As some of my readers may know, I was diagnosed with Bipolar 2 on March 15th 2021 and have had my medication treatment plan changed by being tapered off antidepressants and changed to Lithium. Before taking the Lithium, I did lots of research into the drug and the potential side effects. I also tried to find information online about individuals who had started lithium therapy but I found very little. I thought it might be useful if I presented my own experiences of starting on lithium so that others who commence treatment can at least learn a little about the process.
What is lithium?
I’m not going to go into a huge amount of detail here because there’s plenty of information online (such as NHS, MIND and NICE) but basically lithium is a naturally occurring mineral which is used as a mood stabiliser mainly used to treat symptoms of Bipolar disorder including mania, hypomania and recurrent depression.
Before taking lithium
When I was initially offered Lithium, I was asked questions about my diet, including how much alcohol I consumed on a weekly basis. This is because the medical staff need to make sure that you are not on a low sodium diet as this can cause excessively high lithium levels when you start your treatment. Other basic checks were performed including height and weight to establish BMI.
Following my appointment with the Community Psychiatric Nurse (CPN) and a virtual consultation with the Psychiatrist (due to COVID) I was advised to begin tapering off my antidepressants. I reduced from 40mg to 20mg of Citalopram straight away, coming off the tablets completely and then reduced my Mirtazapine from 45mg to 30mg and then down to 15mg, tapering the dose every two weeks. I’m still taking the Mirtazapine 15mg at the moment and can’t wait to be done with them as they’re making me very tired.
The Psychiatrist provided me a weblink to read up on Lithium therapy and whilst reading from this site and other resources, I learnt about a purple booklet that was available which included a lithium alert card to carry in my purse. I was advised that the card is useful in case of a medical emergency so as to inform medical staff that you are a lithium user so that you can be treated appropriately. The booklet also provides a good overview of treatment, side effects and precautions.
As soon as an appointment was available (I managed to get a cancellation two weeks after my diagnosis), I had my initial checks. This included taking my blood pressure, having an ECG and blood tests. The blood tests check your kidneys and thyroid and these, combined with the ECG and blood pressure tests make sure your body is working as it should be. This also provides a baseline so the doctor can see if the lithium is causing any issues.
The first week
I was contacted by Mental Health Services to collect my first prescription a few days after my blood tests. This script was for two weeks on a starting dose of 400mg and was for Lithium Carbonate MR (modified release). I was advised on the exact days I could take the very first tablet and was given a window of several hours (8-10pm) in which to take the medication. I decided to wait until the Sunday night (as oppose to taking them on Saturday) as I had read that a common side effect was sickness or diarrhoea and my husband and I wanted to go out for the day on the Sunday. This was a wise move as I did have tummy troubles for about five days after beginning treatment.
Tip: I recommend setting an alarm on your phone to remind you to take your medication. Mine is set for 9.30pm and I take my tablet as close to this time as possible. If you forget to take your Lithium or you take it late, it can cause problems so this is best avoided.
My first blood test was on the Friday following the first dose so I had taken the medication for five days. I also had my blood pressure taken and my weight. The nurse then had a series of questions for me checking for side effects. The only one I had initially was diarrhoea. They also found that I’d put on a little weight which is apparently very common with lithium use.
Week 2 – further side effects
When you have started Lithium, you have a blood test each week. Mine was exactly a week after the first one at the precise time of 10.10am as you need to have taken the last dose at least 12 hours before bloods are taken. Again, questions were asked to ascertain any issues and this time I still had problems with diarrhoea but not as bad as before. Another issue I has an urgent need to pee on a frequent basis. This is a known side effect but a rather unpleasant one when you want to go out for the day but are conscious of always needing to be nearby some facilities after having a drink.
As well as frequently needing the loo, I had also developed heavy and sore boobs. This was not on the questions list but I felt it was likely to be Lithium related so I mentioned it when asked if I had any other problems. I was advised that the issues may be related to Prolactin levels but I’ve not yet received any form of confirmation and this symptom has gone.
My prescription has now been upped to two 400mg tablets each night so the dose has been doubled. This seems like a big leap to be but I’m sure the psychiatrist knows what he’s doing!
Another issue I had this week was feeling a bit ‘funny’ when I didn’t drink enough. I’d gone out somewhere and hadn’t made sure I stayed hydrated. It’s difficult to describe how I felt accurately but I guess the best term I can use is feeling ‘spaced out’. I’ll definitely be making sure I drink plenty from now on as it was not nice.
Week 4 – more side effects maybe?
When I arrived for my appointment this week, I was advised that I’d reached the therapeutic level of lithium required so I didn’t need a blood test so I collected my prescription and went. My next blood test is in two weeks and I think, after that, they will be come even less frequent.
With regard to side effects, there are a few things now troubling me – feeling cold nearly all of the time, having dry hair which gets knotted easily and seems to absorb all of my conditioner no matter how much I put on, and yesterday my nails went white in the shower which I’ve never experienced before. It’s hard to know if I’m super aware because I’m looking for anything that might be even slightly different about my body or if these are the effects of my body getting used to a new medication. Either way, I really hope this needing to pee all the time thing goes away because it’s simply not funny!
Benefits of treatment
So far, it’s difficult to tell if the Lithium has had any effect on my mood. I’ve been coming off two forms of antidepressant medication so I think that has caused issues with how I’m feeling. Also, my bipolar cycle usually means that I’m okay for some months of the year and then depressed at other times and I was already euthymic (stable) prior to receiving my diagnosis. Whilst I’ve been reading about Lithium, I’ve learnt that it’s very effective at preventing mania and hypomania but not so successful at stopping depressive episodes so I guess it’s a case of waiting to see what happens.
So that’s my experience summed up. Obviously, if you start on Lithium, it might not be yours as we all respond differently and present with different side effects, but hopefully, it’s given a short overview of what it’s like to start on this medication. I think one of the things to bear in mind when taking any form of tablets for mental health is that most if not all of us have some form of side effects and unless they are causing serious problems, it’s usually worth persevering whilst your body gets used to them. The purple booklet (make sure you ask for one because I wasn’t given one automatically) clearly states what to do in the event of having too much lithium in the body (known as lithium toxicity or lithium poisoning) and explains which symptoms are problematic.
Those of you who follow my blog and regularly take the time to read my posts will know that I’ve recently been diagnosed with Bipolar Disorder 2. In brief, Bipolar Disorder is a mental health condition which is characterised by extreme mood swings including bouts of low mood known as depression, periods of elevated or high mood known as mania or hypomania and euthymic state where the mood is stable. Although it’s taken until the age of 43 to get what I now feel is an accurate diagnosis, I’ve been experiencing issues with my mood since the age of around 17 and, even though I’m not an expert in mental health conditions, I have developed a high level of self awareness through the years and have come to learn what helps me manage my moods and what doesn’t. So, in today’s Monday Matters, I’m going to talk about how important it is to be self- aware (which I believe I’m pretty good at) and self-accepting (which I’m probably not so good at – yet!). I’m also going to touch upon ways in which an individual can begin to make improvements and develop in both areas.
What is self awareness?
Self-awareness is a conscious knowledge of one’s own character, behaviours and feelings. Basically, it’s all about knowing exactly who you are and why you behave in the way you do. Self-awareness is not an inherent trait – it’s something than can be learnt and cultivated using a range of reflection and introspection techniques.
I believe increased self-awareness is vital in helping us to find ways of managing a range of mental health conditions including bipolar disorder, depression and S.A.D. (Seasonal Affective Disorder). It can also help anyone who has other issues with their moods too for example, in early pregnancy or in the days leading up to a period.
How does self-awareness help us to manage mood disorders?
Enables you to make helpful choices in terms of coping strategies If you know yourself well, you will be able to identify and describe how you feel more easily and be able to make better choices in terms of self help and coping strategies. For example, when you are depressed, you may need to focus on celebrating small achievements, practising gratitude or using distraction techniques to change the focus from negative thoughts. If you’re feeling manic, hypomanic, wound up or angry, you may need to turn to relaxation techniques or use some soothing rhythm breathing to create a sense of calm.
Helps you spot patterns and cycles If you have full knowledge of what your different moods look like e.g. the key features of your depressive cycle, or how you present when you are manic or hypomanic, then you can more easily spot patterns or cycles quickly and be more pro-active in managing your episodes. For example, careful monitoring has helped me to identify the times of year when I get depressed, triggers which impact on my mood and how long my cycles of low / high mood tend to last. This was particularly useful to share with my CPN (community psychiatric nurse) and the psychiatric but also really helps me to cope with my illness.
You can establish what works and what doesn’t more easily Through taking a step back and thinking about issues I’ve had in the past, I’m able to identify what works e.g. sticking to a routine, going for daily walks, practising yoga and mindfulness and what doesn’t work e.g. ruminating over past mistakes, avoiding all contact with friends and family.
Makes therapy even more useful When you attend therapy sessions, whether you access them via the NHS or if you pay for them privately, it’s really important to ensure quick progress due to the time constraints e.g. with CBT offered by the NHS there’s a maximum number of sessions you can have and if you are paying for each session you want to feel that each hour is worth the cost. Having a good understanding of how you’ve been feeling, the ability to explain the changes you’ve made and the impact they’ve had can all help with presenting issues, solving problems and making progress with your treatment. Obviously, professionals are very good at picking apart what you say but it helps speed up the process so you get better faster and learn new skills with maximum efficiency.
Helps you communicate better with others Whoever you are talking to about your illness, be it your CPN, psychiatrist, best friend, partner, family member or work colleague, having the confidence in your ability to explain how you feel and what you think might help or exacerbate your issues, is vital if you want help and support or to feel listened to. This can improve your relationships in a number of ways so that, depending on who you are talking to, you might feel accepted, closer in your friendships, better understood, more confident and able to assertive. It might also help others to see things from your point of view so that they can be more empathetic.
Improved personal and work relationships Being aware of yourself and your moods is useful for maintaining positive relationships with your partner, family, friends and work colleagues. If you know, for example that you are feeling particularly irritable, you can bear this is mind when you engage with others. For example, I know that one of my symptoms of hypomania is extreme irritability and that this results in little annoyances becoming hugely frustrating and me becoming less tolerant of situations and people. I have to try really hard not to display my irritation too much, accepting that it is my illness causing the difficulties and that others are not the issue. By recognising this symptom of my bipolar disorder, I can take steps to manage my feelings and hopefully avoid upsetting others with what I say and what I do. It doesn’t always work, but at least the awareness is there.
Another part of self-awareness is your knowledge of how you come across to other people. Sometimes people can become overly anxious about this to the point of becoming obsessed about what other people might think of them, but I think a little acknowledgement in this area can be useful. For example, in terms of my bipolar disorder, when my mood is stable, I’m probably seen as articulate, friendly, assertive and optimistic, whereas when I’m depressed, I’m probably viewed as quiet, negative and passive. During periods of hypomania, people are likely to see me as irritable, agitated, easily distracted, overly forward and impulsive. By knowing how you present to others, you can help your partner, family, friends and work colleagues to understand how your mood disorder impacts on you and it can also help them spot signs of deteriorating mental health so they can offer support.
What are some easy ways to develop my self-awareness?
You can improve your self-awareness by working with a trained therapist or by using a range of self help style strategies or a combination of both. Here are some ideas which may help.
Therapy Therapy sessions can be really useful for getting to grips with difficulties and the effect that thoughts, feelings and behaviours can have on each other and on our lives. I’ve had individual sessions which focus on CBT (Cognitive Behaviour Therapy) techniques and group sessions which have looked at compassion, mindfulness techniques and self-acceptance (i.e. it’s not your fault that you have difficulties etc) All of the forms of therapy I’ve accessed have been helpful and I’ve taken lots from them all but I think CBT is particularly good for finding out about yourself.
Journalling I wrote about the positive impacts of journalling a few weeks ago and if you choose a reflective style, you can find out lots about yourself, how you interact with others and positive and negative ways in which you tend to solve (or exacerbate) problems in every day life. You can either choose a free-form style where you just write what comes into your head, or a more structured style where you respond to particular prompts. Either way can be really eye opening. Try searching ‘journaling prompts’ on Pinterest and make a list of some of your favourites in your bullet journal or other notebook so you can pick and choose.
Try to be more open-minded It’s easy to think that our way of doing something is the best way or that our opinion is more valid than others, but what if someone else’s way is better or when you listen carefully enough, you find that a different opinion makes more sense or is more logical? Even if you don’t agree with another person, you should always try to listen to their point of view as it helps you learn things about yourself and can help you develop your own potential.
Take the helicopter view This one is a CBT technique and one which can be really difficult to do (for me anyway!). Basically, it’s a metaphor for taking a step back to see the bigger picture. If we’re too close in, our emotions take over and we lose the sense of perspective which we would likely gain if we were less involved. If you imagine a helicopter taking off and viewing your problem for a little further away, it would be able to assess the situation with clarity, see why you are reacting the way you are, offer impartial advice (as would be offered to you by a close friend) and take time to consider the best solution based on all of the information. If you would like more information about this click here for further explanation and a PDF worksheet.
Make some ‘about you’ lists If you love writing lists as much as I do, this is one which you’ll really enjoy whilst finding out about yourself as you go. Rather than writing endless to-do lists, why not write about you, your strengths and weaknesses, your likes and dislikes, what makes you happy, a personal bucket list etc. And no, this is not self-indulgent, it’s perfectly okay to make things all about you every once in a while – especially if you helps you get to know yourself and makes it easier to manage your moods.
Keep a mood diary I see lots of bullet journal spread mood trackers on Pinterest and Instagram which look really pretty any colourful by the end of the month due to different colours for the various moods. However, in my opinion, they tend to contain limited information and are therefore of limited use, as they just show that a person’s mood has changed throughout the month or has mainly stayed the same. Personally, I prefer to keep a detailed mood diary as this enables me to make notes about my mood alongside what has triggered it. I also like to be able to describe changes in my mood from one part of the day to the next. For example, I might wake up feeling really happy and full of energy, but then something might trigger a completely different mood e.g. I might see or hear something which upsets me or makes me cross. I find the Bipolar UK Mood Scale and Diary really useful as a starting point for tracking moods but I also like to create more detailed records by utilising space in sheets such as this one from Get Self Help. The first is designed to help individuals with lived experience of the various types of Bipolar Disorder but the second can be used by anyone who is dealing with mood changes.
What is self-acceptance?
Self-acceptance is about accepting everything about yourself – the good and the bad, the rough and the smooth. It’s about recognising that we are all unique, complex human beings with strengths and weaknesses. It’s also about knowing than no-one is perfect and that we all make mistakes and have periods of difficulty in our lives.
Self-acceptance is not about making excuses for bad or inappropriate behaviour, but it does make it easier for us to evaluate how our feelings and emotions may affect our actions so we can work on making changes for the better or recognising why we might be struggling with some of our relationships.
In my opinion, self-acceptance can be pretty difficult, especially if you have perfectionist tendencies like I do. Most of us are easily able to accept the good bits about ourselves, but can the same be said about our flaws and our failures?
How can I learn to accept myself?
Practise self compassion If you’re having a tough time at the moment, one of the worst things you can do is beat yourself up about it. During periods of difficulty, you need to be as compassionate towards yourself as you can. If you were ill with sickness or a headache you generally wouldn’t think twice about resting up, spending the day in bed or whatever you need to get well again. The same needs to apply during periods of high or low mood. Be kind and accept that you’re not your usual self and then either ask for help from one of your supporters or choose appropriate coping strategies that you know work. If you find it difficult to practise self compassion, think about what a good friend would say to you to make you feel better – then say it to yourself. Click here for some more ideas.
Be openly curious rather than judgemental
This is a primary aspect of mindfulness and one which I believe can be hugely helpful during times of difficult emotions. Being curious about what is going on for us allows us to accept what it happening and notice the associated feelings. For example, we might note that we feel anxious or angry and then explore the affect that this is having on us in terms of bodily sensations e.g. tension in the shoulders or tightness in the facial muscles. Then, rather than judging the feelings and sensations as good or bad, we accept that they are there are are just part of our experience.
Be proud of your strengths and celebrate your achievements We all have lots of strengths and we have all achieved things in our life (learning to manage our mental health is one of them). On a day when your mood is stable and you’re feeling okay, try making a list of things you’re good at and another of all of your achievements. So for example, you might be good at sleeping, drawing, cooking, papercrafting, planning, organising etc. You may have completed a degree or a distance learning course. You could be proud of yourself for all kinds of reasons such as singing in a choir, doing a presentation in front of others, teaching your children to have good manners or even developing a successful planning system in your bullet journal.
Find out more about your diagnosis Having recently been diagnosed with Bipolar Disorder (2) I am still coming to terms with accepting my diagnosis and learning more about the condition – including finding out about Lithium which is the medication I’ve been put on. For me, this was pretty straight forward as I have been dealing with the symptoms of the illness for a long time and it was more a case of finally being offered an explanation for the difficulties I have. But, everyone is different and you need to be patient with yourself and others in getting to grips with your mood disorder and what it means for you. The worst part for me, is knowing that I may improve my ability to manage my moods, but that doesn’t mean that I won’t continue to have difficulties in the future. This will take time to accept and also, due to different medication, I won’t know the effect this will have on my mood cycle in the future.
Try to be more accepting of others You might think this is a strange one to have on a list of ways to accept yourself, but bear with me! If you learn to accept others for who they are and accept that you can’t change how others think, feel and react, then you can focus on how you react to them. This can help you accept that everyone is different and we all have valid thoughts, ideas, beliefs etc. By doing this, you can increase your tolerance levels and improve your relationships with others whether it’s a romantic relationship that you want to develop or a work relationship which you find difficult to bear. It will also help you see that there’s no set right or wrong way to do things and may help you be more assertive, stopping you from worrying about the approval of others so much.
Use positive self talkAffirmations are a great way of accepting yourself as you are and recognising your strength to recover from periods of difficulty. Here are some good examples:
I choose to love and accept myself
I love and appreciate myself
I have many accomplishments that are worth celebrating
I value myself above all else
I’m proud of myself and my achievements
I’m filled with gratitude for who I am
I love that I am real, rather than perfect
I have enough, I do enough and I am enough
I am proud of myself for daring to try.
I am resilient and can get through this.
Mood disorders are very common and there are lots of us out there who are striving to help ourselves manage our condition in any way we can. Even if you don’t have a diagnosis, I hope today’s post has been useful in some way. I appreciate that it is difficult to put into practice some or all of the ideas when you’re really struggling but if you develop a routine of self care during periods of euthymic (stable) mood it should be a little easier to keep going during high or low periods.