Someday I’ll write up a “Top Ten Recurring Bipolar Forum Topics” post and try not to be too cheeky about it. The number one recurring theme, however, is variations on the theme, “OMG just dx’d bipolar WTF do I do?!?”
Since it seems to be something every newly diagnosed person has on his or her mind, here are the tips I’ve given over and over and over in forums. So many times that I’m not even posting responses to these topics anymore.
First, there’s the issue of the diagnosis itself. Who gave it? Do you agree with it? Do you feel like a second opinion is warranted? If your diagnosis came from a therapist, counsellor, family doctor, or GP, you should probably see a psychiatrist for verification. In fact, if anyone other than a psychiatrist gave the diagnosis, you should probably double-check with a psychiatrist. Not that they will necessarily agree, particularly if you are a “complicated” case, but psychs are trained in diagnosing mental illness. If you are the doubting type and skeptical of the diagnosis, a second or third (or fourth, for me) opinion may be in order. In general, once you’ve been given the diagnosis a couple of times by different people, you can usually hang your hat on it.
So assuming that’s settled and you have bipolar disorder and can be convinced to try treatment, the next step is… Treatment! This means medications. Not everyone goes for this, but the cold hard reality is that most people with bipolar disorder simply cannot make it (at least not for the long haul) without psychotropics. Most of the time that means a mood stabilizer at a minimum, but monotherapy – taking just one drug – really isn’t that common, at least in the US, and many people with bipolar take antidepressants or antipsychotics as well. The prevailing wisdom is to treat the bipolar first, and then tackle any other issues. Yes, these are scary drugs. Lithium and lamotrigine are the first-line mood stabilizers most people try early on, but there are tons of options and it can take awhile to find a cocktail that suits you. Always read the full pharmacy inserts on the drugs, and keep in mind that your doctors wouldn’t be prescribing them if they didn’t think they would help you. Do try to trust the doctors, even though there is certainly reason to be hesitant when it comes to psychoactive drugs.
Next step: take care of substance ab/use issues. Sometimes docs will have you clean up your act before they will treat the bipolar. I think this is wrongheaded because it can be hard to get off drugs or alcohol until the drugs treating bipolar are working. Self-medication is the main reason behind the very high rates of drug and alcohol use among people with bipolar disorder. Many of us find that once we are stabilized, we don’t need or crave those substance anymore. Although it may be hard to believe at first, this is really quite liberating!
OK, so you have the basics in hand: a diagnosis, drugs, and substance use. Now it’s time to educate yourself. Read everything you can about bipolar disorder, particularly books and articles that are scientific in nature. Read lots of books – borrow them from the library if you can’t afford to buy them. If your library has few options, ask for an interlibrary loan. There are loads of good resources available written for every level of reader, from teens to people who dig nerdy literature. Do dig around on the Internet (if you found this article, you’re probably already doing that) but keep a level of healthy skepticism of what you find there. It’s not all high quality information and a lot of people don’t understand the illness well, even if they suffer from it. A handy thing to ask yourself as you read all you can is whether you can identify with what you’re learning. If it doesn’t ring true to your experiences, maybe a reconsideration of the diagnosis is in order. When I started reading about bipolar disorder in depth, it was scarily familiar stuff.
After that, find yourself some support. Most people seem to need a therapist for at least awhile; after all, it’s a major adjustment and can be hard to accept. A lot of people with bipolar disorder also have years of bad stuff to process and work out, so take advantage of whatever services you can get your hands on to help you out. Support groups are another good option; these can come in the form of group therapy, support groups from NAMI or DBSA or other organizations, and even online forums. Hopefully you can also lean on friends and family for support, but not everyone is so lucky, which leads me to the next step…disclosure.
Disclosure is tough. I’m going to write a whole post on it before long. You don’t have to tell anyone about your condition unless circumstances warrant it, but again, hopefully you will have some supportive family and/or friends who will help see you through. You will have to tell these people about your diagnosis and probably help them learn about it too. This may be part of your therapy or self-education efforts. Everyone has different feelings on the topic of disclosure, but it’s probably good to have at least one person with whom you can come clean. A therapist can also help you work this out.
Finally, make emergency plans. Carry a wallet card with your medication information, wear a MedicAlert bracelet, make sure our family knows your treatment preferences – any and all of these may be appropriate for you. There are also special legal documents you can file to protect your interests in case you have to be hospitalized or are otherwise deemed unfit to make your own decisions. Hopefully you will not be in a position to put these plans into action, but it’s something worth considering, just in case.
Hopefully this is useful advice for people just getting over the shock of a bipolar diagnosis. Everyone has to take his or her own path in accepting, treating, and working with the illness, but these basic steps are a good start.