MENTAL HEALTH MINUTE GUIDELINE: BIPOLAR/MANIC/HYPOMANIC

Bipolar disorder, manic or hypomanic episode

•Reduce or stop substances or foods that elevate or alter mood
-caffeine-coffee,tea, cola, energy drinks with taurine, guarana, yerba, gingko
-amphetamines, crystal meth, cocaine, ecstacy-E, alcohol, marijuana

•Make sure your physical health and medications have been checked
-thyroid problems, neurologic conditions, infections can mimic mania/hypomania
-steroids, methylphenidate, decongestants, diet or stay awake pills, St.John’s wort
(hypericum), ginseng, supplements may cause/worsen mania/hypomania

•Caution with use of antidepressant medications
-antidepressants may cause, bring out or worsen a hypomanic or manic episode
-can be used cautiously as an adjunctive add-on to mood stabilizing medications
-if stopping –must taper some down gradually to prevent withdrawl

•Mood stabilizing medication for acute episodes and future prevention
-Lithium-well proven-need to monitor blood level, kidney and thyroid counts
-Valproic Acid-need to monitor blood level, liver and blood cell counts
-Atypical Antipsychotics- many indicated for treatment and prevention
of bipolar manic and depressive episodes-not only used for psychosis
-Lamotrigene-effective for depressive phase only-watch for rare but serious rash
-benzodiazepines (valium,lorazepam,clonazepam)-useful as adjunctive or short
term add on to above first line recommended mood stabilizers

•Safety first, prevent damage to yourself, family, friends, job, finances
-prevent or stop uncharacteristic risky behaviour-fast driving, extreme sports,
unsafe sex, fighting, gambling, excess spending, drug and alcohol use
-protect your job security-consider the need for illness leave for health reasons
-protect finances- limit access to funds, credit cards, bank accounts, stock trades
-you, family, society to consider brief hospitalization to get well and for safety
-appoint someone to look out for you if you have an episode and can’t yourself
(power of attorney for personal care, advance directives)

•Healthy lifestyle, thinking habits and peer support
-regular sleep and wake times, regular meals, exercise, peer support groups
-Cognitive Behaviour Therapy(CBT)-a type of talk therapy to develop thinking
skills and habits to keep you accurately grounded in your decisions and actions
Seek emergency/urgent help if thoughts/plans to hurt yourself or others

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