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Returning home after a severe bipolar episode can disrupt medication routines, sleep, and social life. Here’s how to get ready for what’s ahead.
Some years ago, I was discharged from a psychiatric hospital after a stay for mania and psychosis. Of course, it was a relief to go home, but re-adjusting to everyday life after five weeks in the hospital was challenging. From previous hospitalizations, I knew to expect some of this and had tried to prepare, but some things simply can’t be fully planned.
Other challenges simply catch you off guard. Some no one warns you about, and others you only recognize once you’re back in your own space and routine. These surprises can make the transition harder even when you feel ready.
Here are five things to consider when re-adjusting to life at home.
1. Medication Regimen and Sleep Routine
I was on six different medications, and in the hospital they were managed by nurses. I figured that, being a nurse myself, I would grasp my medication routine quickly, but I found it difficult. I needed to make sure that I followed the instructions given to me.
The medication times and sleep routine at home were also different. In the hospital, I would get my first round of sedation at 9 p.m. and then my second at 10 p.m., then I would go to sleep and wake between 5 a.m. and 6 a.m.
When I got home, my medication times were thrown out the window because of socializing or staying up past 10 p.m. So when my nighttime sedation was pushed back, so was my sleep, and I would wake mid-morning, which is something I don’t like. I knew I had to make a decision between going to sleep early and waking up early versus going to sleep late and waking up late, but at 25, this felt like a decision I didn’t want to make.
In the hospital, it was easy to stick to a regular sleep routine, but with all my newfound freedom, I found it difficult. I was fed up with the number of medications I was on, and it was easy to see how people don’t stay on their medication (I’ve managed to adhere to mine since being discharged).
2. Isolation and Loneliness
The loneliness during the first couple of weeks was a killer. While in the hospital, I was surrounded by people, but at home during the day, the absence and silence were deafening.
And the loneliness made me sad, really sad. I thought I would be alright because most of my friends are nurses and work shiftwork, but they had continued with their lives while mine stood still, and they were still busy even when they weren’t working. The hours of loneliness ate me up inside.
3. Lack of Routine and Boredom
The loneliness was not helped by the boredom, and in a vicious cycle, the boredom fed the loneliness.
There were certain times when I couldn’t drive due to my medications. Yet even if I could have driven, I had nowhere to go. I was supposed to be ‘recovering,’ but ‘recovering’ was fairly boring.
Sure, I had presentations to prepare for and a few articles and blogs to write, but they didn’t require me to go anywhere.
4. Grief for a Life Without Bipolar
Coming home to the remnants of an episode serves as a reminder of how unwell I was, which is always very upsetting. After every hospitalization, the reality check hits hard. I realize how severe bipolar can be and that’s when I mourn for a life without it.
5. Fear of a Depressive Episode
Just like night follows day, I worry about depression following mania. As established, the first couple of weeks out of the hospital are pretty emotional, but I second-guess every negative emotion.
- I cried for a few hours because I was lonely. Is that normal, or is it the beginning of a depressive episode?
- I was bored all day. Is that normal, or is it the beginning of a depressive episode?
- I was restless today. Is that normal because I didn’t get out of the house, or is it the beginning of a mixed episode?
These questions, and many more, continue to swirl around my head, and it’s exhausting! I’m constantly on the lookout for a manic-comedown, but not only that, I worry about a resultant hospitalization for depression. My biggest fear is psychotic depression.
Granted, those first few weeks after discharge were hard, but I’ve made it through and am settling back into my usual routine.
Although it can be challenging, planning at least one activity each day can help you get out of the house and keep rumination at bay. I still worry about a possible depressive episode — realistically, I may carry that concern until winter passes here in Australia. But overall, I feel content and grateful to be home.