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.



I have been taking an interest in an American website www.psychcentral.com recently. I am not sure how I found it but think, possibly, it was via a link on Facebook or on another bi-polar blog. These blogs, far from being morbid and self-indulgent, are positive, uplifting and provide much useful advice even if only via a link to a website. A psychcentral blogger, Margarita Tartakovsky has written several articles. One of these is Ten Things to Improve Life and these are my interpretations. The first is write a better story for your day. I say this can be on paper or in your head. I make a list of things to do each day such as exercises, yoga, walks and playing my piano. Reflecting on the positive aspects of a day is also a good idea so writing a diary – something I wish I had done throughout my life – where you log all the good things that happened – can make you feel better.

A more difficult item on her list is Identify what is keeping you stuck. This can be negative thinking or perhaps even another person. Low self esteem can prevent us doing what we need to do. I am stuck at present in ‘Writers’ Block’ although those reading this might think this is not the case. I have a novel that needs a ‘middle’ and lots of re-working and my view is that it is ‘in a mess’. When I looked at it recently I reckoned it was a load of rubbish. When my mood lifts, I may see that it is not so bad. Making myself write up my ideas from Margarita’s blog is releasing something.

Easier is go to bed earlier. I have been doing this for some time now and I do feel better when I am in bed between 10.30 and 11 especially if it means I have time to READ.

Also easier is participate in physical activity which you enjoy. I like walking and yoga so I have built this up in the last two or three weeks and it has made a difference to my mood. I hope to start swimming again in a nearby pool but the weather has been so wet, cold and miserable. This is a form of ‘being stuck’. If I could force myself to go I would benefit.

More difficult is to focus on ‘right now’ and be grounded in the present. I know people on Mindfulness courses at present. Mindfulness has been found to help with depression and negative thinking. Staying in the moment, without looking back or worrying about the future, really does help the mind to stay positive. I find that when I am writing I am purely in the moment which is, I am sure, why writing has been found to be so therapeutic.

Physical Action is another one of the Ten Things. Often anxiety and depression can make us ‘freeze’ and fail to do things which we need to do. Being pre-occupied prevents us from pushing on with pleasurable activities, leaves us confused and unable to make decisions which then leads us to feel angry with ourselves. ‘Just do something’ even if it is only a crossword or a Sudoku puzzle. Along with this improvement, however, we must ensure we set realistic and attainable goals. For example, don’t struggle with the Telegraph crossword if a concise one in another paper brings more success.

The seventh item was to reframe a situation in a more positive light. Margarita quotes the well-known saying ‘when life throws lemons at you, make lemonade’. When I am struck with a low period I try to tell myself it is nature’s way of making me rest and accept it instead of fighting it. I take my breakfast back to bed and have my laptop and a book at the ready. I tell myself that not socialising is my need for solitude. Of course, it doesn’t work all the time but it is worth a try. However, it is a fact that over-stimulation is not good for those with bi-polar so the lows are often nature’s way of reducing stimulation. On a more basic level, if someone shows they do not want to be friendly, tell yourself that you are deciding you don’t want to be friendly with that person. When you suffer with Bi-Polar it is important to choose your friends and avoid those who cause aggravation. Decisions also need to be yours and yours alone.

Number eight on Margarita’s list is be grateful.  This, according to her, attracts positivity, opportunity and success. Writing down a list of ‘blessings’ has worked for me in the past. So often when we are depressed we forget what is good in our lives.

For control freaks, the next on the list is let go of what you can’t control. Sometimes we can’t see what it is that is holding us back or depressing us. Identifying what we can change and what we cannot change is key to combating depression. We might not be able to change a situation but we CAN change our attitude to it. Sometimes we cannot control something but we can manage it. This is true of Bi-Polar Disorder. We can’t control this as, even with medication, the brain will sometimes do it worst, but we can watch for Early Warning Signs (EWS) and be aware of triggers that can either bring us down or send us into over-exuberance. Then we can take appropriate action. If we know we have ‘tried’ then we will not beat ourselves up about it.

Finally there is create an intention. After reading this, I decided to have some things on my TO DO list that could be prefaced by ‘I will ….’  However, somewhere we have to remember our realistic and attainable goals. Don’t say ‘I will …..’ if it is something that would be hard to achieve, expensive or detrimental to your well-being.

Good luck with the Ten Things. Let me know how you do.