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This is the most important lesson I have learned. I know of no case where a person with bipolar disorder has been successful in long-term stability without medication. In fact, I know of several cases where loved ones were lost to suicide because they went off their medication. In my own case, this was a hard lesson to learn, as I found out that every time I went off my medication, I went into an episode. Now I am religious about taking it every day.

2. H.A.L.T.
Never get too:
This is a reliable, easy to do, self-check method to keep yourself from going into an episode. Any time you feel a little "off balance," or "off center," check to see if you are experiencing any of these things, and take care of it. I have usually found that when I do that, I am at least one of these things (usually 2 or even 3), and when I meet that need, I feel much better.

Even though this is one of the items in the HALT self-check method, it is so important as to be a lesson itself, right up there in importance with taking your medication. In virtually every case of a manic episode, it has begun with losing sleep. In fact, one of the checklist symptoms of having bipolar is the decreased need for sleep. Although the hours needed for sleep is different for each person, it is absolutely crucial to maintain an adequate amount of sleep every night to maintain stability.

Although medication and sleep are crucial for stability, and people have been able to avoid episodes with just those two things in place, the best and longest periods of stability have been achieved by also having a good treatment team in place as well. The best treatment team consists of a primary care physician, a psychiatrist, and a therapist or other type of professional counselor, who follow you on a long-term basis. I even include my pharmacist as part of my treatment team, having kept the same one for the past 3 years, so that he is familiar with me, my disorder, and all my medications, whether psychiatric or medical. This way, when a new one is added, he will warn me of any possible drug interactions with medications I am already taking, as well as any side effects of a new medication.

Unfortunately, this is only learned by trial and error, and over time, as you learn your triggers by having had episodes in the past and discovering what led up to them. In my own case I now know that indisputably, even going one night without sleep is an absolute trigger to an episode. The same with not taking my medication-I might get away with it for a couple days, but any more than that, and an episode is inevitable. Another trigger in my case is getting "too excited". I have to watch myself, and keep myself from getting that way as, in my case, that leads to mania. Also, in my case, doing too much leads to feeling overwhelmed, and that feeling of being overwhelmed triggers a depressive episode. Triggers are different for different people, but loss of sleep, stress, fear, anger, overdoing things, and getting "too excited" are examples of triggers to watch out for.

Unfortunately, there is no cure for bipolar disorder. But bipolar is controllable. People who suffer from the disorder have been able to go many years without an episode. My mother, who also has bipolar, has not had an episode for 8 years now. How has she done it? By taking her medication religiously, always getting the right amount of sleep, having a good treatment team in place, avoiding her triggers, etc. Basically, by doing all the things I have listed in this "Lessons Learned" article. These are not difficult things to do, but you do have to put forth the effort to do them on a consistent basis, however much you hate to sometimes.

Although I was diagnosed with bipolar only 3 years ago, looking back I can see that I probably had the disorder all my life. All I know was that I never felt "normal," always felt a little out of sync with the rest of the world-and, especially since being diagnosed, all I've ever wanted was to be normal. I envied everyone else, who seemed so much more capable of handling stress, of dealing with the daily ups and downs that were crises to me. That changed for me, however, when my sister committed suicide because of not taking her bipolar medication. I attended a Survivors of Suicide meeting not too long ago, and expressed in that meeting that I just wanted things to be normal again (implying that they had been normal before, forgetting for a moment that they actually never had been normal for me). Someone said, "Things will never be the same again. You will have to find a new normal." A new normal. It made me think. And it showed me a way to apply it to my bipolar. What is normal for a person with bipolar? It is different for each one of us. We cannot compare our normal with someone who does not suffer from mental illness. What we can do is accept our normal for what it is, and accept ourselves for who we are.

Sometimes we get so caught up in the daily struggles of coping with bipolar that we neglect ourselves, our needs, and even our hopes and dreams. Yes, we have the same right as anyone else to dream! And the same chance as anyone else to achieve our dreams! We are not "less than," or "not as good as," or "damaged goods." We are not broken people, we just have broken brains. Be good to yourself-give yourself the same breaks that you would give anyone else. Be kind to yourself-do things for yourself that you would do for a friend. Take care of your needs-do not neglect them.

You need to speak up for yourself. You are your own advocate. You cannot expect your doctor, or anyone else on your treatment team, to be able to read your mind. They only know what you tell them. If you are on a new medication, and you are feeling "funny," you need to call and tell your doctor or psychiatrist. If you are feeling as though you may be cycling into an episode, you need to tell your psychiatrist or therapist. It may be necessary to change the dosage of your medication, or to change medications. Only you know what is happening inside you, and you need to speak up. You need to speak up when you are out of medication, also. Never, never, go without medication for any reason.

Although there is help for you in controlling your bipolar, when all is said and done, long term stability is ultimately your own responsibility. It is up to you to take your medications. It is up to you to self-check using HALT. It is up to you to get the right amount of sleep. It is up to you to put a good treatment team together. It is up to you to know your triggers and avoid them. It is up to you to accept who you are. It is up to you to be good to yourself and to take care of yourself and your needs. It is up to you to speak up for yourself and to communicate with your psychiatrist and treatment team when something is not right. It is up to you to keep your bipolar under control.

Although I am not a doctor or psychiatrist, and cannot guarantee that if you follow these lessons learned that you will never have another bipolar episode, I can assure you that if you do, you stand a better chance of long-term stability than if you don't.

About the Author

Michele Soloway has dealt with bipolar disorder from a very young age. Her grandmother, mother, brother, herself, and her teenage son all have the disorder. She also lost her sister to suicide because of bipolar disorder. Michele has a blog for bipolar survivors at, and is also a contributing writer to and

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