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Early Warning Signs (EWS) and how to deal with them

There was a time when, following a move and a new GP, I struggled with my Bi Polar and would pay visits to the surgery in the hope that some help would be forthcoming. When I related my symptoms I was told that I was being super sensitive to the feelings and frightened of descending into previous illness that had resulted in hospitalisation. I often wondered if she had read my notes.
After attending a Living with Bi-Polar course I learnt that these thoughts, feelings and behaviour are important for they are our EWS (early warning signs). While these may differ between us, many are commonly experienced by sufferers of BPD.

If you are reading this because you suspect you may have the condition I hope you will be heartened by the knowledge that all these feelings will pass but there are some things you can do to make yourself feel better in the meantime. However, if you identify with the symptoms you should consult your GP who may refer you for further assessment.

My trigger is usually a period of stress even if I think, at the time, that I am coping. Sometimes, I have a fall, a sign my balance is off centre or that I am not concentrating. I may have been exceptionally busy with normal activities but not manic. Holidays and Christmas can cause this.

So what are my early warning signs of bipolar depression? First I begin to wake up tired rather than refreshed and find it difficult to get up. I am aware that something in my life is missing and that is the sense of joie de vivre, being able to enjoy simple activities and generally looking forward to what life has to offer. I begin to lose interest in activities I previously enjoyed. Over a few days I notice I am feeling overwhelmed with a range of daily activities that I would normally take in my stride. I begin to forget things and find it difficult to plan ahead. Time becomes short and I cannot fit in what needs to be done. This causes some anxiety and I become aware of a few worries. These increase over a few days. My sleep is disturbed. Whereas my medication usually knocks me out, suddenly I either cannot get off to sleep or I wake with a start in the night. Early waking might happen but if I am lucky my medication will allow me to drop off again. While I have been enjoying my food when well, now I feel sick in the mornings and may feel giddy or uninterested in food. I may have difficulty swallowing, particularly where tablets are concerned. As a writer, one sign is that I stop writing or find it difficult to engage with a manuscript that previously had excited me. I begin to spend more time sitting on the sofa but achieving little. I get things out and do nothing with them, start to read an article but fail to finish. A number of half read papers start to pile up. By now the kitchen is untidy and my normal attention to cleanliness is notably absent. Dishes in the sink and cold cups of tea sit forgotten on the table, made before I wandered off to do something else. I am now feeling unsociable and am reluctant to answer the phone or make arrangements to meet with friends. If one of my friends cannot meet up I may experience a feeling of relief.

Now none of the above is a serious warning sign on its own. As the peer specialist told us, ‘it is when several EWS are observed and they hang around for a while.’ The key is being aware. Unsurprisingly most of the delegates on my refresher course last year identified with many of the above signs.

Luckily I now recognise these signs and rather than ignore them which my GP thought I should, I know that I need to take some action.

There are a few strategies which can bring you back on to a previous mood level before depression takes hold. Some cost money and others are there for free. The following ideas are a mix. You may not find them all helpful but some should suit where you find yourself at the moment.
• Getting out for a walk, however short, in the fresh air and, hopefully, sunshine, will boost endorphins.
• Writing a mood diary and recording daily activities will get you writing.
• Reading poetry takes less concentration and might help. Try humorous poetry.
• Set achievable goals especially when tidying up neglected areas. Choose a few shelves or one file at a time. To plan to tidy the whole house will result in failure and increase your despondency.
• If you can find a reasonably priced therapist book a reflexology session for deep relaxation.
• Experiment with ‘tapping’ techniques. Tapping therapy or EFT (Emotional Freedom Techniques) is explained on various websites. If you are unsure it would be worth paying for half an hour of therapy for a demonstration and help with setting intentions.
• Write a To Do list every day with achievable tasks. Keep it short and cross off those completed. This aids memory too.
• Phone or visit a member of your family.
• Watch ‘happy’ television programmes and avoid the news which can increase anxiety.
• If reading is a problem, watch an interesting documentary dealing with a topical debate.
• Write down three positives for each day. These could include cooking a meal, phoning a friend or watching tv. A walk in the sun, sending an email to a friend or writing your diary also qualify.
• Take the pressure off yourself. Instead of berating yourself for not getting out of bed in the morning, give yourself permission to stay in bed for a short time. If it is a choice you will feel better. You will soon be getting up more smartly when you feel better.
• Accept you have an illness and that this phase is part of your illness. I was told this a year ago and found it liberating.
• Tell yourself that your brain worked hard and was overstimulated before this phase. Depression is often the brain’s way of ‘having a rest’. Let it rest and don’t fight it or force yourself to do things you find difficult at this time. Make a choice to rest your brain and keep occupied with physical activities that are possible at the moment. This is NOT giving in or being lazy. It is allowing your brain to recover.
• Listen to music or play an instrument.
• Do some stretching exercises each day. Practise yoga and feel the difference.
• Remember depression does pass.

Some of the points above I have already written about on my blog eg the idea of writing down 3 positives each day. Other points here will be expanded on in future posts.

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