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Healthy
Lifestyles
Improving
and Maintaining the Quality of your Life
You have the power to change.
Whether
you are newly diagnosed with a mood disorder or have been managing
depression or bipolar illness (also known as manic depression) for
years, you can benefit from a healthy lifestyle. While you cannot change
your diagnosis, you can change aspects of your life to manage or lessen
your symptoms and improve the quality of your life.
When
you were first diagnosed with a mood disorder, you may have felt
powerless or afraid. This brochure will suggest ways to empower yourself
and play an active role in the way you live day-to-day with your
illness. Regular appointments with your health care provider and
attendance at DBSA support group meetings, in addition to the
suggestions outlined here, can put a healthy lifestyle within your
reach.
This
web page was developed from a survey of DBSA support group members –
people living with a mood disorder just like you – as a resource on
the lifestyle issues they said were of greatest concern. Add a few ideas
of your own, or ask for suggestions from your doctor or DBSA support
group. Use the checklist found at the end of this brochure to
periodically evaluate your lifestyle. Many of the suggestions detailed
here may become habits after a period of time, and healthy habits help
build a healthy life.
Reducing
Stress
Stress
can cause or worsen symptoms of mania or depression. It is important to
learn what causes your stress, ways to identify and deal with stressors
and ways to minimize your overall day-to-day stress level. Stress may be
caused by a variety of factors, both external and internal – some of
which you may not be aware of. Repeated or constant stress can lead to
tension, chronic pain, anxiety and an inability to enjoy life. With the
right treatment and therapy, you can learn to anticipate and deal with
stress, and with support, you can work on breaking out of stressful
patterns or situations.
Recognizing
and Handling Causes of Stress
Learn
how to recognize causes of stress, or “triggers,” such as difficult
people, financial matters, noise, lack of time or high pressure
situations. Review your daily activities periodically in search of
triggers you may not be aware of – look for patterns in your symptoms
and stress levels. You may want to discuss your stressors with your
doctor or therapist.
Keeping
a journal of the time of day and what you were doing when you felt
stress can be helpful. Many people have also found a mood calendar to be
a great help. DBSA offers a Personal Calendar to track symptoms of mania
and depression, mood swings, medications taken and co-existing symptoms.
Contact DBSA for more information.
Whenever
possible, develop ways to control when and where you deal with stressful
situations or people, choosing times when you are as calm and rested as
possible.
Develop ways to prepare yourself for stressors that can’t be avoided,
such as talking with a trusted friend before dealing with a stressful
situation, setting aside time to be alone after stressful incidents or
taking a break during the day for a brief rest or meditation.
Canceling or postponing a stressful encounter if you are not feeling
well is a legitimate way of taking care of yourself.
Communication
Arrange
to have a supportive “buddy” (possibly someone from your DBSA group)
and set aside time to talk to one another about stressful issues and
offer support and guidance.
When
things are troubling you, talk about them with a trusted friend (your
“buddy” or another good friend), family member or health care
provider before stress builds up and leads to a crisis.
If
you are not ready to talk about a troubling issue, write down your
feelings and thoughts in a journal or on paper you throw away. Writing
can be a good release, and reading your journal entries over a period of
time can give you some insights into some of your thought, feeling or
behavior patterns.
It
may be easier for you to express yourself through music, art or other
creative activities. It is not necessary for you to worry about the
quality of your work or share it with anyone when you are finished.
Relaxation
Allow
yourself to relax and set aside time for relaxation. Make a commitment
to spend some time relaxing at the same time each day or week. Write it
on your schedule or calendar if you need to be reminded.
Experiment
with different relaxation methods until you find the one that is right
for you. Some methods that have worked for others include:
-
Walking
-
Listening
to music
-
Light
exercise such as dancing or bicycling
-
Breathing,
muscle tension or visualization exercises. These involve taking deep
breaths and concentrating on your breathing; or tensing, then
relaxing muscle groups one by one, from toes to head; or visualizing
a calm, safe, stress-free place. Ask a therapist for suggestions or
instructions.
-
Meditation
or yoga
-
Music
-
Art
Spend some time using your
relaxation techniques immediately before or after stressful events.
Don’t use alcohol or illegal drugs to cope with stress.
Other
Stressors
Evaluate your money
management and ask yourself if it could be contributing to your stress
level. Learn ways you can get out of debt. Consider budgeting: calculate
the money you need for fixed monthly expenses such as rent/mortgage,
utilities, transportation and food, and try to set aside money for these
things before the bills are due.
Evaluate your time management
and ask yourself if it could be contributing to your stress level.
Consider keeping a personal planner or calendar. Leave notes for
yourself as extra reminders of important tasks, phone calls or
appointments.
Remember to set aside time in
your schedule to relax.
Set realistic expectations
for yourself. No one can “do it all.” Perfection is impossible, yet
many people believe they must be perfect and put themselves under stress
trying to achieve perfection. Work on accepting yourself as you are and
not punishing yourself for your mistakes. Concentrate on being satisfied
with your accomplishments rather than feeling inadequate because of
things you have not done. Break large tasks down into small, manageable
steps.
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Physical
Well-Being
Healthy
sleeping, eating and physical activity habits do not have to be
complicated, depriving or uncomfortable, and can make a big difference
in the way you feel. Many people have found that simple changes such as
eliminating caffeine or taking walks regularly have helped stabilize
their moods. Though symptoms of your mood disorder may disrupt sleeping,
eating or physical activity, making things as consistent as possible,
especially sleeping, can help keep your symptoms from worsening. Regular
habits can also help you spot the beginning of a manic or depressive
episode more quickly.
Sleep
Lack
of sleep or too much sleep can worsen moods. Keep a regular sleep
schedule whenever possible. Set an alarm if necessary, and try to get up
at the same time every morning, even on weekends, and go to sleep around
the same time every night. If you tend to have insomnia, try avoiding
naps during the day, since they can interfere with nighttime sleep.
Adopt
bedtime rituals or ways that you can slowly wind down from your day and
ease yourself into bed. Try
using relaxation exercises to get to sleep.
Avoid
over-the-counter sleep medicines, unless your doctor has recommended
them and is monitoring your use of them.
Avoid
caffeine, especially near the end of the day. Check ingredients –
certain sodas and teas can contain as much caffeine as a cup of coffee.
Large meals may keep you awake; light snacks may help you sleep
(milk and turkey are often helpful).
Changing
the time of day you take your medication may help you sleep. Discuss
your medication, its side effects, dosage and time of day taken with
your doctor.
If at all possible, avoid
late evening or overnight shift work. If you must work a late shift, try
to work the same hours every night, so you are asleep at the same time,
for the same amount of time each day.
If you wake up early in the
morning and are unable to get back to sleep, it may be helpful to get
out of bed and do a quiet activity like reading.
If you find yourself needing
significantly more or less sleep than usual, you may be experiencing
symptoms of depression or mania. Be aware of any changes in your sleep
patterns and discuss them with your doctor or mental health
professional.
Eating
Right
Eat a variety of foods daily
to get the energy, protein, vitamins, minerals and fiber you need.
Include plenty of vegetables and fruits (preferably raw) and whole
grains.
Moderate your intake of fat,
cholesterol, sugars and salt.
Drink at least 8 glasses (64
oz.) of water per day, more if you exercise. If you are taking certain
types of medication, you may require even more water. Check with your
doctor or pharmacist.
Moderate your intake of
alcohol and caffeine, or better yet, avoid them completely.
Avoid crash diets that
deprive you of food, or of one or more food groups. Instead of radical
diets, use a combination of regular physical activity and smaller
portions at mealtimes if you are concerned about your weight.
Be aware of changes in your
appetite. Loss of appetite or overeating may be symptoms of depression.
Discuss any changes with your doctor.
Don’t skip meals, even if
your energy and appetite are low.
If you tend to overeat, look
for stressors or triggers that may cause overeating. Discuss ways to
avoid or cope with these triggers with your doctor or therapist. It may
be useful to write down how you are feeling or what has been happening
at the time you overeat to help determine your triggers.
Have food on hand that is
healthy, quick and easy to eat, such as fresh fruit, yogurt, whole grain
bread, crackers or bagels for times when you are in a hurry or don’t
feel like preparing a meal. Try to schedule regular grocery shopping
trips so you don’t have to eat fast food or junk food just because you
are hungry.
Exercise
Choose a method of physical
activity that you enjoy – one that will not feel like a chore. You may
want to choose several activities so you have variety.
Focus on making the
experience as pleasant as possible. For example, if you feel
self-conscious exercising in a gym or outdoors, begin by exercising at
home. If you feel you need extra motivation or company, try exercising
with a friend or family member.
Consult your doctor before
beginning any exercise regimen. Do not choose a method of exercise that
puts your health at risk. Consider all of the medications you are taking
and be sure that factors such as increased heart rate and sweating will
not cause problems with your medication. You may need to take special
precautions when you exercise, such as drinking extra water.
Start slowly and work up to a
healthy frequency. Pace yourself so you don’t run out of energy and
become discouraged early.
Don’t ignore your own
physical limitations or exercise to the point of pain.
A good exercise goal to work
toward is 30 minutes a day, 3 times per week.
Work more physical activity
into your daily routine. Take the stairs instead of the elevator, get
off the bus before your stop and walk an extra block or park at the far
end of the parking lot.
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Treatment
A
good treatment plan is the foundation of a healthy lifestyle. Though it
may take time to adjust to medication and therapy, they are your best
defenses against symptom recurrence. Everyone has a different physical
and emotional makeup, so it often takes time and patience for you and
your doctor or mental health professional to find the right treatment
strategy for you. It is most important that you communicate your needs
to your health care providers and work with them to discover the best
possible approach to symptom management. Your loved ones can play an
important role in your treatment plan, too. You can help them to help
you by making them aware of your medication needs and having them watch
for signs of symptom recurrence.
Your
Health Care Provider
Talk
with your doctor about your medication and any side effects you may be
experiencing. It may be helpful to write down your questions and bring
your list with you to your appointment. Take notes on what your doctor
tells you.
If
you have trouble talking about particular concerns, you may want to
bring a trusted friend or family member to the appointment with you or
request that your appointment begin in the doctor’s office rather than
the examination room. If you need extra time to discuss particular
concerns, let the doctor’s office know when you make your appointment.
If questions arise after your appointment and your doctor is unable to
speak with you, see if a nurse is available to address your concerns.
If
you are dissatisfied with your health care provider or the treatment
plan you have been given, talk with him or her about it. If your
difficulties cannot be resolved, seek another health care provider. For
interpersonal or “talk” therapy, choose a therapist who treats you
with respect, listens to you, recognizes your needs and is skilled in
treating people with mood disorders.
Medication
Learn the facts about medication from your doctor, pharmacist or
DBSA. Ask your doctor or pharmacist to give you the detailed written
materials that are packaged with your medication. DBSA also publishes
several brochures describing the various treatment options. Know what
side effects to expect and what to do if these side effects interfere
with your daily activities. Talk to your doctor about ways to minimize
any uncomfortable side effects. If you have particularly troublesome
side effects, see if other treatment plans are available.
Never
stop taking medication or alter your dosage without talking to your
doctor first. Never augment your medication with herbal or
over-the-counter remedies without first checking with your doctor.
Know
what time(s) of day to take your medication(s) and take them at the same
time every day. If you have trouble remembering, use a wristwatch with
an alarm or place a reminder note in a highly visible place.
Find
out if there are any specific foods or activities you need to avoid.
Some medications may reach high levels in the body if you become
dehydrated or sweat excessively. Others may react with certain foods or
alcohol or cause you to be sensitive to sun or light.
Support and Symptom Monitoring
Keep track of your symptoms using a journal or DBSA’s mood
calendar mentioned in the “Reducing Stress” section. Learn to
recognize patterns and combinations of symptoms that may indicate that
you are or may soon be having a manic or depressive episode. Inform your
health care provider and loved ones when you feel your symptoms
increasing and ask them to observe your behavior.
If
you are experiencing symptoms of mania or hypomania, have someone else
hold on to your credit cards, bank documents and car keys. Avoid
shopping, gambling or drinking and try to maintain a regular sleep
schedule. Your doctor may prescribe additional medication.
If
you are experiencing symptoms of depression, try to avoid isolation by
scheduling brief, manageable meetings or outings with others. Adjust
your activity schedule so that you are not overwhelmed, but have small
things to do each day. Have loved ones lock away or remove anything you
might use to harm yourself.
Write
down a plan of action to follow if your symptoms become severe and you
are unable to take part in day-to-day activities. Include the names of
your health care providers, medications you would and would not prefer
to be given, facilities where you would and would not prefer to be
treated, and other important information such as medication allergies.
Also include necessary insurance information such as provider, group
number and phone number.
Write
down directions for care of your children and/or pets, as well as a way
to notify your employer and the things to tell him or her in the event
that you are unable to function or need to be hospitalized.
Make
a list of symptoms that may indicate trouble, such as
-
Self-destructive
behavior
-
Abusive
or violent behavior
-
Extreme
agitation or irritability
-
Grandiose
ideas
-
An
increase in compulsive behaviors, spending, gambling, sexual
activity or substance abuse
-
Major
changes in sleep habits – inability to get out of bed or decreased
need for sleep
-
Thoughts
or threats of suicide
If
you are thinking about death or suicide, go to a hospital emergency room
or contact a medical professional or a capable loved one or friend
immediately.
Consult
your health care provider to determine whether you should develop a
medical advance directive, and consult legal counsel to determine if a
statement of Power of Attorney is appropriate.
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Relationships
Living with a mood disorder can make it difficult to maintain
friendships, family relationships and intimate partnerships.
Relationship trouble may arise from unpredictable or careless behavior
during manias or social withdrawal during depressions, and may be made
worse by others’ lack of understanding of mood disorders. Though you
may feel lonely and isolated at times, you are not alone – almost
everyone who has dealt with a mood disorder has been frustrated by
interpersonal difficulties. Education, communication and acknowledgement
of feelings are some things to keep in mind when working to build or
rebuild relationships.
Acquaintances
Be interested in others. Ask them about themselves and listen to
what they have to say. Look for interests you have in common, or new
things you might learn from them.
Volunteer,
join community activities, take classes or find other ways to involve
yourself socially. Attend your DBSA group regularly and participate in
social events the group holds. If there is no group in your area,
consider starting one. There are surely other people near you who need
support. DBSA can help you take the first steps.
Friends
Be aware of your friends’ needs and feelings. Keep appointments,
return phone calls, be there for your friends when they need you. They
will appreciate this and probably do the same for you.
Educate
your friends about your illness and explain that it may cause you to
have mood swings or act in ways they are not used to seeing you act. Be
honest about your needs and limitations.
Be
aware of, or ask others to watch for inappropriate behavior on your
part, such as talking incessantly or being demanding, and be open to
constructive criticism from friends. Rather than becoming defensive when
someone points out such behaviors, consider their comments and try to
learn from them.
If
you are going through a period when you need extra support, try to
depend on more than one of your friends. You will get a variety of
perspectives and avoid “wearing out” one friend.
Share
your progress and stable moods with the friends who have supported you.
Family
Educate your family about your illness, especially if you are newly
diagnosed. If your family is reluctant or unwilling to accept your
diagnosis of a mood disorder, you are not alone. The stigma our society
places on mental illness causes many families to have misconceptions
(for example, that mental illness is a character weakness, that you are
lazy or “faking it,” that people with mental illness are dangerous).
To correct these misconceptions, obtain educational materials from DBSA
and share them with your family.
Show
that you are determined to work on managing your symptoms and
demonstrate to your family that you are following your treatment plan.
Try to keep a positive attitude. Often, your family will reflect it back
to you.
Encourage
your family to get support, too. They can discuss their reactions to
your diagnosis, symptoms or behavior and ask questions with a qualified
therapist or at a DBSA support group meeting.
Let
your children know they are not to blame for your illness. Explain this
to them while keeping their developmental level in mind. For young
children, it may be easier to say you aren’t feeling well or that you
are taking medication to help you feel better. Older children can also
be affected. They may be concerned about who will take care of them or
what they can and can’t depend on. They may be more focused on how
your mood disorder affects them than how it affects you. If they do not
understand that your mood disorder is an illness, you may want to
explain that you are going through a very difficult time but are getting
help, and still care very much about them.
If
your child is diagnosed with a mood disorder, educate the entire family
about the illness, work to reduce stress in the home and improve your
listening and communication skills. Help your child learn relaxation and
coping methods and work for stress reduction and other accommodations at
his or her school. Find a doctor who is knowledgeable about mood
disorders in children.
Consider
family therapy as a way to discuss the changes that are happening and
develop ways you and your family can help one another.
Intimacy
Educate your partner on your illness. Remind your partner that your mood
disorder is not caused by him or her, but by an imbalance of chemicals
in your brain. Give your partner some concrete ways he or she can help
you – by understanding when you don’t feel like going out; by
helping ease the burdens of housework or child care; or by giving you a
hug at the end of a long day. When you find yourself feeling irritable,
emphasize that it is not because of your partner but because of your
illness.
Set aside some time for you and your partner to be alone together with as
few distractions as possible. This may mean taking a walk together in
the morning, having dinner together or just lying down quietly together
at the end of the day.
Consider couples therapy, where feelings and fears can be expressed in a
safe manner. Your partner can offer another perspective to your
therapist and help you make use of your therapist’s suggestions in
your day-to-day life.
Be open with your partner about any sexual side effects of your
medications. If you experience sexual dysfunction, work on non-sexual
intimacy such as touching and holding.
Be open with your doctor about any sexual side effects of your
medications. Be aware of changes in your sex drive and discuss them with
your doctor to determine whether they are side effects or symptoms of
your illness. If you feel uncomfortable talking about sexual issues, it
may be helpful to use some techniques such as writing down your concerns
beforehand or talking to your doctor in his or her office rather than
the examination room.
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Work
Mood disorders can affect people on the job in many ways. Sometimes
it may be necessary to reduce work hours or stop working completely in
order to deal with depressive or manic symptoms. Other times, work is
not a problem, but questions may arise about how open to be about your
illness.
It is important to be in a work environment that is not uncomfortable or
unduly stressful and does not aggravate your symptoms. If you are not
employed, volunteer activities can help maintain a daily routine,
provide contact with others and give a sense of accomplishment. Whether
you are employed part-time, full-time, unemployed or involved in
volunteer work, it can be helpful to consider your stress level and
needs for accommodation as well as your unique skills and long-term
goals.
Finding Employment
Develop a plan for securing the job you want with concrete actions
you can take, such as looking in the newspaper; sending out resumes;
making phone calls; talking to people you know in your business of
choice or taking classes to learn new skills.
Don’t let past setbacks keep you from pursuing your goals. Though you
may not have the job you originally planned, you can still do
satisfying, rewarding work.
If you have been unemployed for significant periods of time, emphasize
your skills on your resume, rather than your employment dates.
Be
aware of factors that may help or hinder your work. For example, you may
feel stress when dealing with too many people at once, or you may be
more comfortable in a large group. You may work best on your own or
require directions and a more structured environment. You may enjoy
simple tasks and find them relaxing, or be bored by simple tasks and
enjoy complex, challenging work. You may work best in the morning,
afternoon or evening. Look for a job that is in a comfortable
environment for you and fits into your natural sleep/wake routine if at
all possible.
Assess
your skills. Ask yourself what you are good at and what you enjoy. Make
a list of your skills and the jobs where you could use them.
Look
at classified ads for jobs you would like to have and make a list of
qualifications needed for each one. Find out what you have to do to
obtain the needed skills for your ideal job(s) and what jobs or
education may help you learn or improve those skills.
Find
out if your community offers job training programs or placement
services.
Maintaining
Employment
Do your best work regardless of your feelings about the job. Don’t
get discouraged if you don’t have the ideal work situation. Work on
improving the skills you are using. Your job does not have to be
permanent.
Pace
yourself and conserve your energy. Working part-time for a while is
better than working overtime and exhausting yourself right away.
Be
alert for symptoms of worsening mania or depression. If you are worried
that they may significantly interfere with your job or put you or your
co-workers in danger, take the day off and arrange to see your doctor or
mental health professional as soon as possible.
Talking
with Your Employer About Mood Disorders
It is your choice whether
or not to tell people at your job about your illness. You may choose not
to tell anyone. You are not obligated to tell your employer or
co-workers about your mood disorder any more than you would be if you
had any other medical illness.
However,
if you need accommodation on the job, such as shorter hours, a different
start time, more frequent breaks or extended time off, you may need to
be honest with your supervisor. Set up a meeting with him or her and
bring the facts (including written educational materials, if you want)
about your mood disorder. Consider asking your doctor or therapist to
write a letter on your behalf. Know
your rights. If you think you have been discriminated against in a
hiring or employment situation, find out the facts and the next steps to
take from the Equal Employment Opportunity
Commission (EEOC).
A
healthy lifestyle can be yours.
Paying attention and making changes to aspects of your life such as
stress management, physical fitness, medical treatment, relationships
and daily job or volunteer activities can have far-reaching positive
effects on your mental and physical health. There is no right or wrong
way to go about making these changes and you can make them at your own
pace. The right healthy lifestyle plan is the one that works best for
you.
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Personal
Wellness Checklist
1.
I
know my biggest stress triggers. They are__________________________________
________________________________________________________________________
2.
I
have someone to talk to or a place to write things down, when my stress
level is high.
3.
I
have a way to relax. It is ________________________________________________
________________________________________________________________________
4.
I
eat a variety of foods and get the nutrients I need. I have healthy food
on hand.
5.
There
have been no major changes in my appetite lately.
6.
I
participate in some type of physical activity (for
example,_____________________) ____times per week.
7.
I
am getting adequate sleep. There have been no major changes in my sleep
habits lately.
8.
I
am taking my medication as prescribed. I know what to expect from my
medication.
9.
I
am involved in social activities such as
____________________________________
________________________________________________________________________
10.
My
friends are aware of my needs, and I am considerate of theirs.
11.
I
have educated my family and loved ones about my illness to the best of
my ability.
12. I have a job, hobby or volunteer activity where I feel comfortable. It
does not cause too much stress, and I am using and improving my skills.
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