DON’T TAKE THE BAD DRUGS. Roughly 60% of individuals with bipolar disorder will have a problem with alcohol or other drugs during their lifetime.  It is important to use no street drugs at all, and to be very careful with alcohol, and this is particularly true during manic or depressive episodes.

LEARN TO MONITOR THE ILLNESS. Recognizing episodes early (and having a plan for how to deal with them) can help to prevent full relapse, especially for mania.  Changes in sleep (a change of more than 3 hours in bed) are a particularly important sign to monitor.  It is also useful to record symptom levels on a daily basis, to help evaluate how well treatment is working.  You can download a treatment contract for relapse prevention and a daily mood chart at manicdepressive.org.

GOOD SLEEP HYGEINE. Changes in sleep are not only an important symptom of the mood swings, but are also a cause of the mood swings.  Missing sleep (especially less than 5 hours a night) can trigger mania or hypomania.  Remember, sleep debt is cumulative.

BALANCE ACTIVITY LEVELS. During mania, one tends to be over active, and to seek out stimulating activities, like partying, using alcohol or drugs, spending money and sex.  Avoiding stimulating activities may prevent the mood swing from escalating.  Likewise, when depressed, one may struggle just to get out of bed.  Forcing yourself to function and be active is good.  Physical exercise, social activity, and activities which are intrinsically enjoyable tend to be antidepressant.

MONEY MANAGEMENT. It is often a good idea to plan to give credit cards, debit cards, checkbooks, and perhaps car keys to a trusted individual in the beginning of manic swings.  Setting a rule not to make a major decision in an abnormal mood state without clearing them with a trusted individual is also often a good idea.  Of course, being careful with money is a good idea in any mood state, since debt is a risk factor for depression.

SEXUAL IMPULSIVITY can be a problem, since mania directly increases both impulsivity and sexual drive.  Avoiding being in situations that would later be regretted is smart.  Birth control is an important consideration at all times. Lithium, Tegretol, Trileptal and Depakote are all associated with birth defects.  Tegrelol, and to a lesser extent, Trileptal, can decrease the blood levels of contraceptives, so the doses may need to be increased.

COGNITIVE THERAPY has been shown to be effective in both unipolar depression and bipolar disorder, and it is effective in self-help versions.  Two resources are the book Feeling Good: The New Mood Therapy by Dr. David Burns (this is research tested), and the computerized cognitive therapy, such as is provided free on the website livinglifetothefull.org.

SOCIAL SUPPORT.  This has both positive and negative aspects.  Both imitate relationships and casual friendships protect against depression.  High “expressed emotion” relationships with high levels of criticism or over protectiveness are a risk factor, and family counseling may be useful for this.