Managing your emotions

Events in our environment lead to thoughts, which lead to emotions, which lead to behaviour.

The problem with emotions is that they aren't willed into being, they're reflexes. Therefore we can't reproach ourselves for having negative emotions, as they are a normal reaction, and in fact are there to protect us. We should pay attention to what our emotions are telling us. If you're unable to understand what emotion you're feeling you can listen to your body. If your muscles are tense you're probably worried, if you're blushing you're probably embarrassed, if your heart is beating fast and your stomach is in knots you're probably angry or scared, and so on.

Our emotions come from our thoughts, so in order to reduce the intensity of our  (negative) emotions we need to change the way we think. We need to avoid cognitive distortion, which is an exaggerated or irrational thought pattern. We can do this by taking a step back and asking ourselves the following questions:

• What else could I think in this situation?
• What would someone else think if they were in my shoes? (Friend/family member)
• If you were an outside observer of this situation what would you think?

Try not to think in terms of 'always' or 'never', although this is easier said than done when depressed.

One good way of tracking your emotions is through using a mood diary. I personally use the app 'daylio' which lets me use emojis to record how I'm feeling each day and what activities I've done, which allows me to go back and see mood trends and to remember better times when I'm depressed. For example I can look back and see that I'm usually happy on days when I go on a walk and use my exercise bike.

Sometimes it feels like emotions manage us rather than the other way around- think 'Inside Out' (or 'Vice-versa' in French)- but it is possible to mitigate them. One such strategy is Mindfulness, and this will be the topic of my next post.

Sex and pregnancy

As this is quite an intimate topic, I'm not going to talk about my own personal experience, but instead globalities.

Sex

Libido in people with bipolar disorder fluctuates , as it does in the general population, but in a more extreme way. When depressed people with bipolar have an extremely low libido, and when manic an extremely high one.

It is wise to always keep a condom on you, which should have a CE logo on it, to show that it abides by EU regulations. Regularly check the date of condoms, as old ones which have passed their expiration date may split. If a condom does split, and you believe that you have been exposed to HIV, you should go to A&E within 48 hours, but ideally within four hours, as an urgent treatment can be given which reduces the risk of contamination.

Contraception

Avoid contraception that has to be taken regularly like the pill, as it is very easy to forget to take it when manic. There are 13 types of contraception so you should be able to find one that fits your needs, but remember that only condoms protect against STDs.

A link has been found between hormonal contraception and both depression and low libido, so it may be preferable to use a non-hormonal contraception like the copper coil. However it's worth bearing in mind that this form of contracet may cause long periods, heavy bleeding, and increased cramping.

 

Pregnancy

When deciding to start a family a person with bipolar needs to plan ahead, as certain medications are not compatible with pregnancy and you may need to be weaned off and gradually put on new medication  over the course of six to eight months. In the case of an accidental pregnancy, you should talk to your psychiatrist or GP as soon as possible.

Be wary of doctors saying that you should completely come off all medications, as while there is always a small risk of complications, there are medications which are safe for pregnancy, and being unmedicated can be dangerous for the mother, which in turn is dangerous for the baby, particularly if the mother then has a relapse and has to take stronger medication. If you want to find out if your medication is safe for pregnancy and breastfeeding you can look at the French searchable website CRAT, or for anglophones, these websites may be useful
https://www.aboutkidshealth.ca/Article?contentid=341&language=English

https://www.healthline.com/health/pregnancy/teratogens

Bear in mind that being unmedicated in pregnancy may also increase the chances of post natal depression, or indeed post natal psychosis, which can be dangerous for both you and your baby. You may be told that you can't breastfeed if you take certain medications, so it's worth discussing alternatives with your doctor, but you should also bear in mind that bottle feeding may allow for more sleep if you have a partner who can help with night feedings, and as we know a lack of sleep can provoke relapses.

Healthy lifestyle

Euthymia (see post by the same name) is reached through stability. It is thus important to have a regular routine. The main categories for this are sleep, leisure activities, exercise,  healthy eating, and hygiene and cleanliness.

Sleep

Sleep and bipolar disorder have a symbiotic relationship. Getting enough sleep and going to bed and getting up at the same time every day helps to prevent relapses. That includes weekends and holidays (yes I know! I'm bad at this too!) Staying up all night (due to partying etc) is particularly inadvisable, as it takes a week to recover from a sleepless night.

Getting to sleep isn't always simple, as insomnia is common in people with bipolar disorder. It is important to speak to your doctor should this occur, as a lack of sleep can lead to mania, and inversely sleeping little (but, importantly, still being full of energy) is a symptom of mania. 

Leisure activities

It is important to have leisure activities, and to do things with your day (particularly if you don't work), as the less you do, the less you'll want to do. Taking time for yourself and doing something that you enjoy is an important part of self-care, and can be combined with getting out and seeing people, which can help combat loneliness, which people with bipolar often struggle with.

People with bipolar are often creative, whether this be musical or artistic, and this creativity can manifest in all phases of the illness- take Tchaikovsky for example, one can clearly hear the difference in his music between his depressed phases and his manic periods. Try finding an activity that helps you express this creativity, whether that be by joining a choir, taking up knitting, or painting Warhammer figurines.

Try to avoid watching too much TV/ being on screens too much, as while they provide a temporary distraction, they can be isolating, and staying in all day and watching Netflix may feed your depression. On the other hand, watching something low-key such as a romcom is a good idea when manic, as it is calming. Avoid films with subtitles as when manic it is difficult to concentrate enough in order to read.

Exercise

We all know that exercising is important in order to be healthy, and yet many of us don't do enough. You should aim for three to five 30 minute sessions per week, however it's important to remember that it's not all or nothing. It's near impossible to start exercising, however, if you're in a depressed phase, so the thing to do is to start while you're stable, as exercise releases endorphins that make it as effective as antidepressants in lifting mood. This can be dangerous however in a manic phase, as your mood is already too 'up', so exercise should be avoided when manic, no matter how much energy you have.

Healthy eating

Eating a balanced diet not only helps to keep our body healthy, but our brain too. It's ok to have treats, but 80% of your diet should be healthy, which means low in fat, sugar, and salt, and high in vitamins and minerals. It is also important to eat the right quantity of food. If you want to reduce your portions try drinking a large glass of water before eating (we sometimes mistake thirst for hunger) and eating more slowly- it takes ten minutes to start feeling full.

You should also be drinking 1.5 litres of water per day. Our bodies are 65% water and dehydration can make us feel irritable, sad, and lead to concentration and memory problems.

Hygiene and cleanliness

It feels damn near impossible to shower sometimes when depressed, but maintaining basic bodily hygiene is important. This doesn't have to mean showering every day (depending on your body odor and personal preference) but turning up to work smelling none too fresh can lead to problems. If you're staying at home in your pyjamas then this obviously isn't as important, but showering and brushing your teeth can sometimes help you feel a bit more human again.

I don't believe the expression 'Cleanliness is next to Godliness', but I do believe that our environment has an impact on our mental health and vice versa. I'm not in a position to lecture anyone about this, as I'm far from tidy myself, but I know that I do personally feel better when the sink is empty at the end of the day and I don't have to burrow through the laundry basket in order to find clean clothes.