Is it Bipolar Disorder or Depression?

Bipolar disorder is commonly misdiagnosed as depression. One of the reasons is that most people with bipolar disorder seek help when they’re in the depressive stage of the illness. When they’re in the manic stage, they don’t recognize the problem. What’s more, most people with bipolar disorder are depressed a much greater percentage of the time than they are manic or hypomanic.

Being misdiagnosed with depression is a potentially dangerous problem because the treatment for bipolar depression is different than for regular depression. In fact, antidepressants can actually make bipolar disorder worse. So it’s important to see a mood disorder specialist who can help you figure out what’s really going on.
Indicators that your depression is really bipolar disorder:

* You’ve experienced repeated episodes of major depression.
* You had your first episode of major depression before age 25.
* You have a first-degree relative with bipolar disorder.
* When you’re not depressed, your mood and energy levels are higher than most people’s.
* When you’re depressed, you oversleep and overeat.
* Your episodes of major depression are short (less than 3 months)
* You’ve lost contact with reality while depressed.
* You’ve had postpartum depression before.
* You’ve developed mania or hypomania while taking an antidepressant.
* Your antidepressant stopped working after several months.
* You’ve tried 3 or more antidepressants without success.

Exploring bipolar disorder treatment options

If your doctor determines that you have bipolar disorder, he or she will explain your treatment options and possibly prescribe medication for you to take. You may also be referred to another mental health professional, such as a psychologist, counselor, or a bipolar disorder specialist. Together, you will work with your healthcare providers to develop a personalized treatment plan.

Comprehensive treatment for bipolar disorder

A comprehensive treatment plan for bipolar disorder aims to relieve symptoms, restore your ability to function, fix problems the illness has caused at home and at work, and reduce the likelihood of recurrence. A complete treatment plan involves:

*Medication – Medication is the cornerstone on bipolar disorder treatment. Taking a mood stabilizing medication can help minimize the highs and lows of bipolar disorder and keep symptoms under control.
*Psychotherapy – Therapy is essential for dealing with bipolar disorder and the problems it has caused in your life. Working with a therapist, you can learn how to cope with difficult or uncomfortable feelings, repair your relationships, manage stress, and regulate your mood.
*Education – Managing symptoms and preventing complications begins with a thorough knowledge of your illness. Education is a key component of treatment. The more you and your loved ones know about bipolar disorder, the better able you’ll be to avoid problems and deal with setbacks.
*Lifestyle management – By carefully regulating your lifestyle, you can keep symptoms and mood episodes to a minimum. This involves maintaining a regular sleep schedule, avoiding alcohol and drugs, following a consistent exercise program, minimizing stress, and keeping your sunlight exposure stable year round.
*Support – Living with bipolar disorder can be challenging, and having a solid support system in place can make all the difference in your outlook and motivation. Participating in a bipolar disorder support group gives you the opportunity to share your experiences and learn from others who know what you’re going through. The support of friends and family is also invaluable.

Do You Need Therapy

DO YOU NEED THERAPY?
SUICIDAL THOUGHTS
Certainly the most important indicator that you need therapy is if you are having suicidal thoughts. This is especially true if you have begun to think that there are no other options left and that suicide is the only way to end this pain. If you have formulated a plan on how or when you will kill yourself, I urge you to seek help now! Make an appointment with a therapist as soon as possible or go to your local hospital, if the crisis is severe call a crisis help line and let them help you make it through the night, seek help in the morning. Suicidal thoughts and depression are episodic, in that you will have periods which are worse than at other times, but the intense feelings will abate if you give yourself time and seek counseling.

LOSING CONTROL
If you are no longer able to control your anger, if you are no longer able to control your periods of despair, if it seems that your life situation is no longer under your control and you are entirely at the mercy of someone or something else, if your interpersonal relationships are falling apart and your are at odds with members of your family and your co-workers and you are losing friends, if these things are happening to you there is a good chance that your depression is beginning to take control of your emotions and it is taking control of your life situation. If you do not make the decision to intervene and seek counseling your depression will worsen and regaining control will become more and more difficult.

ARE YOU GOING CRAZY?
You may have the feeling that you are going crazy. This is not an uncommon thought when a person first experiences the symptoms of depression. Without defining what the term "crazy" means, a person who is actually going crazy probably does not have a complete realization of what is happening to them and will most likely blame their problems on someone or something other than themselves. They many times think that they are sane and it is the rest of the world that has gone "crazy". The automatic thought "I think I am going crazy" arises due to a reaction to the symptoms of depression. The confusion, the loss of memory, the anger, the despair, the ups and downs (especially for manic depressives), and the loss of control of our emotions, all are perplexing when we first become depressed. This feeling that we are losing our minds happens as our depression begins to take control, it is also a very good indicator that intervention is needed and that it is time to seek therapy.


DOES THERE NEED TO BE A CRISIS?
Most of us only begin to consider that we need therapy when there is a crisis, where our life has come to a point where we are no longer in control, or we are having strong suicidal urges. Yet our depression does not have to reach a crisis stage before we seek therapy. One of the main reasons I am writing this article is to help people recognize the warning signs of depression so that they begin to work on healing before the depression reaches a crisis stage. In fact my ultimate goal is to inform enough people so that most of us do not even need therapy, but are able to recognize that we are depressed and use improved self help methods to avert a crisis and heal ourselves.

HOW TO START
Anyone who knows or suspects that they are depressed would be wise to first have a complete medical evaluation in order to determine if there is a possible organic cause of the depression. It is possible that certain medical disorders such as hypothyroidism are the cause, especially if the onset of depression is sudden or cannot be explained by reaction to environmental influences. The problem may also be caused by an adverse reaction to prescription or illegal drugs such as amphetamines. If you begin your therapy by going to a psychiatrist (who is also a MD) he/she will give you a medical evaluation, if you do not start with a psychiatrist then a complete physical by an internist or family doctor is recommended. While I do urge you to rule out any possible organic cause by seeing an MD, I do have reservations about beginning your therapy choices with a visit to an internist or family doctor. My concerns will be covered in the section on drugs and again in the section on pitfalls later in this article. I caution you not to become overly optimistic and fixate on the possibility that the depression has an organic origin because for most of us this is not the cause, but it should be investigated.

One of the first considerations when we are trying to heal or improve our mind is with our physical body. If we abuse or neglect our physical body, our mind will be adversely effected. Whether or not our depression has been caused by the abuse or neglect of our physical body, or if our depression can be cured by stopping the abuse or neglect is not what I am addressing at this time. The point is that if we abuse and neglect our physical body and we are depressed, the depression will be worsened and our efforts to heal our mind will be more difficult and take a longer period of time. This is true even if the method of therapy is drugs only, because if we are physically fit our body can more readily assimilate the drugs and possible side effects will have less of an impact.

If you determine that you are depressed, I do not suggest you undertake a rigorous program of physical exercise for the express purpose of ending the depression, especially if exercise is the only method used to combat the depression. It is not uncommon for a depressed person to begin an exercise program by buying an expensive pair of shoes, an exercise machine or sports club membership, and a new exercise outfit, only to find that within a short time the symptoms of depression make it impossible to follow the regimentation, commitment, and motivation needed to insure the success of the exercise program. There is a good chance that I will be buying your expensive exercise machine for ten cents on the dollar at a garage sale next summer. On the other hand, I do highly recommend that you start a mild program of physical exercise consisting of walking, stationary bicycling, or mild aerobics, for 20 to 30 minutes a day, five days a week. This will help clear your mind, it will help you focus while investigating your mental health care options, and mild exercise will help with motivation and commitment when first beginning your therapy.

A Breathing Exercise to Calm Panic Attacks

A Breathing Exercise
to Calm Panic Attacks

Here's a simple breathing exercise that will restore your comfortable breathing and soothe many of the physical symptoms of a panic attack.

You may have already tried deep breathing and not had much success in soothing your panic symptoms. The reason for that is that most descriptions of deep breathing leave out a critical step.

A simple, but powerful, technique
If you have Panic Disorder or Social Phobia, this deep breathing exercise may be the single most important coping technique I can show you. It's also useful with other anxiety disorders in which the physical symptoms are less prominent, but still present. Comfortable, deep breathing is the key to relaxation. All the the traditional relaxation methods (yoga, meditation, hypnosis) place a central emphasis on breathing.

I can't catch my breath!
Feeling like "I can't catch my breath!" is probably the most common of all panic symptoms. Your breathing feels labored, you strain to take a deep breath, you fear you're not going to get it - and the harder you try, the worse it feels!
When you feel short of breath, it doesn't mean you're not getting enough air. In fact, people will often say "I can't catch my breath", and this shows that they're getting air, because we talk by making air vibrate. If you're talking, you're breathing! It's not a dangerous symptom.

But it does get people very scared, and it produces other uncomfortable physical symptoms, so it's worth your while to be able to correct it.

You've probably already had it told to you, and you've probably also read it as well, that what you need to do is "take a deep breath". If you're like most people, that advice hasn't helped you much. It's good advice, but it's incomplete. It doesn't tell you how to take a deep breath. A good breathing exercise should tell you how to take a deep breath, and that's what I'm going to do.

Here's the Key
When you feel like you can't catch your breath, it's because you forgot to do something.

You forgot to exhale.

That's right. Before you can take a deep breath, you have to give one away. Why? Because, when you've been breathing in a short, shallow manner (from your chest), if you try and take a deep inhale, you just can't do it. All you can do is take a more labored, shallow breath from your chest. That will give you all the air you need, but it won't feel good.

Go ahead, try that now and see what I mean. Put one hand on your chest, the other on your belly. Breathe very shallowly from your chest a few times, then try to take a deep breath. I think you'll find that, when you inhale, you use your chest muscles, rather than your diaphragm, or belly.

When you breathe in this shallow manner, you get all the air you need to live, but you can also get other symptoms which add to your panic.

You get chest pain or heaviness, because you've tightened the muscles of your chest to an uncomfortable degree. (The chest pain people feel in a panic attack isn't from the heart, it's from the muscles of the chest). You feel lightheaded or dizzy, because shallow breathing can produce the same sensations as hyperventilation. You also get a more rapid heartbeat, and maybe numbness or tingling in the extremities as well.

All from breathing short and shallow!

One of the very first things that people need to do is to learn and practice belly breathing.

Belly Breathing Exercise
1. Place one hand just above your belt line, and the other on your chest, right over the breastbone. You can use your hands as a simple biofeedback device. Your hands will tell you what part of your body, and what muscles, you are using to breathe.
2. Open your mouth and gently sigh, as if someone had just told you something really annoying. As you do, let your shoulders and the muscles of your upper body relax down with the exhale. The point of the sigh is not to completely empty your lungs. It's just to relax the muscles of your upper body.

3. Close your mouth and pause for a few seconds.

4. Keep your mouth closed and inhale slowly through your nose by pushing your stomach out. The movement of your stomach precedes the inhalation by just the tiniest fraction of a second, because it's this motion which is pulling the air in. When you've inhaled as much air as you can comfortably (without throwing your upper body into it), just stop. You're finished with that inhale.

5. Pause. How long? You decide. I'm not going to give you a specific count, because everybody counts at a different rate, and everybody has different size lungs. Pause briefly for whatever time feels comfortable. However, be aware that when you breathe this way, you are taking larger breaths than you're used to. For this reason, it's necessary to breathe more slowly than you're used to. If you breathe at the same rate you use with your small, shallow breaths, you will probably feel a little lightheaded from over breathing, and it might make you yawn. Neither is harmful. They're just signals to slow down. Follow them!

6. Open your mouth. Exhale through your mouth by pulling your stomach in.

7. Pause.

8. Continue with Steps 4-7