“It was really scary,” she says. “It was totally new to my family. There’s no history [of bipolar disorder] in the family, so we were just fully listening to the professionals because we really did not know what we were doing.”

Cassie was later transferred to Sunnybrook. In addition to medication, doctors recommended she participate in regular therapy sessions, but the thought made her feel uncomfortable.

“At the time, I think it was just the stigma around therapy,” she says. “I didn’t want to feel like I was different from the rest of the girls in my house [at university]. I felt like I didn’t need therapy.”

One year later, though, and she says she can’t imagine not continuing with it.

“It’s become something I look forward to doing,” she says. “It’s totally non-judgemental, [the therapist] is listening to what you have to say. Even if sometimes it’s not giving you the solution to everything, it’s nice to be able to share what I’m going through and let it out to someone.”

Dr. Rachel Mitchell, a child and adolescent psychiatrist at Sunnybrook, says evidence shows that a strong relationship between therapist and patient, the “therapeutic alliance,” is key to making talk therapy successful.

“Regardless of the type of therapy, or the focus of the session, the relationship with the therapist is one of the most therapeutic aspects of the treatment,” she says. “It’s the support from that relationship. The stronger the alliance, the better it is.”

Cassie says one of the ways she’s seen a difference in her life since starting therapy is in how she handles tough emotions. She gives the example of selecting her courses for the beginning of her second year and not being able to get the ones she wanted. It was a frustrating experience for her, but she was able to handle it using some tools she’d learned in therapy.

“After emailing the person I needed to talk to, I went for a walk rather than getting very frustrated in front of my computer and freaking out,” she says. “Taking some deep breaths, realizing some things aren’t in my control, and that it will work out helped me manage how I was feeling.”

She says it’s a recognizable change from how she would have handled it before entering therapy, and she’s seeing changes in many aspects of her life.

“I’ve gained the confidence of just being me,” Cassie says.

Dr. Mitchell says while the thought of therapy might be uncomfortable, almost everyone can benefit from it.

“Therapy is an opportunity to learn about yourself,” she says. “So much of the time people feel alone and don’t feel like they have the support they need. Speaking with a mental health care professional can help individuals feel supported, and learn how to manage their emotions and cope during difficult times.”

Cassie says for someone who is new to therapy, or considering it for the first time, it’s important not to expect everything to feel better immediately, but to try and stay positive.

“Trust the process,” she says. “It’s okay to sit with those hard emotions because they will pass. Keep working at it. Things can get better, even when it totally feels like it will not.”

Dr. Mitchell says it’s important to expect therapy to be challenging.

“Therapy is hard work. You’re not going to want to go some days. But if you stick with it and stay committed, therapy can be helpful,” she says. “Sort of like exercise, you’ll feel better after you do it.”

For Cassie, her continued work in therapy, and following her doctor’s guidance for medication, is paying off.

“It’s the best I’ve been in a long time. I feel like things have just been coming into place,” she says. “I feel happy and settled and ready to just get back into the swing of things.”

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:

• Find a local crisis resource at ca/gethelp
• Crisis Services Canada
  • Phone: 24-hour, toll-free 1-833-456-4566
  • Text: 45645 (4:00 p.m. – midnight Eastern Time)

The post Finding the confidence to be me: how talk therapy helped Cassie King manage bipolar disorder appeared first on Your Health Matters.

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.

Mental health resources for coping during COVID-19 from Sunnybrook experts.

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:

• Find a local crisis resource at sunnybrook.ca/gethelp
• Crisis Services Canada
  • Phone: 24-hour, toll-free 1-833-456-4566
  • Text: 45645 (4:00 pm – midnight Eastern Time)

The post Bipolar disorder and COVID-19 appeared first on Your Health Matters.

Although the cause of Carrie Fisher’s death was reportedly a massive heart attack, one could say that she actually died of bipolar disorder. It is well known that heart disease is society’s leading killer. In contrast, it is largely unrecognized that people with bipolar disorder are at particularly high risk of heart disease. Shining a light on the heart-bipolar connection serves a number of important parallel purposes, including the promotion of assertive approaches to optimizing heart health, reducing the ongoing stigma toward bipolar disorder and other forms of mental illness, and encouraging further research efforts on this topic.

Carrie Fisher was not only a luminary artist, she was also a luminary advocate for mental health, focusing especially on bipolar disorder, a condition from which she suffered. Because of Ms. Fisher’s profession and talents, hers is an epic and singular story that has and will continue to touch the world for many years. But hers is also a typical story, albeit tragically so, of a young woman who experienced the onset of bipolar disorder early in life, who survived decades of the effects of bipolar disorder on her mind and brain, and who, it could be said, was ultimately felled by the impact of bipolar disorder on her heart.

Based on the most recent data from the United States general population, not only are people with bipolar disorder more likely to have heart disease, they also experience heart disease up to 17 years earlier, on average, than people who do not suffer from mood disorders. A sixty year-old woman with bipolar disorder may have the heart of a mentally healthy woman in her late seventies. The extent to which bipolar disorder increases and accelerates the risk of heart disease exceeds what can be explained by smoking, drug and alcohol use, sedentary lifestyle, nutrition, physical side effects of psychiatric medications, and even traditional heart disease risk factors such as high blood pressure and obesity. All of these factors are particularly common among people with bipolar disorder, but they are only part of the story.

Almost certainly, the distress caused by the symptoms of bipolar disorder, alongside the stress caused by the impact of those symptoms on people’s lives, contributes in part to elevated heart disease risk. There are a number of biological processes that could form the heart-bipolar bridge, including elevated levels of inflammatory markers, which have been shown to coincide with the episodes of mania and depression that define bipolar disorder and which increase the risk of heart disease.

Studies have also found evidence of poor blood vessel health among people with bipolar disorder, in the brain as well as the body. The scientific literature on this topic is so compelling, and yet so under-recognized, that a recent scientific statement from the American Heart Association positioned bipolar disorder (as well as major depressive disorder) among youth as a risk factor for early heart disease.

It is worth noting that among teenagers, bipolar disorder is twice as common among girls than boys. It is also worth noting that the extent of increased risk of heart disease attributable to bipolar disorder is even greater for females than it is for males. In losing Carrie Fisher, the world has lost a warrior princess who gifted us with valiant efforts both on and off the screen. As we each consider the ways in which we will honor her memory, let us consider all of the young warrior princesses (and princes) with bipolar disorder for whom the prospects of a long and healthy life rest on early and assertive approaches to heart health.

The post The princess at the heart of bipolar disorder appeared first on Your Health Matters.