By: James E. DelGenio MS, LCPC
Senior Staff Therapist
The Family Institute at Northwestern University
How to be well when you have a mood disorder?
Coping with a mood disorder is no easy task! It takes professional support, education and experience to manage the debilitating symptoms. In my practice, I have found that if I can provide a structured program which includes education and training to:
- Remain stable
- Learn coping skills
- Learn to overcome social dysfunction
- Have a network of friends and supports
- Thrive in a job or school
I have also found that it takes an average of about 1 year to reach those goals, while some people may never reach all five. In addition, most people will always need some level of support their entire lives. The bottom line is you can’t do it alone! You need a doctor and therapist who can collaborate regarding treatment. I have listed below the 10 elements necessary to cope with a mood disorder. See Disclaimer at the end of this article.
1) Take the medication as prescribed by your doctor.
Not all my clients require medication but when coping skills and symptom management don’t make a significant impact on symptoms, it’s time to consider medication. This is a tough one. No one likes to have to take medication, possibly every day for the rest of your life. Moderate to severe mood disorders will require medication for symptom management. It’s all about body chemistry, therefore, it’s no one’s fault. It is a biological problem first and foremost. It’s like being a diabetic; you must take the medication as prescribed in order to be well.
2) No caffeine, substance abuse or alcohol.
People with depression and mood disorders often have problems with sleep. I do not recommend using caffeine. It interferes with the sleep/wake cycle. I also don’t recommend working the night shift i.e., midnight to 8 AM. It is too hard to get adjusted to a night shift and it also wreaks havoc with the sleep/wake cycle. Tell your doctor or your therapist if you are not sleeping.
As far as alcohol and substance use, it is as simple as it is hard. Don’t do it! Mental illness alters reality. Alcohol and substance abuse alter reality. There are negative relationships among alcohol and drug use, addiction, mood disorder and relapse. The bottom-line is USE CAN BE THE SAME AS ABUSE! Don’t use, ever! If you already have a problem, get professional help and go to your AA or NA meetings as often as it is necessary to maintain sobriety.
Note: Some Doctors and even therapists say that it is OK to have 1 or 2 drinks once in a while on special occasions even if you are not an alcoholic. I question this because alcohol is a depressant. Why would you take a depressant when you are taking an anti-depressant? I call this the Elvis (Presley) syndrome. Reportedly, Elvis took uppers to counter act the downers, to counter act the uppers. It eventually killed him. If you do drink, I strongly recommend that it be infrequent and on special occasions only. This should be one or two drinks at most and I encourage you to monitor your mood in the following few days. Look for increased depression, disturbing thoughts or anger and irritability. This will tell you if you can have one or two or none.
3) Take care of your physical health.
Be sure to have annual dental and physical exams. Some medications require regular blood testing. Some physical ailments can cause depression. See your doctor regularly.
4) Be social, outside of the family.
Depression tends to make people isolated and withdrawn. People need contact with other people to remain grounded in reality. Even family cannot take the place of social contact in its benefit concerning reality testing. People with mood disorders cannot always trust what they feel, see or hear. They need to “check it out” with other people.
We all use our friends to test reality; you just don’t think of it in that way. For example, you call up your friend and say, “Do you know what happened today? I had an argument … She said… I said …” Who do you think was right?” It’s over simplified but you get the idea. People need other people for many reasons. For people with a mood disorder, reality testing or “checking it out” is just one of them. I recommend at least two social activities per month with people other than family.
5) Be active.
People with mood disorders tend to be sedentary. They need to walk and get exercise as much or more than any of us. I recommend taking a brisk walk, weather permitting, at least 4 times per week for 40 minutes. Pick your days and stick to them as much as you can. It is widely accepted today that walking (cardio work) reduces anxiety and improves your mood so get out there and walk.
Note: Always consult with your doctor before starting any exercise program.
6) Plan to have fun.
When you were a child, it didn’t take much to have fun. You simply go outside and find some other kids and the party is on so to speak. As an adult, we need to plan to have fun. For example, if you had a boring weekend you might say to your spouse, “This was a lousy weekend. Next week we need to plan to get together with …” Get the idea? People with mood disorders tend to become consumed with their symptoms. Planning is a very important part of meeting your social goals.
7) Work on a hobby daily.
A hobby is a wonderful way to cope and help structure your day. When no one else is around or when you are experiencing negative thoughts, feeling low or just plain bored a hobby fills the bill. The key word here is coping. People often complain about too much free time and yet they will say, “I don’t have a hobby,” but they will sit for hours ruminating about their symptoms. That is just not healthy. So, don’t tell me why you can’t work on a hobby. Tell me what hobby you are going to choose and get to work. Hobbies should be worked on at least 1/2 hour any time you are having difficulty coping with your symptoms. I have seen some do paint by number as an easy way to distract themselves. The nice thing is you can pick it up and put it down and walk away.
8) Do your chores on assigned days.
Chores are a great way to distract yourself from your symptoms. Most any physical activity is a good distraction from your negative thoughts and symptoms. Chores are another way to distract yourself and give you a clean environment. Make a cleaning schedule and stick to it. When you have depression, the idea of cleaning the entire house or apartment can be overwhelming. Break your chores down into one or two chores each day. Tape it on your refrigerator or someplace where you will see it every day, and then, stick to your cleaning schedule. For example:
- Monday is vacuuming
- Tuesday is bathroom cleaning
- Wednesday is washing the floor
- Thursday is cleaning the kitchen
- Friday is changing the sheets and towels day
- Saturday is laundry day
- Sunday is a free day. It is your reward for doing your chores all week long.
This is not about how you feel. If you felt good, you wouldn’t need this stuff. If it’s Monday and you are scheduled to vacuum – do it. It is a coping skill and it also gives you the added benefit of a healthy environment in which to live.
Try to come up with your own list of distraction activities. The more things you try, the less likely you will be a victim of your disorder.
9) Get at least 5 to 7 hours of sleep per night.
As I stated earlier, sleep is very important to maintaining your mental health. Too much sleep is not healthy. No sleep is a quick ticket to a psychiatric hospital. I could take just about anyone in the world; if I kept them awake long enough, they would lose touch with reality. Lack of sleep usually indicates that the person is not taking their medication as prescribed. Remember Goal # 1. Take the medication as prescribed by your doctor. If you’re still not sleeping, notify your doctor. It only takes a few sleepless nights to lose touch with reality and relapse to severe symptoms.
10) Make healthy choices!
This is my generic one. This one may very well be different from person to person. What is a healthy choice for one person may not be healthy for another. For example, if you have a mood disorder, poor sleep and alcohol use are mental health issues.
Issue 1 Sleep
Typical response: “It’s not the caffeine. I like coffee. It doesn’t affect me. I’ve always drank coffee.” Whether it’s coffee, soda or tea, caffeine interferes with sleep. It is the most obvious reason for poor sleep. I would certainly recommend discontinuing caffeine before asking the doctor for a sleeping pill. Avoid caffeine for one month and see if you don’t sleep better.
Issue 2 Alcohol
Typical response: “What? I can’t have a glass of wine with dinner? I don’t do it often. It’s just one glass. It’s not like I’m an alcoholic.”
Alcohol is a depressant. It may affect your mood for days, even weeks. Don’t deny the obvious. This is just not a healthy choice. So, remember, what is healthy for one person, may not be a healthy for you. Make healthy choices!
Not in the Chicago Area!
Now I can work via face time with anyone, anywhere in the country and it may still be covered by BCBS Insurance. Check with your BCBS representative.
For those in the metropolitan Chicago area, I have offices in Millennium Park on Michigan Avenue, and near 22nd St and Wolf Road in Westchester. Call James E. DelGenio MS, LCPC, Senior Staff Therapist at The Family Institute at Northwestern University, 847-733-4300 Ext 638.
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Disclaimer: This material is meant to be used in conjunction with psychiatric treatment, medication, if necessary, and supportive therapy. Always share this material and your questions about this material with your doctor and therapist.