How to Manage Bipolar Disorder: 6 Strategies for Symptom Control Beyond Medication

Dr. Tracey Marks, a psychiatrist, outlines six practical strategies for individuals with bipolar disorder to manage their symptoms, emphasizing that these interventions are complementary to, not a replacement for, medication. The core premise revolves around proactive self-management and establishing structure to mitigate the severity and frequency of mood episodes. The first strategy involves identifying personal triggers for both depressive and manic episodes, such as work stress, arguments, or crucially, insufficient sleep, especially during longer spring and summer days. These identified triggers form the basis for later relapse prevention.

The second and third strategies focus on self-monitoring and routine. Keeping a mood diary is recommended for tracking mood fluctuations and recognizing the onset of an episode. Establishing a consistent daily routine, with fixed wake-up, bedtime, and meal times serving as 'anchor points,' is highlighted as particularly vital for individuals with bipolar disorder due to their sensitivity to changes in structure. This routine helps prevent the free-floating days that can lead to sleep deprivation during manic phases or excessive sleep during depressive phases.

Strategies four and five address specific phases of bipolar disorder. An activity plan is proposed for depressive phases, acting as a 'disaster management plan' to combat oversleeping and social withdrawal by forcing physical movement, a concept rooted in behavioral activation therapy. For manic or hypomanic phases, where sleep deprivation can exacerbate symptoms, dark therapy is introduced. This involves creating a dark environment or, more practically, using blue light blocking glasses from 6 p.m. to 8 a.m. to block blue light, which significantly impacts the body clock and can trigger mania.

The final strategy is developing a comprehensive relapse prevention plan. This plan utilizes the previously identified triggers, with the assistance of a therapist or doctor, to brainstorm ways to either avoid triggers or reduce reactivity to them. While acknowledging bipolar disorder as a biological illness not solely dependent on environmental factors, Dr. Marks stresses that controlling triggers can significantly reduce the number and severity of episodes. The episode concludes by offering downloadable resources, including a mood diary, trigger worksheet, activity plan, and relapse prevention worksheet, to aid listeners in implementing these strategies.

"The mainstay of treatment for bipolar disorder is medication, but I'm going to be talking about things you can do to help prevent or even manage symptoms in addition to taking medication."

"Identify things that trigger an episode either an episode of depression or mania."

"It's pretty common in the spring and the summer for the longer days to trigger a manic or hypomanic episode it because people will start sleeping less."

"People with bipolar disorder are particularly sensitive to changes in structure and routine."

"Sleep deprivation is really what can trigger another or a manic or hypomanic episode."

"It's kind of like having a disaster management plan in place before the hurricane comes."

"Any amount of activity and movement is an improvement and this is what we call behavioral activation therapy."

"There's been more studies showing a connection between bipolar disorder and your body clock and people with bipolar disorder can be particularly sensitive to the light-dark schedule."

"Using blue light blocking glasses from 6:00 p.m. to 8:00 a.m. And this has the same effect because it's blocking the blue light which is the light that really affects your body clock."

"Bipolar disorder is a biological illness that's not solely dependent on your environmental stresses or triggers but there is the potential to reduce the number of episodes that you have or the severity of them by controlling your triggers."