Successfully Managing Bipolar Disorder

Julie Fast, author of: "Take Charge of Bipolar Disorder: A 4-Step Plan for You and Your Loved Ones to Manage the Illness and Create Lasting Stability" is our guest. She is joining us from her home in Oregon.

Natalie is the HealthyPlace.com moderator

The people in blue are audience members.

---

Natalie: Good evening, everyone. I want to welcome everyone to the HealthyPlace.com website. Our guest is Julie Fast, author of: "Take Charge of Bipolar Disorder: A 4-Step Plan for You and Your Loved Ones to Manage the Illness and Create Lasting Stability"

Ms. Fast has written several books on bipolar disorder, including "Loving Someone with Bipolar Disorder" and she's a writer for Bipolar Magazine. She also developed the "Health Cards Treatment System" to treat her own Bipolar Disorder. 

Good evening, Julie and welcome to our site. Thank you for coming.

Julie Fast: Thank you. I am happy to be here.

Natalie: One thing that really caught my eye: you had experienced the symptoms of bipolar disorder for 15 years, starting at age 16, before being diagnosed. You had the classic signs wild mood swings from mania to depression, psychotic episodes. You even lived with and married a man whose bipolar symptoms were so bad at one point that he had to be hospitalized. Yet, you never recognized your symptoms as being indicative of bipolar disorder. And even if you didn't know the term "bipolar disorder," it's amazing to me that you didn't view yourself as being "ill" in some way. How is that?

Julie Fast: I have bipolar II which is one of the reasons it took me so long to get diagnosed. Bipolar I is depression with full-blown mania. Bipolar II is depression with hypomania - a milder form of mania. Bipolar I is very easy to diagnose as a person who is really manic is easy to see. Bipolar II can be very difficult to diagnose- especially before all of the attention paid to bipolar disorder in the media these days - simply because people with mild mania never go to the doctor- they feel too good. I never even knew that the summers I used to have where I went absolutely wild were a mood swing. I just thought they were the real, non-depressed me.

It's hard to believe that just 10-20 years ago, the ignorance surrounding bipolar disorder was enormous. When my partner went through his terrible manic/psychotic episode in 1994, I had never heard of bipolar disorder - so I had nothing to compare. All I knew is that I was much more depressed than he was and that I had never experienced full-blown mania. This explains why I never connected the illness with myself even though I am a 100% classic bipolar II diagnosis.

After he got out of the hospital, I could no longer explain away my terrible mood swings, nor could I run away from them anymore and I was diagnosed in just 20 minutes- after 15 years of being sick all of the time. It is depressing to think of what my life would have been like if things were as they are today.

Natalie: As I mentioned at the top, Julie Fast has written several books on bipolar disorder. Tonight we're discussing her new book, due out next week, "Take Charge of Bipolar Disorder: A 4-Step Plan for You and Your Loved Ones to Manage the Illness and Create Lasting Stability" Julie, what is the theme of this book?

Julie Fast: The main theme is that it takes a comprehensive plan to manage this illness. Medications are very important, but they are not enough. I thought that medications would be the answer to all of my problems- so I didn't have anything in place in case they didn't work.

Natalie: Managing the illness and creating lasting stability. For many people living with bipolar disorder, that sounds like a dream come true. How easy is that to accomplish?

Julie Fast: I want to be very honest here. There is no quick fix with bipolar disorder. I personally have to manage the illness all day, every day. By doing this I have created my own stability. It is better than anything I have experienced before. It's not easy in terms of the time and effort it takes, but it is a LOT easier than being so sick you can't work or you have to go to the hospital. For the five years after my bipolar diagnosis, I was really too sick to function. This is when I created my own management plan and that is what has made the difference. From the tens of thousands of people I have talked to regarding bipolar disorder, I know that many people struggle if they don't manage the illness daily. I liken it to diabetes. You don't eat well one day and then go have a cake the next without repercussions.

Lasting stability means diligent, daily management with a plan that works. It's unfair we have to work so hard at this, but we do. I often say that I would give anything to be normal, but I am not normal and I have to accept that and do what I can.

Natalie: And is it within most people's grasp or is it something you must dedicate years to before you see some real results?

Julie Fast: We all have different degrees of this illness - but I can guarantee that there are tips in this book that can show results in a few days. I know because that is how it was for me. For example, there is a chapter called "Bipolar Conversation". With the one skill learned in this chapter, people with the illness and the people around them can learn what to say and what not to say when a person is in a mood swing. This can change a relationship almost overnight.

There are many things that take years, such as my being able to work again. I am very limited in my work options in that I can't handle a 9-5 office setting, but at least I can do work from my home or on a part-time basis. I wasn't able to do this at all until I used the four steps in this book. Writing these books is very hard for me. I am sick in some way the entire time, but I use my skills and I keep going. This is one of the main ideas I want to get across in Take Charge. Few of us have a recovery where the illness is completely gone. Because of this, we have to find something that works for us or the illness will take over.

Natalie: What are the 4 steps to taking charge of bipolar disorder?

Julie Fast: 1. The first step is medications for bipolar. What many people might be surprised to know is that only about 20% of people respond quickly and effectively to bipolar medications. The rest of us have to try a variety of medication combinations in order to eventually find something that works. Unfortunately, this can take years and the side-effects are often terrible.

2. The next step is lifestyle changes. The good thing about these changes is that they are often free. The bad thing is that they are not simple to start. For example, drug and alcohol abuse are the number one reason for poor treatment outcome. And yet, simply stopping the behavior is difficult for many people. Caffeine is another trouble maker, especially for people with anxiety. Stopping caffeine can make a big difference and many people do this successfully.

3. The third step is behavioral changes. This step had a huge impact on my life as it is, where I finally realized that my odd, confusing and often very scary behavior is totally normal for bipolar disorder.

4. Finally, the fourth step is asking for help. This section is not simply going to a doctor or therapist, which are naturally helpful and important. Step four teaches people how to ask for help from the right person and then helps family members and friends.

Natalie: The step that deals with medications and supplements -- in your online autobiography, you state that you stopped taking medications because you were unhappy with the side-effects. And you promised your doctor at the time that if your condition got really bad you would restart them. Knowing that each person is different, I want to know specifically for YOU, was that a good thing?

Julie Fast: I really had no choice. I was given 23 medications within my first four years of treatment of bipolar disorder with little result. I also gained over 50 pounds and was physically miserable. This was simply not acceptable and I would not let doctors do this again. I believe that effective medication treatment should be done very carefully and individually. Simply throwing a medication at someone to see if it fits, is a disservice to those of us with the illness and for many people, especially those with rapid-cycling, because it makes the illness much worse.

Having said this, I very much believe in medications. I have gone on antidepressants out of necessity. Considering that antidepressants should not be used alone in the treatment of bipolar disorder unless under strict observation by a doctor or in conjunction with a mood stabilizer, I had immediate rapid-cycling between depression and mania almost daily towards the end. I was SO sad to stop the meds as they worked. Last year, due to some personal and work triggers, I once again was too ill to manage on my own and I started Lamictal. It has worked well for me and helps about 25% of the time. Sometimes I have real breakthrough and I know what it is like to have a quiet brain, but it is rare.

I think meds are lifesaving for most people, but there needs to be a lot more help for those of us who don't get much relief from medications. That is why I wrote Take Charge of Bipolar Disorder.

Natalie: Lifestyle changes, behavioral changes, asking for assistance from others all seem helpful. But I want to know how difficult is it to effectively manage the illness and create lasting stability without taking antipsychotic medications and mood stabilizers for bipolar disorder?

Julie Fast: It is VERY difficult! I try new antipsychotics all of the time. When Abilify came on the market I was so excited and yet I still had trouble. I now take it in emergencies. Mood stabilizers are essential but not all of us respond well to them. I say- try everything you can until you find something that works- but just do it slowly and with a good doctor

Natalie: The last step: "Asking for help from family members, friends, your doctors." A lot of people have trouble doing that. Why is that? And what suggestions do you have for dealing with that issue?

Julie Fast: First of all, it is very rare for someone to say, "I need help." That is so straightforward and if we were all like that a major part of the problem would be solved. The reality is that the person without the illness will often only get clues that a person needs help. So you will have to know the clues. It is hard to ask for help in the middle of a mood swing. I teach people to have something in place before they get sick so that others know what to do without the person with bipolar disorder having to talk so much about what they need. It's all about talking when you are well so you can get help when you are sick.

When I am sick now, my family and friends know that I will be either depressed, psychotic or anxious and they know what to do. It took years for this to finally work- but it works!

Natalie: The second part of that is: if you are a family member or loved one and someone comes to you and says "I need help" - one of the biggest problems or frustrations is that most of us don't know what that means and what to do. What suggestions do you have in that regard?

Julie Fast: How could you know what do to unless someone teaches you? I really don't know one person who innately knows how to help someone in a mood swing. They have to be taught. A book like Take Charge definitely teaches you many of the skills you need, but the real teacher is the person with the illness. Ask them what they need and what helps during specific mood swings. Each person is different, for example, when I am psychotic, I can't stand to be touched, but when I'm depressed I need touch. There is no way a family member or friend can just know this by osmosis. We have to talk about it. There seems to be this big separation between those of us with the illness and those who want to help.

"Here is what I say and do when I am depressed and here is how you can help". You can do this with every mood swing. It takes time to get people to work together, but they can.

Natalie: One last thing I'd like to address and then we'll get to some audience questions: You have written several excellent books on bipolar disorder. You write regularly for Bipolar Magazine. So I know you've met and interviewed a lot of people living with bipolar disorder. What common characteristics or traits do those people who are successful at managing the symptoms of bipolar disorder have versus those who aren't so good at it?

Julie Fast: Here is something interesting. Over the past four years, I have received and read over 30,000 emails from people who have bipolar disorder or who love someone who does. And out of all of those letters, and I am not kidding, not one of them said something new about this illness. We all get sick in the same way. I have had letters from Saudi Arabia, Thailand, Australia, Finland, etc. and they all have the same questions and stories. This shows me that this is not an individual illness with an individual cure.

This means that a set management plan that is specific in what needs to be done, will work for everyone. Oh, I would say that the people with a management plan that they use every single day, are the ones who are successful- they take the meds they can take and always keep trying to find new ones that work more successfully, they watch their sleep, they accept that partying or working at a stressful job will probably make them ill, they surround themselves with supportive people and teach those people how to help them, they keep going no matter how sick they are or how much they want to die and they know the first signs of mania so they can get help before it goes too far. And most of all, they know and believe that this is a serious and often life-threatening illness - they have done nothing wrong- the behaviors can be embarrassing and scary at times, but the person with bipolar disorder is not flawed in any way.

I would say that the people in this chat room are those who are doing what they can to get better. This illness can take everything from you. You have to be ready to fight it in any way you can. People who manage it successfully keep going even when they feel too sick to function.

Natalie: Julie, here's our first audience question:

alice101: I have a question: Julie, you said that you went through several doctors before you found a good psychiatrist. how does one go about finding a good doctor?

Julie Fast: I had three docs before I found the right one. One of the problems, of course, is insurance but here are some suggestions: You have the right to interview your doctor just as you would any employee. We forget they work for us: we pay them!

My doctor is amazing, and has been good to me (he is the coauthor of my books) but you have to be selective. You will know when you have the right one because he or she will look in your eyes and really ask how you are and then in a really short period of time, make you feel that things are going to get better. So shop around!

rleet: How do I remove my own frustration and focus on helping? I am a caregiver.

Julie Fast: Well, that is certainly the most important question. First of all, anyone who has to help a person with bipolar disorder is going to get very frustrated. You never know who you are going to talk to! Will they be depressed today? Or yell at me?

Here are some tips: Remember it is an illness, and the better it is managed, the less frustration you will have at their behavior so management is the first step. Second, set limits! You have the right to your own life. Let the person with the illness know you care, but that you need them to help themselves while you help them this is such a huge topic- Take Charge of Bipolar Disorder covers the question in more detail.

Rainycloud: What do you do when you live with someone who denies your illness?

Julie Fast: I have a friend who just had a major manic episode. Her father simply refuses to believe that what she did, had anything to do with an illness. He doesn't understand Bipolar.

You have a few choices: Ask them to read my first book Loving Someone with Bipolar Disorder. At least they could see that the illness is real! Next, do what you can to get better and find someone who does believe you and wants to help. Sometimes the answers to these difficult questions can seem harsh.

Also, you can gently ask for help from this person, but you can't change them. It's tough.

Robin: How do you feel about the Bipolar diagnosis for young children, around 11? Do you think if you had been diagnosed earlier, your life with bipolar would've been different?

Julie Fast: That is a good question. I actually believe that bipolar disorder in children is quite different than the adult diagnosis. Children have more behavioral problems as well as acting out problems. I did not have the signs of bipolar at age 11, so I think that bipolar is being used as a bit of a grab bag for kids and needs to be watched carefully. I definitely would have benefited if I had been diagnosed at 16 when mine started

Natalie: Here's an audience comment, then we'll go to the next question:

merril: Juvenile Bipolar is often like oppositional defiant disorder... with a bit of ADD. The most challenging part is to find medications for someone whose biochemistry is changing by the month or more often!

Julie Fast: I totally agree- in fact- I have read that the ODD, OCD, Anxiety and Bipolar symptoms are now all lumped into a Bipolar diagnosis.

Candra: Hi Julie! I have ultra-rapid cycling bipolar II, and I was wondering: when do you personally know you are having a psychotic episode? What symptoms do you exhibit, and what can you do to prevent it from going any further?

Julie Fast: Psychotic symptoms include intrusive thoughts: I want to die, I wish I could be hit by a car, I suck, I am a failure; hallucinations, seeing yourself get killed, seeing animals scurry around chairs, hearing things or smelling things that are not there; suicidal thoughts - active and passive; paranoid thoughts such as - someone is following me- or people are talking about me at work; and finally delusions where you think something such as a billboard has special meaning for you. It's very uncomfortable and I have lived with these symptoms all of my adult life.

clance13: My daughter is having problems with keeping a relationship, going and finding a guy. What should I tell her?

Julie Fast: Ah... the problem most of us have. Keeping a relationship is difficult for anyone but when you have Bipolar, there is so much more stress added.

I suggest that she works on the illness first- get my books- or any book she can find and work on reducing symptoms so that she is less of a burden to a person. We are clingy and needy or so manic we are irritated and hard to be around. Then I would suggest working on communication skills- such as being a good partner by taking care of yourself first.

I have done all of this myself and it has worked- though romantic relationships are hard.

tuttifrutti: My daughter often begs me to kill her and I just don't know what to do. I have been asking for help for years and unfortunately I have been seen as a crazy mum.

Julie Fast: She begs you to kill her because bipolar disorder is making her say and feel these things. It is beyond scary to hear someone you love talk this way, but I am not shocked. I have often wished someone would kill me. Wanting to die is really wanting to end pain.

You can talk to her this way: "you have an illness that makes you suicidal. It is painful and horrible. Many people have this illness and they hurt like you do. Let's work together on getting help for the illness and focus on that first. What can I do right now is to help you focus on what is causing this instead of what you are feeling."

I am often suicidal as I am often stressed and my family now knows to say this to me. And finally, she needs to talk to her doctor about medications, especially an antipsychotic medication.

These are all such important questions and I know it is frustrating to get such short answers! I do cover all of this in the books in more detail

stredoa: I am 21, bi-polar, engaged and am getting married next year. I am often clingy with my fiance and sometimes he says I am too clingy. How can I work on this without feeling hurt, because I want to hug him or be near him when I know I need to give him space?

Julie Fast: Take care of yourself first. I have a chart in my book called the Chain of Neediness. It goes like this: When I am sick I can ask for help in this order: professional, therapist, support group, friend who understands bipolar disorder, partner, family, others.

If you put your partner first in your health care, you will scare him into thinking you need him too much. Remember, the illness may make you this way and the better you manage the illness, the less needy you will be. When you need that hug, consciously ask what is going on and what you really need.

carolm: It is possible to completely recover from bipolar disorder? My daughter had classic symptoms for several years, then began getting better. She is totally off all medications and has been for many months and doing great. Should we expect it to come back?

Julie Fast: This is definitely possible, but very, very rare. I assume she has bipolar I? people with bipolar one can have long periods of stability between mood swings, or only have one severe episode and never have one again

carolm: They never classified her as I or II.

Julie Fast: Wow, that is just amazing, isn't it? I assume it is I, as II is much more chronic in terms of depression. So, yes, this is possible and wonderful! Just watch very carefully for triggers such as getting laid off from work, having a baby, etc. It can come back.

doug: How do I talk to my kids about my bipolar?

Julie Fast: It depends on the age. I have a four-year-old nephew and he knows all about it. I say "I am sick today" and he knows I am depressed and that I cannot love him as much that day. I may just have to sit with him.

Older kids can definitely help and be part of the treatment plan. Believe me, they know what is going on, so they should be involved.

Maturity matters as does fear. Are they scared? That is one thing you will need to address- it may be more important to make them feel safe than to involve them in a treatment plan. My policy is to be honest with everyone, including the children in my family- it is just a matter of degrees.

Natalie: How do you deal with someone who is diagnosed Bipolar but doesn't want to believe it? I'm sure in the beginning, it's difficult. But we get lots of letters from parents, spouses, etc. with this question.

Julie Fast: Over 50% of people diagnosed with Bipolar disorder refuse to believe they have the illness. Those are pretty discouraging numbers! The main problem is that one of the symptoms of Bipolar is to think you don't have bipolar. This is common in schizophrenia as well. I suggest that you work on yourself, set limits, learn how to talk to them when they are in a mood swing, remind yourself it is an illness and they really are not doing this to you personally, they are sick. Sometimes, if you change and learn to respond to them instead of reacting you may get some results. I wish I had a more definitive answer for this one.

Natalie: Here's an audience comment:

binoman: I can answer that Natalie. I've had this problem over and over again. You keep on talking until they get it. It's a difficult situation, but you eventually get used to knowing that you are not going to be well received with anything you say.

Julie Fast: I agree with the comment- you can keep trying, but when doing that you can keep changing yourself and learn more about the illness in order to help yourself.

Natalie: Our time is up tonight. We have been talking to Julie Fast, the author of "Take Charge of Bipolar Disorder: A 4-Step Plan for You and Your Loved Ones to Manage the Illness and Create Lasting Stability" and "Loving Someone with Bipolar Disorder: Understanding and Helping Your ". You can purchase them by clicking on the links.

Thank you, Julie, for being our guest. You were an interesting guest with very helpful information and we appreciate you being here.

Julie Fast: Good night everyone.

Natalie: I encourage everyone to sign up for our mailing list. It's free and we'll notify you of other events happening on the HealthyPlace.com website. I also invite you to sign up for the first and only social network for people with mental health conditions as well as their family members and friends.

Thank you, everybody, for coming. I hope you found the chat interesting and helpful.

Good night everyone.

Disclaimer: That we are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.