Great idea for a discussion thread, @eth. This following is going to be a very long rave!
I too have Bipolar 1. Mostly I've been treated by psychiatrists over my life. But these days I have both a psychiatrist and a psychologist, and I find both very helpful. I've read many times that the combination of psychiatry and psychology is the most effective form of treatment for bipolar, among other conditions. For a couple of years, I also had a support worker, who was trained as a social worker, which was also very helpful too.
I've had lifelong sleep disorders of various kinds, a common feature of bipolar. I've struggled to achieve sleep hygiene for a long time. I'm probably doing better with this just at the moment than at most other times in the past. It's only taken me to the age of 56 to manage even a fragile handle on this, even though I know it's a keystone of managing bipolar well.
The only self-monitoring records I have ever found helpful are daily activity plans. They helped me get out of a state where I was doing almost nothing everyday for a long time. They have helped me develop better habits and routines and I no longer need to plan out my hours on paper and follow my written instructions to myself in the way I used to do. At the moment, I use only a little dates diary and write my appointments and activity plans for out of the flat in there. I still fall down and fail to follow through with these things at times. But I seem to be able to recover more quickly from depressive holes and get back into rhythm with some routine. I would return to detailed written plans if I felt I need to though.
I too get overstimulated and overwhelmed very easily. It means I need to have a fair bit of time to myself to process my experiences, take time out and settle myself down again into a semblance of balance.
Meditation of various kinds has helped me in an ongoing way and I've been using the techniques I've learned for decades, though I've only done it in structured ways for shortish periods of time. Mostly I use the techniques 'ad hoc', as needed, and to help myself fall asleep at night. My main meditation activity is to focus on breath to help me calm myself, with occasional use of mantras, some of my own invention now.
SANE forum has been extremely helpful to me for a few years now.
I have a long time companion that I live with. I am independent and self-managing with my mental health and he is not highly involved. But I do ask him about what he is observing with me at various times, and he usually has helpful answers. Just because of the kind of person I am, I probably would not respond well to intervention from other people. I rely on my regular sessions with professional support people for that.
I have never had uncontrolled spending, though at high times I have some tendency to spend more than is needed or usual. I have been a bankrupt, but this was due to poverty, which I've lived with my whole life, and an extended period of time when I need to partly live on my credit card to survive (not to mention the bank's complete unwillingness to strike any kind of achievable payment plan for me when it was all coming to a head). It was only a small debt of about $5000, but it wreaked havoc and I was reminded of it in various real life ways over and over for a number of years. I refuse to have a credit card these days and now have no debt whatsoever.
Anger has been a problem for me in my life, best treated by anti-psychotic medication, which then gave me the opportunity to change my patterns of behaviour. But I live a life relatively free of external stressors now and I still worry that, under stress, this terrible and self-eroding way of being could return. As with my tendency to be overstimulated, I get stressed and destabilised by external factors very easily.
Being granted the disability pension around 2010 has given me the only financial security I've ever had in my life, and has made my life livable in a way it never was before. I've had about 50 jobs in my life, including the short freelance gigs, and have had breakdowns from almost all of them. These repeated breakdowns have become harder and harder to recover from each time. I still haven't really recovered from the last one, in 2008. The longest I've had a full time job was nine months when I was 17. Aside from that almost all my jobs have been temporary, casual or part-time. I resent the pressure put on people with lifelong mental and physical illnesses to work at jobs that are likely to further damage their health.
I wasn't diagnosed with bipolar until I was in my late 40s, even though my manic behaviours probably began at around age 16. I have read that 10-20 years in getting a proper diagnosis for bipolar is fairly common. I was initially diagnosed in my late 20s with clinical anxiety and depression, and medicated for that. This meant I spent decades of my life medicated only with anti-depressants, which triggered and maintained the biggest mania of my life, one that lasted for five years (with mixed features and rapid cycling as part of it). During that whole time the main feature of the mania was extreme sexual behaviour, another common feature of bipolar.
Having said that, my most enduring problem over all this time has been with depression, which I've experience ever since I was a young child. Anti-depressants are an integral aspect of my treatment in an ongoing way. These days, of course, they are moderated by mood stabilisers. But without anti-depressants, I may not even be alive. Looking back on my relation to anti-depressants over time, I'd say it's better to be manic than dead.
I too have damaged relationships beyond repair with my mental illness. My marriage was broken due to it and my relation to my parents was very distorted. I abandoned them altogether for about seven years of my life without telling them where I'd gone, which was devastating for them. Very fortunately, we reconciled after that time and forgave each other for much damage between us all.
Despite all this, I've never been hospitalised for my condition, and I will do my utmost to continue that freedom from stigma. I have a pretty good intellect and have managed to mostly seem very rational and 'talk the talk' when it counted, even when my inner world was in chaos and my behaviours extreme.
I am very compliant with my medications. This is greatly helped by my psychiatrist always actively involving me in all decisions about them. I would go so far as to say we are equal partners in deciding what will happen with my medications. This empowers and motivates me in my self care, bolsters my confidence in myself as an independent human being, and generates and maintains a better sense of self esteem. As many of us with mental illness will be aware, having any kind of mental health diagnosis can be a devastating blow to self esteem and confidence. Most of us are excrutiatingly aware of the stigma attached to it by others. Anything that loved ones can do to minimise this and empower our self determination is highly desirable in my view.
Weight gain is one of the most common problems complaints about medications for bipolar, and one of the main reasons for people going off their meds and into big trouble again. I have had trouble with weight gain too. I gained 35-40kgs over several years, going from a size 12 to a size 20. Exercise and diet is the mantra most often trotted out with this. But, with the mood instability and mental ill health that usually persists to some degree even with treatment, it is usually much more difficult for people with bipolar to enact these improvements in any sustained way. It's very demoralising also to find yourself failing to stabilise or lose weight despite what feel like great efforts and endless exhortations about it from others. That's how it's been for me anyway.
Earlier this year I worked out that, if I continued to gain weight at the same rate year after year, as I had been doing, that in ten years time I would weigh 170kgs. I discussed this with my psychiatrist and we decided to make some major changes to my meds, opting instead for ones with less of a weight gain profile. Consequently, for six months this year my mental health has been in an extended period of instability during the changeovers, including a two month period where I was so depressed I slept 18 hours a day. It's only over the past few weeks that I feel I've started to come good again. Fingers crossed things continue to improve. All of this highlights my opinion that, whenever possible, it's best to maintain a consistent mix of medications over the long term. If it's working fairly well, I'm mostly say, don't change it. Changing meds frequently generates further instability. Of course, sometimes changing meds is unavoidable or desirable for various reasons.
Bipolar is a complex condition, often emcompassing various other mental health issues under its umbrella term. I have suffered long term social anxiety (since childhood), general anxiety, mild paranoia and various other sub-conditions as part of my bipolar. The Black Dog Institute, which specialises in research of mood disorders, has online reading material about bipolar. It is stated there that it is the most inheritable of all mental illnesses, citing an 80% rate of genetic involvement. My experience also tells me that this condition is a physical brain disorder, not something that can be changed or improved with psychological therapy or self help strategies alone. Mood disorders run in my family.
These are my current thoughts on my own condition. As with everything, experiences change us and change our views. All of the above is simply my own personal perspective at this point in time.
Thank you if you've read this far! Wishing everyone the very best in their ongoing journey with mental illness, or caring for a loved one with it.
