If your mood feels stuck — not a full episode, but not quite stable — here’s what might help, from rethinking your meds to trying therapy or the ketogenic diet.
One of the many conundrums that people who live with bipolar disorder deal with are mood states that are, well, not so great — but not totally debilitating, either. You’re plagued by a low feeling, but it’s still possible to power through the day somehow.
You don’t sink any further into a depressive episode, yet your mood never lifts despite your usual mood management methods.
In a word, things just suck. You have “the blahs,” big time. What is going on?
When Your Mood Won’t Budge
As yet, science has no answers. Mood symptoms that emerge between episodes appear to be an inherent feature of bipolar, and the reason why is not known. Nor are there diagnostic tests to pin down what’s happening.
As with any other aspect of bipolar, there are no instant solutions, either. Instead, you’ll need to work with your care provider to find something that helps. You might switch to a different mood stabilizer in the anticonvulsant or antipsychotic class, then another one. Things don’t change. What now?
It may be time to step back and take stock — evaluate what has worked in the past, what has not worked, and what hasn’t been explored yet.
Circle Back on Bipolar Medications
From a medication perspective, I always check if the person has had a fair trial with lithium. Lithium is an extremely effective mood stabilizer, although not everyone responds to this treatment. If there was a failed trial of lithium in the past, look into what happened and why. Consider another trial, perhaps at lower dosages.
Use of antidepressant medications in bipolar treatment continues to be a controversial subject, partly because their effectiveness for bipolar depression has a poor track record and largely because there is evidence that antidepressants can trigger a switch into hypo/mania. However, ongoing low mood presents a rationale for their use when carefully monitored.
In recent years, the FDA has approved several medications specifically for bipolar depression. Talk with your provider about those options.
Revisiting Therapy — What Might Work Now
I am a firm believer in the healing power of therapy. I’ve heard many success stories about people living with bipolar who have overcome risky and unproductive behaviors with the help of a wonderful therapist. And there’s no denying the benefits of learning coping strategies in skills-focused talk therapy.
When “the blahs” settle in, it may be that unaddressed emotional issues are dragging down your unconscious and sapping your energy. Psychotherapy provides a safe space to uncover and work through those quagmires.
At the least, a therapist, counselor, or social worker can help you review your current self-care methods and experiment with new ones to see what might break the logjam of your low mood.
Finding the Right Fit In Talk Therapy
If you had a good experience with therapy but aren’t currently seeing someone, consider going back for a tune-up. If you tried therapy and weren’t impressed, you might not have been ready to open up at that time, or you might not have found a good fit with the practitioner.
Also, you may benefit from a different therapeutic approach. Narrative therapy, acceptance, and commitment therapy, mindfulness-based cognitive therapy, and dialectical behavior therapy, to name just a few, each have advantages depending on what type of healing would be most useful at present.
Can the Ketogenic Diet Help With Bipolar Depression?
When you’re stuck in low gear, so to speak, it pays to review where you’re at with the three big players in self-care: sleep, exercise, and diet.
If you’re open to a radical change in your eating habits, read up on the ketogenic diet. Small trials of bipolar management using a ketogenic diet have had promising results, especially for treatment-resistant depression.
Be aware that it’s early days yet as far as the scientific evidence. And preliminary reports suggest that success depends on strict adherence to the diet plan for months, which may not be easy.
The ketogenic diet calls for practically eliminating carbohydrates of any kind — not just sugary processed foods, but also fruits, alcohol, and a range of starchy foods, Grains and grain-based products such as pasta and cereal, root vegetables such as potatoes and carrots, and legumes (dried beans) all fall on the no-go list.
RELATED: Could Ketogenic Therapy Be a Game Changer for Bipolar Disorder?
Instead, the protein-rich diet relies on fats as the body’s main energy source. Recommended foods include meats (including red meat, ham, and sausage), fatty fish (salmon, tuna, mackerel), eggs, tofu, cheese and butter, and nuts and seeds.
Note that nutritionists and dietitians generally recommend a balance of lean protein, healthy fats, and complex carbohydrates, with carbs making up around half or more of the total. Alert your medical and mental health practitioners if you are thinking about trying the ketogenic approach.
Editorial Sources and Fact-Checking
- Danan A et al. The Ketogenic Diet for Refractory Mental Illness: A Retrospective Analysis of 31 Inpatients. Frontiers in Psychiatry. July 6, 2022.
UPDATED: Originally posted May 6, 2023