Hmm, am I forgetting something?

by Julie A. Fast

Traveling with children can be stressful at the best of time, but for parents of kids with bipolar disorder, an extended family vacation can be a daunting prospect. Here are some tips to make some great memories:

Consider a shorter stay

If this is your first family vacation, you may want to try day trips, weekend getaways and other short adventures. You’ll soon learn what stressors or triggers to look for with children who live with bipolar disorder. Work your way up from a day to a week away.

Prepare! prepare! prepare!

Longer and more involved trips require a ton of preparation so doing your homework is essential. For example, if you are going to an attraction or theme park, there can be many triggers—crowds, noise sensitivities—that you need to be aware of. Do some research and find out when attendance tends to be lowest. For example, generally, crowds at Disney World are packed during spring break and reading weeks for colleges, but more manageable after the holidays or in early fall.

A road less traveled 

If it’s simply not a good idea to vacation at a crowded theme park then opt for something with less stimulation. Go off the beaten path; a peaceful camping trip at a state or national park can be fun, or perhaps rent a cottage at a small private beach. Look at a themed trip that speaks to your child’s interests. If your daughter is passionate about horses, plan a horse-back-riding day camp or spend a day visiting a few museums if your son is a fan of dinosaurs.

Plan out long drives

For most kids, and adults alike, long car rides can be exhausting, but especially for children who have bipolar. Consider the side effects of medications in doing homework about vacations i.e. some meds can make your children thirsty and hungry and then they’ll need restroom and snack breaks more regularly.

The must-haves

There are a few items that top the list of every parent who’s ever survived a trip with children who have bipolar. First is a DVD player, either a portable unit or something already incorporated into the vehicle. Keeping kids occupied and distracted from the actual act of traveling is important. The second is portable video games, and for the same reason as a DVD player. Let your kids pick the movies and make sure you approve of the ‘games’ your child chooses.

Maintain routine

Children who live with bipolar disorder are more sensitive when their routines are disrupted or they face new surroundings, sounds and experiences. Even though you will be away from home, as much as possible, try and stick to your usual routine. Try to keep meals and bedtime the same and even bring ‘comfort’ items from home. Obviously, the most vital routine is making sure your child’s medication schedule remains the same. If you have to, set an alarm on your phone or watch if you need a reminder.

A little help

If you’re on your own, it’s a good idea to ask for a little assistance; enlist the help of staff at a theme park or restaurant, for example. Explain that your son or daughter has a brain illness and gets over stimulated and can’t stand in long lines; many places will accommodate moving you to the front of the line. Perhaps you can let people at the front of the line know that your child is prone to melt-downs; generally most people are sympathetic and won’t be upset for you to cut in.

Hotel hints

When researching all aspects of your family trip, choose your hotel stays carefully. Most parents will agree that finding lodging that offers other activities is essential; an indoor pool can be a lifesaver for when the weather does not cooperate. Also, if your child generally a very early riser or tends to be loud and possibly disruptive, ask the hotel for a room with no one on either side of you; connecting rooms or a suite is also a very good option.

Every child is unique

Since the symptoms of bipolar disorder are unique to each child, you’ll need to tailor your vacation plans according to your kid’s tendencies. For example, if, during the summer he does better in the morning, find a destination that offers activities at this time of day and then go back to the hotel in the afternoon to wind down. If you know too much stimuli and crowds will most definitely trigger a manic episode, maybe opt for a cottage someone quiet and plan day trips into town.

Expect a few snags

Try not to be too disappointed when things don’t go as planned. Realize that traveling with kids in general (those with bipolar or not), can be challenging so don’t expect perfection. Realize that if you get upset that something didn’t go as planned, this stress will trigger unwanted emotional behavior from your child. Try to be as flexible as possible, go with the flow and infuse some humor into any mishaps.

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Despite the rapid daily shifts in moods, many parents are no strangers to the seasonal aspects of bipolar disorder with their children; there is a noticeable depressive slump during the fall and winter months, followed by an upswing and stirrings of mania during spring and summer. Here are seven things to know:

#1 History of the seasons and bipolar

The seasonal recurrences of depression and mania have been an unexplained phenomenon since ancient times, notes bphope columnist and author Demitri Papolos, MD. There have been documented seasonal episodes of illness in some manic-depressive patients with a preponderance of manic episodes in the spring, and depressive episodes in the winter, as far back as the fifth century.

#2 Seasonal ebb and flow

“Many children not only experience seasonal perturbations of mood—their hour-to-hour mood and energy level may vary as well,” explains Papolos. Children and adolescents, during the fall, will often experience lower energy in the morning, and then increased irritability and anxiety, whereas the evening period this is lower. This pattern is often reversed during the spring.

#3 Sleep patterns change

Many parents notice that starting in the spring, when the light begins to change and the days are longer, their child’s sleeping patterns will change. So, the child or teen who slept deeply and for long hours during the winter is suddenly awake at 4 a.m. or 5 a.m. He may be unaware that others in the household are sleeping or that he should be sleeping as well. He will have boundless energy for school and other activities and may obsess about them.

#4 Seasons and management of bipolar

Knowing how the seasons impact the symptoms of bipolar, also gives indications to the management of the disorder. Parents should consider talking to their child’s psychiatrist about adjust the medication protocol to reflect this mood fluctuation throughout the year. The dosage of meds that may have previously stabilized the child may not be as effective during the periods of change in the light/dark cycle.

#5 Biological behaviors

Neuropeptides, neurotransmitters and hormones all play a part in our brain activity and our behavior. “The timing of events within the central nervous system is at least as important as the special arrangements of the central neuronal activity in the brain,” explains Papolos. This may explain the therapeutic effects of bright light treatment in “seasonally-cycling bipolar patients.”

#6 Seasonal affective disorder

The term Seasonal Affective Disorder (SAD) was coined in 1984 by Norman Rosenthal, MD. He described the seasonal pattern of depression and bipolar disorder. Rosenthal reported that the depression symptoms, or ‘winter blues,’ improved when patients received daily bright light therapy during the fall and winter. In looking at children with bipolar disorder, it is shown that perhaps light therapy tends to work better as a preventive treatment, so recognizing the pattern and potential for relapse during the year is important.

#7 Light therapy explained

As a complement to medication, psychotherapy and a lifestyle wellness plan, light therapy boxes may be a viable option. The box provides a balanced spectrum light equivalent to natural daylight and can help regulate the body clock function and help synchronize sleep/wake patterns as well. The patient sits in front of a bright light unit (a portable box) for a specific amount of time and during an optimal time of day. The timing of using such a therapy option should be considered, as exposure too fast or using the light box for too long may in fact bring on manic symptoms of bipolar disorder.

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The pervasive stigma about mental illness can still discourage families from seeking psychiatric treatment for children suspected of having bipolar disorder. However, psychiatric treatment should feel no different than going to see an allergist or any other specialist. Here’s what parents and caregivers need to know:

#1 What to expect the first visit

The goal of the first visit is a thorough psychiatric evaluation to assess the functioning status of your child at home, at school and with her friends. The doctor will look at each of these areas to determine if there are problems to be identified. Mental health experts will then looks closer at any troubling behaviors to ascertain whether these are reasonable reactions to life events—bullying at school, an ill relative, family conflict—or whether the emotion does not fit the problem.

 #2 A bipolar disorder diagnosis

A psychiatrist will take a thorough look at the child’s symptoms, the length, severity, and frequency and will assess using specific criteria from the American Psychiatric Association’s DSM-V. He or she will look at if your child has periods of extreme or unusual irritability or elevation in moods that are coupled with sleeplessness, or increases in energy and fast-paced thinking and speech.

 #3 A look at other illnesses

Impulsive behavior and exaggerated mood swings can sometimes mean psychiatric disorders other than bipolar. The doctor will look at other illness that mimic the symptoms of bipolar such as ADHD, borderline personality disorder, impulse control disorders, anxiety disorders, schizoaffective disorder and developmental disorders. It may also be determined that your child could have comorbid condition to a diagnosis of pediatric bipolar disorder.

 #4 What you can do

If your teen is old enough, encourage him to write down the symptoms he notices that reflect either/both hypomania or depression or the emotional reasons for your visit to the health professional initially. It is wise as parents for you to also do this as it will provide a different and perhaps more accurate perspective. Keeping a log or chart of symptoms will also be extremely helpful if your child’s psychiatrist, in consultation with you and your son or daughter, considers medication to be warranted. In order to find the correct dosage, a careful monitoring of any side effects and behaviors in general is essential feedback.

 #5 Treatment

If your child’s psychiatrist determines that medication is a consideration, then the family will meet with him or her. Medication can be effective, and sometimes it is absolutely necessary; however, the decision to use prescription drugs will be made after a discussion with you, your child and the doctor. Many psychiatrists try and start out with the lowest possible dosage and then adjust accordingly. Keep in mind that medication will be only one part of the total wellness program, which will include counseling, sleep and a healthy lifestyle.

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Having been diagnosed with bipolar disorder over 15 years ago, I considered that my life was inevitably doomed and I would succumb to the same fate as my mother. Growing up, my mom had multiple hospitalizations, numerous suicide attempts and a mental illness that tried to claim her life time and time again. In the past, I have spent many nights staring at a hospital wall in a psychiatric unit and have pondered in dread, “Why am I cursed with this mental illness and what will become of me?”

Fearing the Curse of Bipolar Disorder

At the age of 25 years old, I plunged into a bipolar episode that eventually convinced me that I did not have a
promising future and I feared the curse of this illness that soon enveloped my entire life. I was always known as an outgoing and successful person to the world, someone who wildly chased her ambitions and succeeded in meeting her personal goals. I may have had bipolar symptoms growing up, but nothing that pointed to the fact that I was headed for an immense mental breakdown that nearly claimed my entire existence. My downward spiral included a immense mania that lasted for weeks, which sparked a maddening psychosis that soon led to a depression that disabled me for months. Subsequent to my first hospitalization, I medicated myself to sleep day and night for two entire weeks. I could not stand to see the daylight and the only time that I felt at ease was when I was not awake.

Bipolar disorder stripped me of my dignity, confidence, and a belief that life could actually get better. As I scribbled a letter in an attempt to explain why I was going to end my life, I could not form one coherent sentence. During my university years, I produced five thousand word essays in two days, but I could no longer write anything at all. I was hollow and there was nothing left inside of me. It felt as if this curse robbed me of who I was and I believed the lie that I did not deserve to live because it was never going to get better.

Embracing Bipolar Disorder and the Gifts to Follow

I have always been a passionate person, but before bipolar disorder, I lacked significant meaning and happiness in my life. I did not feel that I had a cause to strive for, or even a place in the world where my light truly shined. I always felt uneasy about where to live, what to do and who to be. I had a gaping hole of insecurity in my heart and I never felt at peace. Once I realized that bipolar disorder is manageable, I have since been blessed with astounding gifts due to my efforts in spreading awareness about mental illness. I reflect on founding the Stigma-Free Society and I often ponder, “Who would I be and what would I be doing with my life if I had never been diagnosed with this mental illness?”

The pain that I experienced felt unbearable at the time, and while in the midst of my struggles, I could not see beyond the borders of this curse. However, these experiences have taught me that I have a choice in how I approach and manage my illness.

There are still days that I am deeply challenged, but because I have been through so much devastation, I am now equipped to get through anything. It is so difficult to see any light in this illness, but when I reflect on the challenges that I have overcome, I am grateful to embrace others, understand my mother’s hardships, and appreciate all of the gifts that have been so graciously given to me over the years. I know now that I  would not have wanted my life to have gone any other way.

Have you found any positive meaning and/or purpose from having bipolar disorder?

Jon Press opens up about having bipolar disorder and other mental illnesses in his family. Do people ask you how things are going? He suggests responding with HONESTY. Here’s why: