The Bipolar Handbook by Dr. Wes Burgess, M.D., Ph.D.

*This review is crossposted from SMS Book Reviews (my book blog)

Stars: ****


Summary: The Bipolar Handbook comprehensively illuminates every area of the disorder by drawing upon the real questions asked by patients and families during the nearly twenty years that Dr. Wes Burgess has worked as a bipolar specialist.

So what's covered exactly?

• Basics of Bipolar (types, mania, depression, mixed-state, cycling etc....)
• Healthy Life Changes (stress reduction, sleeping, nutrition, weight loss, vitamins/herbs/supplements, exercise, caffeine/alcohol/drugs/tobacco, health fads etc....)
• Medical Treatment (info and common questions on meds used for Bipolar - mood stabilizers, anti psychotics, anti anxiety + seldom used meds, new meds, treatments without meds, meds that make bipolar worse and seizures with depression.
• Finding the Right Doctor
• Psychotherapy (types and their differences, benefits, choosing a therapist, 4 stages of Bipolar recovery etc....)
• Strategies for Career Success (choosing a career, interviewing, decreasing stress, dealing with supervisors and coworkers, boundary issues, work attitudes, disability etc....)
• Healthy Relationships (conversation, socializing, love, sex, anger/jealousy, fantasies/obsessions, social boundaries, finding the right partner, etc...)
• Women's Issues (Bipolar premenstrual syndrome, pregnancy, women's sex issues, hormone supplementation, bipolar women in abusive relationships
• Crisis Management (family and friends, warning signs of crises, psychosis, hospitalization, etc...)
• Resources (websites/forums/groups, services/organizations, US health information, books, etc....)
• Official DSM-IV Diagnostic Criteria for Mania and Atypical Depression and NIMH list of symptoms of mania, combined bipolar and unipolar depression and psychosis.

That's a lot crammed into one book but each section (except the last two which are Appendices) are made up of questions and answer from Dr. Burgess's own patients and families. For example some of the questions in the Bipolar Basics section are:

"What does the name "bipolar disorder" mean?, If I have bipolar disorder, how much of my life will I actually be sick?, Does bipolar disorder cause physical health problems, Can I be hopeful about my future, Why do you talk about bipolar disorder like it is a disease? I think I am a normal person?"

In the section on medications, there are a bunch of questions under each med listed. For example under Lamotrigine (Lamictal) some of the questions are:

"How do you decide when to prescribe lamotrigine?, What are the usual side effects of lamotrigine?, Does lamotrigine cause weight gain? "

I can't say whether the career part was helpful as I don't have a job of any kind. The section on disability was very short and isn't US specific which was nice. The book has helped me understand a few things better (I have bipolar) and inspired some questions that I asked my doctor about to clarify. The book was written in 2006 but as of today, only two of the links listed no longer work, which is great. Personally I can think of a few better sites to go to then was listed but it's a good start.


Buy The Bipolar Handbook from Amazon.com
Dr. Wes also published The Bipolar Handbook for Children, Teens and Families - buy from Amazon.com

Dr. Wes Burgess's Website (info on his practice as well as short articles on mental health issues)

Other Reviews
Fear and Anxiety

March 1 is Self Injury Awareness Day (SIAD)

March 1st is Self-Injury Awareness Day around the world. The date doesn't seem to be as well-known as I think it should be.

First Signs is the home of the offiical website for SIAD but is in the UK. However most if not all of the information provided is helpful to anyone wanting to help spread the word that self-harm is real and is more than just a cry for attention.

I would have posted this sooner but I just found out today.

You may also be interested in these posts by Dr. Kathleen Young:
Common Myths about Self Injury
Self Injury Awareness Day

MY STORY:
I started self-harming at about age 16 (1999) and wasn't able to quit until 2004. Since then I've had two slipups but I was able to stop them from continuing. I still struggle with thoughts of SI, especially if I accidentally hurt myself or someone else does. Sometimes I find myself wishing it had happened to me. How did I stop? It wasn't easy. It tooks years of therapy and a few hospital visits, medication and a class on trying to stop SI. IT involved finding out why I did it and coming up with less harmful ways to get the same effect. The hardest part of it all was deciding that I wanted to quit once and for all. Without the determination to quit, you're not going to be able to resist the temptation. I wouldn't be surprised if the temptation never fully goes away for me.

Here are a few hints:

1. Some people find reading books or websites about self-harm make them feel better and some people find it makes them feel worse. I found the information helped me understand it but after that, chatting online about it with other self-harmers made me want to do it.
2. Try and figure out why you do it. There are a variety of reasons. Usually: you like to see the blood, you feel pain when otherwise you feel numb, you can control the pain unlike other pain or you feel it's self-punishment.
3. Research things to try instead of self-harming, based on your reasons for doing it:
   
   
   • Draw lines with red washable marker on your arm if it's the blood you like
   • Keep an elastic around your wrist and snap it on your wrist (this one worked for me)
   • Journal or talk to someone who cares

Helpful Links:
(Remember, if you find reading about it makes you WANT to do it, stop reading.)
Selfinjury.net
Crimson Tears

I'm back on Seroquel for now...

The last few weeks have been rough. My lack of meds has really taken a toll. I was anxious, irritable and raging internally at times. I was also a bit depressed at the same time. So my doctor and I decided I needed a little something. I'm on 50mg of Seroquel at night. When I become pregnant I'm to stop taking it immediately and we'll try med free again. If I have problems again while pregnant, we will take them one at a time and figure out what to try then. I may go back on Seroquel or try something else, it depends on what symptoms I'm having.

I was feeling like a failure at first, because I wanted to do it med free but I've since come to my senses a bit. Getting pregnant and staying healthy are my priorities and if I need a little medicine to do that, great.

I've also been thinking a lot lately about the standards we set for ourselves so I'll probably be doing a post on that soon.

Update on Me

I've been off meds for 1 month and 2 weeks now. I'm definitely starting to notice a difference now but I'm perservering. I'm a bit more angry, frustrated, anxious, paranoid and I don't sleep as well but I'm also enjoying not feeling drugged. I know this is not an option long term but I'm certainly going to enjoy going to sleep when I want for now. If I don't get pregnant soon or being pregnant doesn't make my moods a bit better (it has in the past) then I'll ask the doctor for a little something.

Going off my meds to get pregnant

With my doctor's help I'm tapering off my meds so I can get pregnant again. I'll be med free starting Nov. 22/09. I was on 300mg Seroquel XR, 400mg Tegretol, 25mg Lamictal and 1mg Clonazepam daily. I'm down to 50mg Seroquel XR daily and on Saturday I take the last pill.

I've noticed a bit more depression and some more anger and frustration (which the Seroquel normally helps with) but so far so good.

I'll keep everyone updated.

Mental Illness Awareness Week

NAMI (National Alliance for the Mentally Ill) is hosting Mental Illness Awareness Week October 4-10, 2009.

Be sure to check out the NAMI website for info on mental illnesses, medications, outreach, up to date news and more.

If there's anyone you haven't told about your mental illness that you think you can, now's the time. I realize many people don't want to share because they are afraid of stigmatization but it's never going to stop until people realize that lots of people are affected by mental illness and it's not their fault.

Article: Regulate Your Sleep

---- This article was not written by me. It is being reprinted with permission ----

Regulate Your Sleep
To sleep, perchance to dream.............

Sleep is taken for granted by many people- but not for those of us with bipolar disorder! If you're the partner or parent of someone with bipolar disorder, you've certainly seen the problems we all have. The illness truly can cause TONS of sleep issues - some of these issues are caused by the illness, while others are controlled by the person with the illness. It's a pretty vicious cycle. The good news is that with just a few tips you can dramatically improve your sleep situation. It takes a lot of observation and sacrifice, but it can be done.

The Chicken and the Egg- is it you or is it bipolar disorder?

One of the main obstacles a person with bipolar disorder faces is the chicken and egg nature of the illness. If you can't sleep at night, is that because you're manic, wired from medications or is it a reaction to a decision you made the day before that affected your brain chemicals? These are important questions. There are two steps you will need to take to stop the chicken from laying the egg that created the chicken that.....: You will have to manage the illness successfully so that the mood swings reduc e and don't affect your sleep as strongly and then identify, monitor and ultimately stop your own behaviors that cause sleep problems. I have many tips on how to reduce mood swings in my books. This newsletter will cover personal behaviors that cause sleep issues as they are easier to change! And of course, as you do this, the bipolar gets better and you really are managing bipolar disorder more successfully which leads to regulated sleep! This is a sweet, non vicious cycle ;)

What is Regulated Sleep?

When you go to sleep easily, sleep and dream deeply and wake up refreshed on a set schedule every night, you're experiencing regulated sleep. (How often do you get to experience this!) This type of sleep lets the brain send out the chemicals that control emotions on a set schedule. To put it simply, regulated sleep stabilizes the brain chemicals that control emotions. So, it makes a lot of sense that the more regulated sleep you can get, the more stable you can be.

The Role of Your Circadian Rhythm

Our bodies work on a 24 hour biological clock called a circadian rhythm. If you have bipolar disorder, this is a process you need to understand very clearly. The circadian rhythm of your body determines when you need sleep and when you need to wake. It is through this rhythm that your body knows when to start and stop certain chemicals such as serotonin. This is a natural clock- the problem is that busy lives often make it difficult for people without bipolar disorder to sleep according to their circadian r hythm. When you add bipolar disorder to the problem, disruptions to the cycle can be VERY destabilizing.

You Can Control Your Rhythm

The more you upset this rhythm by working odd hours, staying out late and partying, ignoring what you put in your body, cultivating stress, or watching upsetting tv before bed for example - the less likely you are to find stability. As you read this you may think, but I have to work these hours! I have to take care of my kids! I have to have coffee in the morning! Well, some of these behaviors may be exactly what you have to change in order to kick your circadian rhythm in gear so that you can sleep better and get your brain working more effectively.

Common Barriers to Regulated Sleep

- Shift work or work that upsets your sleep patterns such as an ever changing schedule
- Travel to different time zones
- Drugs and alcohol
- Medications
- Anything new- new baby, new job, loss of a job, new city, etc
- Caffeine!
- Stress
- Bright light before bed

This list is pretty endless isn't it! I could write 100 more barriers and still not get to them all - and yet everything on the list would have one thing in common- an upset circadian rhythm.

This newsletter will focus on three off the list: caffeine, stressful situations and bright light at night. Just working on these areas can improve your sleep immediately.

Sleep Stressor #1 Caffeine

Ah, as many of you know, I had a little iced coffee habit this summer due to the amazing coffee at the restaurant where I sit and write. I knew it was bad for me, but I kept thinking- just one more time and then I'll stop! I eventually had to stop when I realized the coffee that I drank in less than 15 minutes was literally affecting my sleep nightly. It was not worth it in any way. I have enough bipolar disorder sleep problems as it is- adding caffeine to the mix is just stupid. I have a friend who is a ve ry no nonsense person. When I tell her about one of my bad habits, she very kindly and humorously says- "Well Julie! That's just stupid!" In other words, why on earth would I do something to undermine the work I do daily to stay stable?

Limit Your Caffeine!
My coauthor Dr. John Preston is on a caffeine awareness crusade. He suggests that a person with bipolar disorder limit caffeine consumption to 250 mg or less a day. Considering that a 12 oz Starbucks coffee has 260 mg- this can be a problem! (Decaf has about 10mg.) I started to drink iced tea when I went out. Then I realized that a few glasses of tea at 50mg a glass could cause problems as well. Is there no justice! Lucking I like decaf and it doesn't bother my sleep at all.

A New Caffeine Threat....
What is it? Energy drinks like Red Bull! People drink these sugary, caffeine drinks without thinking of their effect on mood swings. Red Bull has 80 mg of caffeine and lots of sugar. The combination is a brief high followed by a low. Just like a candy bar and a coffee. I've seen a lot of teenagers drinking energy drinks as they are considered cool. I like to be cool- but these days I prefer being stable.

It's your choice. Only you know if caffeine is disrupting your circadian rhythm and causing mood swings. I know that decaf is my only option if I want to curb anxiety and sleep better at night.

Sleep Stressor #2 Stress!

Stress is an outcome of a behavior - either yours or that of someone else. This means that 50% of stress is in your control! Over the years, I've systematically removed the major stressors that cause sleep trouble. I really limit going out for late nights. I know that if I stay out at karaoke past midnight I simply will not get to sleep. I still do this once in a while- but know I will have to take sleep meds. Staying out every night like I used to is simply impossible. I also worked on the relationships in my life that used to cause stress to the point that I went over the problems in my head when I tried to sleep. This was a process of course. Some of these people are family members. I can't change them, but I learned not to set up or walk into stress traps. For example, my brother and I love each other greatly, but I can't be in his life the way I would like to right now- it's too stressful. Fighting with him upsets me for hours- so I don't do it. It's the same with my mot her. There are things we discuss and things we don't. She loves me and I love her, but there is no reason for us to cause each other stress. Our whole family dynamic is so much better now and I think we all sleep better.

Work Stress
I can't work a 9-5 job. I realized this a long time ago. I can remember coming home from work after having trouble with a colleague and talking about it all evening and then not being able to sleep from worry. It's as though the conversation continued even when I was asleep. I can't do this anymore. It's a loss as I really want to work with other people. Does your work cause you so much stress that it affects your sleep? If this is the case, you have to decide what you can and can't change. You can make it a goal to sleep better at night no matter what it takes. For some it means changing jobs- especially if the hours are crazy. You have a lot more control over stress than you think. It's ok not to be passive and let the world make it hard for you to sleep.
If I have trouble getting to sleep, wake up at night or wake up too early in the morning and then sit there and get worried about a stressor in my life, I am going to change that stressor. My sleep is too important.

Sleep Stressor #3 Blue Light at Night

I recently met with a psychiatrist friend who is very interested in the effects of blue light on people with bipolar disorder. Apparently, certain parts of the light spectrum affect people in different ways. For a long time, the idea was that light in general was the culprit when it came to mania and agitation, but new research suggests that it might be the blue light alone that causes the problem. What is the biggest source of blue light in most American households? The television. If this blue light is st imulating, it makes sense that watching TV, DVDs and playing video games at night can over stimulate the brain and make it very difficult for you to get regulated sleep. He suggests wearing special blue light blocking glasses at night to block the blue light so that your circadian rhythm can kick in on a more natural schedule.

What! No TV!
As most of us don't have these glasses, the main solution to the problem is to stop exposure to blue light a few hours before bed. This means turning off the TV and reading, talking, doing crafts, family time, games, books on CD, writing or just relaxing as opposed to sitting in front of a television before going to bed. Hmm.. I've done it. I go to my room and read, write in my journal and listen to music. There is absolutely no question that this helps my sleep. The problem is that it feels a bit lonely an d boring sometimes. It's always a trade off isn't it? Going out and meeting friends at karaoke versus going to bed early and waking up more refreshed. I've learned to compromise by going out, coming home earlier than I used to and then sitting in my room relaxing before I turn off the light. What will work for you?

Never Give Up!
There will always be situations where you can't control your sleep situation. I went to visit friends in a city a few hours away last weekend and ended up sleeping in two different beds as I moved around town. I didn't have my own pillow- it was too quiet- I was worried about being somewhere new, it was daylights saving time, etc. etc. I went into a down swing when I got home. I've decided that sleeping somewhere comfortable when I travel is the best way to insure that I have a good trip. This means a hotel room or planning ahead a bit more to find out my sleeping situation. It's that serious for me. What a bother- I want to have fun, but my body wants regular sleep. I want make the right sleep choices for the rest of my life as I don't want my life to be ruined by mood swings! I won't give up on regulated sleep- the more I learn about my body, the better choices I can make. You can do the same.

A Simple Goal
My goal is to help people throughout the world find a plan that works for them. If every person on this newsletter mailing list learns to manage this illness more effectively, it's a really great start. I use the Health Cards for Bipolar Disorder and the tips in my books to stay stable. All of my books have information for family and friends as well. Remember, educate yourself, take your meds, learn what works for you, teach others what you need and always know that bipolar disorder is a treatable illness. :)

ABOUT THE AUTHOR: Julie A. Fast, best selling author of Take Charge of Bipolar Disorder and Loving Someone with Bipolar Disorder and Get It Done When You're Depressed is a critically acclaimed six-time author, award winning bipolar disorder advice columnist, national speaker, and sought after expert in the fields of bipolar disorder and depression. Julie's work specializes in helping people manage all aspects of their daily lives - despite the complications that bipolar disorder creates. To learn how to personalize a plan to help yourself or a loved one find and create stability that ensures the quality of life that we all deserve, visit: BipolarHappens.com