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.
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.
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.
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:
- 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
Spend some time using your relaxation techniques immediately before or after stressful events.
Don’t use alcohol or illegal drugs to cope with stress.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Personal Wellness Checklist
- I know my biggest stress triggers. They are__________________________________ ________________________________________________________________________
- I have someone to talk to or a place to write things down, when my stress level is high.
- I have a way to relax. It is ________________________________________________________________________________________________________________________
- I eat a variety of foods and get the nutrients I need. I have healthy food on hand.
- There have been no major changes in my appetite lately.
- I participate in some type of physical activity (for example,_____________________) ____times per week.
- I am getting adequate sleep. There have been no major changes in my sleep habits lately.
- I am taking my medication as prescribed. I know what to expect from my medication.
- I am involved in social activities such as ____________________________________ ________________________________________________________________________
- My friends are aware of my needs, and I am considerate of theirs.
- I have educated my family and loved ones about my illness to the best of my ability.
- 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.