Saturday, May 31, 2008

Recovery Steps for Depression and Bipolar Disorder

(Taken from the website of Depression and Bipolar Support Alliance (DBSA)

Relief of symptoms is only the first step in treating depression or bipolar disorder. Wellness, or recovery, is a return to a life that you care about. Recovery happens when your illness stops getting in the way of your life.

What is Recovery?

SAMSHA (the Substance Abuse and Mental Health Services Administration/Center for Mental Health Services) ( defines recovery as:

Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential.

Next Steps in Recovery

Depression and bipolar disorder are mood disorders, real physical illnesses that affect a person’s moods, thoughts, body, energy and emotions. Both illnesses, especially bipolar disorder, tend to follow a cyclical course, meaning they have ups and downs.

Treatment for these illnesses can also have ups and downs. As much as we may want it to, wellness often does not happen overnight. It is normal to wish you could feel better faster or to worry that you will never feel better. However, know that you can feel better, and that ultimately you are in charge of your recovery. There are many things you can do to help yourself.

Relief of symptoms is only the first step in treating depression or bipolar disorder. Wellness, or recovery, is a return to a life that you care about. Recovery happens when your illness stops getting in the way of your life. You decide what recovery means to you.

You have the right to recover according to your needs and goals. Talk to your health care provider (HCP) about what you need from treatment to reach your recovery. Your HCP can provide the treatment(s) and/or medication(s) that work best for you. Along the way, you have a right to ask questions about the treatments you are getting and choose the treatments you want.

It can also be helpful to work with a therapist, family member, friend and peer supporters to help define your recovery. Your definition of a meaning life may change at different times in life. At times, depression and bipolar disorder might make it seem difficult to set a goal for yourself.

Sometimes it might feel almost impossible to think about the things that you hope for or care about. But goal setting is an important part of wellness, no matter where you are on your path to recovery. Work on what you can when you can.

Setting Goals

Identifying life goals is the heart of the recovery process. When we see a future for ourselves, we begin to become motivated to do all we can to reach that future. Goals can be big or small, depending on where you are in your recovery journey.

Ask yourself:

  • What motivates me?
  • What interests me?
  • What would I do more if I could?
  • What do I want?
  • What do I care about, or what did I care about before my illness?
  • Where do I want my life to go?
  • What brings me joy?
  • What are my dreams and hopes?

It can help to start small and work up to larger goals. You might want to begin by setting one small goal for yourself at the beginning of each day. As you move forward with your recovery, look at the different areas of your life and think about your short and long term goals.

Short term goals might include:

  • Be out of bed by xx:00 am.
  • Finish one household chore.
  • Call a DBSA support group.

Long term goals might include:

  • Get training or experience for a job.
  • Change a living situation, e.g., find an apartment
  • Build a relationship with a friend or family member.

Remember break your goals down into small steps at first. Looking at a goal such as 'move to a new city' can be difficult to visualize and plan all at once. Ask yourself what you need to do first. What can you do now that will help you eventually reach this goal? Not only will this help move you closer to your goal, but it will also help give you a positive feeling of accomplishment.

What are some things I can do that might help me feel better?

Know the difference between your symptoms and your true self. Your HCPs can help you separate your true identity from your symptoms by helping you see how your illness affects your behavior. Be open about behaviors you want to change and set goals for making those changes.

Educate your family and involve them in treatment when possible. They can help you spot symptoms, track behaviors and gain perspective. They can also give encouraging feedback and help you make a plan to cope with any future crises.

Work on healthy lifestyle choices. Recovery is also about a healthy lifestyle, which includes regular sleep, healthy eating, and the avoidance of alcohol, drugs, and risky behavior.

Find the treatment that works for you. Talk to your HCP about your medications' effects on you, especially the side effects that bother you. Remember to chart these effects so that you can discuss them fully with your HCP. You might need to take a lower dosage, a higher dosage, or a different medication. You might need to switch your medication time from morning to evening or take medication on a full stomach. There are many options for you and your HCP to try. Side effects can be reduced or eliminated. It is very important to talk to your HCP first before you make any changes to your medication or schedule.

Talk with your HCP first if you feel like changing your dosage or stopping your medication. Explain what you want to change and why you think it will help you.

Treatments for Depression and Bipolar Disorder

Treatments that work can help you:

  • Reach your goals.
  • Build on the strengths you have and the things you can do.
  • Plan your health care based on your needs.
  • Live your life without the interference of symptoms.

Treatments can include some or all of these elements: therapy, medications, peer support, and overall lifestyle changes.

Medications for Depression and Bipolar Disorder

Your HCP might prescribe one or more medications to treat your symptoms. These may include:

■ Mood stabilizers: These medications help balance your highs and lows. Some mood stabilizer medications are called anticonvulsants, because they are also used to treat epilepsy.

■ Antidepressants: These medications help lift the symptoms of depression. There are several different classes (types) of antidepressants.

■ Antipsychotics: These medications are primarily used to treat symptoms of mania. Even if you are not hallucinating or having delusions, these medications can help slow racing thoughts to a manageable speed.

Talk Therapy

There are many types of talk therapy that can help you address issues in your life and learn new ways to cope with your illness. Goal setting is an important part of talk therapy. Talk therapy can also help you to:

  • Understand your illness
  • Overcome fears or insecurities
  • Cope with stress
  • Make sense of past traumatic experiences
  • Separate your true personality from the mood swings caused by your illness
  • Identify triggers that may worsen your symptoms
  • Improve relationships with family and friends
  • Establish a stable, dependable routine
  • Develop a plan for coping with crises
  • Understand why things bother you and what you can do about them
  • End destructive habits such as drinking, using drugs, overspending or risky sex
  • Address symptoms like changes in eating or sleeping habits, anger, anxiety, irritability or unpleasant feelings

Peer Support

Support from people who understand is another important part of recovery. There are many ways to get this support. DBSA offers a variety of ways to interact with your peers, such as support groups, discussion forums, and an interactive chat room.


A healthy lifestyle is always important. Even if symptoms of depression or bipolar disorder make things like physical activity, healthy eating or regular sleep difficult, you can improve your moods by improving your health. Take advantage of the good days you have. On these days, do something healthy for yourself. It might be as simple as taking a short walk, eating a fresh vegetable or fruit, or writing in a journal. A talk about lifestyle changes should be a part of your goal setting with your HCPs.

You have the power to change. You are the most important part of your wellness plan. Your treatment plan will be unique to you. It will follow some basic principles and paths, but you and your HCPs can adapt it to fit you. A healthy lifestyle and support from people who have been there can help you work with your HCP and find a way to real and lasting wellness.

Family and Friends' Guide to Recovery From Depression and Bipolar Disorder

When a friend or family member has an episode of depression or bipolar disorder (manic depression), you might be unsure about what you can do to help. You might wonder how you should treat the person. You may be hesitant to talk about the person’s illness, or feel guilty, angry, or confused. All of these things are normal.

There are ways you can help friends or family members throughout their recovery while empowering them to make their own choices.

The Five Stages of Recovery

It can be helpful to view recovery as a process with five stages. People go through these stages at different speeds. Recovery from an illness like depression or bipolar disorder, like the illness itself, has ups and downs. Friends and family who are supportive and dependable can make a big difference in a person’s ability to cope within each of these stages.

1. Handling the Impact of the Illness
Being overwhelmed and confused by the illness.

An episode of mania or depression, especially one that causes major problems with relationships, money, employment or other areas of life, can be devastating for everyone involved. A person who needs to be hospitalized may leave the hospital feeling confused, ashamed, overwhelmed, and unsure about what to do next.

What friends and family can do:

  • Offer emotional support and understanding.
  • Help with health care and other responsibilities.
  • Offer to help them talk with or find health care providers.
  • Keep brief notes of symptoms, treatment, progress, side effects and setbacks in a journal or personal calendar.
  • Be patient and accepting.

Your loved one’s illness is not your fault or theirs. It is a real illness that can be successfully treated. Resist the urge to try to fix everything all at once. Be supportive, but know that your loved one is ultimately responsible for his or her own treatment and lifestyle choices.

2. Feeling Like Life is Limited
Believing life will never be the same.

At this stage, people take a hard look at the ways their illness has affected their lives. They may not believe their lives can ever change or improve. It is important that friends, families, and health care providers instill hope and rebuild a positive self-image.

What friends and family can do:

  • Believe in the person’s ability to get well.
  • Tell them they have the ability to get well with time and patience. Instill hope by focusing on their strengths.
  • Work to separate the symptoms of the illness from the person’s true personality. Help the person rebuild a positive self-image.
  • Recognize when your loved one is having symptoms and realize that communication may be more difficult during these times. Know that symptoms such as social withdrawal come from the illness and are probably not a reaction to you.
  • Do your best not to rush, pressure, hover or nag.

A mood disorder affects a person’s attitude and beliefs. Hopelessness, lack of interest, anger, anxiety, and impatience can all be symptoms of the illness. Treatment helps people recognize and work to correct these types of distorted thoughts and feelings. Your support and acceptance are essential during this stage.

3. Realizing and Believing Change is Possible
Questioning the disabling power of the illness and believing life can be different.

Hope is a powerful motivator in recovery. Plans, goals, and belief in a better future can motivate people to work on day-to-day wellness. At this stage people begin to believe that life can be better and change is possible.

What friends and family can do:

  • Empower your loved on to participate in wellness by taking small steps toward a healthier lifestyle. This may include:
    • Sticking with the same sleep and wake times
    • Consistently getting good nutrition
    • Doing some sort of physical activity or exercise
    • Avoiding alcohol and substances
    • Finding a DBSA support group
    • Keeping health care appointments and staying with treatment
  • Offer reassurance that the future can and will be different and better. Remind them they have the power to change.
  • Help them identify things they want to change and things they want to accomplish.

Symptoms of depression and bipolar disorder may cause a hopeless, “what’s the point?” attitude. This is also a symptom of the illness. With treatment, people can and will improve. To help loved ones move forward in recovery, help them identify negative things they are dissatisfied with and want to change, or positive things they would like to do. Help them work toward achieving these things.

4. Commitment to Change
Exploring possibilities and challenging the disabling power of the illness.

Depression and bipolar disorder are powerful illnesses, but they do not have to keep people from living fulfilling lives. At this stage, people experience a change in attitude. They become more aware of the possibilities in their lives and the choices that are open to them. They work to avoid feeling held back or defined by their illness. They actively work on the strategies they have identified to keep themselves well. It is helpful to focus on their strengths and the skills, resources and support they need.

What friends and family can do:

  • Help people identify:
    • Things they enjoy or feel passionate about
    • Ways they can bring those things into their lives
    • Things they are dissatisfied with and want to change
    • Ways they can change those things
    • Skills, strengths and ideas that can help them reach their goals.
    • Resources that can help build additional skills
  • Help them figure out what keeps them well.
  • Encourage and support their efforts.

The key is to take small steps. Many small steps will add up to big positive changes. Find small ways for them to get involved in things they care about. These can be activities they enjoy, or things they want to change, in their own lives or in the world.

5. Actions for Change
Moving beyond the disabling power of the illness.

At this stage, people turn words into actions by taking steps toward their goals. For some people, this may mean seeking full-time, part-time or volunteer work, for others it may mean changing a living situation or working in mental health advocacy.

What friends and family can do:

  • Help your friends or family members to use the strengths and skills they have.
  • Keep their expectations reachable and realistic without holding them back.
  • Help them find additional resources and supports to help them reach their goals step-by-step.
  • Continue to support them as they set new goals and focus on life beyond their illness.
  • Help them identify and overcome negative or defeatist thinking.
  • Encourage them to take it easy on themselves and enjoy the journey.

People with depression or bipolar disorder have the power to create the lives they want for themselves. When they look beyond their illness, the possibilities are limitless.

What you can say that helps:

  • You are not alone in this. I’m here for you.
  • I understand you have a real illness and that’s what causes these thoughts and feelings.
  • You many not believe it now, but the way you’re feeling will change.
  • I may not be able to understand exactly how you feel but I care about you and want to help.
  • When you want to give up, tell yourself you will hold of for just one more day, hour, minute - whatever you can manage.
  • You are important to me. Your life is important to me.
  • Tell me what I can do now to help you.
  • I am here for you. We will get through this together.

Avoid saying:

  • It’s all in your head.
  • We all go through times like this.
  • You’ll be fine. Stop worrying.
  • Look on the bright side.
  • You have so much to live for why do you want to die?
  • I can’t do anything about your situation.
  • Just snap out of it.
  • Stop acting crazy.
  • What’s wrong with you?
  • Shouldn’t you be better by now?

What to find out:

Contact information (including emergency numbers) for your loved one’s doctor, therapist, and psychiatrist, your local hospital, and trusted friends and family members who can help in a crisis

Whether you have permission to discuss your love one’s treatment with his or her doctors, and if not, what you need to do to get that permission.

The treatments and medications your loved one is receiving, any special dosage instructions and any needed changes in diet or activity.

The most likely warning signs of a worsening manic or depressive episode (words and behaviors) and what you can do to help.

What kind of day-to-day help you can offer, such as doing housework or grocery shopping.

When talking with your love one’s health care providers, be patient, polite and assertive. Ask for clarification of things you do not understand. Write things down that you need to remember.

Helping and getting help

As a friend or family member you can provide the best support when you’re taking care of yourself. It helps to talk to people who know how it feels to be in your situation. Talk with understanding friends or relatives, look for therapy of your own, or find a DBSA support group.

DBSA support groups are run by people, families and friends affected by depression or bipolar disorder. They are safe, confidential, free meetings where people can learn more about depression, bipolar disorder, and how to live with the illnesses.

One father of a daughter with bipolar disorder says, “DBSA support groups help take a lot of stress out of your life. As a family member, you have to be as prepared as possible, and accept that things will still happen that you aren’t totally prepared for. DO all the research you can. Build a long list of dependable resources and support people, so when a situation arises, you know where to turn and how to take the next step. This really helped my family when we needed it.”

A mother of a son with depression says, “When you are in the middle of a situation, it’s hard to see what’s happening, but when you sit in a support group meeting across from someone who is going through the same things, it gives you perspective.”

page created: May 10, 2006
page updated: December 29, 2006

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