Building Stability with Bipolar Disorder

As someone living with a chronic mood disorder and as a therapist who specializes in bipolar disorder, I’ve given a lot of thought to building stability with this condition. What I’ve learned is that it requires establishing sustainable life rhythms that not only support your nervous system and brain, but also prevent disruptions that can trigger mood episodes.

Disruptions take many forms, including stressful situations that accumulate, or subtle changes in mood or mind that catch you unawares. The good news? The tools that research shows are the most effective for noticing warning signs and building stability are accessible, actionable, and can start working for you today.

Prevention strategies are the groundwork for building a life where you’re able to show up consistently in the things that matter to you, whether it be work, relationships, or for yourself.

What stability with bipolar disorder can look like

Navigating life with a bipolar disorder diagnosis can feel like an art form and a science. It involves managing a chronic disorder with neurological underpinnings and mood swings that impact your emotions day to day, and might influence how you show up in the world. Whether it’s exhaustion from a depressive episode making it hard to go to work, or impulsivity in decision-making from the pressure of mania (or hypomania), your internal state can be reflected in your daily choices.

Building stability doesn’t mean an absence of these symptoms. It means achieving manageable care that allows you to live the steady, fulfilling life you deserve.

Someone in this situation might say, “Yes, I still have depressive episodes, but they’re shorter and lighter, and I know my toolbox of skills to make it through.” For most, as we’ll discuss later, this realism is possible through resources like medication, therapy, lifestyle changes, and prevention strategies.

For me, stability with a mood disorder looks like:

• A life rhythm where adequate sleep, healthy meals, exercise are non-negotiable
• Balanced between social life and downtime
• Daily medication
• Check-in appointments with my psychiatrist several times a year.
• Monthly or weekly therapy

Therapy has been particularly helpful for processing attachment wounds and relationship traumas that came from living with untreated symptoms.

As for how stability feels? It’s a quieter life, with quieter insides. My mind is no longer fighting as many ruminative, self-recriminating thoughts or existential doubts, and my body doesn’t feel the dull ache of depression in my chest.

I still check in with myself to gauge if my mind has been getting antsy. I might ask, “Did I get high anxiety before going to an event? Was it harder to stay calm when my partner irritated me?” Even if the answer is a yes, I know that these are old symptoms resurfacing, and not who I am. I know how to invoke rest by taking it easier that day, spending time in nature, or being around close friends who ground my nervous system.

Despite how it may feel, you’re not alone in the work of building stability. I once worked with a client who had managed her diagnosis for decades. She’d worked hard to practice mindful self-care, including carving out time to decompress after overstimulating social activities, committing to her favorite aerobic exercise, and taking her medication regimen seriously. There was a certain gravitas in how she described her acceptance of the disorder and her willingness to adapt her life in order to manage it.

The right medication is non-negotiable

Medications for bipolar disorder including mood stabilizers (e.g. Lithium, Lamictal), atypical antipsychotics (Abilify, Seroquel, etc.), and adjunct categories are necessary for most people, because they tackle differences in brain functioning.

Meta-analyses drawing from large bodies of research have shown that during bouts of mania and depression, physical changes in the brain can be seen, including:

• Overactivation of the amygdala that guides emotional reactions
• Increased brain inflammation impacting executive functioning
• Decreased levels of BDNF, the protein that controls nerve cell health
• Hyperactivity of the HPA axis, that’s part of the stress response system
• Differences in white matter including glutamate, involved in emotional regulation

Medication is usually essential for addressing these fluctuations. A sobering reality is that untreated episodes of depression or mania can cause neuro-progression, or increased damage to the brain. Research has repeatedly highlighted the importance of careful prevention to avoid this pattern as we get older.

It’s important to practice patience and persistence when you’re working with a psychiatrist to find the best medications. Personally, I had to try more than 8 medications over the course of 5 years, and the many changes or tapering of doses required me to lean into hope. In the process, I learned the importance of advocating for myself with my psychiatrist through doing my own research, asking questions about common outcomes and side effects, and tracking mood changes to keep my provider up to date.

A collaborative provider is an essential part of your support team. It can be wonderful to find a psychiatrist who is focused on your specific life factors and struggles, stays responsive when medications aren’t helping, understands your concerns about side effects, and provides attentive follow-up care. This sort of provider might be difficult to find right away. But advocating for yourself is a powerful step, and is one you can start doing at any stage of the relationship. If you are currently searching for a psychiatrist, Alma's database of insurance-based providers is a helpful resource for finding someone who is both compassionate and skilled.

After getting your prescriptions, it’s crucial to take them consistently. To make sure you’re following all instructions, you might consider using a pill organizer, or creating reminders on your phone to take them at the same time each day. Also, be sure to communicate unanticipated side effects to your psychiatrist, and follow any additional steps like routine bloodwork required for certain medications.

Therapy is a foundation for stability

Psychotherapy is another important tool for building stability with bipolar disorder. An attentive, collaborative therapist can help you improve regulating your emotions, guide exploration of emotional triggers, and apply evidence-based approaches to support brain functioning.

Your connection with your therapist matters a great deal. When you feel hopeless, your therapist will hold hope for you. When you’re starting to doubt who you are underneath the symptoms, they can speak to the parts of you that go far beyond a diagnosis. When you have compounded pain from stigma or unjust treatment you’ve endured, you’ll receive unwavering support from someone who understands how bipolar disorder can impact your relationships and sense of self.

For proven therapy approaches to managing bipolar disorder, there are three specific modalities to consider: Interpersonal and social rhythms therapy (IPSRT), cognitive and behavioral therapy (CBT), and dialectical behavioral therapy (DBT). Find out more about each below.

Interpersonal and Social Rhythms Therapy (IPSRT)

Interpersonal and Social Rhythms Therapy (IPSRT) was created to help those with bipolar disorder cultivate balanced life routines. It’s rooted in the reality that life events have major impacts on mood changes and how intense they can become.

With an IPSRT-trained therapist, you’ll learn to track life stressors (such as grief, identity shifts, relationship conflicts, or feelings of isolation) that impact your moods. You’ll also use tools like the Social Rhythm Metric to track your sleep, sunlight exposure, socializing, eating, and other routines.

IPSRT places emphasis on maintaining a steady circadian rhythm. Research has shown that not sleeping enough or oversleeping can both increase the likelihood of manic or depressive episodes. Circadian disruptions like jet lag and daylight savings time changes can easily throw off our biological clock as well. When coupled with increasingly less need for sleep over the course of several days, there can be a risk of oncoming mania or hypomania. But IPSRT skill-building has been demonstrated to help decrease the likelihood of future episodes.

Cognitive Behavioral Therapy (CBT)

CBT has been well-researched as a tool for lasting behavioral change, including for building robust neural networks, regulating emotions, and decreasing insomnia. It is known to be particularly helpful for managing mood swings and grounding in the present moment. However, it might not be the most appropriate for managing severe mania.

Many interventions focus on building mindful control of your thought life and bringing more compassion into your inner monologue. These are critical for tackling harsh, intrusive thoughts that often come with depression or anxiety. Strategies like body relaxation and cognitive restructuring can also be of great help for slowing down racing thoughts. You can explore CBT techniques here. To develop the skills and tailor them to your unique situation and needs, consider finding a CBT-trained therapist to work with.

Dialectical Behavior Therapy (DBT)

DBT is another behavioral approach that helps with regulating strong emotions and mood swings. Studies show that DBT can decrease the intensity of manic episodes and help to strengthen cognitive functioning. While DBT skills help with managing bipolar symptoms, it does not necessarily decrease their frequency in the way that medications can.

Interventions for regulating feelings like anger or overwhelm often come with memorable acronyms like STOP (Stop, Take a step back, Observe, Proceed mindfully) and TIP (Tip the temperature, Intense exercise, Paced breathing). You can read more about DBT skills here. An Alma therapist can help with integrating these tools, or you might consider finding a therapist-led DBT support group where you can learn alongside peers.

Building your long-term bipolar support system

When we look at our lives as part of bigger systems, it becomes clear that it can take a village for each of us to live well and keep growing. For those with bipolar disorder, this might look like having your family coming alongside you to learn about symptom management and advocate for your needs. But for many, ignorance and stigma make it hard to rely on others, even family. I too have struggled before to find support while discerning which people in my life were safe to rely on.

Others may have responded to our requests for support with dismissal, judgment, or worse. It can be hard to remember that their reactions speak more to their emotional bandwidth, ignorance, or personal limitations than they do about us. If this has been your experience, it can be helpful to proceed with wise caution as you build your support system. If certain individuals in your life have already proven themselves to be caring and trustworthy, consider starting with them. You deserve to be met with compassion and understanding regardless of what is happening in your life.

Building a sturdy support network takes time, and also requires that we show up for ourselves. During depressive episodes, I’ve had to learn to resist the urge to stop responding to others because of negative self-beliefs. If I notice myself starting to withdraw or shut down, I try to realign with my core relational values. These are true regardless of how I’m feeling, including my commitment to maintaining honest, vulnerable connections with loved ones.

Sometimes deepening connections requires educating others about the disorder. You might choose to share about your inner experiences, or find it easier to direct them to educational materials like podcasts, books, and advocacy sites.

It can be challenging to find “our people” regardless of our best efforts. Some will find the most safety in a support group. The Depression and Bipolar Support Alliance (DBSA) is a national organization that provides free local peer-led groups in-person and online. There are also therapists who run virtual bipolar support groups within their state. These are spaces where you can meet with others who truly get it.

Finding healing relationships in times of need remains a challenging task, and this deserves to be acknowledged. There can be real grief from having a mood disorder that impacts how consistently you are able to show up for those you care about. Processing this deserves its own time and space, and is something an attuned therapist can help you work through.

6 Prevention strategies you can start today

There are many bipolar management strategies that you can incorporate into your life right away. To be most effective, they should be tailored to your life and preferences.

Take some time to look over the following five sections and ask yourself:

• “What do I think needs work?”
• “What sort of symptoms do I want to prevent?“
• “What changes can I tackle first?”
• “Which changes would be easiest to make?”

1. Track your moods

Tracking moods on a regular basis helps with staying self-aware and proactive in treatment. Mood trackers operate as self-check-ins for noticing mood and energy patterns across time.

The DBSA’s free mood tracker is available, and you can use this questionnaire to track hypomania or mania. Another resource for tracking mixed episodes, when symptoms such as restlessness, irritability, or racing thoughts often show up together, can be found here.

Noting and naming your moods across days or weeks helps you to discern what stabilizing techniques to use. If you find yourself shutting down during a depressive episode, you might try to explore ways to move and activate a bit more, through adapted self-care activities that feel less overwhelming. You might also choose to prioritize rest time over other responsibilities.

2. Implement healthy routines

Essential routines around consistent sleep and wake times are made easier through sleep hygiene.

Other useful routines include consistent meal times and diet, exercise, and restful activities for recovering from day-to-day stress.

If you struggle to stick with routines, it might be easier to focus on major problem areas. For example, if you travel regularly across time zones, pull all-nighters, or have an irregular work schedule, this might be where problem solving starts.

Admittedly, having an active social life can sometimes conflict with maintaining your personal rhythms. This is where episode prevention becomes critical to prioritize. It can be helpful to prepare in advance how you want to turn down social invitations when you know they could be destabilizing. Whether through a thoughtful text or honest disclosure, you can still keep loved ones close while holding boundaries around your lifestyle needs.

If you use alcohol or other substances, you might take time to consider the research around how they negatively impact your mood and mind. Alcohol has been shown to worsen depressive and manic symptoms, and substance use with bipolar is tied to increased violence and even suicide risk. There can also be interactions with your prescribed medications. Oftentimes, the best solution is to stop using substances altogether.

3. Keep steady social rhythms

A balanced social life typically includes restful solitude and quality time with others. But how much you need from each category can change across seasons of your life.

To avoid the extremes of social overstimulation or isolation, try to gauge how often you need to see friends or family before you start to feel antsy or lonely.

You might schedule gatherings in advance to keep your weeks feeling full and balanced. To become more aware of your social preferences, try tracking your social schedule across several weeks. You’ll start to understand your baseline needs, and spot moments where more or less connection might be helpful.

4. Manage your work stress

Maintaining a good-enough work-life balance is a tall order for most people, including those with bipolar disorder. But having more sensitive circadian rhythms can make certain types of schedules harder, such as overnight shift work. Even with day jobs, there will be stressors outside of our control that could throw you off balance.

Creating a work routine that supports your mental health is easier said than done. But whether through commute, workspace, or end-of-work-day routines, you can try to bring order to spaces that are inherently stressful.

Some people choose to seek ADA accommodations in order to make their schedule and workload more adaptive. This can be a complicated process, especially when disclosing your diagnosis becomes involved. It’s important to know that sharing the specifics of your diagnosis is not a requirement, whether with HR or with management. Some recent research suggests that for some, disclosure can improve outcomes including personal productivity and feeling more supported by management. But ultimately, we must each discern how safe our work environment is for any degree of vulnerable disclosure.

5. Practice regular mindfulness

Consistent mindful or meditative practices are proven to increase overall quality of life, and can even moderate levels of depression.

When you regularly practice noticing and releasing mental chatter or intrusive thoughts, you are better able to calm your nervous systems and help your mind rest.

Meditation can also strengthen the ability to connect with your true self through the flow of your breath and body. Here is a collection of mindfulness practices designed specifically for bipolar disorder.

6. Notice early warning signs

Along with learning practices for stability, it’s important to notice the tell-tale signs of when balance might be slipping. This is a fundamental part of mood management, and a therapist can help you to build your awareness of symptom shifts and even help unpack the situations that could be reinforcing them.

We can also create a list of “yellow flags” to track important changes in sleep, spending habits, impulsivity, becoming irritable, or feeling withdrawn. You might ask yourself: “What are my personal “tells” that I’m starting to feel depressed, overly energetic, or agitated?” If you have a history of rapid cycling episodes, which happen at a more frequent pace throughout the year, you may want to share your list with one or two trusted people who can provide their perspective.

Also, try to write down a plan of action for how you’ll respond to these signs. If you start to feel that you can’t sleep for days at a time, make a plan to contact your psychiatrist. In darker depressive moments, decide beforehand who you can call for support, what self-soothing skills you’ll use, and when to call crisis support. Your therapist is an important resource during these times, but calling the Suicide & Crisis Lifeline (988) is the most critical step to take.

A common sign for some people can be thinking about stopping their medication once they start to feel better. Sometimes the urge stems from missing the energy of mania that medication has taken away. When depression draws life from your bones, the upswings in mood can feel like real relief. And if others have come to see you as “fun one,” you might struggle to go without these euphoric moments.

If you’re thinking about stopping your medications, first speak with your psychiatrist. Also, consider the research on untreated bipolar and longevity. Stability and preventing severe episodes are actually critical for longevity because they extend your lifespan and improve quality of life. And living a life of genuine fulfillment requires having a consistent foundation to stand on.

The truth is that both our personality and sense of identity can be impacted by having a mood disorder. You might not always feel like yourself, or as positive around others as you’d like to be. There is real grief here. Thankfully, medication and therapy can help with overcoming these challenges. But if you’re feeling noticeably muted or numb on a certain medication, let your psychiatrist know so they can make the necessary changes.

Self-compassion when you’re struggling

During bouts of mania or depression, many feel a sense of shame. Other people may have labeled you as “hyper,” “crazy,” or a “downer” at some point, and these cuts can run deep. Being misunderstood due to a mental health diagnosis becomes harder to carry when we feel pulled to criticize ourselves. Some might also struggle after episodes where they acted in ways they now regret.

It’s important to remind yourself that symptoms are not a personal failure or character flaw. They’re the signs of a condition. All the strategies in the world can’t prevent episodes sometimes, but they might become less intense than they were before. The impulses are not you; they’re your tired brain.

But this might not always feel comforting, particularly in the lowest moments. This is where self-compassion comes in. Compassion for yourself that is grounded in reality is a reminder that stability isn’t perfection. instead, it’s the ability to course-correct and try again without self-blame. Instead of questioning your ability to make wise decisions or take care of yourself, try to use self-care, take things more slowly, or pause doing things that make you feel worse. A therapist who is trained in Compassion Focused Therapy can also be a great resource to help you build habits of self-compassion.

Others who have lived with this disorder can also speak powerfully to the experience. Carrie Fisher, an actress who had bipolar, once said, “One of the things that baffles me… is how there can be so much lingering stigma with regards to mental illness, specifically bipolar disorder. In my opinion, living with manic depression takes a tremendous amount of balls… Bipolar disorder can be a great teacher. It’s a challenge, but it can set you up to be able to do almost anything else in your life.”

Sometimes the most compassionate thing you can do for yourself is to remember your values. Whether it’s health, honesty with loved ones, or to live life to the fullest, your values are meant to guide you on your lowest days. You can channel even limited energy into the priorities that align with your truest desires. Even if you feel like you’re not succeeding, knowing that you’re taking the right steps can provide some real reassurance.

Stability is built one day at a time

Just like creating a life that feels truly meaningful, stability with bipolar disorder isn't a destination. It's a daily practice to chip away at one day at a time. More importantly, stability is not just achieved once; it’s a core value and true north that guide daily choices. Real hope can come from this kind of empowered action, and the strategies we explored in this article are great places to start.

You deserve to flourish, and you can steadily build towards this. You’re also not alone in the journey; there are whole communities of likeminded people walking alongside you. Emerging discoveries about new treatments, the strength of those who love you, and your deep commitment to yourself will guide the way forward.