Bipolar disorder Pendulum: stories and information bipolar and coronavirus – five steps to staying well Here are five key steps to staying well:1. Ensure you have an adequate supply of medication:• Manic episodes can be triggered by suddenly stopping medicines, particularly lithium. Remember to order medication in good time. If you do run out, some pharmacies will agree to dispense a short supply of an ongoing prescription. Don’t take “no” for an answer if the alternative is to run out of medicine. If you are self-isolating your pharmacy may be able to deliver your medicines, call them first. You can also register for the NHS App where you can order prescriptions. If you go in person you may have to queue. Don’t be put off by the wait. 2. Keep track of your mood: mania relapse prevention:• You can keep track of your mood using a mood scale. Early in the course of a manic relapse there is the opportunity to nip things in the bud and avoid a severe episode. However time is always short: act immediately.• Mania is usually treated by adding a prescribed anti-manic medication, or by increasing the dose of an existing medication. Examples may include medications like risperidone, olanzapine, haloperidol or quetiapine. Other medications can help with insomnia or agitation.• Your doctor may already have given you a short-term supply of a medication to be used to treat early symptoms of mania, with instructions on how to use it. In these circumstances, we still advise that, if possible, you seek medical advice as soon as you can, even if you have previously been given advice on what to do. This is to make sure that your symptoms receive the necessary monitoring and that you receive support in these difficult times. If you are unable to start treatment yourself, do seek help from your mental health team, your general practitioner or 111, our your local service crisis line as soon as you can.• Finally, limit activity that may reinforce your high mood. Reduce stimulation. Sleep is particularly important in tackling early manic symptoms, so do your best to focus on a good night’s sleep. Plan the daily activities that are most calming for you and stick to them. Listen to the advice of friends and family who you know have helped in the past. 3. Keep track of your mood: preventing depression:• If you experience symptoms of low mood, such as low energy and feelings of hopelessness then contact your GP or mental health team for advice. You can ask them for a medication review.• There are ways you can try and prevent depression:a) Maintaining contact with friends and family is important to reduce isolation. This is challenging at the moment, but you can plan video calls and stay in touch via text or instant messaging.b) limit the amount of time you watch the news as this can increase anxiety & reduce screen time. c) contact our email & call back service at [email protected] or 07591375544 (please note this is not a crisis line). 4. Think about your physical health:• Bipolar disorder is often associated with physical health problems. Your physical condition may make you vulnerable to the effects of the Covid-19 virus, for example if you are over 70 or have a pre-existing health problem. Details of these conditions and advice is available at: NHS coronavirus conditions.• Make sure you take care of your physical health by:a) eating healthily, staying hydrated but limit caffeine and alcohol. Make sure you have the supplies of food you need.b) trying to get enough sleep & getting up and going to bed at the same time everyday to establish a good routine.c) exercise, for example under current rules you’re allowed to run or cycle once a day. 5. Lithium toxicity and virus infection:• Be particularly careful if you are on lithium treatment and you have a high temperature. The risk is you may become dehydrated, so make sure you drink about 2 litres of water a day. If you have a fever take paracetamol to bring your temperature down. If your temperature is very high (38 deg C), if you vomit or have diarrhoea then lithium treatment should be paused until you can drink adequately – SEEK MEDICAL ADVICE before you do this. You can contact 111, your GP or your mental health team. The link to the original clinical advice document can be found here: clinical advice document.