For people living with Bipolar Disorder, holiday times can present a real challenge. It’s all too easy to slip into a false sense of security and disregard the routines that contributed to successful coping, especially if mood has been stable for a long time. Follow these guidelines and you and your psychiatrist won’t have a mess to clean up in the weeks after New Year.
Let’s start with your medication regimen. If you, your doctor and your psychotherapist have worked hard to stabilize your mood, make sure nothing interferes with your medication schedule. Holidays are busy, and it’s tempting to skip a dose here and there, or put off ordering and picking up refills with the rationalization, “I feel fine.” Missing medication puts you at risk.. Fluctuating blood levels of mood stabilizers are not only bad for mood, they’re bad for the brain. When traveling, make sure the pill dispenser is locked and loaded and easily accessible. I always recommend carrying an extra week of medication because it’s impossible to predict if and when travel arrangements might be derailed due to weather or transportation complications. A few years ago I got a frantic call from a patient who had flown overseas at Christmas to visit family. He put all his medicine in his checked baggage which was lost. Within a few days he was in medicine withdrawal, which caused restlessness and interfered with sleep. By the third night he was in big trouble mood-wise. Fortunately we found a cooperative pharmacy, but it still took several disquieting days for his sleep pattern and mood to stabilize.
Speaking of sleep, it is very important for individuals with Bipolar Disorder to pay attention to their sleep hygiene and level of stimulation. It can be great fun to catch up with friends and stay up past the normal bedtime, but it is essential to remember that, viewed from inside the brain, positive emotions like excitement still are a stress to basic biorhythms and can interrupt the sleep-wake cycle. It is tempting to cram in lots of activities and socialization, but the brain is not like a factory working overtime whose energy can be shut down with the flick of an electric switch. The brain needs need quiet time at day’s end to wind down, even more so in bipolar individuals. Otherwise intense images and impressions of the day can swirl through the mind like a flashing billboard. Each bipolar patient manifests overstimulation in unique ways: some become sound sensitive; other become preoccupied by bodily sensations like increased heart rate or muscle tension. Each person with bipolar disorder needs to recognize their unique symptoms of overstimulation so they can develop a plan—sometimes an extra or as-needed extra dose of anti-anxiety or anti-agitation medication is useful—to modulate mood and insure a restful night. For certain, no one is suggesting that bipolar individuals shouldn’t have fun at holiday time; rather, keep a watchful eye on signs of over stimulation so it can be managed early, before it gets out of hand.
With respect to exercise, one of the greatest benefits from working out is its inherent mood-stabilizing property. When down or sluggish, exercise enhances mood and energy. When anxious and agitated, exercise has a calming effect. It’s hard to remember the last time a bipolar patient complained that exercise made their mood worse! Look around during holidays and you’ll see many young persons in colorful sweats—usually featuring their college insignia or logo— running through the neighborhood. Not all of them are bipolar, of course, but it’s good to be reminded it is possible to make time to stay physically active.
As for diet, although the evidence is not convincing that people can destabilize their mood by overindulging, it is always best to be nutrition-conscious and avoid deviating too much from standard fare.
Bipolar patients are often exquisitely sensitive to changes in daylight and temperature. Seasonal affective lights have gotten smaller and more easily portable so there’s no reason to stop using them especially for those whose mood responds to light therapy.
And last, there’s the issue of substances and bipolar disorder. By far, alcohol presents the greatest risk to mood during holiday times. Alcohol has a short duration of action; depending on what’s in the stomach, blood alcohol levels peak quickly and two or more drinks in rapid succession can easily put someone above the legal limit and interfere with the steady state blood levels of mood stabilizer that is onboard. Some medications slow alcohol metabolism so blood level can go higher than they usually do. Remember, the authorities are always on the lookout for people driving under the influence and othing is more sobering than getting a DUI. Also, although it has a soporific effect at sub-intoxication levels, alcohol is a strong central nervous system depressant and also complicates liver metabolism of many mood stabilizing medications, driving medication levels above or below their steady-state therapeutic window. Bipolar individuals who are already stressed or depressed at holiday time are often particularly vulnerable to alcohol; their moods can plunge violently after an alcohol binge. As for other substances there is little doubt that stimulants like amphetamines, cocaine and ecstasy, or downers like marijuana and benzodiazepines, wreak havoc with mood. Partying is fine, but fooling with recreational drugs is playing with fire.
Follow these guidelines and have a great time. One of the upsides of bipolar disorder is emotional sensitivity and responsiveness; when mood is well-managed that can translate into increased capacity for pleasure and enjoyment. Those who stick to the rhythm that got them well have every reason to anticipate having a very merry holiday time.
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