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.



So today, Monday 19th January is reckoned to be the most depressing day of the year. Reasons given are that it is usually very cold, the Christmas spirit is waning and people are realising they have not kept some of their new year resolutions.

Let’s start with resolutions. Setting unattainable goals is a precursor to depression Those prone to this devastating mental illness may set targets in the thought that this will keep them out of the new year trough of despair. But failing to keep resolutions can lead to loss of self esteem, a feeling of failure and a sense of ‘here we go again’.

If you do want to set resolutions, make them simple and achievable. For someone prone to new year blues, this could be to ‘go to bed earlier’ and ‘to get up earlier’, the first helping the second resolution to be achieved.

Avoid closed statements in resolutions such as ‘get up at 8am’ which allows for no flexibility on a bad day. To be ‘in bed by 10.30’ will not work on a night when you have been to the cinema or have friends round.

Ideal resolutions would include:

  • Keep a diary and make at least one positive entry each day – something done or planned.
  • Write down three positive thoughts each day
  • Go for a walk each day for at least 20 minutes. Increase the time gradually.
  • Walk in the late morning when the sun is at its best and temperatures are mild.
  • Don’t economise on heating. Being cold can lead to confusion.
  • Arrange to meet a friend or friends at least once a week.
  • Join a group such as a painting group or walking group.
  • Avoid junk and processed food.
  • Eat fruit and vegetables every day.
  • Keep a mood diary. There are charts available but a range of -5 through 0 to +5 is the best. The one below is coloured. The green area signifies a normal mood, yellow is where the mood is higher but is not affecting function. Light blue is the ‘low’ mood area but again does not affect function. Dark blue at the foot of the chart would indicate deep depression. For those with Bi Polar the bright pink/orange would indicate mania.

Keeping a mood diary is useful if you need to see a doctor about your depression. However, you should be keeping a diary of events, encounters, stressful times, upsets etc so that this can be viewed alongside. For example, if you have fallen out with your partner one day, it would be perfectly normal for your mood to sink into the lower green/light blue area.

 As for the waning Christmas spirit, some people find this festive season stressful with family difficulties and reminders of those who are no longer in our lives for a variety of reasons. Try to plan some outings for January which will help ease your depression.

 For those who are physically ill or disabled, reading self help books and using social media to keep in touch with others should help mood.

 Let’s hope the rest of January is good for you.