What is the Triad of Care?

There is logic behind the title of this post.

The first meaning is that while you and I cannot control our diagnoses we can control the actions we take to try to rein in the symptoms. Second, there is a doctor-recommended order to the steps we take and that is: start by finding a medicine your body tolerates, combine that with weekly psychotherapy, and to maximize the benefits of medicine and therapy you have to take care of yourself!

Medicine

Medicine is the first line of defense. Unlike cold medicine which masks symptoms, the medicine prescribed for bipolar disorder actually tries to fix the chemical imbalance in the brain. For that reason alone, medicine should be the first action you take for the happiness of your future self.

Most therapists cannot prescribe medicine. Psychiatrists are able to prescribe medicine, but are no substitute for therapists. In my experience, Psychiatrists rely on questionnaires and short conversations, but seeing one is an essential step on the long path to control.

Let me set your expectations now. It is very unlikely that the first prescription you are prescribed will either control your moods or be tolerated well by your body. Most medicines ask for 2-6 weeks for the effects on your mood to kick in, but the potentially debilitating side effects will show up the day after your first pill. For me personally, I was prescribed Geodon first which made me too groggy the following day to stand up let alone go to work or take care of my kids. Enduring that for a week I demanded a new prescription. The one I am currently on is Abilify which made me nauseous the first few days but that did go away (and was easily treated with over the counter Pepto-bismol).

Medicine is the first step toward help in the short and long-term, but it is only the first leg of the Triad of Care.

Therapy

Everyone could benefit from talking to a therapist, but when you have bipolar disorder, having a therapist is a critical asset. Therapists are like friends that you can talk to about anything, but unlike Jane who you’ve known since elementary school, therapists are highly training to spot the symptoms of manic or depressed mood swings and help you through them.

My suggestion to you is to set up a weekly meeting time with your local therapist, and for each visit to bring notes about how your mood/behavior has been since you last talked. It may also help to have those closest to you provide you with input on what they have noticed in your actions/moods.

If you have healthcare then you can assuredly find a therapist through the mental health department. Going this route will cost you time away from work, as well as the payments your health plan expects of you. Another route to a therapist, for those lucky enough, is the Employee Assistance Program offered by most employers. EAP for small employers could be a phone number you can call to talk with someone, or an on-site therapist at larger companies. EAP is a confidential service that does not require payment, time away from work, and will not be disclosed to your coworkers if you use it.

Therapy is the first part of self-care after finding the medicine that agrees with your body, but there are other ways you can help yourself.

Self-care

Taking care of yourself basically involves three things: making sure you get enough sleep, eating right, and getting daily exercise.

Lets get eating right out of the way. I would be a total hypocrite if I said anything about eating healthy, so I will leave it at: I hear eating healthy helps, but my fried/salty/sweet-oriented diet does not give me any first hand experience with this sage wisdom. I will say that limiting caffeine has personally helped me with irritability, but your mileage may vary.

Sleep on the other hand I can speak to out of personal experience. For me, the number of hours I sleep is almost as important as the time I go to sleep. I need a minimum of seven hours of sleep, and need to be in bed trying to fall asleep by 10:30pm. If either of those rules are violated, you can bet my mood the next day is affected. It is important not to follow the guidelines that work for me, but to find the ones that work for you :).

Last but not least, my favorite, exercise. When I say exercise I do not mean getting a gym membership. For me, I tried many types of exercise (pull ups, push ups, sit ups, running, etc.) but could not stick with them. The exercise that works for me is WALKING! Yep, just plain old walking. Thirty minutes of “walking with intent” is all of the exercise you need (or so says my general practitioner). I found running too intense, although i was probably doing it wrong. In any case, pop on an audiobook (free from your library), a podcast (free free free), or some music (YouTube, Pandora – Free) and just start walking. If you focus on what you are listening to, then you wont feel the distance or time and you will have gotten your exercise for the day!