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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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Overspending during depression and bi-polar highs

There is a common problem with those who suffer mental health problems that sometimes they get carried away with their spending and overspend often to the point of landing in debt.

It is a well known fact that we think that buying the ‘next thing’ will make us happy and using a £5 off voucher if you spend £35.00 in the supermarket is actually saving you £5 when, in fact, you are probably spending more than you would if you did not have the voucher.

I came across the article below which, forgive me if it is wordy, does explain some aspects of why we overspend. At this time of year when we are feeling drab and the nights are still closing in before 4.30 it is easy to think that going out shopping and buying something we have always wanted or a holiday that we see others enjoying will be the answer to our low mood.

http://www.getrichslowly.org/blog/2015/01/14/why-we-spend-are-you-falling-for-these-costly-biases/

I did read something about spending to make  ourselves happy. It is on a previous blog on happiness. Apparently we buy something and experience some temporary feeling of satisfaction so we think it has worked. In fact the feeling soon goes away and sometimes our mood can plummet when we realise that the purchase did not act as the magic bullet. The realisation that we have spent £x and got no long-term reward can send us into a decline of regret and evoke feelings where we ‘beat ourselves up’ for falling for this ploy once again. The temporary easing of our anxiety can bounce back to hit us full in the face, worse than before.

I am now subscribing to the minimalist theory. A few pairs of black leggings, a good pair of boots and a few tops and layers are seeing me through the winter. I have a lovely skirt I bought in the Mistral sale which I wear to go out and my previous purchases for winter come out occasionally. There is NO need for any more new clothes so the January sales will not be seeing me this year.

Try it and see if you feel better by NOT spending.

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WRITING AS THERAPY FOR DEPRESSION

What came first? Writer’s block or depression?

So I said to my psychiatrist that I am now wondering whether it was Writer’s Block that brought on my latest bi-polar depression. Of course, the depression may have caused the block. But when I think back, a rejection in October hit me hard and I distracted myself with a manic decorating spree. When the depression hit me in January, I thought that was the reason that I was no longer writing but now I look back, I stopped writing prolifically before the depression struck. Yes the occasional blog but not what I call ‘real’ writing. Even the blog posts became less frequent.

In Issue 61 of Mslexia, Roselle Anguin discusses the therapeutic effect of writing but her statistics and research throw more light on the link between writing and depression. As a group, writers have a high incidence of mental health issues but writers are also better equipped to cope with these issues, even to heal from them. A previous survey in Mslexia suggested that 69 per cent of women writers have been treated for some kind of mental health problem, in contrast with 29 per cent of women in the general population. The survey discovered writing could make women feel more positive, relieve depression and alleviate the symptoms of stress and anxiety.

Writing, of course, has therapeutic benefits for non-writers too. But if you suffer from mental illness and you are not a writer, you are missing a vital strategy to engage with your feelings and express emotions such as fear and anxiety.

Fortunately my depression has lifted and I have started writing again but I have been thinking about the ‘chicken and egg’ situation of whether depression causes, or is caused by, writer’s block. All writers have days when the words don’t flow but when even a pen and notebook do not stir ideas and the computer stays switched off for no explicable reason, it is clear that the block has taken over your life.

Julia Cameron, in The Artist’s Way, suggests several tactics for releasing your creativity and dealing with the inner critic who repeatedly tells you that you cannot write and, if you do, what you write is rubbish. One of her methods is the ‘morning pages’. Just take your notebook and write three pages of drivel after which you should be able to write the ‘serious’ stuff.

This could work with depression too. That is, once you can stay out of bed for sustained periods although I have tried taking the notebook to bed and it has worked. Just write anything that comes into your head without worrying about it being part of your next or present Work In Progress WIP) could ease anxiety and is immediately liberating. Writing down your fears can make them seem quite trivial which can be enlightening. After all, in your mind your fears are mammoth and sufficient to stop you undertaking normal daily activities. So they must be real. But the truth is most will be much less than you had imagined. Your fears, once written down, will not seem so dire. If they are grounded in fact and you have problems that will seriously affect your life, writing them down may help you find a solution even if this is only temporary. Redundancy, for example, is a real threat to your income and the house, bills and food but being proactive and listing a few plans such as visiting the Job Centre for a Careers interview could ease the dread.

Writing can also be used in other ways. Writing down five ways to make yourself better, five things you like about yourself, five strengths, five things you want to do in the next six months. All of this is using the power of the pen to empty the mind. This in turn will allow in more positive thoughts – probably one or two of your plans will reach fruition.

For those with Bi-Polar, keeping a diary of activities, meetings with friends, reflective thoughts on the past day and an indicator of mood can help track mood levels and, if there are changes, you can look at what you were doing a few days before the mood changed. This has been one of the most helpful strategies I have used since being diagnosed with BPD. The diary can be useful when seeing professionals too as you can, prior to the appointment, overview what has been happening in your life.

But I never write, I hear you say. Forget that, take a positive stance and promise yourself that you will start writing. Just a few words is all it takes. A shopping list, a few nice menus and a sentence or two about your feelings that day. Then start planning, making lists and writing more reflective accounts.

It is worth it so give it a try.

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