lifestyle

• Maintain a structured routine.
• Get enough sleep.
• Keep contact with a circle of friends.
• Find a medication regimen that fills your needs.
• Find a mental health professional who understands creativity.

HEALING BY FAITH - Resolving Mania

One grey, wintry day, as I sat by a window and looked out on my back porch, I pondered my fate after 14 years of manic depression, two of those in recovery. I had made much progress. I was working a professional job, had not had a manic episode in two years, and was managing a social life for the first time in ten. Still, I looked out on a life that had no great passion. The driving impulse of my manic episodes of the past had continued to elude me.

I reflected on what was missing from my life and the answer to a quandary I had yet to resolve. What was the nature of my psychotic, religious episodes? Though having shelved my inquiry into the meaning of God’s contact with me, I had to ask myself whether they were real or not. The evidence was overwhelming. I had a collection of episodes filled with the acts of spiritual oneness too numerous to count, which left me enchanted with the promise of sitting at God’s knee. I yearned for the mental state where I was certain of a destiny enshrined in a sense of the sacred.

I had experienced 14 years of vivid memories of living touched by God. They had filled my life with purpose. Yet, 14 years after this strange conveyance to the history of the universe I believed I was part of, I was once more relegated to a world where the immediacy of sacred purpose eluded me. I had spent the last two years out from under the shadow of God, filled with the early struggles of recovery, going to work everyday living in the mundane world, and fulfilling the boring tasks of existence. I felt bereft. The magic of life was missing. It was time to take those earlier experiences off the shelf that had put them there. Were they real or but delusions?

The answer was central to my recovery. If those manic highs were true, then I was part of world history, enshrined in the goings on of the eternal. Yet, after 14 years of being introduced to this cosmic existence and being locked out months later, I questioned their validity. Was I to be famous, or was I one more anonymous body of ordinary humanity? While my recovery had been significant, I had held back by not resolving this issue.

The answer came to me as I sat thinking. I imagined God speaking to me. There are those who can live in my presence in conscious awareness, but, after 14 years of trying to live in that state, perhaps you are not one of them. You have to take the same road most of humanity has, living in blind belief that there is a God. Like your ancestors who for thousands of years moved the belief in God step by step forward over a lifetime, you have to hand off God’s reality from one generation to the next. This was a powerful thought, and it made perfect sense.

In that moment, I had my answer. My psychotic, spiritual episodes were just that, psychotic and delusional. They were not to be sighted as proof of a sacred reality. I was set free in that moment. Finally, I could let go. A vision of clarity ensued. This epiphany would affect the rest of my life. I didn’t know it at the time, but I was healed.

Now, 25 years later, I can see my life rebuilt and full. My life has blossomed. I rely on the signposts of the familiar: religious observance, ethical dealings with others, and spiritual practice. We talk about religion as faith. “Take it on faith; what works is what’s real. Its proof is in the living.”

USING BIPOLAR AS AN EXCUSE Taking Responsibility for Your Actions

Joshua sat on the couch opposite me, the tension in the room growing by the moment. “I don’t owe her an apology; I was in the midst of a manic episode at the time. They told me when I was in impatient treatment that I have a chemical imbalance; so it’s not my fault I slapped her, and now she’s exaggerating the injury.”

Joshua by this time was angry, plenty angry. He couldn’t see the point I was making that while a chemical imbalance may have influenced his actions, his actions were regrettable, and he should acknowledge this. He finally agreed in a statement to me that his actions were, indeed, regrettable, and a reflex reaction to his ex-spouse’s provocative statement still carried the sting of unresolved anger. The trust between them, already strained, had grown worse.

In treating bipolar disorder, this situation is not rare. Often, when volatile, those with a major mental illness diagnosis are confused and troubled by mild messages they receive from others. If a lack of knowing right from wrong at the time of a mental breakdown has been established, there is diminished capacity according to the law. What is lost in this logic is the damage done to the victims of angry outbursts. That is not to say a victim may not have fanned the flames of anger and has some responsibility for the eruption of verbal or physical attack. We do not live in such a pristine world of black and white, or all or none thinking. In the case of my client, his ex-spouse was not the perfect victim. But, in the aftermath of harsh words and/or physical assault, is clinging to the notion that a chemical imbalance is the culprit a fair release from culpability?

There is much work in healing the breakdown of civility which goes on with those in stressful situations. Even though you may be delusional, your actions may result in pain to another. Aren’t you then responsible for their pain? Too often one is loath to apologize, feeling it will only supply ammunition to an opponent and will weaken a claim to be the righteous one, the one wronged. This does not lead to understanding. It only increases the gulf already formed.

Setting the record straight implies acknowledging the damage done and can result in the beginning of a dialogue. “I’m sorry you were injured by my actions, or, what occurred between us is regrettable; let’s strive for a better understanding.”

But, the argument that a chemical imbalance is at the heart of a divide is an over-simplification and an easy way out. If you make a mess, then you have to clean it up. Sometimes it’s just what is needed.

Ten Ways to Take Responsibility

1. Be honest with yourself; admit your limitations.
2. Acknowledge your contribution to the misunderstanding.
3. Mentally exchange places with those you’ve harmed and
4. see the situation from their view.
5. See an outsider to mediate a dialogue.
6. Cool down before reacting.
7. Take time before trying to resolve an issue.
8. Recognize the futility of all or none thinking.
9. Seek understanding with goodwill.
10. Educate yourself on the difference between being reactive in the face of an altercation and looking at the aftermath for your opportunity to set things right.
11. Remain open.

Trusting Your Diagnosis of Bipolar

“To comply or not to comply, that is the question.” How d you know when your meds are working? When is it ok to stop, or so you think? How do you know when taking them that normalcy has returned and you question whether it’s the meds or a turn for the better in your mental outlook? More to the point, is your diagnosis correct?

We have many fears and biases when it comes to illness. There are those who will go to the doctor at the first sign of a sniffle or a cold. At the other end of the spectrum, there are those who attribute their good health to the lack of medical intervention. Somewhere in the middle of that is a nagging persistence of symptoms, which causes us to question whether a trip to the doctor is prudent.

With bipolar disorder we are sometimes the last to see the efficacy of seeing a doctor, going for treatment, or getting a prescription. In my own case it took 12 years before I firmly accepted that the adherence to taking medication on a daily basis and for the rest of my life was a necessity; no more questioning, but rather acceptance.

How do you know when your meds are working? You know when the drama exits your life, or when your friends and family comment on your newly-acquired stability; when you wake up in the morning feeling refreshed by sleep, anticipating a daily structure to your life. Recognizing others’ feedback has some value to it. It has less to do with accepting a label and more to do with the orderliness of your life.

Sometimes we only see ourselves through the gaze of others. Before you decide to quit your meds, think about the long view, of having a life you find worth living. How else can you measure compliance and stop screwing up you life with one more question, one more doubt of a bipolar diagnosis?

Ten Ways To Evaluate You Have the Right Diagnosis

1. Your life is orderly and measured.
2. When your doubts surface, rely on the feedback of friends and family.
3. Monitor your inner sense of composure.
4. Ask yourself, are you at peace with yourself.
5. If there is a repeat of your inner turmoil, when do you question
   its cause?
6. Be aware of sudden shifts in mood and outlook.
7. Question your own motives when questioning others’ feedback.
8. Seek the advice of professionals when questioning your mental health.
9. Question your own behavior if you are in constant conflict with others.
10. Allow yourself to take meds and see if calmness returns.

Bipolar Disorder - Defining Recovery

Recovery means many things, depending on whom you talk to. The term is used to define various scenarios in mental illness. The concept of recovery implies a cessation of symptoms and a return to some baseline of normalcy. Compliance with a medication regimen that stifles delusional states is also viewed as recovery.

One thing recovery doesn't infer when it comes to mental illness is a cure. There is no cure for mental illness. Instead, recovery applies to adherence to a medical and psychological treatment and perhaps, a spiritual orientation as well. The implied directive here is that by following a treatment plan, your mental health can be “earned back.” The diagnosis of mental illness is often in conjunction with a substance abuse diagnosis that needs to be treated at the same time. The term dual diagnosis has sprung up to treat the twin diagnoses of substance abuse and mood disorder. Since bipolar disorder is connected to and bears a lifetime of treatment, like alcoholism, we talk about recovery in the same way.

There is a point here to be made. The addiction model often applies to bipolar disorder. Patients enjoy their symptoms and mania is seductive. Instead of a drug, they want their “adrenaline high.” “Don’t take away my symptoms,” they cry. “Save my delusions, those soothing daydreams.”

We need to stay focused. Our objective is to create better mental health for the patients and their loved ones. Getting lost in a confrontation over symptoms and side effects only moves us off the main track, recovery, and onto a siding where we neutralize and avoid difficult decisions. We must stay centered on getting better. Hope, compliance, and a positive attitude are essential to the recovery process. Recovery comes with acceptance.

Five Ways to Enhance Recovery

1. Compliance with a medication regimen
2. Seeking psychotherapy
3. Attending a support group
4. Developing a spiritual outlook
5. Keeping an open attitude

A Relapse Plan for Bipolar Disorder

For those who have experienced recovery from bipolar disorder, and for their families, fear of relapse is a major concern. The person, once recovered, can become anxious at the thought of being out of control again. Like a walking time bomb, their recovery can so easily become erased. Relapse is a subject which needs to be addressed by both the individual and their family. It is necessary to broach this subject as relapses do occur and the patient needs to know that. The important thing to know is its ability to be weathered and dealt with.

Though the patient may view the hospital as a place to avoid, it is also a short-term stay and is no reflection on the client’s ability to take care of himself. It needs to be remembered this is a biochemical event which cannot be controlled 100% of the time. However, a negative attitude toward hospitalization and relapse can create within the ill family member reluctance to open up about symptoms if they recur. A family relapse plan often helps to get over these harsh feelings.

Making a contract to abide by the opinion of a trusted family member is one way for someone bipolar to approach the possibility they are having a relapse. Articulating a “drill” or plan whereby the family helps the loved one receive treatment can substantially reduce fears and concerns in a proactive manner. Addressing the steps needed to affect intervention in the relapse plan includes contacting doctors and therapists, identifying a hospital emergency room close to home, and engaging the ill person’s trust in a designated family member. This can go a long way in reducing the “drama” of the situation and reinforcing a calm manner and demeanor by those involved. Creating a relapse plan is something to bring up with a counselor or therapist trained in intervention. Fear can give way to understanding and hope, fostering acceptance. It is important to remember that the earlier intervention takes place, the fuller the recovery.

10 Items to Include in a Relapse Plan

1. Create a list of early warning signs of mania to give to family members.
2. Brainstorm with family members what action to take.
3. Assign a family member to call the psychiatrist & therapist.
4. Identify location of an emergency room.
5. Select a family member to watch over the children.
6. Agree on who will hold financial resources such as credit cards and checkbook.
7. Designate a family member who will hold car keys and drive client.
8. Decide and agree beforehand on a family member who will be trusted to give honest feedback about patient's behavior when insight is lacking on patient's part. Have patient agree to accept feedback and suggestions from family member at those times.
9. Avoid making life decisions.
10. Family members should be cautioned not to take patient's irritability personally, but rather as a symptom.

Bipolar Disorder and Enjoying the Ordinary

“Enjoyment is not a goal; it is a feeling that accompanies important, ongoing activity.”
- Paul Goodman.

In the case of Bipolar Disorder, enjoyment can be manic or it can be normal. Often those with Bipolar Disorder value the drama of mania over the mundane, everyday enjoyment of the ordinary.

What constitutes “important,” ongoing activity? The answer is: Does it move you forward? Is it lasting, resurfacing at significant events in a life, rather than ephemeral, a transient thrill soon lost in racing thoughts?

A child outgrows its childhood; a caterpillar becomes a butterfly. Mania of the moment is outlived. We prevail by life lived in the present. Enjoyment is found in the “ever present, now.”

Ten Ways to Enjoy the Ordinary

1. Smell a rose.
2. Study a leaf’s patterns.
3. Sit in stillness.
4. Look at the sky.
5. Observe clouds.
6. Appreciate the weight of a stone.
7. Take a warm bath.
8. Study your hand as if it is an object.
9. Run a finger down the arm of a loved one or lover.
10. Draw pictures on a steamy mirror.

The Depressive Side of Manic Depression - Five Ways to Cope with Depression

Depression is not a one size fits all kind of illness. It comes in various sizes and shapes. Each variety has its symptoms and effects. I have had all types of depression—biochemical, situational, and the blues type of depression.

Biochemical depression (unipolar or bipolar) is a genetic, chemical imbalance type of depression and doesn’t require an identifiable stressor, though this often serves as the impetus. My lapses into depression following a manic episode were biochemical. Situational depression, often less virulent than biochemical, can be serious and potent, brought on by a negative life situation (often starting out mild and increasing in intensity). It can be equally as devastating as a biochemical depression. It is a response to a situation that threatens stability. Chronic, low-grade depression known as dysthymia, can be even more insidious and long-lasting. It is often described as “the blues” or “the blahs.” While initially not as impactful as the first two, you are still able to take care of a home and raise children. There is a nagging discontent, a tendency to see the cup as half empty. Its manifestation is often termed being negative. It, too, can turn deadly or contribute to the onset of a deeper despondency. I have had my share of blue days.

I recall a time after a particularly high flying grandiose drama, waking up alone in my apartment to a sense of panic, the loss of my manic high resolving in a sudden drop into nothingness. The crassness of my drop in mood, a crash into the terror of losing touch with life, caused panic; and in that moment I could only foresee my demise. For several hours I was imminently suicidal. Luckily, I was able to pick up the phone and call my sister. After a period of several hours, I regained my emotional footing.

I can only conjecture what would have happened had I not made that phone call. I could not be alone at that moment. It was too overwhelming. When you are that far from a spiritual home, you are filled with hopelessness. Such can be the grip of depression.

Although I still continue to fight depression, I am free of manic episodes and have been for nearly 25 years. Following are ways I have found helpful in coping with depression:

Five Ways to Cope With Depression

1. Consult your doctor and therapist.
2. Get someone to stay with you until you feel better or stay with a friend.
3. Create a routine to keep from ruminating. Avoid extended inactivity.
4. Treat yourself with kindness.
5. Join or help create a support group.