Bipolar disorder is notoriously difficult to diagnose and treat, and has a suicide rate of up to 20%. Studies suggest that half of people living with bipolar disorder have attempted to kill themselves.

Not all people with bipolar disorder have an equal suicide risk. Investigators who examined records from more than 32,000 members of two large prepaid health plans who had been treated for bipolar disorder determined that men with bipolar made fewer suicide attempts than women but were more likely than women to die when they did attempt suicide. 

People who had high anxiety levels made more suicide attempts than other people with bipolar disorder and also were more likely to succeed in their attempts to kill themselves.

The following information from can help you determine when to call a doctor and why type of professional may be able to help.

If you have bipolar disorder, call 911 or other emergency services if you:

• Think you cannot stop from harming yourself or someone else.
• Hear voices that are new or more upsetting than normal.
• Want to commit suicide, or you know someone who has mentioned wanting to commit suicide.

Warning signs of suicide include:

• Use of illegal drugs or drinking alcohol heavily.
• Talking, writing, or drawing about death, including writing suicide notes and speaking of items that can cause physical harm, such as pills, guns, or knives.
• Spending long periods of time alone.
• Giving away possessions.
• Acting aggressive or suddenly appearing calm.

Watchful Waiting

Watchful waiting may be enough if a mood episode has just started and you are taking proper medicines. If your mood episode has not improved within 2 weeks, call your doctor.

If you have a loved one who is experiencing a manic episode and is behaving irrationally, help the person seek treatment.

Who to See

Bipolar disorder is complex and hard to diagnose because it has many phases and symptoms. Sometimes it is misdiagnosed as only depression (unipolar depression), because people are more likely to seek treatment during a period of depression.

After you are diagnosed with bipolar disorder, it is important to keep a long-term relationship with your doctor or therapist to make sure that your treatment is consistent and that your medicines can be adjusted as needed.

Although other health professionals can diagnose bipolar disorder, you will probably be referred to a psychiatrist who specializes in treating such disorders and can prescribe medicines and provide counseling. Other health professionals who can diagnose bipolar disorder include:

• Family doctors (general practitioners).
• Internists.
• Psychiatric nurse practitioners.

Counseling can help you deal with mood changes and the impact bipolar disorder can have on your work and family relationships. In addition to psychiatrists, health professionals who can provide counseling include:

• Psychologists.
• Social workers.
• Licensed professional counselors.

Family member support

If a loved one has bipolar disorder, it may be helpful for you to get counseling to deal with its impact on your own life. Manic episodes can be particularly hard. Talk with a psychiatrist, psychologist, social worker, or licensed professional counselor for your own therapy.

Therapy can also be helpful for a child who has a bipolar parent. The parent’s mood swings may negatively affect the child, causing tearfulness, anger, depression, or rebellious behavior.

Source: Healthwise

If you’re involved with someone with bipolar disorder, the romantic relationship may be exciting, exhausting, and stressful. But it will rarely be easy, especially if the object of your affection doesn’t comply fully with treatment.

Bipolar disorder can be nearly as traumatic for the partners of those with the disorder as it is for the patients themselves. The episodes of depression and mania that bipolar people experience—which can lead to emotional withdrawal, out-of-the-blue accusations and outbursts, spending sprees, and everything in between—have been shown to induce stress, sexual dissatisfaction, and money worries in their partners, as well as depression. Depressive phases, during which the bipolar partner feels hopeless and sad, can drag a healthy partner down, too.

Feelings of stress, isolation, and rejection are common among those involved with a bipolar patient. Outside support and education can help.

“Mental illness is, on some levels, a contagious disease,” says David Karp, PhD, a professor of sociology at Boston College who has studied interpersonal dynamics within bipolar couples. “It brings out very strong negative emotions and feelings of isolation in the partner, who struggles so hard to separate the illness from the patient.”

Relatively few studies have been conducted on the effects of bipolar disorder on relationships, but the research is nearly unanimous that the disorder tends to cause both practical and emotional difficulties for couples.

For starters, the ups and downs of bipolar disorder can disrupt the rhythms and routines of a household. In a 2005 survey of people with bipolar partners published in Bipolar Disorders, more than half of the participants reported that their partner’s illness had reduced their socializing, required them to assume more household responsibilities, forced them to take time off of work, and caused financial strain. The participants also reported that their sex lives sagged when their partner was in a manic or a depressive phase; three-quarters of the women who were interviewed and 53% of the men complained of infrequent sex when their spouses were depressed.

Another study of bipolar caregivers found that 86% of the participants characterized the stress they experienced as a result of their partner’s illness as “major.” And 9 out of 10 said they found it difficult to keep the relationship going.

Building a team for support
Many people enter into relationships with a bipolar person unwittingly, thinking it will be smooth sailing, says Adele Viguera, MD, a psychiatrist at the Cleveland Clinic who works with bipolar couples seeking to start a family. “Maybe they meet the person when the person is hypomanic, not realizing that mood can change,” she says.

Tim, 37, tried for three years to sustain a relationship with a woman eventually diagnosed with bipolar disorder. “She would cycle between extreme happiness and depression,” he says, recalling her paranoia, impulsiveness, and self-destructive insecurity. “She broke up with me and started dating other people, and then when I dated other people she tried to win me back.” Like many people with bipolar disorder, Tim’s girlfriend also struggled with drug and alcohol addiction and got deep into debt—with his credit card. Tim eventually broke down emotionally himself, ended the affair, and tried to forget the experience. “Half of me moved on, but half of me will always love her,” he says.

Divorce and separation are common in relationships involving bipolar disorder, but according to Dr. Viguera, such relationships don’t have to be destructive and separation is hardly inevitable. Both parties have to participate in its success, however. “Taking care of bipolar disorder is a team effort, involving the two people and a psychiatrist or other mental health professional,” she says. While she would never speak to a spouse without her patient’s consent, such open communication empowers both parties to make treatment decisions that lead to a healthier relationship.

Mental health professionals aren’t the only ones who can lend a hand. The stigma of mental illness can make couples hesitant to look elsewhere for help, but Karp emphasizes that extended family members and trusted friends can all provide invaluable support. “Spread it around a little bit,” he says. “People need support systems. By keeping the illness a secret, people place an additional burden on themselves.” Karp also recommends that anyone who cares for someone struggling with bipolar person find a support group in their area.

Bipolar marriages can work
Fred and Kristin Finn, of Grand Rapids, Mich., describe their marriage as loving and supportive, despite that fact that Kristin was diagnosed with bipolar disorder as a teenager. Their teenage daughter has also been diagnosed with the disorder.

The pillars of their success, both say, are open communication (Fred is free to reign in Kristin’s clothes spending when he thinks she is manic) and predictable schedules. Kristin says carving time out for her own sleep is crucial, as is making time for each other. “We make sure that every Friday night we set aside time for each other,” she says. “Every single Friday night he comes home from work, we turn on some music, we sit, and we talk. My family and friends know—nobody calls us during that time period. Nothing can keep us away from our Friday night, because it’s our time to connect.”

For his part, Fred says he would encourage anyone involved with a bipolar patient to educate themselves as much as they can about the disorder. You may not always like what you learn, he warns, but keeping surprises to a minimum makes your relationship easier to navigate. For example, he says, he is worried about the long-term effects of medication on Kristin’s health. And while both his daughter and his wife comply with medication and therapy, neither is symptom-free.

“No matter what you’re doing, there will be symptoms,” Fred says. “Once I learned about how the symptoms manifest themselves, once I started reading that and becoming more familiar with that, it gave me a better understanding of how to cope with these things. Getting angry because a person has bipolar disorder won’t help anything. Bipolar is treatable, medications and counseling help a great deal, but there’s still things about bipolar disorder that I don’t think I’ll ever figure out.”

This is a perfectly healthy stance to take, according to Karp. He urges people with bipolar partners to remember what he calls the “four Cs”: I can’t Control it; I didn’t Cause it; I can’t Cure it. All I can do is Cope with it.

Source: Healthwise

You can still be a great parent, despite bipolar disorder — and you may find that you’re even more motivated to keep yourself healthy.

Being bipolar doesn’t have to end your dream of becoming a parent. While it’s natural to be nervous or concerned about how well you’ll be able to parent — and whether your children will have this illness too — many people with bipolar disorder have happy, healthy children and families.

Bipolar Disorder: Parenting Challenges

Being a parent is difficult for anyone. But being a bipolar parent does come with a unique set of stressors, worries, and challenges that parents without mental illness don’t worry about.

Parenting with bipolar disorder can be “immensely challenging, but often a good motivation for patients to stay compliant with their medication,” says Adele C. Viguera, MD, a psychiatrist and the associate director of the perinatal and reproductive psychiatry program at the Cleveland Clinic in Ohio.

Getting good control of your bipolar disorder is important just to be able to function in everyday life, and even more so if you plan to be a parent. “Take care of yourself first, or else everything else goes by the wayside,” stresses Dr. Viguera.

And don’t look at your disorder as something that will prevent you from being a good parent. “Patients with bipolar disorder are perfectly fit, wonderful parents,” says Viguera. “It’s just a condition that has to be managed.”

Bipolar Disorder: Finding Support

First and foremost, you need a great support system, says Viguera. You will need help taking care of your children — all parents do. So accept that and don’t be afraid to ask for help, she adds. Ask parents, grandparents, friends, and other family members to pitch in when you need it.

Staying compliant with your medications and your doctor visits is a necessity, as well as getting good sleep, eating healthy foods, and getting regular exercise, says Viguera.

“You want to make the disease a non-issue in a way,” she says. The goal is to manage bipolar disorder so well that it’s really not a part of your day-to-day life.

Bipolar Disorder: Managing Challenges

But when you notice symptoms of depression or mania starting to surface, admit it, and seek help quickly. If you don’t, your bipolar disorder can start to affect your parenting.

“When parents are depressed, they can feel inadequate because they recognize that they’re not able to do what they’re [normally] capable of doing for their child,” says Viguera. “But I think it’s important for them to articulate that and for them to receive the assurance that it’s an episode.”

Bipolar Disorder: Start With Stability

You have to feel confident in what you can do, how stable you are, and in your support system to be an effective parent with bipolar disorder, says Jennifer Keener. This 36-year-old mother of two is bipolar. Keener, who lives outside of Cleveland, became pregnant unexpectedly after a couple of good, stable years with her disease. But she was still nervous about having a baby.

“Am I doing something that’s bad?” Keener says she kept thinking during her pregnancy. “I’m giving life to this child and I have this terrible illness — that was scary for me.” Keener’s husband is also bipolar, so she was particularly concerned about the effect that their mental illness would have on their child.

“The more I thought about it, the more I think I developed a better appreciation for life because of what I had battled and what I had overcome,” she says. “I was able to live a relatively happy life, and when I had [the baby] that gave me more purpose. I found life much more enjoyable.”

Bipolar Disorder: Worth the Effort

Keener knows that she has challenges, but doesn’t feel that having bipolar disorder makes parenting any more difficult than it is for people without this disorder. She is aware that she must take care of herself and keep her disease well managed to be the best parent that she can. And, she says, it’s well worth the effort.

“Parenting is a challenge, and if it’s something that you’ve always wanted to do and that you really want to do, I think you put a lot of effort into it,” says Keener.

What’s her advice to other people with bipolar disorder who want to become parents?

“Basically, have enough confidence in yourself and know that you’re pretty capable,” she says. “Mental illness doesn’t necessarily impair someone as much as they may think.”

By Malinda Gibbons-Gwyn

As if mood swings, mania, panic, relationship issues, and deep depression experienced by people with bipolar disorder wasn’t hard enough to bear, 56% of bipolars also have a substance abuse problem¹, which can make treatment even more difficult. 

Experts say that some bipolar patients are known to self-medicate with drugs or alcohol—though it’s not recommended. In fact, they say, it does more harm than good.

“Using drugs or alcohol is usually a complicating problem because it reduces medication compliance,” says Bryan K. Tolliver, MD, PhD, an addiction psychiatrist at the Medical University of South Carolina in Charleston. “Bipolar patients who use [alcohol or drugs] have more frequent mood swings, more hospitalizations, longer hospitalizations, and higher rates of suicide attempts.”

The drug of choice for most bipolar patients is alcohol, although cocaine, opioids, marijuana, and methamphetamines are also widely used, sometimes in combination with alcohol. Besides the self-medication hypothesis, research suggests that the impulsivity and poor judgment demonstrated by bipolar patients may predispose them to substance abuse. There is even evidence that drug or alcohol use can “unmask” bipolar symptoms in genetically vulnerable people. 

Generations of suffering
While the genetic link between bipolar disorder and substance abuse remains inconclusive, Cheryl Murphy, of Las Vegas, is sure that both burdens run in her family. Murphy, 62, once lost custody of three of her four children and has attempted suicide five times. Now sober for 25 years, she is functioning well. She is also raising her 3-year-old great-grandson because her granddaughter, who also has bipolar disorder, abuses drugs. Murphy’s great-grandson, too, was recently diagnosed with bipolar disorder. 

“We have six generations of substance abuse in my family and five generations with a mental health disorder,” she says. “They say it takes five generations to break a cycle. I am hoping I can be the power of example to them.”

A dearth of research
It’s been difficult to study the link between bipolar disorder and substance abuse because, traditionally, research on bipolar patients has screened out substance abusers, and vice versa, says Dr. Tolliver. He and other experts would like to see more research into treating patients with both problems; about 20% of people seeking treatment for a mood disorder are also substance abusers. In a 2004 study, 41% of alcohol abusers and 61% of drug abusers who sought treatment for their problem were also found to have a mood disorder such as bipolar.

Meanwhile, many bipolar patients, like Caroline, 25, may not be getting the treatment they need. Caroline has been hospitalized for a manic episode and sees a psychopharmacologist to manage her medications, which have included Seroquel, lorazepam (Ativan), divalproex (Depakote), lamotrigine (Lamictal), methylphenidate (Ritalin), Abilify, and Geodon. Currently unemployed and living in New York City, she has trouble sleeping and drinks heavily two to three nights a week.

“I can drink eight cocktails and be fine,” Caroline says. However, her psychopharmacologist is not aware of her drinking, and Caroline doesn’t plan to address it, though she is vaguely aware that she’s at risk—not only for potential drug and alcohol interactions, but also for unsafe situations. 

Three years ago she was in a bar, nearly blacked out, when a stranger attempted to lead her out the door. One of her coworkers confronted the man, who claimed to be Caroline’s brother. He left without her, but some rapes were later reported in the same area. “I dodged a bullet,” Caroline says.

Source: Healthwise

1. according to a 1990 study

If you and your doctor are not satisfied with the amount of improvement you’ve had while on an antidepressant, you’re not alone. In a three-month study of 4,000 depression patients, at least half didn’t get complete relief from the first antidepressant they tried. 

Doctors talk about a “response” to an antidepressant, which means at least some improvement, and “remission,” which means that the symptoms go away altogether. For most people, remission is a realistic goal. If one antidepressant doesn’t do the trick, your doctor may consider the following options.

• Increasing the dose of the antidepressant you’re on
• Continuing at the same dose and adding a second drug: either another antidepressant (combination therapy) or add another type of drug (augmentation therapy)
• Switching, which involves gradually stopping the first drug and starting a second
• Starting psychotherapy, if you’re not already attending sessions

When to switch antidepressants

“My hope for every patient is that major depression remits as soon as possible with few side effects,” says George I. Papakostas, MD, an assistant professor of psychiatry at Harvard Medical School. 

The three factors listed below go into his decision to call it quits with a particular drug or to continue using it and add something else.

• Tolerability: How severe are the side effects, and how much trouble are they causing?
• Time: How long have you been on medication?
• Degree of improvement: Have the depression symptoms improved in proportion to how long you’ve been on medication?

If you’ve had only a slight improvement in symptoms but the side effects are burdensome, your doctor will switch you to something else altogether. Your doctor may also recommend a total switch if you’re experiencing little or no improvement, even if side effects aren’t a problem. 

Dr. Papakostas says most psychiatrists agree that if an SSRI hasn’t worked for you, switching to an atypical antidepressant—Wellbutrin, Cymbalta, Remeron, or Effexor—may be a good idea.

Higher doses of antidepressants

If you’re doing well with an antidepressant but there’s room for improvement, increasing the dosage may be a smart move, especially if you’re not experiencing side effects. If you don’t notice a significant response after six weeks at a higher dosage, switching to another antidepressant is probably the most appropriate therapeutic intervention, says Kenneth Robbins, MD, clinical associate professor of psychiatry at the University of Wisconsin–Madison.

Adding another drug to the one you’re already taking may also help.

Some of the medications doctors may prescribe include Wellbutrin, lithium, thyroid hormone, or Provigil.

Depending on a patient’s exact diagnosis and tolerance for side effects, doctors sometimes prescribe an atypical antipsychotic, a class of drugs used in bipolar disorder and schizophrenia that includes olanzapine (Zyprexa), risperidone (Risperdal), clozapine (Clozaril), and quetiapine (Seroquel).

Mounting evidence suggests that these drugs may boost the effectiveness of antidepressants. Some of the drugs in this category, such as aripiprazole (Abilify) and quetiapine (Seroquel XR), have been approved as add-on treatments for people already taking antidepressants, whereas olanzapine (Zyprexa) is approved specifically for use in combination with fluoxetine (Prozac), which can be taken in a combo pill called Symbyax.

Doctors prescribe other atypical antipsychotics—such as risperidone (Risperdal) and clozapine (Clozaril)—off-label, meaning the U.S. Food and Drug Administration (FDA) has not approved the drugs for depression.

When not to quit antidepressants
Patients who want to stop taking antidepressants should do so gradually, with their doctor or psychologist’s guidance. However, fear of suicidal tendencies and fear of addiction should not be factors.

News reports have linked antidepressant use to a higher risk of suicide, but the research actually shows the drugs may increase thoughts of suicide. No studies have linked the medications to the act itself. A far greater number of patients experience a decrease in thoughts of suicide. And only 1% to 4% of patients—children and adults—appear to be at risk. “Of the patients we see, 30% to 40% have already thought about suicide before they even get treatment,” says Maurizio Fava, MD, professor of psychiatry at Harvard Medical School. Dr. Papakostas says numbers like these suggest that getting proper treatment for depression is far more likely to prevent suicide attempts than increase them.

For people concerned about becoming dependent on antidepressants, relax. According to Dr. Papakostas, abruptly stopping antidepressants can result in discontinuation symptoms (such as nausea, insomnia, and agitation) for a week or two, but most patients are able to ease off the drugs gradually without suffering from withdrawal.

Source: health.com

As recently as 10 years ago, doctors advised women with bipolar disorder not to have children. While that thinking is now dated, bipolar women often face tough decisions about how to handle their medication during pregnancy. 

Most drugs prescribed for bipolar disorder carry some risk of birth defects, yet women who discontinue medication risk relapsing into a manic or depressive episode; during the postpartum phase the relapse rate is as high as 50% to 70%, by some estimates. Even more alarming, bipolar women are 100 times more likely than other women to experience postpartum psychosis, a severe mood disorder that, at its very worst, can result in infanticide.

Sally, 37, started taking lithium after a severe manic episode seven years ago. She eventually switched to other drugs, but in 2007 she stopped her medication altogether when she learned that she was pregnant.

The pregnancy was uneventful. Her daughter, Stella, did arrive six weeks early, but after 21 days in the hospital Stella was finally at home and thriving. 

Sally, meanwhile, was falling apart. “I was extremely hyperactive,” she says. “I was going a million miles an hour.” Everyone had told her, “When the baby sleeps, you sleep”—but she couldn’t rest. While Stella napped, Sally would clean her Jackson, N.J., home yet again, wiping down doorknobs and light switches. She baked blueberry cobbler at 6 a.m. and pulled weeds into the night. 

Though she had restarted her meds the day she gave birth to Stella, after a string of sleepless nights several months later Sally finally realized that lithium was the only thing that would bring her back to her senses. And it did. 

Yet Sally continued to have doubts that she was strong enough to be a mother. These are doubts that many women with bipolar disorder share. 

Say no to drugs?
Two years ago, Meredith, 26, of Dix Hills, N.Y., was diagnosed with bipolar disorder and began taking lithium. Now she is planning her wedding and, each night, takes a cocktail of mood stabilizers, antidepressants, and antipsychotics: lithium, Abilify, propranolol (Inderal), and escitalopram (Lexapro). “I was grateful for the lithium at first,” she says. “But then I was like, ‘There go all my options for having kids.’” 

When it was first approved by the FDA in 1970, lithium was believed to cause heart-valve defects in an extremely high percentage of infants born to mothers who were on the drug (about 1 in 50). Decades later, new research has downgraded the risk, to about 1 in 1,000 to 2,000.

Bipolar medications aren’t considered as risky during pregnancy as they once were, but they aren’t exactly harmless either. According to the FDA’s letter-grade system for drug safety during pregnancy, most psychotropic drugs pose a potential risk to the fetus. Studies have found that the anticonvulsants valproic acid (Depakote) and carbemazepine (Tegretol) can cause birth defects ranging from physical deformities to spina bifida, for instance, while some research suggests that another anticonvulsant, lamotrigine, may carry an increased risk of cleft palate.

The risk of birth defects is small, yet the decision to stop taking medication is common, even among women with severe psychiatric illness. Last year, after she got engaged, and after consulting her psychiatrist, Meredith decided to start tapering off lithium. “I, personally, would like to not be on any medication,” she says, when considering a future pregnancy. “I just don’t want to take any chances.” 

Should bipolar women discontinue their medication? According to reproductive psychiatrist Catherine Birndorf, MD, the founding director of the Payne Whitney Women’s Program at New York Presbyterian Hospital, “There’s not just one answer.” The severity of bipolar disorder varies widely from person to person, and for this reason it’s difficult to standardize care for pregnant women with the disorder, Dr. Birndorf explains. “Each case must be considered on an individual basis,” she says. 

But what many of Dr. Bindorf’s patients do not initially realize is that untreated illness—and not just medication—can be risky. According to a 2007 study in the American Journal of Psychiatry, women who discontinued mood stabilizers during pregnancy spent over 40% of their pregnancy in an “illness episode.” And research suggests that the effects of maternal depression on the fetus can lead to complications both during and after pregnancy. 

Still, many bipolar women believe they have to stop taking all of their medications for the sake of their child—and often psychiatrists or OB/GYNs steer women away from medication, according to Margaret Spinelli, MD, director of the Women’s Program in Psychiatry at Columbia University. 

“I hope that women will come to a perinatal psychiatrist to get an evaluation,” says Dr. Spinelli. “Because they can become so ill. And the problem is that if they become really ill during the pregnancy off the medication, it may take a lot more medication to stabilize them.” 

Postpartum planning
A complication-free pregnancy with or without medication doesn’t mean a woman is in the clear. For any bipolar mother, the trickiest time is not the pregnancy itself but the postpartum period. 

Postpartum difficulties are not limited to bipolar women, of course. Many women experience the crying episodes known as the “baby blues,” and an estimated 10% of women go through a more severe postpartum depression. Women with bipolar disorder are at much higher risk, however; postpartum psychosis—which is believed to be a form of bipolar disorder—occurs in as many as 25% to 50% of deliveries. 

While postpartum psychosis is a serious risk, it’s a risk that can be treated, and often prevented, with medication. It’s extremely important for a woman with bipolar disorder to have a plan in place with her family and her doctors in the event that she does become psychotic, says Dr. Spinelli. Due to the high risk of psychosis, bipolar women should “really start medicines at least before they deliver,” she adds. 

As the field of perinatal psychiatry grows, many bipolar women are choosing to stay on medications to avoid any chance of postpartum psychosis or manic episodes. “I’d heard so many horror stories of people harming the baby,” says Michele Noll, 37, of Atlanta, who has delivered two healthy babies while taking mood stabilizers. 

“I did not have mood swings,” Noll says of her pregnancy and postpartum period. “Nobody even knew I was bipolar.”

Breast-feeding presents another challenge. Even though some medications are safe while nursing, feeding a baby requires waking up often throughout the night. And in people with bipolar disorder, sleep deprivation can trigger a manic episode. 

Shanun Carey, 25, of Manchester, N.H., became so manic while breast-feeding that she was “bouncing off the walls,” eventually volunteering to clean her neighbors’ apartments to burn off excess energy. When her daughter was six months old, Carey realized she had to stop breast-feeding to get healthy again; she switched to formula so she could resume her medications and a regular sleep schedule. 

Formula isn’t the only solution. Rachael Bender, 30, of Naples, Fla., who writes a blog called My Bipolar Pregnancy, realized that losing sleep would be a huge challenge in trying to breast-feed. But she did want to try, so she and her husband worked out a system when her daughter was an infant. To save Bender from getting the baby up and back to sleep, her husband slept in the guest room, next to the bassinet, and brought the baby in to Bender when the baby was hungry. “The hardest thing about the whole pregnancy,” Bender says, “was the sleep after she was born.” 

The next generation
Sally, who lapsed into depression after the lithium got her mania under control, still struggles with the ups and downs of bipolar disorder. Because she is committed to being a great parent to Stella, she has made what she says is the most difficult decision of her life. 

“Absolutely, I will not have another baby,” Sally says, acknowledging that no matter how many times her healthy daughter kisses her, or her husband tells her she’s a wonderful mother, she still has doubts related to her bipolar disorder and the amount of attention it requires. “I want to be the best mother I can be, and if I had two children I’d worry that I was spreading myself too thin,” she says. 

Meredith knows that pregnancy will be “a difficult time,” and people have already questioned her decision to have children; a family friend even told her that it would be a “heartache” for her if she did have a child with bipolar disorder. Bipolar disorder does tend to run in families: Studies show that a person is 10 times more likely to develop the disorder if a parent is bipolar. 

None of this has swayed Meredith’s desire to be a mother. 

“I’m not going to not have a child because I’m afraid they’re going to be bipolar,” says Meredith. “I’ve seen so many wonderful things and I’ve done so many wonderful things, and I plan to do a lot more. My kid will have a better life than a lot of kids out there. This isn’t going to stop me.”

By Michele Hoos

Teaching your child tolerance not only makes moral sense, but will also help him to be adaptable in the modern world. In this era of rapid globalization, it is likely that your child will grow up to interact and do business with people from vastly different cultures from different corners of the world. If your child demonstrates a genuine respect and comfort with diversity, it will likely expand his opportunities and success in life. But tolerance is not simply “tolerating” differences among people, but refers to a broad respect and appreciation of diversity. The following strategies teach children to value difference, and not fear it. 

It is OK to talk about differences.
Tolerance is not about pretending everybody is the same. Teach your child that it is OK to recognize and discuss differences. People have different beliefs, look differently, and have different customs. These differences aren’t good or bad, per se, they are simply different. Curiosity is fine as long it is accompanied by an attitude of respect. 

Expose your child to diversity.
Perhaps the best way to develop an appreciation of diversity is through exposure. Whether it is through school, an extracurricular activity or travel, expose your children to different kinds of people. Be positive about cross cultural interactions and friendships.

Bear witness to the commonalities of the human condition.
People from all cultures have families, care for children, work hard, and exhibit kindness and loyalty. So while people vary tremendously in terms of beliefs, culture and traditions there is an underlying humanity which unites us all. Look for points of connection on this deeper level, and discuss them with your children.

Get to Know Individuals
While it is OK to acknowledge cultural differences, reject rigid stereotypes. Get to know people from other cultures or groups as individuals. Recognize that there is tremendous variation within any group, and don’t be presumptuous about what people are like or what they value. Let the person show you who they are, just as you would with someone within your own culture.

Educate yourself and your children.
Learn about other cultures, lifestyles, and religions. This can be done through travel, movies, books and food, or simply by having your culturally different neighbors to dinner.

Model tolerance.
Long before you introduce your child to the concept of tolerance, your child will be watching your interactions with the world. Do you stick with your own kind or do you interact with and befriend people from diverse backgrounds? Do you demonstrate fear or reticence around people who look differently, have a different religion, or different sexual orientation? Do you get to know people for who they are, and reject stereotypes?

By Cindy Jett, LICSW

Many of us who deal with having a mental illness have a hard time managing stress. We often turn to unhealthy habits, such as smoking, substance abuse, self-injury, or other negative coping skills, to deal with problems and stressful situations.

Source: Clearview Women’s Center

Dialectical behavior therapy (DBT) is a system of therapy originally developed by Marsha M. Linehan, a psychology researcher at the University of Washington, to treat persons with borderline personality disorder (BPD) . DBT combines standard cognitive-behavioral techniques for emotion regulation and reality-testing with concepts of distress tolerance, acceptance, and mindful awareness largely derived from Buddhist meditative practice. DBT may be the first therapy that has been experimentally demonstrated to be generally effective in treating BPD. Research indicates that DBT is also effective in treating patients who present varied symptoms and behaviors associated with spectrum mood disorders, including self-injury. Recent work suggests its effectiveness with sexual abuse survivors and chemical dependency.

Linehan observed “burn-out” in therapists after coping with non-motivated patients who repudiated co-operation in successful treatment. Her first core insight was to recognize that the chronically suicidal patients she studied had been raised in profoundly invalidating environments and therefore required a climate of unconditional acceptance (not Carl Rogers’ humanistically “positive” version, but Thich Nhat Hanh’s metaphysically neutral one) in which to develop a successful therapeutic alliance. Her second insight involved the need for a commensurate commitment from patients, who needed to be willing to accept their dire level of emotional dysfunction.

DBT strives to have the patient view the therapist as an ally rather than an adversary, in the treatment of psychological issues. Accordingly, in DBT the therapist aims to accept and validate the client’s feelings at any given time while nonetheless informing the client that some feelings and behaviors are maladaptive, and showing them better alternatives.

Linehan and others combined a commitment to the core conditions of acceptance and change through the Hegelian principle of dialectical progress (in which thesis + antithesis ? synthesis) and assembled an array of skills for emotional self-regulation drawn from Western psychological traditions (e.g., cognitive behavioral therapy and an interpersonal variant, “assertiveness training”) and Eastern meditative traditions (e.g., Buddhist mindfulness meditation). Arguably her most significant contribution was to alter the adversarial nature of the therapist/client relationship in favor of an alliance based on intersubjective tough love.

All DBT can be said to involve two components:

An individual component in which the therapist and patient discuss issues that come up during the week, recorded on diary cards, and follow a treatment target hierarchy. Self-injurious and suicidal behaviors take first priority. Second in priority are behaviors which while not directly harmful to self or others, interfere with the course of treatment. These behavors are known as therapy-interfering behaviors. Third in priority are quality of life issues and working towards improving one’s life generally. During the individual therapy, the therapist and patient work towards improving skill use. Often, a skills group is discussed and obstacles to acting skillfully are addressed.

A group component in which the group ordinarily meets once weekly for two to two-and-a-half hours and learns to use specific skills that are broken down into four modules: core mindfulness skills, interpersonal effectiveness skills, emotion regulation skills, and distress tolerance skills.

Neither component is used by itself; the individual component is considered necessary to keep suicidal urges or uncontrolled emotional issues from disrupting group sessions, while the group sessions teach the skills unique to DBT, and also provide practice with regulating emotions and behavior in a social context.

If you’re trying to get in shape this season, utilizing this list could be a big help. Running, in short, can suck at times. This is especially true if you’ve just started up or are getting back on a running schedule. When you’re ready for a run these tunes will help you make the most of every mile because they have just the right energy, beat, emotion, rhythm and urgency that focus you mentally and give you that extra bit of adrenaline you need to finish your workout strong.

1. “Enter Sandman” by Metallica

2. “Born to Run” by Bruce Springsteen

3. “Satisfaction” by The Rolling Stones

4. “Bad to the Bone” by George Thorogood & the Destroyers

5. “Runnin’ with the Devil” by Van Halen

6. “Back in Black” by AC/DC

7. “Born to be Wild” by Steppenwolf

8. “Eye of the Tiger” by Survivor

9. “Welcome to the Jungle” by Guns N’ Roses

10. “We Are the Champions” by Queen

11. “Heartbreaker” by Led Zeppelin

12. “Alive” by Pearl Jam

13. “You’re the Best” by Joe Esposito

14. “Lose Yourself” by Eminem

15. “Harder, Faster, Stronger” by Kanye West

16. “Rock and Roll” by Led Zeppelin

17. “Start Me Up” by The Rolling Stones

18. “Sweet Home Alabama” by Lynyrd Skynyrd

19. “Break on Through (to the Other Side) by The Doors

20. “Riot” by Three Days Grace

21. “Thunder Kiss ’65″ by Rob Zombie

22. “Shake Ya Tail Feathers” by Nelly

23. “The Bone” by Insane Clown Posse

24. “Tubthumping” by Chumbawumba

25. “Move Your Body” by My Darkest Days

by Jennifer Steele