Bipolar disorder is a mental health condition that has an impact on an individual’s mood states, leading to episodes of depression as well as mania, which can include abnormally elevated mood states of euphoria and heightened energy that disrupt basic functioning and judgement.
Managing bipolar disorder over the course of the COVID-19 pandemic may be impacted by lockdown measures and changing safety regulations.
Dr. Ayal Schaffer, head of the Mood and Anxiety Disorders Program at Sunnybrook, board member of the Canadian Network for Mood and Anxiety Treatments, and past vice president of education for the International Society for Bipolar Disorders, shares insight on bipolar disorder during the pandemic and what individuals can do to help manage the disorder.
How are patients with bipolar disorder being affected by the COVID-19 pandemic?
Dr. Schaffer: The pandemic has had a worldwide impact on family and social connections, work, life, finances, as well as individuals’ physical and mental health.
For individuals with bipolar disorder, along with their caregivers, these disruptions may lead to changes in much-needed daily structure routine, treatment, access to resources and social connections. It can be difficult to adapt to such drastic changes and cause additional stress in many ways.
However, I have found that the vast majority of my patients have shown tremendous resilience during the pandemic. Perhaps this is related to years of needing to develop coping strategies to manage the adversities and challenges associated with having a mood disorder. There has also been an emotional “coming together” effect, with nearly everyone in society sharing some of the more difficult elements of the pandemic. In some ways, patients with bipolar disorder are “experts by experience” in dealing with difficult times, and I remain so impressed with their fortitude during the pandemic.
What are some coping strategies that can help individuals with bipolar disorder as the pandemic continues?
Dr. Schaffer: People with bipolar disorder can be exquisitely sensitive to changes in the rhythms of life – whether they be seasonal changes, changes in circadian rhythms as a result of shift work, or travel across time zones. There is, in fact, a specific type of psychotherapy called social rhythm therapy that has been specifically developed to help people with bipolar disorder stabilize their daily cycles. So, as I noted earlier, patients with bipolar disorder may have extra knowledge and experience in how to maintain a healthy schedule, something that is so important for everyone during the pandemic.
Establishing a routine each day can help provide structure when external factors continue to change. This can involve going to bed and waking up at routine times, which can improve healthy sleeping habits.
Being physically active can also help relieve stress and anxiety, and boost more positive emotions. This can be as simple as going for a walk in the neighbourhood or trying exercise options online.
Now that spring has arrived, getting a healthy dose of natural light, ideally before noon, is also important to maintaining healthy biological rhythms. Spending time outside every day and staying connected with friends and family online or on the phone can be helpful strategies.
The notion of behavioural activation has also been shown to be helpful to improve mood and stabilize mental health. Structuring the day to include one physical activity, one social activity and one cognitive activity (i.e. spending 20 minutes reading), ideally all before noon, can go a long way. The pandemic might make this more challenging, but it’s a good goal to maintain.
Finally, making arrangements to maintain therapy through virtual sessions with your mental health-care provider can also be helpful. Continuing to take medication as it is prescribed and maintaining consistency is also an important part of treatment.
What are some signs that it is time to seek additional help and support from their health-care team?
Dr. Schaffer: Anyone with bipolar disorder who is experiencing symptoms of their illness should be monitored by their health-care team. While virtual appointments may not feel the same as traditional appointments, they can be helpful for quick check-ins, and in some cases, may be even more convenient.
There are many ways friends and family can help their loved one with bipolar disorder. It is also important for caregivers to take care of themselves. Individuals with bipolar disorder and their families may find it helpful to read the latest international resource on the disorder, which was created with support from experts in Sunnybrook’s Department of Psychiatry along with the department’s Patient and Family Advisory Council (PFAC). The Patient and Family Guide to the CANMAT and ISBD Guidelines on the Management of Bipolar Disorder provides patients and families with information about up-to-date evidence-based treatments available for bipolar disorder and the importance of collaboration between patients, families and their health-care teams.
If an individual is in crisis and has expressed that they have had thoughts of suicide or are contemplating suicide, please call 911 or visit your local emergency department. Help is also available through community resources. There are also crisis resources listed below.
If you need help in an emergency please call 911 or visit your local emergency department.
If you’re feeling like you’re in crisis or need somebody to talk to, please know that help is also available through community resources: