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

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.

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

Saphris Approved for Schizoprhenia and Bipolar 1

Saphris an an atypical anti-psychotic created by Schering-Plough which has just been approved by the U.S. Food and Drug Adminitstration (FDA). I don't know if it's available in Canada or will be come available.

More Info is Available: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm177401.htm

[Guest Post] Mental Health Resources in California

*This post is by Sarah of Puss Reboots*

Parents of children (under the age of 18) with mental health issues should know about California's Mental Health Parity Law (AB 88).

Since July 2000, California health plans have been required by law to cover treatment for nine diagnoses of severe mental illness (SMI) and serious emotional disturbance (SED) in children.

· Schizophrenia
· Schizoaffective Disorder
· Bipolar Disorder
· Major Depression
· Obsessive-Compulsive Disorder
· Panic Disorder
· Eating Disorders (Anorexia Nervosa and Bulimia Nervosa)
· Autism or Pervasive Developmental Disorder
· Serious Emotional Disturbance in children and adolescents

The law is aimed at children under the age of eighteen and they must meet certain criteria listed on the SPD Bay Area site.

Regardless of age, there are a number of online resources for Californians suffering from mental health problems:

· NAMI California
· Depression Screening
· California Resource Guides at SAMHSA
· About.com California
· Bay Area Community Resources
· MHEWC
· Freedom From Fear
· MentalHelp.net
· California Department of Mental Health
· California Department of Education
· California Black Women's Health Project
· California Department of Managed Care

Article: Straight Talk About Psychosis

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

I like to talk about psychosis- I want people to see that it has been around forever and that it's a very normal part of many mental illnesses, especially bipolar disorder- and yet it freaks people out. If you've ever been psychotic, it freaks you out too!

Here is a brief definition.

Psychosis is defined as a loss of contact or break with reality, which shows itself in a number of different ways including the following: paranoid thoughts- is someone talking about me, looking at me funny or following me? Hallucinations- where you see, hear or smell something that isn't there. Such as a rat running around a chair or hearing a voice that says, "Julie, you need to get out of this store!" Suicidal thought such as, 'Take that gun and kill yourself," are psychotic. I had my first p sychotic thoughts in the form of hallucinations- when I got stressed and I was standing on a street corner- actually that doesn't sound too good- when I was waiting for a cross walk light- I saw myself walk into the street- and get hit by a car. My body would fly in the air and land right on the street in front of me. It scared me a lot. I used to call these visions 'death images' because I didn't know what they were. I thought everyone had them. I used to see a lot of dead bodies and severed hands when I walked in the woods too. That is just one symptom I had. These are all psychotic hallucinations.

Then there are delusions- where you have very unrealistic or even bizarre beliefs. I once drove by a beer commercial billboard and thought, "Is that a message for me? Did I do something wrong with that beer last night?' I would never drink that nasty beer anyway- but it seemed real. Psychosis is basically your brain going wonky- all of the chemicals and neurons that normally process information correctly start to process information both internally and externally falsely. What is hard to explain if you've never been psychotic is how real it feels. For example, when I get paranoid, I really believe it. Even if there is absolutely no information to prove that the feelings are real. Paranoia was always really bad for me in a classroom setting.

I've learned to manage my psychosis by keeping away from my triggers such as large groups, arguments and messing with my meds. I know the first signs that I'm getting sick and I talk myself out of it. If a voice tells me I have to leave somewhere, I say to myself, "Actually, I don't. That is just a voice and I'm not listening." I can work around it now- and I always know that when I get psychotic, I'm doing too much.

Mild psychosis can be self treated and major psychosis can be prevented by knowing the signs it's starting and getting help immediately. This may sound unrealistic, considering how serious psychosis can get, but there is usually a treatment window.

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

Mental Health Magazines

I was scanning the internet for mental health magazines and this is what I found. If you know of others, please comment!

BP Magazine (US) (Internation orders accepted but more expensive, however...)

BP Hope (CA) (Same magazine as above, but I think you can order from Canada for normal price)

Moods Magazine

Plant a Flower for Children's Mental Health

Today's Parent magazine has a campaign for Healthy Kids 2009. Read about the Healthy Kids campaign.

Want to plant a flower for Children's Mental Health?

Also check out:

Parenting a Child with Bipolar Disorder

What to do when access to treatment for your mentally ill child is delayed

Kids and Anxiety

Mental Health Resources (Canada)

Bipolar Online Support Groups

Sorry everyone I've been going through some crazy stuff lately. Thought I might have to go to hospital there yesterday. It's been crazy around here, I think I'm depressed and manic all rolled into one. I can NOT handle both of my kids right now so one is visiting Grandma. I'll talk to my doctor (or at least his receptionist) tomorrow.

Anyways, wanted to point to some Online Bipolar groups that have been helping me lately in case others are in need:

CafeMom BipolarMoms - this is only for CafeMom members and to be a member you must be a mom. But it's been VERY helpful.

CafeMom BipolarDiaries - same deal as above.

DBSA Bipolar Forums - from Depression and Bipolar Support Alliance, lots of members, great help

Bp Hope Ning Community - Ning communities are great. This is by the creators of Bp Hope Magazine. Forums, Groups, Blogs, Pics and more.

I Guest Posted at Mental and Emotional Health

I forgot to tell everyone that I did my first guest post about Bipolar, check it out!

Understanding Bipolar II

Mood Chart

I started keeping a mood chart mid April but beginning of May was changed to the one my doctor wanted me to use. I still have trouble filling it out everyday. I'm not convinced I have Bipolar. It made sense when he explained it to me, that when I get severly frustrated, angry and anxious I'm hypomanic but I feel those when I'm depressed and when I'm not. If I'm not depressed but am frustrated and angry most of the day, does that make me hypomanic? I don't think so. My next doc appt isn't until July 8th so I'm going to be so confused until then.

It made sense when I read about dysphoric hypomanic but now I'm not so sure. Only a few places mention that. Most say hypomania is like light mania and that I should be having endless energy etc... Well I don't. I almost wish I did so I could get something done around this house. I struggle with what to put on the mood chart daily.

Social Rhythms affect our mood/health

I just discovered a blog called Psychotherapy Brown Bag which is a professional mental health blog (I added a new blogroll to the side with it in) Read the sidebar to find out why it's called that.

I wanted to mention a post I found interesting. It mentions bipolar the most but is true of all people, even those not mentall ill, but more so to those with depression and bipolar.

It's called:

Social Rhythms in Bipolar Disorder: How daily behavioural patterns can increase vulnerability to both mania and depression by Michael D. Anestis, M.D.

I hope it's helpful to someone. I'll try to find something to post on a different mental health disorder next time.

Flip-Flop

I flip-flop between being depressed and wanting to do nothing but sleep to feeling energized and having ideas in my mind about whatever (homeschooling, housecleaning, blogging) and wanting to go nonstop in fulfilling those ideas. It's very annoying.

I found a site called Bipolar Chick, very informative. I specifically wanted to share the page that talks about the different kinds of bipolar. If you are bipolar, you might find it interesting.

Struggling With My Diagnosis

This isn't my personal journal where I document my day but I do want to include a bit about how I'm feeling as well as encourage any readers to share their experiences as well as including news and information I find about mental illness.

Lately I've been really struggling with my diagnosis. If you're new here, you won't know that my diagnosis recently changed from depression to bipolar 2. Until recently I thought I had severe depression, occasional anxiety and panic attacks plus unspecified personality disorder (leaning more towards Borderline PD but with not enough "yeses" for a diagnosis.

Why is this diagnosis bothering me so much? Who knows if I even have a personality disorder now or ever did. Maybe it was bipolar all along. All along as I researched my depression and read books and web pages and chatted in forums I thought I had depression. I skipped the parts about bipolar and read about depression. When I did read books about bipolar or saw TV or movies with bipolar patients, I thought "I'm glad that's not me." For the past almost 10 years I was being medicated for the WRONG thing. Since it's bipolar 2 and not 1 that I have, I never had a severe manic episode so it wasn't as obvious. I had a hard time describing my thoughts, the racing thoughts with violent thoughts amongst them. The anger, the frustration, the anxiety, the confusion, they were looked at as separate "feelings" that I experience just as the average person was, not as what they are, my hypo manic state. The doctor didn't use the name "rapid-cycling" but he did mention that I go through my "poles" pretty quickly which is very true. I can go from extreme happiness to extreme depression to hypo manic and back again all throughout the day.

Lately I've been plagued by violent thoughts, thoughts of harm, mostly to myself and I can't stop yelling. I snap very easily. My med combination is still being worked out and so I'm not "stable" yet so I'm not eligible for certain mental health programs yet. I understand they don't want an unstable person to suddenly go off and try to hurt him/herself or even worse, another person but meanwhile, it's NOW that I need the support, not when I'm stable.

My pills make me stupid and at night, they knock me out in 30 minutes. The first time I took them my husband thought I had a stroke that's how smashed up they made me. I refused to go to bed even though I couldn't keep my eyes open and was swaying back and forth because I was so hungry. My loving hubby made me a bowl of cereal which I proceeded to "eat" and wear as it dribbled out my mouth. I stumble over my words when I talk and lose my train of thought very easily.

I haven't even taken my pills yet and I'm exhausted, it's been a crazy week so that's enough for now. If anyone read this, PLEASE comment so I don't feel so alone. If you struggle with mental illness too, please stick around as I work on getting this blog up and running some more. Feel free to comment anonymously if you are a blogger or otherwise well known and don't want anyone else to know you struggle.

Knowing Your Diagnosis

Do you know what your diagnosis is? You should. Depression isn't really a diagnosis. It's usually something more indepth such as Clinical Depression or Treatment Resistant Depression. Knowing your diagnosis allows you to look it up, to find people who have the same problem as you and to ask intelligent questions.

Ask your doctor what your actual diagnosis is. If he/she is reluctant to tell you, I'd be wary. You have every right to know.

So what did the doctor say?

Major Depressive Disorder, Unipolar Depression or Clinical Depression?
Look here.

Treatment Resistant Depression?
Look here and here.

Dysthmic Disorder?
Look here.

Bipolar Disorder?
Look here.

Schizophrenia?
Look here.

Personality disorder? Any kind?
Look here.

Anxiety Disorder? Obsessive Compulsive Disorder? Post-Traumatic Disorder?
Look here.

Just do an online search to anything your doctor tells you.