What Works to Manage Bipolar Disorder

Here is what works for bipolar disorder:

1. A deep understanding of the symptoms of bipolar- what they look like and feel like.

2. Lifestyle changes to prevent triggering these symptoms.

3. Avoiding ALL substances that can lead to more mood swings with an emphasis on anything that can cause mania.

4. Medications to treat the remaining symptoms.

This is a possible management plan and the only one I have seen work long term for those of us who have complicated and very active bipolar disorder. My book Take Charge of Bipolar Disorder explains this plan. It works!


PS: Mania is weird. We love it in the moment- but we are just downright odd. I can take pictures of myself for hours when manic. I feel like a model. I primp and do things I would NEVER do as a stable person. Yes, it can be funny, but overall is is life altering and dangerous. I am lucky I survived my years of letting mania flourish. I no longer allow it in my life.

Julie’s Soap Box: There is No Natural Treatment for Bipolar Disorder

There is no natural treatment for bipolar disorder at this time. If you are working with a natural health care practitioner and they tell you that there are supplements or diet changes that will prevent mania or psychosis, this is simply incorrect information. Anyone who tells you that cannabis is a treatment for bipolar disorder is not reading the research.

I am consistently dismayed at the lack of information there is for natural health providers about the nature of the very serious, physical illness that is bipolar disorder.

My goal is to educate health care practitioners on the basics of bipolar management so that a working plan can be followed. I believe in natural medicine as it works in many areas of our lives, but for bipolar disorder? It is not enough.

Mania and psychosis are relentless symptoms that are very different from depression. Also, depression and bipolar depression are two very different illnesses.

My coaching practice is filled with clients who have loved ones who want to treat bipolar naturally who then live in continual mood swings.

Yes, there will be some people who find natural medicine helpful, but for people with bipolar one or people like myself who have intense, rapid cycling bipolar that is easily affected by incorrect supplements, natural medicine alone is a difficult path.

If you are able to find a natural health care practitioner who is also willing to use medications judicially when the symptoms are too intense, then this is a path to follow. I work with Julie Foster, a natural medicine based nurse practitioner from Pohala Clinic – A Place of Healing here in Portland. She is a good example of a natural practician to knows when a touch of western medicine is needed.

Stability is the marker for a working management plan. If you are stable, then what you are doing is working. Stable means little to no mood swings. If there is mania of any kind, then the current system you are using is not enough. I am rarely stable. This means that I have to use natural treatments along with some western style medications. Do I want to do this? Of course not! I would much rather approach bipolar naturally, but the reality is that this illness is a rough one to manage. We need a range of treatments and a daily management plan.

Supplements and a diet change are not enough.


PS: My soap box for the day!

10 Top Myths About Bipolar Disorder

Julie Fast holding Lithium

My latest article for Health Central tackles the biggest myths I see in the bipolar world today. I wonder which ones you find interesting or those that might not be your opinion!

Here is one that many find surprising.

MYTH: Medication Should be the First-Line Treatment for Bipolar Disorder.

This myth often shocks people, and please know that I’m not saying that meds don’t work. They’re an essential part of any plan. I use them daily for certain symptoms, but they’re rarely enough to stop mood swings. To truly manage bipolar, the majority of people with the illness must regulate sleep, focus on healthy relationships, and avoid triggering behaviors (traveling without careful planning, accepting shift work, taking too many classes) and substances (antidepressants, stimulants, steroids, and marijuana due to THC).

If our lifestyle increases bipolar symptoms, all medications can do is keep a lid on a boiling pot. Side effects are the number one complaint about medications. By focusing on lifestyle changes first, we reduce the need for high doses of medications and automatically reduce nasty side effects. In my opinion, medications are for what we can’t manage on our own.

“It’s true that there’s a dogma that medications are the only treatment for bipolar,” says Jim Phelps, M.D., the author of three books on bipolar and founder of psycheducation.org . “It’s entrenched in much of the literature, but it’s just not correct. Putting management techniques first and meds second is so important.” Our current health care system is behind the curve when it comes to this myth. Medications are important, but lifestyle education comes first.”


Click here to read 10 Top Myths about Bipolar Disorder from Health Central.



My Bipolar Disorder Origin Story

Julie A. Fast. 17 and hypomanic in Europe!

My bipolar origin story. I am have naturally occurring bipolar and psychosis. My path was interesting, but absolutely typical.
16 years old sitting in a book store reading comics and my favorite authors. I hear a booming voice say, “You need to leave now!”
This was the start of my psychotic disorder.
At 17, I went on a tour to Europe and have my first long term, intense hypomania almost full blown manic episode.
AT 18, I got hypomanic at Auburn University and left to move to a school that was closer to my favorite hockey team. (Wow, that was a great decision. 😟)
At the end of my 18th year, had my first dysphoric manic depression.
At 19, my first suicidal, psychotic depression.
Summer of 19, another euphoric hypomanic episode at Glacier National Park where I was working.
This is naturally occurring rapid cycling bipolar disorder two, leaning towards bipolar one. I have a separate psychotic disorder. My correct diagnosis is schizoaffective, bipolar type.
Diagnosed in 1995 at age 31 and put on 22 medications including ALL of the new SSRI anti depressants. This turned my rapid cycling bipolar into ultradian rapid cycling (daily mood swings) and I have never really recovered.
Natural bipolar is genetic. I had zero trauma. My life was fine. The bipolar was the problem.
I’m now 55 and have daily mood swings. I live with them and manage them through the ideas in my books. My life is amazing in many ways, but bipolar and psychosis are ever present.
It is my goal to END the expression of bipolar disorder in future generations through the concept of epigenetics.
What is your bipolar origin story?
I believe my paternal grandfather had bipolar and it is on that side of the family in my other relatives. There is no bipolar on my maternal side.


Do Medications Work for Bipolar Disorder?

Bipolar and medications: For those who question if bipolar is a physical, chemical brain illness, I have a story for you.
I use a off label medication for my depression. It has saved my life. Over the past few weeks, I reduced this medication to see if I still needed it at the higher dose. At first, I didn’t see much change, then the to be honest almost forgotten dreaded sobbing, suicidal mood swing jumped on me from behind and ripped through me like a hurricane. This is after reducing my meds for TWO WEEKS. I have not had one of these suicidal down swings that are scary and life threatening since.. the last time I reduced the medication to see if I really needed the higher dose.
Now, almost three weeks into the change, my brain has simply shut down. It is not working. I am functioning. I am not depressed and I know how to work around this, but feeling it again after so many years of fighting it with the ideas in my books and this med is simply mind blowing.
My brain has just stopped working. I can feel it idling. My thoughts are there- I have my to do list- I know exactly what I need to do and I know exactly how to do it and the ability to move forward is simply gone. I am sitting.
My management skills will allow me to get through this. I will get my work done and even though it’s going to be hard, I know how to make it happen. But the toll it takes on me is enormous. It will take even longer to work than it does when I’m on my meds at the right dose. Three hours of work that will take three hours extra to get done will now be three hour of work that will take six extra hours to get done. I will have to use every single skill I write about in Get it Done When You’re Dressed.
I found this medication in 2012. It saved my life. I don’t have side effects. I use it and have a much easier life. But it is not healthy to use it at high doses and I need to be aware of this.
So what to do? I am talking with my prescriber today and I will go back up on my dose. I can reduce it, but not this much.
People who want to tell us not to take meds or not to get ECT or not to get the help we need for our chemically imbalanced brain are ABUSIVE. They want to control us and tell us that bipolar is psychological or emotional. It is not either of these things.
My life is exceptionally good. I have friends, family , more work than I can handle, lots of ideas and people who want to hear them. I manage my bipolar 24 hours a day and I get on with my life as best I can. Reducing one medication caused what you see in the pictures. It created this out of the air- not out of my life.
Take your meds if they work. Take your meds if you need them. Bipolar, schizoaffective and schizophrenia are physical genetic illnesses that involve brain chemistry. This becomes even more clear when the meds are not working.
There is about a 20 minute difference in these photos. This is the true nature of rapid cycling bipolar.

Are You Wearing out the People in Your Life with Your Bipolar Needs?

The Hierarchy of Needs List for People with Bipolar Disorder 

Those of us with bipolar disorder can be complicated people with complicated emotions.  We are often over the top and because of this, our needs can seem larger than life. As a result, we may rush into things blindly and ask the people in our lives for help without thinking of the consequences to the relationship as a whole . We may say, “I’m sick, please help me!”  to the wrong person and often too many times. This can lead to many relationship problems and in some cases, the end of a relationship.  

I ruined quite a few friendships in this way when my need for help turned into neediness!  I made the mistake of reacting from neediness before I thought of what I could do for myself first or how my actions would affect the other person.  I just naturally turned to the people I felt close to. And I turned to them a bit too much. You may have had the same experience! 

This all changed when I created what I call my hierarchy of needs list. This is a list of people (and sometimes activities) you can turn to when the going gets tough. It has a specific order of people to contact like a chain of command and it guarantees you the help you need while respecting the boundaries of others.  The first step is to see what you’re currently doing that may be seen as neediness. 

Common, needy mistakes 

  • Constantly call a partner at work 
  • Expect a ‘best friend’ to be therapist
  • Tell too much to people you don’t know well, especially in a romantic situation 
  • Miss the signals others are sending you
  • Tell a coworker all about your bipolar disorder problems. 
  • Put the burden of your needs on family members 
  • Assume that others want or should to help you with bipolar disorder 

I did all of the above with disastrous results and then I had an epiphany:   

Just because someone is a friend, family member or a partner, it does NOT mean they are the best person to turn to when you need help with mood swings. 

No matter how much someone cares for you, if you constantly assault them with your needs, they will get overwhelmed.  And sometimes, you may pick the 100% wrong person to ask for help and become very embarrassed! (Been there! Done that!) The secret is to determine who can help in certain situations and then put them in order of their ability and desire to help you. This takes time, but it can change your negative relationship patterns around bipolar disorder forever. 

The following is my hierarchy of needs list. 

Julie’s List

1. Myself: I use the treatment plans in my books, write in my journal, exercise, and really examine what is going on with myself before I turn to others. This took many years to perfect. I’ve learned to live with a lot of bipolar pain on my own. 

2. My therapist, doctors and coauthor Dr. John Preston:  Trained professionals know how to hear your needs and help you without getting overwhelmed. I am respectful of their time and make sure I ask for their help in an appropriate way, but they have received quite a few desperate phone calls. 

3. Friends with ability to help me without getting upset:  I have many friends who will hold my hand when I cry. They can listen to all of my ‘problems’ without getting upset. I know how to limit these conversations and always make sure we talk about how they are doing as well.  These are the friends whom I know I can call at 3AM and they will say- “I’m here for you Julie.”

4. My mother:  I definitely turn to my mother- but I often do it in a physical way. I watch her garden, play with her puppy and just exist.  She always knows when I’m sick and now knows what to do and most importantly, what not to do. We’ve been a team for a long time.  When I’m very ill, she is always there for me, but unlike in the past, I think of her needs as much as my own. 

5. Social friends who help me get better through activities:  I have dear friends who like to watch movies, play games, go to happy hour and talk about the world. They are often my first choice when I need to be around people and just turn the focus off of bipolar disorder. They are ready to talk about the illness when I need to, but I try to keep things lighter so that I can have some fun even when I’m sick. 

7. My brother: People help in so many ways you may not recognize. My brother doesn’t talk much about my bipolar. In fact, I don’t think he knows what to say- but he does use my treatment plan I talk about in my books. He helps me around the house when I get depressed. He does my lawn, fixes appliances, sees how I am and does fun things with me. We never talk about bipolar unless I say, “I’m sick today and I need to get out and do something.”  And if I’m getting manic, he lets me know! 

This list changes and grows- but I’m always at the top.  This list can also include a support group, meditation, a walk with a dog or a visit to the coast. It’s up to you.  What matters is that there is not only one person on the list- such as a partner or a friend. That is just too much burden to place on one person. 

Create Your Hierarchy of Needs List 

Once you have given this some thought, you can make your own list.  If you had not read this article first, who would have been at the top of your list? Have you overwhelmed some people in your life? Who would you put there now?  People can be helpers and listeners, others are doers and others love you but want absolutely nothing to do with this illness.  They may not even talk about it or believe it’s real.  It’s up to you to recognize their qualities instead of trying to make them fit your needs.  If you’re feeling overwhelmed by making this list or that there are not enough people in your life to help, please remember that it took me many years to get where I am today.  If you are not sure how to ask for help, start with a support group that focuses on stability and a therapist who can help with behavior changes, you can then add more personal relationships to the list. 

You are Ready for Stable Relationships! 

As a result of creating and using my hierarchy of needs list, my relationships are more long term and stable. Sure, some of my friendships end and it’s very hard, but it’s not from bipolar disorder neediness.  Now that I have the list, I’m reminded that there is help out there. I’m amazed at how learning about what I need and then recognizing who can really help has changed me. It’s about understanding how bipolar disorder affects my life and my needs while also respecting the needs of others.  Your list may surprise you. Sometimes it’s the least expected people who can help the most! 


Questions to ask the close people in your life: 

How do you feel when I talk with you about bipolar disorder? 

What role would you like to play in my management plan? 

Is there someone else you feel I could talk to? 

What do you want our relationship to look like in terms of bipolar disorder? 

This can be hard as you may get some super honest answers- but this is what leads to true and lasting relationships. 


Questions to ask yourself before you ask for help: 

1. What has my relationship with this person been like so far? Am I asking too much? 

2. Has this person said that I can call any time? 

3. Have I done all I can on my own to help myself? 

4. Is this something that should go to a health care professional? 

5. Does the person I want to lean on have too much going on in their lives? 

6. Is there someone better to turn to? 

7. Am I there for them in the way I need them to be there for me? 


If you have bipolar or care about a child or friend with bipolar, I recommend Take Charge of Bipolar Disorder.

If you are a partner of someone with bipolar disorder, I recommend Loving Someone with Bipolar Disorder:Understanding and Helping Your Partner. 

If you want an advanced management plan that allows you or a loved one to reduce meds and manage bipolar disorder on a daily basis, I recommend The Health Cards Treatment System for Bipolar Disorder.