Bipolar Weekly

Category: Depressive episodes

blogs that include the topic of depressive episodes

How routine and structure help in maintaining a positive life when you have bipolar disorder

July 7, 2024 /

A healthy routine and structure has helped me be more resilient, reduce fluctuations in mood and has contributed to a sense of happiness and fulfillment in my life.

During acute depressive episodes, many people end up spending most of their time in bed. There are logical reasons for this. The most obvious being that during depressive episodes one of the symptoms is an incredibly high level of fatigue. Plus, the warmth of being under the covers helps ease the physical pain that one also experiences during these episodes. Once your symptoms become more manageable, finding a routine and a structured life can help create a more consistent feeling of wellness when you have bipolar disorder.

The first thing I do every day is take my medication. I make sure to put them in the same spot every night before I go to bed. During my last severe depressive episode my concentration was poor. Often, I wouldn’t be sure if I took my medication or not. The idea of filling up my own pill organizer when I was unwell seemed impossible. I had my pharmacy put my meds in blister packs until I was able to fill pill organizers on my own. I have an alarm on my phone that tells me when to take my meds in the evening. I have had occasions when a change in residence or life events disrupted my routine and I got into a pattern of saying to myself it’s just one dose multiple times. This has led to manic and depressive episodes. It’s a priority for me that I am consistent with taking my medication.

After my last episode, volunteer work helped provide the structure I needed to get back into a life where I could do more in a day. Even though, it was just for three hours twice a week it gave me a reason to shower, interact with people and it made me feel like I had a weekend. Even on the days I didn’t volunteer, I started to get up and structure my days as if I would be volunteering. It also helped me get my sleep routine on track because I was staying up late and waking up at random times because there was no reason to get up early.

Finding a peer support group that I could attend once a week was the next addition to my schedule that was helpful. It kept me accountable for lifestyle choices that promoted wellness and it provided connection and a commitment that was within my capacity to keep. Organizations like the DBSA have online peer support groups for people who have bipolar disorder.

Walking to my volunteer job was a nice way to add a little bit of exercise to my day. I don’t walk as much as I used to but I play tennis or badminton once a week. I usually walk when I notice a depressive episode starting which prevents them from getting worse and lasting as long. I imagine if I made walking a more consistent part of my routine I would probably have less episodes but nobody is perfect.

When you have bipolar disorder it is crucial that you get enough sleep. For most of the people that I have met who have bipolar disorder a lack of sleep can be a red flag that their mood may be going high. Finding a sleep routine that suits your individual needs is important. I go to bed around 10:30 pm. For some, complete silence is necessary. I can’t sleep in complete silence because it becomes an opportunity for my brain to be filled with stimulating racing thoughts. I use headphones to listen to the same Netflix show every night. It interrupts the verbal chatter that goes on in my head and since I have been listening to it for very many years, it has become boring for me so it helps me sleep. I don’t watch the show, I just listen to it. I used to listen to old radio shows like Our Miss Brooks, but for some reason that stopped working so I had to try something else. If the amount of sleep I am getting becomes worrisome to me, I contact my psychiatrist.

Family and friends can support people who are developing a routine by inviting them to join you when you are doing a regular activity, such as walking. It’s important that it is an invitation rather than an appointment when people are severely unwell. For example, if someone said, “I am going for a walk tomorrow. If you’re up to it, would you like to join me?” This takes some pressure off, and it makes it easier for someone who has bipolar disorder to participate. If the person is unable to go on the day, it’s important you go on the walk anyway.

Adding structure and routine into your life when you have bipolar disorder can relieve stress, make you more consistent with taking your medication and help you build a support network. This can empower you to create a life that includes long term consistency and resilience.

8 Steps to Rebuild Your Life after an Acute Depressive or Manic Episode.

June 9, 2024 /


After my first manic episode, I lost my job, my dream of becoming a Japanese interpreter, all of my money, all of my friendships and relationships with the people I had in Japan and my marriage ended in a divorce. Since then, I have had two manic episodes and a depressive episode that destroyed my life in a similar fashion.

I haven’t had an acute manic or depressive episode since 2010. Now, I can reflect on what I did to rebuild my life. I am only sharing what worked for me. I am not suggesting that this is a foolproof simple way of rebuilding your life.

1. Rest
This one is hard for people to understand. Acute manic and depressive episodes take a physical toll on the body. Just like any other illness, one requires rest to recuperate from this. How much rest do you need? Everyone who has bipolar disorder is different but I, and many people I have met, have taken a year while for others it may be months. When I ignored my bodies need for rest, it made me feel worse because I would beat myself up for not being more active. It’s not uncommon for people to need to spend many hours in bed during this time.

2. Work with your psychiatrist to the best of your ability
There is no x-ray or blood test a psychiatrist can use to diagnose how symptomatic you are. I’m not a psychiatrist and I do not know what goes into the decisions they make for treating their patients but I do know that the more information I can provide my psychiatrist the better. This may include completing mood charts, notes on side-effects, and descriptions of how much you are able to do in a day. If possible, try to get your medication in blister packs otherwise you might be frustrated with trying to remember if you took them or not.

3. Keep Moving
After my first manic episode the fatigue was so bad that every step felt like I had heavy weights shackled to my ankles. I had to brush my teeth with both hands and showering was like climbing a mountain. When you are this unwell exercising may not be possible but any movement helps. If at first, you just try to walk from your bed to the TV as much as possible that’s a win. Everyday, try to move a bit more than the previous day and eventually you will gain momentum and your activity level should grow exponentially.

Step 4 Get on the other side of the door

During an acute depressive episode, my anxiety is extremely high. The idea of leaving my home becomes horrifying. However, the longer I isolate the worse my symptoms get. My goal became just to get on the other side of the door and exit my place. I had no destination in my mind, or how long I would be gone. I just put on my runners and left.

5. Peer Support
Finding a peer support group for people who have bipolar disorder can be extremely helpful. For me, it helped give me hope to know that other people who have bipolar disorder were able to recover and the tips I learned from them were helpful. Plus, talking to people who understood what I was going through helped a lot. Many people who have bipolar disorder are kind, compassionate, fascinating, intelligent, and just cool people to spend a couple of hours with. Organizations like the Depression and Bipolar Support Alliance (DBSA) have online peer support groups for people who have bipolar disorder.

6. Grieve the Losses
A manic or depressive episode can lead to huge losses in life such as job loss, financial instability, divorce, loss of relationships with colleagues, and friends. It isn’t our fault that the episodes happen, but many people and organizations cannot separate who we are as people from the behaviour they see when we are not well. Acknowledging, the pain of these losses and addressing them through journaling, counseling and/or peer support was helpful for me.

7. Volunteer Work
When you are well enough, volunteer work can be a great way to transition back into a more active life. There is a full range of time commitments from a couple of hours a month to several hours a week. Volunteering can provide more structure into your life, create connection with people who are appreciative of your help and it can give your a sense of fulfillment.

8. Identifying Your Capacity
The last step may be the hardest. At some point, we have to reflect on patterns that have emerged after multiple episodes. Bipolar disorder can be highly reactive to stress. For some, full-time work, a busy social life, an intense workout routine and a family may be possible. For others, this level of activity could result in recurring episodes. A person who can do more than other people who are limited in the scope and how much they do are not more successful. They simply have a greater capacity to do more.

Dealing with the devastation that comes as a result of acute manic and depressive episodes is awful. It takes time, patience and support but it is possible to find a life you enjoy again.

Addressing Self-Isolating When You Have Bipolar Disorder

October 9, 2022 /

When you have bipolar disorder it is easy to feel like you are alone and disconnected from the rest of the world. Our symptoms are difficult for people to understand because they only see behaviour that they might find frustrating, confusing and maybe even scary. This can lead to ruptured friendships, job loss and distancing by family members. Plus, some of our symptoms include negative thoughts and anxiety which may lead to an illogical fear of leaving our homes.

During my last manic episode, I was experiencing a lack of inhibitions which led to an impulsive decision to move to a small town. I was still high and experiencing psychosis when I moved there and I only have vague memories of what happened when I arrived. When the manic episode ended the tremendous darkness of a severe depressive episode seeped into my body.

I had never lived in a small town, and I did not know anyone who lived in the community. My mania had caused me to lose my job and I lost any connection I had to my former colleagues. My behavior when I was high caused ruptured friendships and distance between me and my family members. My appetite tanked. The most I would eat during the day was one sausage roll and maybe some orange juice. Some days, I didn’t eat anything at all. I didn’t have enough money to even get the internet or cable TV so I watched the same three DVDs everyday and I listened to the radio. I was so exhausted and achy that I spent most of my time in bed.

When my mood is low my anxiety is high. This means when I was awake, I was in a constant state of fear even though I was not in any danger. Plus, I was afraid that people would recognize me from when I had my manic episode if I went out in public and I feared how they would react to me. I would only leave my home to get necessities and then I would hurry back to lie in bed with body aches, fear and awful negative thoughts bombarding my brain.

I am fortunate because I have family members who care about me and were determined to support me regardless of the fact that there were no signs that I would be getting better anytime soon. They called me everyday imploring me to keep eating and encouraging me to keep trying to get better. In retrospect, all of those phone calls were crucial in helping me through that period in my life.

At some point, my energy improved, and I spent less time in bed, but I was still fearful of leaving my home. I made a goal to just get on the other side of the door to my house. It didn’t matter what I did or where I went after that. I just needed to get on the other side of the door. Once I was able to leave my home I found support and connection to people at a local church and gradually I started to feel more comfortable outside my place.

The piece that really made a huge difference for me is when I reconnected with my friends who have bipolar disorder. They understood what I was going through and reminded me of the tools I needed to implement to rebuild my life. Their support helped me tremendously in getting my life back on track.

Getting stuck in self-isolation is scary. You become imprisoned in your own home. The longer the isolation lasts the larger the gap between yourself and the rest of society feels. For me, the only solution was to just get on the other side of the door to my home. I had to take that one step that opened me up to the possibility of returning to the support and potential for joy that comes from being connected to people. This one step eventually grew into a life that I enjoy that includes a sense of fulfilment and stability.

Rebuilding Your Life After a Severe Episode

November 22, 2021 /

Having bipolar disorder can result in many losses that may destroy one’s belief in the possibility of returning to a positive life. Acute manic or depressive episodes can result in a lose of employment, relationships with a spouse, friends, and colleagues. Plus, it is common for people to lose all their money and assets.

For example, one could have a severe manic episode that results in an extreme amount of spending which can burn through people’s savings and assets. During this episode, one can become irritable which can lead to a loss of a job or relationships. If you experience psychosis such as hallucinations, paranoia or delusions of grandeur, people do not understand you are simply not well and may become fearful of you which can also lead to a loss of relationships. Perhaps, your spouse decides they cannot deal with the drama of your illness, and they leave. In just a couple of months, you can lose all your money, assets friendships, job, and spouse.

At the end of a manic episode a depressive episode will follow which includes symptoms like extreme exhaustion, body aches, poor concentration, suicidal ideation, and an inability to enjoy anything. It feels like you are a shell of a human being and it’s easy to become hopeless. However, it is possible to rebuild your life after this happens even though it seems impossible. I, and many other people who have bipolar disorder, have been able to claw their way back to a life they enjoy after these types of incidents.

My first depressive episode was the greatest amount of suffering I have ever experienced. I had lost everything. My career, marriage, all of my money and most of my friendships. My appetite was so poor I hardly ate anything, and I had to use two hands to brush my teeth. I spent several months lying in bed. This is common during depressive episodes because the fatigue is extreme, and the warmth of the bed helps ease the pain of the body aches.

To recover from this episode I made incremental improvements in my life on a daily basis. My first goal was to spend more time sitting up in bed rather than lying down the whole day. Eventually, I was able to spend more time out of bed. Then, I built on the tiny successes everyday. I would simply do my best to make the day a little bit better than the previous day. Eventually, this created a kind of moment that helped me start down the path of wellness.

This November I have been participating in Move for Movember, an initiative where I have to walk 60 km in one month for the 60 men who die by suicide every hour around the world. You can donate by clicking here. I was hesitant to participate in this campaign because last month I walked 0 km. But I used the same approach to completing the challenge that I have used to rebuild my life when bipolar takes so much from me. At first, I just did 2 km/day. Everyday, I managed to do a tiny bit and recently my walks have been longer. I have completed 56 km and there are still a few days left in November.

When bipolar disorder destroys your life the thought of ever having a life you enjoy again seems unfathomable, but it is possible. Methodically rebuilding your life one small piece at a time is the only way to get your life. Many people who have bipolar have done it so there is always hope that life will get better.

Allan Moves for Movember

November 1, 2021 /

The rate of suicide among people who have bipolar disorder is approximately 10 -30 times higher than the general population. Researchers estimate that between 25% and 60% of individuals with bipolar disorder will attempt suicide at least once in their lives and between 20% (of mostly untreated) people who have bipolar disorder will die by suicide. The reasons why this occurs can be complex but I will try to explain it from the perspective of someone who has the illness.

Most of these deaths occur during depressive episodes. When you understand the symptoms of depressive episodes it is easier to understand why these deaths occur. The first problematic symptom is that depressive episodes give you suicidal ideation. Our illness impacts our thoughts and behaviour when we are acutely ill. This is a physical response caused by the illness. In my experience, pep talks and trying to have a positive attitude will have little impact in improving these thoughts when our symptoms are severe. In fact, people may conclude that they are to blame for their symptoms because they are not trying hard enough to have a positive attitude which reaffirms any negative thoughts they are having about themselves.

There are other symptoms of depressive episodes that can contribute to suicidal ideation. You have thoughts that you are worthless, no one likes you, and every aspect of life appears dark. Depressive episodes create concentration problems which make conversations impossible. During acute depressive episodes it is very difficult to enjoy anything. This means eating, entertainment, family gatherings, music, Netflix do nothing for you. It feels like you are a shell of a human being, and it is easy to conclude that there is no purpose to staying alive.

Often people who have depressive episodes think their episode will continue for the rest of their lives which is rarely the case. We generally go back to baseline, and we may even head into hypomania or mania. It’s a journey to get the right mix of medication, therapy and a positive routine to create a positive life long term. There are many people who have bipolar disorder who are able to do this, one need only attend a peer support group to meet some of them.

This year, I will be participating in Move for Movember. For this campaign, I will be walking 60 km this month for the 60 men we lose every hour around the world to suicide. There is simply not enough support for men to receive the treatment they need to prevent these deaths so I am going to participate in the walk so that in my small way I can contribute to a solution to this problem. If you would like to make a donation in my name please click here.

If you are suffering from suicidal ideation, please know you are not alone. There are many people who have suffered just like you are. It is possible to have a better life. You may not be able to think of a solution to your problems but that does not mean that a solution does not exist.

Below are a few links to resources for support for people who are struggling with suicidal ideation.

Peer Support

OBAD (Organization for Bipolar Affective Disorder)

DBSA (Depression and Bipolar Support Alliance DBSA)

Distress Centre Lines

Crisis Services Canada 1-833-456-4566

Lifeline (US) 1-800-273-TALK (8255)

Befriends Worldwide (International)

Lifeline (Australia) 13-11-14

The “I Am Ok” Costume

October 25, 2021 /

In my experience, most people who have bipolar disorder put a lot of effort into acting like they are fine despite the fact they are really struggling. This problem is not unique to bipolar disorder, but since it is the illness I have, I will focus on it for this blog.  

Many of the symptoms of bipolar disconnect us from people. At times, the illness prevents us from physically experiencing enjoyment. When this happens conversations are extremely difficult. People generally like to talk about positive experiences they’ve had or are having. When depressive episodes rob you from physically experiencing joy then that changes how you interact with people.

For example, depressive episodes prevent you from finding anything entertaining. You could go to a movie with a friend and when they ask you if you liked it you cannot say, “Normally, I would love it George, but right now I am experiencing a depressive episode which messes with neurotransmitters in my body, and as a result I cannot experience enjoyment right now.” I suppose you could say that, but it would probably be hard to maintain friendships if you did this on a regular basis and it is unlikely that your friend would understand what you mean. It is simpler and better for us if we just put the ” I am Ok” costume on and say we liked the movie.

It’s not just depressive episodes that are problematic. Hypomanic symptoms also require a lot of energy to make one appear “Ok.” During one of these episodes, you might notice that people keep asking you to stop interrupting them because you are talking too much or your brain is screaming at you to buy a bunch of stuff you do not need. You cannot say, “Please ignore me for awhile I’m hypomanic. Can I buy your shoes? I love this song. Do you love this song? Let’s dance on the escalator.” Instead of saying or doing these types of things you have to grit your teeth, put the costume on, smile and try not to say anything.

All of this may not seem like a big deal but it’s exhausting. Bipolar disorder is a chronic illness, so our medication helps a lot, but we still have to deal with our symptoms to varying degrees on a regular basis. When we are not well enough to get the costume over our shoulders the consequences can be harsh. A parent may be at a graduation or wedding and be unable to experience the joy of the moment and can be accused of being uncaring or cold. Someone who is hypomanic can lose a lot of money, relationships, and employment.

For me, the only relief I got from wearing the heavy, “I am ok” costume was attending peer support groups at OBAD. The format is simple. You show up at a meeting and just exist without any judgement or expectation. My first meeting was such a relief. My depressive episode was so severe I could barely manage to keep my eyes open and get a word out of my mouth. It didn’t matter. Listening to other people who had bipolar disorder talk about their experience made me feel connected and not alone. I could just be ill, and everyone understood, and they were comfortable with it.

What can people who do not have bipolar disorder do to help us when they notice we are struggling to get the costume on? Unfortunately, there is not much anyone can do. My neurotransmitters do not speak English so pep talks, advice or punitive judgement will not pop me back into wellness. I just need people to be patient and compassionate with me and, in time, I will feel better.

Fall and the Winter Months When You Have Bipolar Disorder

September 27, 2021 /

Over the years of facilitating peer support groups for people who have bipolar disorder, I have noticed that some individuals have their symptoms change in the Fall and Winter. In Calgary, during these months the days become shorter, and it can be uncomfortable to go outside in the cold weather. People tend to become less active and more isolated. All of these factors can lead to depressive episodes. There are some people who struggle with symptoms of mania or hypomania during the winter but most people I have encountered generally see their mood dip.

I used to really struggle during the Winter. My mood would become so low that I would have a hard time functioning. My psychiatrist had to make tweaks to my medication every year to help me get through it. For me, taking Vitamin D everyday has helped and doing fun activities like badminton and winter hiking have contributed to improving my quality of life in the winter.

Some people who have bipolar disorder sit in front of a light box every morning in the Winter. These lamps that are used to treat Season Affective Disorder, an illness that causes depressive symptoms in the winter, can also help people who have bipolar disorder. If you have bipolar, using these lamps can trigger manic episodes so it is important to work with a psychiatrist to determine the best way to use them.  

Having bipolar and leading a positive life is a lot of work. You have to be aware of your symptoms but not focus on them so much that it brings you down. You have to watch your stress level and use any tool available to you like exercise, meditation or counselling to keep it in check. You have to look for patterns like your bipolar disorder reacting to a change in season, negative relationships or the nature of the work you do. Once you learn how your own particular bipolar works and you find the right medication and coping mechanisms you can have a positive life that brings you moments of joy despite the suffering.

I hope you found todays blog interesting. I would be interested in hearing stories of other people who have issues with the change in season. I am a very curious about people who do not live in Calgary and what the winters are like where you live and if there any challenges during the winter months where you live.

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