Treatment Challenges: Finding Your Way to Wellness

What are mood disorders? 
Mood disorders are treatable medical illnesses involving changes in energy, behavior, thought and mood. They are not character flaws or personal weaknesses. A person with bipolar disorder has alternating high and low periods. A person with depression has recurring low periods. Cyclothymia is a milder form of bipolar disorder with highs and lows that are less severe. Dysthymia is a low, depressed mood that is present more of the time than not.

Symptoms of depression include:

• Sad, empty, irritable or tearful mood most of the day, nearly every day

• No interest in or pleasure from activities once enjoyed

• Major changes in appetite or body weight

• Insomnia or sleeping too much

• Feelings of restlessness or being slowed down

• Fatigue, exhaustion, lack of energy

• Feelings of worthlessness or excessive guilt

• Inability to concentrate or make decisions

• Thoughts of death or suicide

Symptoms of mania include:

• Feeling overly energetic, high, better than good, or unusually irritable for at least one week

• Very high self-esteem, feeling like you can do anything

• Decreased need for sleep without feeling tired

• Talking more than usual, feeling pressure to keep talking

• Racing thoughts, many ideas coming all at once

• Distracted easily, thoughts or statements jumping topic-to-topic

• Increase in goal-directed activity, restlessness

• Excessive pursuit of pleasure (e.g., financial or sexual) without thought of consequences

Can I feel better? 
Yes you can. Your treatment for these illnesses may include talk therapy, medication and support from people who understand. Healthy lifestyle choices such as a balanced diet and regular exercise, along with activities like meditating and writing in a journal, can also help you. Different people respond to treatment in different ways. Work with your health care providers to find a plan that fits you.

How can I be sure I’m getting the right diagnosis and treatment? 
Be sure to tell your health care providers all of the symptoms you are having. Report all of the symptoms you have had in the past, even if you don’t have them at the time of your appointment. Since these illnesses can run in families, look at your family history. Tell your health care provider if any of your family members experienced severe mood swings, were diagnosed with a mood disorder, had “nervous breakdowns” or were treated for alcohol or drug abuse. With the right diagnosis, you and your doctor have a better chance of finding a treatment that is right for you.

Is there more than one type of bipolar disorder? 
Yes. The two most common types of bipolar disorder are bipolar I disorder and bipolar II disorder. The highs in bipolar II, called hypomanias, are not as high as those in bipolar I (manias). Bipolar disorder that does not follow a particular pattern is called bipolar disorder NOS (not otherwise specified). Bipolar II disorder may be misdiagnosed as depression if you and your doctor don’t notice the signs of hypomania. In a recent DBSA survey, nearly seven out of ten people with bipolar disorder had been misdiagnosed at least once. Sixty percent of those people had been diagnosed with depression.

How can I spot hypomania? 
Talk to your doctor about the possibility of hypomania if you’ve had periods of several days when your mood is especially energetic or irritable, and/or:

• You feel unusually confident

• You need less sleep

• You are unusually talkative

• Your thoughts come and go faster than usual

• You are more easily distracted or have trouble concentrating

• You are more goal-directed at work, school or home

• You are more involved in pleasurable or high-risk activities, such as spending or sex

• You feel like you’re doing or saying things that are unlike your usual self

• Other people say you’re acting strangely or you’re not yourself

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What are some things that might stand in the way of my wellness? 
Finding the right treatment can take time. If you don’t feel better right away, don’t get discouraged or blame yourself. It isn’t your fault. Being aware of things that may stand in the way of your wellness is the first step toward working through them.

High expectations: The changes that happen in talk therapy will take time and effort. You may need to work through painful issues or change long-term habits. Be willing to take one step at a time. Give yourself credit for small, positive changes. It’s also important to have patience while your body is getting used to new medications. Most medications for mood disorders must be taken for two to four weeks before you begin to see results. Some can take as long as six to eight weeks before you feel their full effects.

Not sticking with treatment: One of the most important things you can do is to stick with your treatment. Your treatment has the best chance of working if you are committed to following it. Keep all your health care appointments and take any medications as prescribed. Don’t stop treatment because you feel better – you need to stay with treatment to stay better.

Need for other treatment: Treatments for mood disorders work together. Sometimes you may need to add another form of treatment. If you are only getting talk therapy, consider adding medication. If you are only taking medication, consider talk therapy. Attending support groups and making healthy changes to your lifestyle can also help.

Other medical conditions: Have a complete physical examination at the beginning of your treatment and once each year, and discuss your medical history with your doctors. Other physical illnesses may cause your treatments to affect you differently. Normal aging or menopause can also change your brain chemistry.

Substance abuse: Alcohol or illegal drug abuse may make your medications less effective or even dangerous. It can also be hard to benefit from talk therapy if you are under the influence. Be honest with your health care providers about your current use of alcohol or drugs. If you are having trouble stopping, talk to your doctors about getting treatment for alcoholism or substance abuse.

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How can I get the most from my treatment?

Be informed: Find out all you can about your illness, its symptoms and its treatments. Talk with your health care providers, visit fact-based internet sites such as www.DBSAlliance.org, and look for books on mood disorders at your local library.

Communicate with your health care providers: You know the most about how you are feeling. Be an active participant in your treatment plan and work with your health care providers to find the best treatments. Don’t be afraid to bring written questions to your doctor’s office or take notes during your appointment. Bring a supportive person to your appointment if it helps you feel more comfortable. If you think that you could be doing better, talk to your doctor about it. If things do not improve, consider seeing another doctor for a second opinion.

Set goals: Talk with your health care providers at the beginning of treatment about what you want to accomplish. Work with them to set goals for the future, decide how to reach them, and check your progress.

Track your treatment, lifestyle and moods: At the end of each day, take a few minutes to write down some information about your treatment (talk therapy, medication and support groups), lifestyle (meals, exercise, relaxation) and mood levels (stable, manic, depressed, mixed). This information can help you find your patterns, anticipate mood changes and make treatment decisions with your doctors. Call DBSA or visit our web site to order a Personal Calendar or download a Wellness Workbook.

Know that you are not alone: According to the National Institute of Mental Health, approximately 19 million adults in the United States have a depressive disorder. Nearly two and a half million adults in the U.S. have bipolar disorder. Because bipolar disorder is often misdiagnosed, many researchers believe that the number of people with bipolar disorder may be much higher.

Find support: You can find people who know what you are going through and can help answer your questions. Patients, family members and friends around the country have come together to form a network of more than 1,000 support groups where you can find information and understanding from people who have had similar experiences. Call DBSA or visit our web site to find a group near you. If there is no group in your area, we can help you start one.

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How can I get the most from my medication?

Be sure you have the correct dosage: Doctors generally begin with a low dose of medication to allow your body to adjust to it, and increase the dosage as necessary. Early in your treatment, your doctor may want to meet with you more frequently to monitor your response to the medication and adjust your prescription. Work with your doctor to make sure your dosage is not too low or too high to be effective. Be patient as your dosage is adjusted. It may take some time to find the right dosage for you, but don’t lose hope. Different dosages work for different people.

Find out about different types of medication. Your doctor may need to prescribe a different type of medication, or add another medication. Keep a record of what you take and how you feel to help with future choices. There are several types (or classes) of medication that are prescribed to help with mood disorder symptoms. Your doctor might prescribe antidepressants, mood stabilizers (sometimes called anticonvulsants), antipsychotics (sometimes called neuroleptics or described as atypical) or a combination of these to help control your symptoms. These medications are not addictive and do not change your personality. Follow your doctor’s instructions about how to take medications and any foods, beverages, other medications or natural/ herbal supplements that you need to avoid.

Take medication as prescribed. To help you remember to take your medications, you might want to use an alarm, pager, or pre-fillable medication container. You can also keep a written checklist, ask someone to remind you, or take medication at the same time as another daily activity.

Talk with your doctor about side effects. Sometimes side effects such as dry mouth, constipation, sleepiness, or blurred vision can keep you from feeling better. Side effects may go away within days or weeks. It may help to change the time you take your medication, take it with food, or ask your doctor to change the dosage or add a medication. Your doctor may also be able to help you find another medication or treatment option with fewer side effects. Never stop taking your medication or change your dosage without first talking to your doctor. If side effects cause you to become very ill, contact your doctor or a hospital emergency room right away.

Avoid medication interactions. Make sure your doctors know all the medications you are taking for all illnesses, so they do not interact.

You are in charge of your health. You have the right to ask questions and request changes in your treatment plan. Don’t give up hope. You can feel better.  

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