1. Mood Disorders Association of Manitoba Presents

2. RECOVERY AND EMPOWERMENT for people with bipolar illness  What is bipolar disorder  Symptoms of Highs  Symptoms of Lows  Causes of Bipolar Disorder  How can you help someone with Bipolar Disorder?  What is Recovery?  What are 13 things that Empower a person  Your Action Plan

3. BIPOLAR DISORDER Manic Depression Or Manic Depression (as it used to be known) is a treatable illness marked by extreme changes in mood, thought, energy, and behaviour. " mania (highs) and depression (lows).  A person’s mood can alternate between the "poles" mania (highs) and depression (lows). This change in mood or "mood swing" can last for hours, days weeks or months.  These swings can be severe, ranging from extreme energy to deep despair.

4. Symptoms of BIPOLAR DISORDER  Bipolar disorder differs significantly from clinical depression, although the symptoms for the depressive phase of the illness are similar.  The severity of the mood swings and the way they disrupt normal life activities distinguish bipolar mood episodes from ordinary mood changes.

5. LIVING WITH BIPOLAR DISORDER AND BEYOND You may have bipolar illness if you have some or all of the following symptoms of depression and mania

6. Symptoms of mania – the “HIGHS" of bipolar disorder  Increased physical and mental activity and energy  Heightened mood, exaggerated optimism and self-confidence  Excessive irritability, aggressive behaviour

7. Symptoms of mania – the “HIGHS" of bipolar disorder  Decreased need for sleep without experiencing fatigue  Grandiose delusions, inflated sense of self-importance  Racing speech, racing thoughts, flight of ideas

8. Symptoms of mania – the “HIGHS" of bipolar disorder  Impulsiveness, poor judgment, distractibility  Reckless behaviour  In the most severe cases, delusions and hallucinations

9. Symptoms of depression - the “LOWS" of bipolar disorder  Prolonged sadness or unexplained crying spells  Significant changes in appetite and sleep patterns  Irritability, anger, worry, agitation, anxiety

10. Symptoms of depression - the “LOWS" of bipolar disorder  Pessimism, indifference  Loss of energy, persistent lethargy  Feelings of guilt, worthlessness  Inability to concentrate, indecisiveness

11. Symptoms of depression - the “LOWS" of bipolar disorder  Inability to take pleasure in former interests, social withdrawal  Unexplained aches and pains  Recurring thoughts of death or suicide

12. BIPOLAR DISORDER NO TREATMENT CAN CURE BIPOLAR DISORDER, BUT  RECOVERY IS POSSIBLE  LIVING A FULL AND COMPLETE LIFE IS POSSIBLE IT IS UP TO YOU

13. BIPOLAR DISORDER 1 in 4 Canadians will be affected by a Mood Disorder this year The Canadian economy loses 52 Billion dollars per year Due to Mood Disorders 90% of people who have a mood disorder never seek treatment

14. What causes Bipolar Disorder? Bipolar Disorder affects approximately 1.5% of all people. In Canada, more than 450,000 people have, or will have this disorder. Although not a single cause has been identified, it is known that many factors, including biochemical, genetics, and environment play a part in this illness. 

15. What causes Bipolar Disorder?  Research suggests that an improper balance of neurotransmitters in the brain is related to the symptoms and episodes of depression and mania.  The biochemical imbalance may represent a genetic vulnerability set into motion by prolonged stress, trauma, physical illness, or some other environmental factor.

16. What causes Bipolar Disorder?  Medications work for most people by correcting the chemical imbalance.  There is growing evidence that heredity is involved, especially in the more recurrent forms of the disorder. The exact mechanism by which Bipolar Disorder is transmitted from one generation to the next is not known.

17. CHEMICAL IMBALANCE

18. BIPOLAR DISORDER Fortunately, very effective treatments are available to stabilize your mood and help you regain and maintain a satisfying and productive life.

19. BIPOLAR DISORDER  You cannot diagnose yourself. Only a properly trained health professional can determine if you have bipolar disorder.  Many people do not seek medical attention during periods of mania because they feel manic symptoms (increased energy, heightened mood, increased sexual drive, etc.) have a positive impact on them.  However, left unchecked, these behaviours can have harmful results.

20. Types of BIPOLAR DISORDER Patterns and severity of symptoms, or episodes, of highs and lows, determine different types of bipolar disorder.

21. BIPOLAR I  Bipolar 1 is characterized by one or more manic episodes or mixed episodes,  symptoms of both a mania and a depression occurring nearly every day for at least 1 week,  and one or more major depressive episodes.  Bipolar I disorder is the most severe form of the illness marked by extreme manic episodes.

22. BIPOLAR 2  Bipolar 2 is characterized by one or more depressive episodes accompanied by at least one Hypomanic episode.  Hypomanic episodes have symptoms similar to manic episodes but are less severe, but must be clearly different from a person’s non- depressed mood.  For some, Hypomanic episodes are not severe enough to cause notable problems in social activities or work. However, for others, they can be troublesome.

23. BIPOLAR 2  Bipolar 2 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.

24. BIPOLAR DISORDER ALL  Because bipolar disorder is complex and can be difficult to diagnose, you should share ALL of your symptoms with your health care provider.  Keep a daily log of how you feel and show it to your Doctor. It will help him decide what and how much of a medication you need.

25. Mood Disorders Many people with Bipolar disorder try to self-medicate with alcohol and illicit drugs “Drown their sorrows” By using alcohol or other substances to reduce the pain or induce euphoria. This only worsens the mood disorder.  -8

26.  Family life is often stressful. Symptoms of both phases are distressing in different ways.  If mood swings are mild, the family may be able to handle them without too much difficulty. When the episodes are severe, coping may be extremely difficult. When Manic Or Depressive Episodes Occur

27.  Depending on the severity of the manic episode, reactions can range from frustration and annoyance to anger and hatred. Family members are dismayed as they see their loved one turning into a stranger.  Spending sprees, promiscuity, criminal acts or other forms of erratic and risky behaviours may occur. The manic person is sure there is nothing wrong with these actions and often takes no responsibility for the consequences. Family members are often faced with having to “pick up the pieces” or “bail out” their relative (both literally and figuratively). What To Expect When Mania Appears What To Expect When Mania Appears

28.  At the first signs of over-activity and after the first night’s loss of sleep, express your concern and take action if necessary.  Don’t tell (or expect) the person to “snap out of it.”  Use a firm but consistent approach. Avoid sounding strict or bossy. Don’t make demands. Don’t argue with the person. The severity of the manic episode will affect how firm or forceful you need to be.  Recognize that people with bipolar disorder are often unable to control their thoughts. Their behaviour is the result of the illness.  Try to maintain your usual routine, for example, serve meals at the regular times.  Try to keep your home as quiet and restful as possible, for example, keep lights low, play soothing music. What To Expect When Mania Appears What To Expect When Mania Appears

29.  Limit stimulation.  Make your expectations clear.  Be supportive and understanding. A depressed person needs to talk with someone who will not be critical.  Encourage self-care, especially with respect to eating, bathing and personal hygiene. For example, prepare balanced meals that can be easily reheated; keep nutritious snacks available; suggest a relaxing bath.  Try to enhance self-esteem and self-confidence by emphasizing the positive and talking about the person’s past and current achievements.  Promote “not getting depressed” over “being depressed.” Provide reassurance that the depression will pass. WHAT TO DO WHEN A DEPRESSIVE EPISODE OCCURS

30.  Monitor all medications carefully. It is common for a depressed person to forget or become confused about medications.  Watch for evidence of hoarding medications. It is often a sign that suicide is planned.  Determine whether there are thoughts of or any plans for suicide. Take action if necessary.  Ask the depressed person if you are doing anything that may be contributing to their condition. Be prepared to do some problem solving.  Don’t tell (or expect) a depressed person to “snap out of it.” This leaves the impression that they are responsible for, or have control over, their condition when they do not.  Above all, get professional help. WHAT TO DO WHEN A DEPRESSIVE EPISODE OCCURS

31.  “One of the things I found useful when I was depressed was to ask people around me to write a list of my positive qualities. At the time I couldn’t have thought up one on my own. It sure helped. And anytime I need to, I can see that someone cares. It’s right there on paper.”  Ask yourself, “How would I like to be treated in this situation?” and act accordingly. Suggestions are: HOW TO HELP?

32.  TREAT THE PERSON WITH THE ILLNESS AS AN ADULT.  EMPHASIZE THE POSITIVE. Focus on accomplishments.  ACKNOWLEDGE EFFORT. Recognize attempts.  USE HUMOUR. Laughing together can help to relieve tension, put things in a better perspective and demonstrate warmth, caring and mutual understanding.  SET CLEAR EXPECTATIONS.  DEAL WITH PROBLEMS SOONER RATHER THAT LATER.  OFFER HELP JUDICOUSLY.  RECOGNIZE THAT STIGMA EXISTS. HOW TO HELP?

33.  Don’t lose hope. Living with bipolar disorder can be discouraging, particularly when relapses occur or in times of distress. But there is hope for recovery. People who live with bipolar disorder can have satisfying and productive lives. Many say they value the insight and sensitivity they have gained from their experience. HOW TO HELP?

34.  “ No one is to blame and you cannot cure a mental disorder for a family member.”  Despite medication compliance, episodes may occur. It may take some time to find the right medications and dosages.  Additionally, the symptoms of the disorder may change over time requiring medication adjustments.  Despite your efforts, the symptoms may get worse.  Separate the person from the disorder. Love the person, hate the disorder, and separate the medication side effects from the disorder/person. Things to consider:

35.  It is NOT okay for you to neglect your needs. Take care of yourself, ensuring you have a rich and fulfilling life. Do not shoulder the whole responsibility for your family member. You may have to assess your emotional commitment.  There is nothing to be ashamed of if someone in your family has a neurological chemical brain disorder.  It is natural to experience many strong emotions such as denial, grief, guilt, fear, anger, sadness, hurt, and confusion. Healing occurs with acceptance and understanding.  Allow your affected family member and other family members to go through their grieving processes at their own pace. This is also true for you. Things to consider:

36. RECOVERY IS: CHOOSINGTO TAKE ACTION

37. Recovery is a journey without an end! There are always new thing to learn and do for ourselves

38. RECOVERY IS: Having an improved quality of life Psychological well-being Accomplishment of life goals living a satisfying life with meaning and purpose.

39. RECOVERY IS: Having what we feel are meaningful, purposeful activities. Being part of our community in a meaningful way.

40. RECOVERY IS: Success is not simply an absence of symptoms or a reduction in inpatient admissions to hospital. Success is also measured by how well we are able to pursue the things that give our lives purpose and meaning.

41. TO RECOVER : We must choose to: Believe Believe that it is possible to have a better life. Hope Hope again. Believe Believe that we are more than our illness Believe Believe that we have the skills, talents and ability to change

42. TO RECOVER: We must choose to: Believe Believe that we, the individual, deserves dignity, love and happiness Believe Believe that we have the ability to address the dissatisfaction we have with our present disabling and disempowering circumstance Believe Believe that we are responsible for our own life. Believe Believe that we have the ability to change the thoughts and behaviours that are barriers to our recovery.

43. EMPOWERMENT IS: 1.Having decision making power We need to be able to make our own decisions about the treatment that is best for us. We also must be allowed to make our own decisions about our own lives if we wish to gain a sense of independence.

44. EMPOWERMENT IS: 2.Having Access to Information We need to educate ourselves about our illness and how it is affecting our body, Only then can we empower ourselves to make the best choices for OWN our OWN recovery.

45. EMPOWERMENT IS: 3. Having a Range of Options from Which to Make Choices. We, as people with lived experience need to be aware of what choices are available to us.

46. EMPOWERMENT IS: 4.Assertiveness Those with lived experiences need to know how to request what we want and need correctly.

47. EMPOWERMENT IS: 5. A Feeling that the Individual can make a Difference. We must be hopeful and believe that recovery is possible and that with effort on our part there will be a change to our current position.

48. EMPOWERMENT IS: 6. Allowing us to reclaim “OUR OWN STORY.” We are often made to feel that we are a case history and not a real person with real life experiences. We need to tell our story and have people listened to it. This is where self-help groups can play an important part in the process.

49. EMPOWERMENT IS: 7. Not Feeling Alone, Feeling Part of a Group Empowerment best occurs when an individual does not feel alone but feels a part of a group, a connection with other people.

50. EMPOWERMENT IS: 8. Understanding that People have Rights We with lived experience need to believe that we are entitled to the same basic human rights that any other individuals are entitled to.

51. EMPOWERMENT IS: 9. Affecting change in one’s life and one’s community When we feel empowered we not only feel a change in our own life, but can work toward changing the lives of others around us.

52. EMPOWERMENT IS: 10. Learning skills that the individual defines as important. The emphasis needs to be on what the individual deems is important to them. We will feel empowered only when we have been given the ability CHOOSE to CHOOSE what is important to us.

53. EMPOWERMENT IS: 11. Changing others perceptions of one’s competency and capacity to act. When individuals with lived experience feel competent around the so called “normal” people in our life, we become empowered.

54. EMPOWERMENT IS: 12. Increasing one’s positive self image and overcoming stigma. When we are truly empowered, we are confident enough to let people know we have an illness. This will help lessen the stigma and we will begin to feel more confident and capable

55. EMPOWERMENT IS: 13. Growth and change that is never ending and self-initiated.

56. Attitude 10% …Life is only 10% what happens to me and 90% 90% how I react to it

57. WHAT CAN I DO TO HELP MYSELF? Being diagnosed with a mental illness is like having any other serious medical condition. It means being more careful in how you live your life. You need to live a more STRUCTURED LIFE And put together your own ACTION PLAN

58. 1)Tell someone how you feel. Ask them to just listen to you. No interruptions, advice, criticism, or judgments just listen. This will help you feel better.

59. ACTION PLAN 2) Take a rest from your responsibilities. Don’t leave all your duties completely, just simplify. Avoid making any major decisions. Ask if employer will make allowances for you at work. DON’T ISOLATE YOURSELF.

60. ACTION PLAN 3.MEDICATION COMPLIANCE: Medications taken to improve our functioning sometimes make us feel physically worse than the illness itself. There are many different types of medications. You don’t have to live with unacceptable side effects. Too many people stop taking medications for this reason; Medications need to be taken for a long period of time to be effective.

61. ACTION PLAN 4) Limit Alcohol and Drug use: Continued abuse of alcohol and or dependence on street drugs --even marijuana-- could alter the course of the illness. DON’T SELF MEDICATE

62. ACTION PLAN 5) Monitor sleep: Normal sleep occurs with fatigue and reduced stimulation. In bipolar disorder, loss of sleep can precipitate or exacerbate an episode of mania. Even losing one night of sleep may trigger an episode. You need at least 6 to 8 hours of sleep a night. Too much sleep can start an episode of depression.

63. ACTION PLAN 6) Positive thinking: Your attitude is perhaps the most important thing you can do towards your own recovery. You are the only one who has full control of YOUR ATTITUDE

64. ACTION PLAN 7) Sleeping. Go to bed and get up at a regular time. Establish a bedtime ritual. Do something calming before bed. Not sleeping is serious with bipolar illness.

65. ACTION PLAN 8) Get some exercise. Any movement will help. Don’t do too much at once. Climb the stairs, take a walk, sweep the floor, etc. Don’t rush from one thing to another. Live in the moment.

66. ACTION PLAN ACTION PLAN 9) Spend time outdoors At least a half-hour per day. Again, don’t overdo it. Walk or just sit outdoors. Even if it is cloudy or rainy. Roll up the shades, let the sun in. Turn on the lights.

67. ACTION PLAN ACTION PLAN 10) Eat healthy foods. Avoid sugar, caffeine, alcohol, and heavily salted foods. If you can’t cook for yourself, ask a friend or family member to cook for you. Buy healthy frozen or canned foods. Make sure you eat 3 to 6 small meals a day, don’t skip meals.

68. ACTION PLAN 11) Obsessing and Negative thoughts. Obsessing can make those issues larger than they really are. Divert your attention. Do something you really enjoy such as gardening, crafts, playing with your pet, reading. Try turning negative thoughts around to positive thoughts. Train yourself and make it a habit.

69. ACTION PLAN 12) Relax. Sit in a comfortable chair. Loosen any tight clothing. Take deep breaths (BELLY BREATHING) Relax every part of your body. Start with your toes. Notice how your body feels. Focus on a favorite scene. Do this for at least 10 minutes a day.

70. ACTION PLAN 13) Nutrition: Balanced intake of food is needed to provide vitamins and nutrients that are essential for a healthy body and mind. Nutrients are not stored so they must be replenished at regular times.

71. ACTION PLAN 14) Build a strong Support system: Surround yourself with people you trust and respect. You must be willing to accept their support and judgment, especially at times when your judgment regarding mental health may be impaired.

72. ACTION PLAN 15) Build a therapeutic Partnership with your Doctor Shared common insights: Empathy and Honesty Trust Confidentiality Persistence-commitment to working at getting better Unconditional Positive Regard

73. ACTION PLAN Build a therapeutic Partnership with your Doctor continued Positive therapeutic relationship is more important than the therapy used. You can’t do this alone, yet you are the only one that can help yourself. Inform yourself about your condition or you will forever be subject to it’s whims.

74. ACTION PLAN 16) Financial Management: Prepare a budget – learn to live within your means. Make financial decisions before episodes occur. Put limits on your spending by decreasing your credit and withdrawal limits.

75. ACTION PLAN 17) Add structure to your life It is important to have regular times for sleeping, meals, medication, exercise and social activities. Don’t overbook activities. Focus your energies, if you get sick you accomplish nothing First rule Self-help.

76. ACTION PLAN ACTION PLAN 18) Educate yourself about your illness To be an effective advocate for yourself and the type of treatment you receive, you will need to know what you are talking about. Knowledge is power

77. ACTION PLAN ACTION PLAN 19) Join a support group Getting together with people who also have an illness such as those in support groups helps. Check the times for groups at the Mood Disorders Association of Manitoba

78. ACTION PLAN ACTION PLAN 20) Write a plan to keep yourself well Making time for paying bills, buying groceries, or cleaning your home. Watching for early warning signs of the illness. Signs of getting much worse. Watch for signs that you are cycling higher.

79. ACTION PLAN ACTION PLAN Everyone develops a different recovery plan, and the right one is the one that works for you!

80. REMEMBER Recovery is a journey filled with hope: Take control. Take charge. Look after yourself. No one else can do it as well as you can!!!!

81. The Mood Disorders Association of Manitoba 4 Fort Street Winnipeg, MB R3C 1C4 PH: 786-0987 TOLL FREE: 1-800-263-1460 E-mail: mdam@depression. mb.ca