Monday, November 08, 2010

How to cope with the hypomanic or manic phase of bipolar disorder (hypomania or mania)?

Dear Friends,

Thanks for stopping by! Trust you have had a blessed and wonderful weekend. Thank God for the beginning of a new week to walk with Him and serve Him.

Recently, I received an email from one of the readers of my blog. She noticed that I don't touch much on the manic state of Bipolar Disorder and on how I am learning to cope with manic state. I have written much on the Depression phase of bipolar disorder and been sharing about how to identify the signs and symptoms, and what are the coping strategies that I have been learning to use to help me to be more functional besides medical help and looking to God.

I have found some helpful articles on the internet on bipolar disorder and the mania / hypomania phase.

Bipolar Disorder causes dramatic mood swings—from overly "high" and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression.

What is mania? What are the signs and symptoms?

Signs and symptoms of mania (or a manic episode) include:
• Increased energy, activity, and restlessness
• Excessively "high," overly good, euphoric mood
• Extreme irritability
• Racing thoughts and talking very fast, jumping from one idea to another
• Distractibility, can't concentrate well
• Little sleep needed
• Unrealistic beliefs in one's abilities and powers
• Poor judgment
• Spending sprees
• A lasting period of behavior that is different from usual
• Increased sexual drive
• Abuse of drugs, particularly cocaine, alcohol, and sleeping medications
• Provocative, intrusive, or aggressive behavior
• Denial that anything is wrong

A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present.

A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Thus even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression.

Descriptions offered by people with bipolar disorder give valuable insights into the various mood states associated with the illness:

Hypomania: At first when I'm high, it's tremendous… ideas are fast… like shooting stars you follow until brighter ones appear…. All shyness disappears, the right words and gestures are suddenly there… uninteresting people, things become intensely interesting. Sensuality is pervasive, the desire to seduce and be seduced is irresistible. Your marrow is infused with unbelievable feelings of ease, power, well-being, omnipotence, euphoria… you can do anything… but, somewhere this changes.

Mania: The fast ideas become too fast and there are far too many… overwhelming confusion replaces clarity… you stop keeping up with it—memory goes. Infectious humor ceases to amuse. Your friends become frightened…. everything is now against the grain… you are irritable, angry, frightened, uncontrollable, and trapped.


This is taken from an article from the website of National Institute of Mental Health (NIMH). NIMH said "NIMH publications are in the public domain and may be reproduced or copied without the permission from the National Institute of Mental Health (NIMH). NIMH encourages you to reproduce them and use them in your efforts to improve public health. Citation of the National Institute of Mental Health as a source is appreciated."

Read more here.

Another helpful website listed Some ways on How to cope with Hypomania:

1. Get enough sleep. Patients experiencing a hypomanic episode often feel a decreased need for sleep. This is an important warning sign of the condition and stabilization is key. Try your best to return your sleep patterns to normal. If you are unable to sleep, contact a doctor or mental health specialist.

2. Refrain from making important decisions despite the impulsive urge. Wait until you feel normal before rushing into any action you may regret later. Maintaining awareness of your character and patterns are important.

3. Refrain from excess caffeine, sugar and alcohol because they are stimulants and may keep you from getting the rest you need.

4. Engage in calming activities and refrain from over-stimulating environments.

5. Identify members of your personal support system, such as family members, friends and loved ones, and reach out to them as necessary.

6. Contact your local medical and/or mental health provider for ongoing help.

7. Call 911 immediately for assistance if you are thinking about suicide

Read more here.

Actually, for me personally, my depression episodes have been more severe, prominent and paralysing, and I have been learning intensively how to manage it besides medication and looking to God. So I was able to write and share what I am learning along the way and what are my coping strategies thus far.

As for manic, whenever I am well, I am a little hypomanic but I don't really get very manic. I am still learning to identify when I am hypomanic and what are the things I do when I am hypomanic. So I don't really have much to share yet and that is why I have not written about it on my blog.

My hypomania is partly controlled by medication. I am taking an anti-psychotic (Seroquel 25mg) every evening which helps to slow me down and sleep through the night.

My psychiatrist is training me to identify my hypomanic phase. Keeping a Mood Chart is one of the way to track and see how my mood fluctuates and what may have caused it. I try to chart down my mood for each day, whether it is depression, normal or hypomanic. This way, I can kind of identify the triggering factors and try to work on resolving it from getting worst or do what can be helpful to get better.

Recently, I have been learning to identify that one of my hypomanic behaviour is I tend to write long emails to many people, or make many gifts or buy many gifts for many people when I am hypomanic. I tend also to take on many projects and have many ideas on what to do. These often lead to over-exhaustion, burn out and eventually depression. So now I am learning to cut down on these whenever I notice it. That's if I notice it :) I am learning to let go and set my priority on choosing what I need to do now and what can wait. Thank God also for some friends around me who constantly remind me to slow down when they sense that I am doing more than I ought to do.

Do you know of any other strategies that is helpful in managing mania or hypomania? Do feel free to share with me and my readers.

Thank you once again for stopping by. Take care and have a blessed week!

Thursday, April 09, 2009

Can Christian suffer from depression?

Many people mistakenly think that there is only 1 type of depression which is due to sin ie spiritual depression. But in reality, depression is a complex condition. There is a condition where depression is a medical condition or a clinical condition which need treatments and managements.

Can Christian suffer from depression?

Dr David P Murray did a series of very informative and helpful videos on Depression and the Christian.

You can find useful videos on depression, .mp3 messages on depression and .pdf notes on depression on this series of messages.

(These series 6 messages on "Depression and the Christian" are also available on .pdf, .mp3 and video formats which can be downloaded from the website of Sermon Audio )

DEPRESSION AND THE CHRISTIAN

BY DR. DAVID P MURRAY

(1) THE CRISIS

INTRODUCTION

Perhaps you clicked on the link to this video out of desperation. Perhaps, like many Christians, you are secretly suffering with a mental illness – maybe depression, or maybe panic attacks – and you have tried many remedies but are growing no better, only worse. Or perhaps someone in your family is suffering in this way and you just don’t know how to respond or help. Or, maybe, you are a pastor who feels helpless when confronted with mental illness among the sheep of his flock.

Whatever your reason for clicking, I hope you will find something in this series of addresses which will either help you in your suffering, or which will help you in ministering to the suffering.

In this introductory address we shall consider the question, “Why study depression?” In the second, we will ask “How should we study depression?” Thirdly, we will look at “What is depression?”. And, in subsequent addresses we will begin to look in detail at the different approaches to helping people with depression. We will look at what the sufferer can do, what the carers can do, and what the Church can do.

Before we go on, perhaps you are asking yourself what qualifies me to speak on this subject. That is a valid question, which I will answer in four ways.

Firstly, let me make clear that I am not a medical doctor. I have, however, checked all the contents of these addresses with an experienced medical doctor who has first-hand experience in treating many patients with mental illness.

Secondly, I have been a pastor for 11 years in the North West of Scotland, both in Wester Ross and the Outer Hebrides, areas with some of the highest rates of mental illness in the world. While I do not consider myself to be an expert, I have had multiple contacts with people who suffer from mental illnesses. This also means that my motivation in making these videos, and my methodology in producing them, is not academic but is highly practical. I desperately want to help sufferers and those who minister to them.

Thirdly, I have had close and painful experience of depression, anxiety and panic attacks among friends and some of those I love most in this world.

Fourthly, I believe that God has given me a burden to speak on this subject, a burden which I cannot ignore any longer. And, I trust, with the God-given burden will come the God-given wisdom to speak in such a way that will minister to God’s suffering people.

WHY STUDY DEPRESSION?

Mental illness is a term that covers a large number of complex conditions. So, before we proceed any further, I would like to state what aspects of mental illness I am going to focus on in this series of addresses. The area I am particularly concerned with is the most common mental illness – depression. As anxiety and panic attacks are also very commonly associated with depression (so much so that doctors are increasingly using the term “depression-anxiety” when referring to depression), we will look at these distressing conditions also.

But firstly, why should we study this subject, depression? Here are eight reasons.

1. Because the Bible speaks about it

There are numerous Bible verses which refer to depression and severe anxiety – its causes, its consequences, and its cures. The Bible does not address every cause, every consequence or provide every cure. But, as we shall see in later addresses, it does have an important role to play in the treatment of Christians who are suffering from depression and anxiety.

It must be admitted that the Bible never states that “Bible Character X had mental illness,” or “Bible Character Y was depressed.” However, it does frequently describe men and women who manifested many of the symptoms of depression and anxiety. In some cases, it is not clear whether these symptoms reflect long-term mental illness or simply a temporary dip in the person’s mental health, which everyone goes through from time to time. For example, symptoms of depression/anxiety can be seen in Moses (Num.11:14), Hannah (1 Sam.1:7,16), and Jeremiah (Jer.20:14-18; Lam.3:1-6). In these cases it is difficult to say whether the symptoms reflect a depression or a dip. Martin Lloyd-Jones argues from biblical evidence that Timothy suffered from near-paralysing anxiety.[1] A more persuasive case for depressive illness can be made for Elijah (1 Kings 17:7-24), Job (Job.6:2-3, 14, 7:11), and various Psalmists (Ps.42:1-3, 9a; Ps.88).

“The Psalms treat depression more realistically than many of today's popular books on Christianity and psychology. David and other psalmists often found themselves deeply depressed for various reasons. They did not, however, apologize for what they were feeling, nor did they confess it as sin. It was a legitimate part of their relationship with God. They interacted with Him through the context of their depression.”[2]

Another significant verse is Proverbs 18:14, “The spirit of a man will sustain his infirmity; but a wounded spirit who can bear?” The human spirit can help people through all kinds of sickness. However, when the healing mechanism is what needs healing, then even more serious problems arise.

2. Because it is so common

1 in 5 people experience depression, and 1 in 10 experience a panic attack, at one stage in their lives. An estimated 121 million people suffer from depression. 5.8 % of men and 9.5% of women will experience a depressive episode in any given year. Suicide, often the end result of depression, is the leading cause of violent deaths worldwide, accounting for 49.1% of all violent deaths compared with 18.6% in war and 31.3% by homicide.

It is also common in Christians. Indeed, these days there would appear to be an epidemic of depression, anxiety, and panic attacks among Christians – both young and old. This is at least partly because of the depressing state of the Church and of the Nation. Every few days there is discouraging news about Church splits or problems, and Christians backsliding or falling into temptation. Then there is the secular and anti-Christian direction of the Government as it continues to dismantle the Judeo-Christian laws and standards that our civilisation was built upon, and as it attacks and undermines family life. On top of this, there is the relentless audio-visual misrepresentation and persecution of Christians through the print and broadcast media. To top it all there seems to be an unceasing diet of bad news on the international stage, with wars, terrorism, and “natural” disasters ever before us.

In these conditions, it is therefore little wonder that Christians react adversely, and get depressed and anxious about themselves, their families, their Church, and the world they live in.

3. Because it impacts our spiritual life

We might say that there are three main elements in our make-up that affect our overall well-being: our body, our soul, and our mind (our thoughts). These are not three watertight and disconnected entities. There is considerable overlap and connectivity. When our body breaks down, it affects our spiritual life and our thinking processes. When our spiritual life is in poor condition, our thoughts are affected, and often our bodily health and functions also. It is therefore no surprise that when our mental health is poor, when our thinking processes go awry, that there are detrimental physical and spiritual consequences.

The depressed believer cannot concentrate to read or pray. He doesn’t want to meet people and so may avoid church and fellowships. He often feels God has abandoned him.

Moreover, it is often the case that faith, instead of being a help, can actually cause extra problems in dealing with depression. There is, for instance, the false guilt associated with the false conclusion, “Real Christians don’t get depressed.” There is also the usually mistaken tendency to locate the cause of mental illness in our spiritual life, our relationship with God, which also increases false guilt and feelings of worthlessness.

4. Because it may be prevented or mitigated

Many people have a genetic pre-disposition to depression, perhaps traceable to their parents’ genes, which increases the likelihood of suffering it themselves. However, even in these cases, knowledge of some of the other factors which may be involved in causing depression can sometimes help prevent it, or at least mitigate and shorten it. Others, with no genetic pre-disposition to depression can also fall into it, often as a reaction to traumatic life-events. And, again, having some knowledge of mental health strategies and techniques can be especially useful in preventing or mitigating and shortening the illness.

One great benefit of having some knowledge about depression is that it will prevent the dangerous and damaging misunderstanding which often leads people, especially Christians, to view medication as a rejection of God and His grace, rather than a provision of God and His grace.

5. Because it will open doors of usefulness

Increased understanding of depression will make us more sympathetic and useful to people suffering from it. This is taught by the converse truth in Proverbs 25:20, “As he that taketh away a garment in cold weather, and as vinegar upon nitre, so is he that singeth songs to an heavy heart.” If we saw someone fighting for life in the midst of a freezing blizzard, the last thing we would do is take his coat away. Such an action would be cruel and heartless, and could easily lead to death. But, says the Bible, similar dangerous heartlessness is displayed by the person who tries to help their depressed friend with superficial humor and insensitive exhortations to “Cheer up!”

In later videos we shall look in more detail at what friends and carers should say and do for those suffering with depression and anxiety. However, the general rule is that those who listen most and speak least will be the most useful to sufferers.

6. Because it is so misunderstood

“Being depressed is bad enough in itself, but being a depressed Christian is worse. And being a depressed Christian in a church full of people who do not understand depression is like a little taste of hell.”[3]

As we all know there is a terrible stigma attached to mental illness. This is the result of widespread misunderstanding about its causes, its symptoms, and the “cures” available. Some of the misunderstanding is understandable. Unlike cancer or heart disease or arthritis, there is no scan or test which can visibly demonstrate the existence of depression/anxiety. It is a largely “invisible” disease. We want to be able to point to something and say, “There’s the problem!” When we can’t, we often wrongly conclude, “There is no problem!” Or, if we are Christians, we may, usually wrongly, conclude, “My spiritual life is the problem!”

This misunderstanding is addressed in the excellent book, I’m not supposed to feel like this (a book written by a Christian pastor, a Christian psychiatrist, and a Christian lecturer in psychiatry). Near the beginning of the book, they summarise what they believe and what they do not believe about depression:

“What we believe: We believe that all Christians can experience worry, fear, upset and depression. We also believe that being a Christian does not prevent us or our loved ones from experiencing upsetting and challenging problems such as illness, unemployment, or relationship and other practical difficulties.

What we do not believe; Although at times we all choose to act in ways that are wrong and this can lead to bad consequences for us and for others, we do not see anxiety and depression as always being the result of sin; neither do we

believe that mental health problems are the result of a lack of faith.”[4]

It is absolutely vital for Christians to understand and accept that while mental illness usually has serious consequences for our spiritual life, mental illness is rarely caused by problems in our spiritual life.

7. Because it is a talent to be invested for God

Like all affliction in the lives of Christians, mental illness should be viewed as a “talent” (Matt.25:14ff) which can be invested in such a way that it brings benefit to us and others, as well as glory to God.

Dr James Dobson, the Christian psychologist, observed that “nothing is wasted in God’s economy.” That “nothing” includes mental illness.

Mind over Mood, while not written from a Christian perspective, illustrates the possible “benefits” of depression thus:

“An oyster creates a pearl out of a grain of sand. The grain of sand is an irritant to the oyster. In response to the discomfort, the oyster creates a smooth, protective coating that encases the sand and provides relief. The result is a beautiful pearl. For an oyster, an irritant becomes the seed for something new. Similarly, Mind Over Mood will help you develop something valuable from your current discomfort. The skills taught in this book will help you feel better and will continue to have value in your life long after your original problems are gone.”[5]

It is usually broken people that God uses most. In Passion and Purity, Elisabeth Elliot

quoted Ruth Stull of Peru:

“If my life is broken when given to Jesus it is because pieces will feed a multitude, while a loaf will satisfy only a little lad.”[6]

8. Because we can all improve our mental health

Most Christians try to take preventative (and curative) measures to enjoy good physical health and spiritual life. However, there is less consciousness of the similar effort required to maintain or recover mental health. There is much less awareness of the biblical strategies and sound mental techniques that can be used to achieve good mental health, which obviously has beneficial consequences for our bodies and our souls.

I have never been diagnosed with any kind of mental illness. However, like most people, and especially like most ministers, I have had low points in my life. My thinking processes have gone wrong, causing times of mild depression, and anxiety.

What I now know about improving and maintaining mental health, and what I hope to communicate in later addresses, would have greatly helped me in these low periods. What I have learned is helping me on a daily basis to overcome disappointment and handle stressful situations without my mental health suffering as much as before.

As I look around me, and especially as I look around the Church, I can see many people who have not been diagnosed with depression, and who are not disabled with it, but who are experiencing long-term, low-level depression/anxiety which is having its own knock-on effect on their bodily health and the spiritual lives.

I believe that it would not be too difficult for them to learn some sound strategies and techniques which will improve mental health, and consequently their bodily and spiritual health.

In the next video we will consider the attitude and spirit in which we should study depression.

Dr. David P Murray served as the Pastor of Lochcarron Free Church of Scotland from 1995 to 2000, and then of Stornoway Free Church of Scotland (continuing) from 2000 to 2007. In August 2007 he accepted a call to be the Professor of Old Testament and Practical Theology at Puritan Reformed Theological Seminary in Grand Rapids, Michigan.

[1] M Lloyd-Jones, Spiritual Depression, (London: Pickering & Inglis, 1965), 93ff.

[2] S & R Bloem, Broken Minds (Grand Rapids: Kregel, 2005), 204.

[3] J Lockley, A Practical Workbook for the Depressed Christian (Bucks: Authentic Media, 1991), 14.

[4] C Williams, P Richards, I Whitton, I’m not supposed to feel like this, (London: Hodder & Stoughton, 2002), 10.

[5] D Greenberger & C Padesky, Mind over Mood, (New York: Guilford, 1995), 1.

[6] E Elliot, Passion and Purity, Power Books (Old Tappan, NJ.: Revell, 1984).


All 6 articles on Depression and the Christian:

  1. The Crisis
  2. The Complexity
  3. The Condition
  4. The Causes
  5. The Cures
  6. The Carer
Related Posts:

About depression, bipolar disorder (manic-depressive illness) and mental illness or mood disorders:
1. About bipolar disorder (manic-depressive illness)
2. Myths and Facts on Mental Illness
3. Treatment of bipolar disorder
4. Various pamphlets and articles on bipolar disorder for sufferer and carer
5. Recovery steps for depression and bipolar disorder or manic-depressive illness
6. Coping skills for bipolar disorder

For friends and carers:
1. Helping someone with mood disorder
2. Family and Friends' Guide to Recovery from Depression and Bipolar Disorder
3. How Carers and Friends can help

Other recent related posts:

1. Trust during rough times
2. Finding meaning in a life with bipolar disorder
3. Mental illness (depression, bipolar disorder, etc) is an illness like any other
4. Video on "Depression - A Stubborn Darkness"

Depression and the Christian

  1. The Crisis
  2. The Complexity
  3. The Condition
  4. The Causes
  5. The Cures
  6. The Carers
  7. Spiritual depression
My Coping Strategies:

1. Looking to God

2. Accepting the diagnosis

3. Medical Helps

4. Balance lifestyle

4a. Exercise

4b. Omega-3 fish oil supplements

5. Research and readings

6. Mood tracking and Journalling

7. Learning to cope with stress and challenges

8. Leisure, hobbies and recreations

9. Support Network (family, church, friends, etc)

10. Counselling / Talk Therapy

11. Correcting faulty thoughts patterns