When the To-do List Becomes the Enemy

From the outside, you look like someone who has it handled. You show up. You get a lot done (for the most part). Your home runs, your child is cared for, and you have your good days. People describe you as hardworking, capable, and on top of things. And yet behind all of this, there are also some really bad, nightmarish days.

What they can't see is the morning you drank your coffee and spiraled into a list like this:

• Meditate before all the responsibilities start

• Eat a high-protein breakfast

• Finish that big project

• Start the next one that’s been on the back burner

• Research support groups

• Plan and take my child on an outing

• Carve out quality time with my husband

Every item is reasonable. Every item is something you genuinely want. And on a depressed morning, even one of them can feel like lifting a car off the ground. Your mind isn't foggy or slow — if anything, it's the opposite, running in anxious overdrive, full of ideas and plans. The problem isn't a shortage of thoughts. It's that the weight of the depression slows the doing to a crawl, and there's never enough energy to do it all.

This is the particular cruelty of this kind of depression: the standards stay high while the fuel runs low. You still expect the version of you who could possibly do all seven. Depression hands you the version who can barely do one — and then anxiety arrives to remind you, loudly, of everything you're not doing. The gap between the two, and the inability to do, accomplish, and achieve all these things, becomes its own source of suffering. And frankly, even a non-depressed person would struggle with getting all of that done!

Why "just push through" is the worst advice to give yourself

Most productivity advice is written for people who are merely busy, not depleted. It assumes you have energy waiting to be organized. It tells you to optimize your morning, batch your tasks, and do the hardest thing first. For a motivated brain, that works. But no, no, no. Do not do the hardest thing first! Here's why that advice backfires on you specifically.

Depression isn't always just about motivation. A lot of the time, it's about capacity — you simply have less to give. So when you force yourself to push through on empty, you don't build a manageable routine. You just run yourself down further. You spend energy you don't have to get through the day, and then you pay for it for days afterward.

People who are used to pushing through are especially good at forcing it. That's exactly why the crash, when it comes, hits so hard.

So if you've been angry at yourself and anxious about not meeting your expectations, try seeing it another way. Needing a simpler approach isn't a weakness. It's knowing your own limits when the depression is active— and developing a manageable productivity plan is key.

Work with the depressed brain, not against it

In Getting It Done When You're Depressed, Julie Fast and Dr. John Preston make a point that runs counter to everything our culture tells us about productivity: you can get real things done while you're depressed. You just have to start — even when the depression is telling you not to. You don't wait until you feel ready, because on a hard day, that feeling may never come. You begin anyway, small. And often the energy and the mental clarity follow once you've started, not before.

Their work, alongside the behavioral principles many therapists use, points to two moves that change everything for people who are used to getting a lot done. They sound almost too simple. They are not. Because the achiever inside of us might not like the ideas.

Move one: Set one goal a day. Just one.

Look at that list of seven again. Now cross off six.

Not forever — for today. Today, you have one goal. Maybe it's "finish the project." Maybe, on a harder day, it's "eat a high-protein breakfast." The size of the goal flexes with the day you actually have, not the day you wish you had.

Here's why this works for your specific brain:

It starves the anxiety spiral. Seven open loops are seven things for anxiety to circle. One goal gives it a single, finishable target. Finished things are quiet. Open things are loud.

It generates evidence. Depression tells you that you're failing, incapable, falling behind. One completed goal is a small piece of contradicting evidence you collected yourself. Do it daily, and you build a case against your own worst narrator.

It protects you from the crash. The all-or-nothing thinker attempts all seven, manages three, and registers it as failure. Set one, finish one, and the day counts as a win. Over a month, "one a day" is thirty completed things — far more than the heroic-then-collapsed pattern ever delivers.

The hardest part, if you're used to doing a lot, isn't doing the one thing. It's letting the other six wait without guilt. They will still be there tomorrow. You are not abandoning them; you are doing what you need to do to first manage the depression.

Move two: Make the plan when you're well. Follow it when you're not.

Depression doesn't just drain energy — it sabotages decision-making and tanks mental clarity. On a low day, choosing what to do can be harder than doing it. Every option feels equally impossible, so you choose nothing and berate yourself for not functioning.

The fix is to separate the deciding from the doing.

When you're having a clearer, steadier hour — and even in depression, those hours exist — sit down and build the plan. Decide what your "one goal" days will look like. Decide what a bare-minimum survival day includes. Decide, in advance, what you'll let go of when things get hard. Write it down somewhere you'll actually see it.

Then, on the bad days, you don't decide. You follow. The depressed brain is a terrible strategist, but can be a perfectly fine employee. You let the well version of you be the boss, and the struggling version simply executes the orders already on the page. Have a plan, and use it. A plan you renegotiate every morning is just one more thing to be anxious about.

Where rest belongs

For people who measure their worth in output, this is the hard one: rest is not the reward you earn after productivity. Rest is part of the plan that enables productivity. Schedule it like a task. Protect it like a deadline. Burnout isn't caused by doing too much on one day; it's caused by never letting the tank refill before you draw on it again.

A sustainable week for a brain that's depressed, anxious, and used to running hard looks very different than what our high-expectation brain wants. One goal a day. Generous rest. Grace for the days when the goal was just "get through it." And yet that pace, held steadily, will carry you past your former all-out sprints every single time — because you'll still be standing.

You don't have to engineer this alone

These changes can work. It's also far easier to brainstorm and take manageable actions with someone in your corner who understands both the depression and the high standards you're not willing to abandon — because you shouldn't have to choose between feeling better and living the ambitious, full life you want.

That's the work I do. Together, we build the plan that fits your real brain and your real life: the daily goal that's right-sized, the structure that quiets the anxiety, the permission to rest without guilt, and the accountability to keep using the plan when depression tells you not to. It's focused, practical, and tailored to you — not generic advice you've already tried.

If you're tired of running on borrowed energy and ready for a sustainable way forward, reach out to schedule a consultation. You've been carrying this on your own for long enough.

This article is for educational purposes and isn't a substitute for individualized professional care. If you're in crisis or thinking about harming yourself, please contact the 988 Suicide & Crisis Lifeline (call or text 988 in the US) or your local emergency services right away.

Holding It All Together, Falling Apart Inside: High-Functioning Anxiety in Women

You get things done. You show up. You hold it together at work, you show up for your kids, you hit the deadlines, you remember the appointments. By most measures, you are doing fine.

So why does it feel like your nervous system never actually gets to rest?

If you're reading this, there's a good chance anxiety doesn't look the way you expected it to. No panic attacks. No visible falling apart. But a relentless hum underneath everything — a mind that won't quiet down, a body that's always braced for something, and a tiredness that sleep doesn't seem to touch—when you get enough sleep.

This is high-functioning anxiety. It's one of the most common things I see in my practice — especially in women carrying a lot: a career, a family, a household, and the invisible mental and emotional load that holds it all together. As someone who has navigated anxiety myself, I know how easy it is to mistake still functioning for doing okay. They are not the same thing.

What High-Functioning Anxiety Actually Looks Like

Anxiety doesn't always announce itself. Sometimes it looks like this:

You can't turn your brain off. Even when things are going well, there's a low hum that never fully quiets. You finish one task and your mind has already jumped to the next without a beat of rest in between. You can be somewhere genuinely good — a dinner, a kid's game, a quiet morning — and still feel like part of you is standing slightly outside it, scanning. The moment the busyness stops, the noise rushes in.

You lie awake — or avoid lying down at all. It's finally quiet. Everyone else is asleep. But instead of resting, you're running tomorrow's list, replaying a conversation from last week, or worrying at 1 a.m. about something you can't control. Or you put off going to bed entirely, because you know the moment you stop moving is the moment everything you didn't deal with during the day comes surging up.

Perfectionism keeps you stuck. High standards aren't a bad thing. But when anxiety is underneath them, perfectionism stops being motivating and starts being paralyzing. You can't finish things. Or you can't feel proud of what you do finish. There's always something that could have been better, there’s always a way you could be better.

You're irritable in ways that don't feel like you. A small comment from your partner. A minor thing your kid does. A frustration at work. Suddenly you're flooded with a reaction that feels far bigger than the moment called for — and then comes the guilt. That snap-then-spiral cycle is often anxiety wearing the mask of anger.

You manage everyone's comfort but your own. You smooth things over before they become problems. You say yes when you mean no. You read the room constantly, adjusting yourself so no one's upset and nothing catches you off guard. It can look like being easygoing or generous — but underneath, it's anxiety trying to stay one step ahead of anything unpredictable. If you can keep everyone happy and fix things before they break, the thinking goes, then nothing can blindside you. The problem is that it's exhausting and impossible to sustain, and over time it quietly strains the very relationships you're working so hard to protect. (This isn't true for everyone with anxiety — plenty of anxious people aren't conflict-avoidant at all — but for those who are, it's often the hardest pattern to see in themselves.)

Your body is always braced. Tight chest. A jaw you don't notice you're clenching until the dentist mentions it. Shallow breathing. Low-grade tension that lives in your shoulders and neck. Anxiety doesn't just live in the mind — it lives in the body, and for a lot of high-functioning people, the physical signs are the clearest tell that something is off.

Slowing down makes it worse. Staying busy feels safer than stopping. So when you finally do sit still — a vacation, a slow weekend morning, a rare quiet hour — you feel restless instead of relieved. The busyness has been doing the work of keeping the anxiety at bay. Without it, there's nowhere to put it.

So Is This Stress, or Is It Anxiety?

It's a fair question — and an important one.

Stress has a source. When the project ships, the stress lifts. When the hard conversation finally happens, the tension releases. Stress is a response to something specific, and it generally eases when that something resolves.

Anxiety is different. Anxiety persists. Solve one problem and the worry simply migrates to the next. The nervous system stays in a low-grade state of alert even when nothing is objectively wrong — because somewhere along the way, it learned that it isn't safe to fully relax.

For women juggling multiple roles — parent, professional, partner, caregiver — anxiety can be especially hard to name, because the demands are real. Of course you're tired. Of course there's a lot to manage. The cultural message is that this is just what life looks like, so you keep going. But chronic anxiety isn't simply a busy life. It's a nervous system that has run on high alert for so long it's forgotten how to come down.

It's also worth saying that anxiety rarely shows up alone. In my work, I see it woven together with mood disorders, trauma, and neurodiversity — along with the particular exhaustion of carrying too much for too long. If your anxiety feels bigger or more stubborn than the usual advice has been able to touch, that complexity is real — and it's exactly what therapy is built to help with.

Why High-Functioning People Often Don't Reach Out

Here's what I hear most often from clients who waited a long time before reaching out:

"I should be able to handle this." "Other people have it so much harder." "Things are actually pretty good — what do I even have to complain about?"

High-functioning anxiety is remarkably good at convincing you that you don't qualify for support. You're managing. You're not in crisis. From the outside, everything looks fine.

But functioning and thriving are not the same thing. And the cost of keeping up the appearance — the white-knuckling, the constant mental effort, the exhaustion of holding the mask in place — is real. It shows up in your relationships, in how present you are with your kids, in your ability to actually enjoy the things that are genuinely good in your life.

You don't have to be falling apart to deserve support. You just have to be tired of feeling this way.

What Therapy for High-Functioning Anxiety Actually Does

A lot of people worry that looking at their anxiety will somehow dismantle what's working — that if they slow down and examine it, everything will come undone.

That's not how it works.

Therapy for high-functioning anxiety isn't about dismantling your capability or your drive. It's about turning down the volume so your life stops feeling so relentless. Together we work to understand where the anxiety is rooted, build real tools for the moments it spikes — drawing on approaches like CBT, DBT, mindfulness, and body-based (somatic) work — and gradually teach your nervous system that it's actually safe to rest.

The goal isn't a life without challenges. It's a life where you're not spending so much energy just holding yourself together — where there's something left over for the people and the things that matter most.

If any of this sounds familiar, I'd love to talk. I work with adults in Colorado and California, focusing on anxiety, depression, and mood disorders. I offer a free 15-minute consultation — no commitment, just a conversation to see if we're a good fit.

Book a Free 15-Minute Consultation →

Amanda Rebel, LMFT, is a Denver-based therapist specializing in bipolar disorder, depression, and anxiety. She sees clients in Colorado and California via telehealth.

When Your Teen With a Mood Disorder Shuts You Out

You knock on the door — silence. You make dinner — they don't eat it. You send a text just to check in, and it sits unanswered. One moment, they're defiant and picking a fight over something so small you're still not sure what happened; the next, they've disappeared behind a closed door and won't come out for hours. You never quite know what you're walking into — whether this morning will be okay or whether something as simple as the wrong breakfast, a misplaced jacket, or an offhand comment will detonate the whole day. Sometimes they seem so far inside their own world that you're not sure they're fully tracking what's happening around them. And if your young adult no longer lives at home, the distance doesn't make it easier — it just changes what the silence sounds like.

If you're caregiving for a teen or young adult with a mood disorder — major depression, bipolar disorder, cyclothymia, or another condition that disrupts their emotional world — you already know that the pushing away doesn't always look like withdrawal. Sometimes it's constant irritability that tips into rage, leaving everyone shaken. Impulsivity that pulls you into a reactive spiral before you even realize what happened, leaving you overwhelmed and second-guessing yourself. Defiance so intense it's hard to remember this is still your kid in there, struggling. Whatever form your child's symptoms take, the intensity — the sheer voltage — is unlike anything your friends are navigating with their teenagers. They're rolling their eyes about attitude and back talk. You're managing something that can detonate without warning, leaving the whole household rattled. This isn't typical teenage moodiness. You've known that for a while.

Here's what's important to understand first: the pushing away — whether it's silence or a slammed door or a screaming match that came from nowhere — is almost never entirely about you, but that doesn't mean you have to absorb it. Staying connected doesn't mean forcing closeness or becoming a punching bag. It means learning to show up in ways your teen can actually receive, while also holding a clear line about how you will and won't be treated.

why they push you away

Adolescents with mood disorders often experience a level of internal chaos that can be so difficult for them to not only articulate but to manage when they are having symptoms. And here's the part that makes it even harder: many teens in the middle of an episode have little to no insight that it's happening. They aren't thinking "I'm symptomatic right now." They're just living it — and their brain is telling them that what they're feeling is reality.

During a depressive episode, they may withdraw because connection feels like too much effort — or because they believe, deeply and irrationally, that they are a burden to you, that nothing matters, that there is no point. Depression often makes people want to isolate, and teens and young adults often don't yet have the self-awareness or the tools to recognize that the voice telling them to pull away is a symptom, not the truth. That self-awareness can be built over time — with the right treatment, support, and experience of coming through episodes and looking back at them. It doesn't happen overnight, but it does happen.

There is also what happens in the body. When a teen is depressed or in a mood episode, their nervous system can become so flooded with intense emotion that connection itself feels physically overwhelming. The pulling away in those moments isn't defiance or rejection — it's self-preservation. Their system is doing the only thing it knows how to do to stop the pain from getting worse. What looks like shutting you out may actually be an attempt to regulate an internal experience that has become completely unmanageable. Understanding it that way doesn't mean you have to like it. But it can change how you respond to it.

During a hypomanic or manic phase, your presence might feel intrusive, like someone pumping the brakes on a mind that is moving fast and doesn't want to slow down. Their brain is dysregulated — flooded with energy, urgency, or irritability — and they are largely acting on impulse. The anger, the defiance, the pushing back against you isn't a considered decision. It's a dysregulated nervous system in motion. They often can't stop themselves in the moment any more than you could talk someone out of a sneeze.

Shame plays a profound role, too. Being diagnosed with a mood disorder — especially as a teenager or young adult, when fitting in feels like survival — can be deeply isolating. Adolescence is already a time of intense push and pull: wanting desperately to belong, while also trying to figure out who you are apart from everyone else. A mood disorder diagnosis lands right in the middle of that developmental tension and can make a teen feel fundamentally other, like they are broken in a way their peers are not, like they will never quite fit. And yet, for some teens, a diagnosis also brings something unexpected: relief. A name for the pain. An explanation that finally makes sense of years of feeling like something was wrong, without knowing what. Both experiences are real, and sometimes the same person feels both, at different moments or even at the same time.

Your presence, however loving, may remind them of something they're not ready to face. Your concern can feel like a spotlight on their worst moments, evidence of everything that marks them as different.

There is also the issue of control. Adolescence is developmentally about building autonomy. When a mood disorder strips away a sense of control over one's own mind, the one thing a teenager or adolescent can still control is who gets in. Sometimes that means keeping you out.

The hardest thing for many parents to sit with is this: your teen isn't pushing you away because they don't love you. They're pushing you away because they don't know how to let you see them like this.

The Trap of Pursuing Too Hard

When our child pulls away, the instinct is often to move toward them — more questions, more check-ins, more engagement. With a teen or young adult navigating a mood disorder, this approach can backfire.

Pursuing too hard and too often communicates, however unintentionally, that their withdrawal is a problem you need to fix. It can trigger more intense emotions. It can escalate conflict.

Watch for this pattern: parent pursues → teen pulls harder → parent escalates → teen shuts down completely. This cycle can feel like the relationship is falling apart, when what's actually happening is a mismatch between how connection is being offered and how it can be received right now.

This doesn't mean giving up. It means learning to offer connection differently — in smaller, lower-stakes ways that don't require your teen to be emotionally available on demand.

How to show up when they don’t want you to

One of the most well-researched findings in mood disorder treatment is that how family members communicate matters enormously. Studies on expressed emotion — the level of criticism, hostility, and emotional overinvolvement in a family system — consistently show that teens and young adults in high-expressed-emotion households have more frequent episodes, harder recoveries, and worse long-term outcomes. The inverse is also true: low-expressed emotion — a calm, consistent, noncritical presence — is genuinely protective.

Be present without requiring a response. Sometimes the most powerful thing you can do is simply be in the same space without asking anything of them. Watch TV in the same room. Sit nearby while they're on their phone. Make food and leave it without commentary. This communicates: I'm here, and I'm not going anywhere, and I don't need you to perform okayness for me right now.

Find the side-door conversations. Face-to-face emotional conversations are high-pressure for many teens and young adults and near-impossible for those who are symptomatic. But side-by-side activities — driving somewhere, playing a video game together, cooking together, walking the dog — lower the intensity. The conversation doesn't have to be about their mental health. It just has to happen.

Send the low-pressure text. Not "how are you feeling today?" but something that doesn't require emotional labor: a funny meme, a photo of their favorite snack, "I saw this and thought of you." You're not asking them to show up. You're just reminding them you exist, and you're thinking of them. Connection doesn't always need a response to be a connection.

Say the hard things simply and without drama. When you do speak directly about what you're seeing, short and calm is better than thorough or tearful. "I've noticed you might be having a hard time. I’m here if you want to talk." Full stop. No follow-up questions. No list of concerns. Just the thing you need them to know.

Keep showing up even when they don't respond. Consistency is the message. Your teen is watching, even when it doesn't look like it. For a young adult living independently, consistency might mean a weekly text, a regular call they know is coming, even if they don't always answer. You're not pestering them. You're being reliable. There's a difference, and over time, they will feel it.

The Difference Between Connection and Control

Here's the possibly uncomfortable question this section raises: Are you trying to stay connected, or are you trying to feel reassured?

When we push for more access, more information, more closeness with a struggling adolescent, we sometimes tell ourselves it's about them. But often, it's about managing our own fear. If they talk to us, at least we know they're okay. If they let us in, at least we have some influence. If they respond, at least we haven't lost them.

These are understandable impulses. Parenting a child with a mood disorder can be so anxiety-provoking. But your teen can feel the difference between you reaching toward them and you reaching for your own relief. One feels like love. The other feels like pressure.

Connection says: I want to know you. Control says: I need to manage you.

Letting go of control doesn't mean letting go of concern. It doesn't mean not setting boundaries. It doesn't mean not doing everything you can to keep them safe and support their wellness. It means coming to terms with one of the hardest truths of parenting a child with a mood disorder: you cannot stabilize their brain for them. You cannot want their recovery more than they do, and you cannot make it happen anyway. You cannot love them into wellness, no matter how hard you try. What you can do — and what the research consistently supports — is be a calm, reliable, low-drama presence that they can return to when they're ready. Your consistency over time is more powerful than your persistence in any given moment.

When to Worry — and What to Do

For many families navigating mood disorders, a mental health crisis will happen at some point. This is not a reflection of your parenting or their character — it is a common feature of these conditions. A crisis is when your child is in danger of harming themselves or someone else. When you are there, the connection strategies in this post do not apply. The tips for staying close, keeping communication low-pressure, and being a calm presence are for the relationship's ongoing work. When things become severe, keeping your child safe — and keeping everyone in the household safe — becomes the only priority. This section is here because crisis is common enough that every caregiver of a teen or young adult with a mood disorder deserves to know what to do before they need to know it.

Signs that the situation needs professional escalation rather than patient connection-building include talk of self-harm or suicide, giving away possessions, sudden calmness after a period of severe depression, complete cessation of eating or sleeping, or behavior that has become threatening or dangerous to others.

But you don't always need a checklist to know something is wrong. Research on caregiver observation consistently shows that parents and caregivers often detect deterioration before formal clinical assessment does. If something feels different — not just harder, but different — trust that instinct. You know your child. That knowledge is clinically relevant.

If your child is in crisis:

• Call or text 988 (Suicide and Crisis Lifeline) — available 24/7 for both the person in crisis and the people who love them

• Text HOME to 741741 (Crisis Text Line) — free, confidential, 24/7

• Call 911 or go to your nearest emergency room if there is immediate danger to your child or someone else

• If your child is a minor, you have the right to initiate a psychiatric evaluation without their consent if you believe they are in danger

A note on HIPAA and young adults: In the United States, if your child is over 18, their medical information is protected, and providers cannot share details with you without a signed release. However, in an acute crisis involving serious and imminent danger, providers may share relevant information with family members under HIPAA's serious and imminent threat exception. This can feel like a wall when you are frightened and trying to help. It doesn't mean you can't call and share your observations — you can always share information with a provider even if they can't share information back. And if you haven't already, talk to your young adult during a stable period about signing a release so their treatment team can communicate with you when it matters most.

If your child doesn't have a treatment team yet, that is the first connection that matters most right now.

You Can't Pour From an Empty Cup

It's worth naming something that often gets lost in the exhaustion of caregiving: your well-being is not separate from your child's well-being. It is directly connected to it. Research on family systems and mood disorders consistently shows that caregiver stress, burnout, and anxiety directly impact the emotional climate of the home, which in turn impacts your child's stability.

And for some families, there was never an easy period to look back on. Pediatric mood disorders are real — some children show signs from early childhood, and the push and pull, the volatility, the disconnection may have been part of the relationship for as long as you can remember. That has its own particular weight, and it deserves acknowledgment too.

Whatever your history with your child, the work of staying connected over the long haul requires that you have the resources to do it. That means sleep. Eating protein. Going for walks. Drinking water. It often means your own therapy and support group. It means finding other parents who genuinely understand what you are living — not just sympathetic friends, but people who know the specific exhaustion of loving someone whose brain works this way. It means allowing yourself to step back from the intensity sometimes without guilt, because sustainable showing up looks different from white-knuckling through every hard moment.

You are not a bottomless resource. The steadier and more replenished you are, the more bandwidth you have to be the calm, consistent, low-drama presence your child needs. Taking care of yourself isn't a retreat from caregiving. It is caregiving.

Parenting a teen or young adult with a mood disorder is some of the hardest relational work there is. If you're looking for more support, contact me to learn how I can help.

Can Ketamine-Assisted Therapy Help With Suicidal Thoughts?

⚠️ If you or someone you know is in crisis right now: Call or text 988 (Suicide & Crisis Lifeline) | Text HOME to 741741 (Crisis Text Line) | Call 911 or go to your nearest emergency room. You don't have to be at the very edge to reach out. If the thoughts are loud, that's enough.

Suicidal thoughts, or ideations, are far more common than most people realize — and far more common than most people talk about. Research shows that nearly half of people living with bipolar disorder experience suicidal ideation in any given year, and rates among those with depression are similarly high. ⁵ If you've had these thoughts, you are not alone, and things can get better. You are living with an illness that, at its worst, turns the mind against itself.

This post is about something that's changing the way we treat suicidal ideation: ketamine-assisted therapy (KAP). Whether you're navigating this yourself or reading on behalf of someone you love, the research is genuinely remarkable.

First: What Is Suicidal Ideation?

Suicidal ideation is a broad term. It covers a wide range of experiences:

• Passive ideation — thoughts like I wish I wasn’t here or everyone would be better off without me

• Active ideation — more specific thoughts about plans or acting on those feelings

Both are serious. Both deserve care. And both have been studied in relation to ketamine with genuinely encouraging results.

What Is Ketamine-Assisted Therapy?

Ketamine is a medication that has been used safely in medical settings for over 50 years — originally as an anesthetic. In recent years, researchers discovered that, in low, controlled doses, it has powerful effects on depression and suicidal thinking.

Ketamine-assisted therapy (KAP) combines a supervised ketamine session with psychotherapy. The ketamine is administered in a safe, clinical setting. A therapist works with you before, during, and after the experience to help you process what comes up and turn insight into lasting change.

It's not about losing control. It's a supported, intentional experience — designed to help your brain do something it may have been struggling to do on its own.

What the Research Says

Here's where things get remarkable.

Most antidepressants take four to six weeks to show any effect. Ketamine can reduce suicidal thinking within hours.

A 2025 real-world study of 96 patients with treatment-resistant depression found a significant reduction in suicidality after IV ketamine — what's striking is that ketamine appeared to reduce suicidal thoughts directly, not simply as a byproduct of improving depression. Even in patients whose depression didn't fully lift, the suicidal thinking still quieted.

A 2024 study of over 500,000 patients found that people prescribed ketamine had significantly lower rates of suicidal ideation compared to those on other antidepressants — both in the short term and up to nine months later. ²

A 2026 systematic review and meta-analysis of 21 studies (927 participants) confirmed that ketamine reliably reduces suicidal ideation in high-risk populations. ³

The pattern across the research is consistent: ketamine works fast, and it works on suicidal thinking specifically.

Your Brain Can Change: The Neuroplasticity Connection

It's not just about a medication doing something to you. It's about what your brain is capable of.

Depression isn't just a mood. It's a brain state. Chronic depression and prolonged stress can actually shrink the connections between brain cells — especially in the areas that regulate mood, hope, and how we see the future. Over time, the brain can get stuck in grooves: the same dark thoughts, the same hopeless loops, the same inability to imagine things being different.

This is where neuroplasticity comes in.

Neuroplasticity is the brain's ability to form new connections, rewire old patterns, and rebuild pathways that have been worn down. Think of it like this: depression carves deep ruts in the road, and your thoughts just keep falling into them — no matter how much you try to steer somewhere else.

Ketamine interrupts that pattern at the biological level.

Research shows that ketamine rapidly increases a protein called BDNF (brain-derived neurotrophic factor) — essentially a fertilizer for brain cells. It triggers the growth of new synaptic connections, particularly in the prefrontal cortex: the part of the brain responsible for emotional regulation, perspective-taking, and the ability to imagine a future. ⁴

These new connections can begin forming within hours of a ketamine session.

This is why people often describe the days and weeks following KAP as a window — a period when things that felt impossible to think or feel differently about suddenly become more reachable. The rigid, tunnel-vision thinking that often accompanies suicidal ideation starts to loosen.

Ketamine opens the window. Therapy helps you climb through it.

The neuroplasticity that ketamine creates makes the brain more receptive to new patterns, new narratives about yourself, and new ways of relating to pain. That's why the therapy component isn't optional — it's what helps make the change stick.

Why This Is Different From Other Treatments

Standard antidepressants mainly target serotonin, dopamine, or norepinephrine. Ketamine works on an entirely different system: the glutamate pathway — the brain's main excitatory system, deeply involved in mood regulation and neural communication.

This is part of why it can help people who haven't responded to multiple other medications. It's not doing the same thing over and over. It's doing something different.

What a KAP Session Actually Looks Like

A few things worth knowing if you're curious:

• My sessions are conducted in a calm, safe office setting

• You are monitored throughout the experience

• Many people feel a dreamy, slightly altered sense of perception — some describe it as floating, or as a loosening of the grip that their thoughts normally have

• Sessions are followed by integration therapy — time to process and make meaning of what came up

• A series of sessions is typically recommended, not just one

The experience varies from person to person.

Is It Right for You?

KAP may be worth exploring if:

• You've tried multiple antidepressants without adequate relief

• You're living with treatment-resistant depression, bipolar 2 depression, or anxiety

• Suicidal thoughts have been a persistent part of your experience

• You're open to a different kind of therapeutic process

It's not a fit for everyone, and it requires thorough medical screening. But for many people who have been suffering for a long time, it represents something genuinely new: a treatment that can work quickly, targets the pain directly, and gives the brain a real chance to change.

You Are Not Stuck

Depression and anxiety lie. They tell you this is just how things are. That it's been too long. That you've tried too many things. That nothing will work.

The research on ketamine-assisted therapy is one of the most compelling pieces of evidence we have that the brain — your brain — is more capable of change than the thoughts would have you believe.

If you've been living with thoughts about not wanting to be here, please know: that is a symptom, not a truth. And there are treatments now that can specifically target that symptom, sometimes within hours.

You deserve to find out what that feels like.

Ready to Learn More?

I offer ketamine-assisted therapy in Colorado and California. If you're curious whether KAP might be right for you, I'd love to talk. Contact me here to schedule a free 15-minute consultation.

If you or someone you know is struggling with suicidal thoughts:

📞 988 Suicide & Crisis Lifeline — Call or text 988

💬 Crisis Text Line — Text HOME to 741741

🚨 Emergency — Call 911 or go to your nearest emergency room

You don't have to face this alone.

References

¹ Chen-Li, D.C.J., Mansur, R.B., Di Vincenzo, J.D., et al. (2025). Effect of intravenous ketamine on suicidality in adults with treatment-resistant depression: A real world effectiveness study. Psychiatry Research, 343, 116282. https://doi.org/10.1016/j.psychres.2024.116282

² Pan, Y., Gorenflo, M.P., Davis, P.B., Kaelber, D.C., De Luca, S., & Xu, R. (2024). Suicidal ideation following ketamine prescription in patients with recurrent major depressive disorder: A nation-wide cohort study. Translational Psychiatry, 14(1), 327. https://doi.org/10.1038/s41398-024-03033-4

³ Tang, W., Jiang, W.W., Que, W.Q., Zhang, W.Q., Chen, H.L., & Zhou, L.J. (2026). Ketamine treatment alleviates suicide ideation in high-risk populations: a systematic review and meta-analysis. Epidemiology and Psychiatric Sciences. https://doi.org/10.1017/S2045796025100371

⁴ Duman, R.S., & Aghajanian, G.K. (2012). Synaptic dysfunction in depression: Potential therapeutic targets. Science, 338(6103), 68–72. https://doi.org/10.1126/science.1222939

⁵ Dome, P., Rihmer, Z., & Gonda, X. (2019). Suicide risk in bipolar disorder: A brief review. Medicina, 55(8), 403. https://doi.org/10.3390/medicina55080403

Amanda Rebel, LMFT, specializes in bipolar disorder, depression, and anxiety. She practices in Denver, CO, and offers online therapy across Colorado and California.

The Time of Chaos: Navigating Bipolar Disorder Through Perimenopause

Perimenopause has been called a "time of chaos." Bipolar disorder can feel like one too. When both are happening at the same time, things can feel completely overwhelming. Here's what's actually going on and what you can do about it.

The Time of Chaos — And Why That Name Fits

Perimenopause has been coined a "time of chaos". That's not drama. It's an honest description of what the body and mind go through!

Perimenopause is a transitional phase that can last anywhere from 4 to 10 years before menopause. During this time, estrogen and progesterone levels don't decline gradually — they swing wildly and unpredictably. That hormonal turbulence causes full-body symptoms: intense mood shifts, anxiety, brain fog, insomnia, weight changes, and irregular periods. And it often starts in the 30s or 40s.

For many women, just having a name for what they're going through brings some relief. It means: this is real. It's not in your head. It's not a weakness. It’s natural. It's your biology going through a massive change — and initiation.

More Than Just Hormones — A Major Life Transition

Perimenopause isn't only a physical event. It's also a significant life transition — a crossing from one chapter of womanhood into another.

Many traditions recognize this phase through the archetype of the crone — not the negative cultural caricature, but something much more meaningful: a woman who has lived enough to know herself, who carries real wisdom, and who is no longer willing to shrink herself for others' comfort.

This is the phase of life that asks — sometimes demands — a hard and honest look at how you've been living. What actually brings you joy? What has been quietly draining you for years? What roles are you ready to step out of, and what do you want to carry forward?

That kind of reflection is powerful. It's also exhausting when you're simultaneously dealing with hot flashes, poor sleep, and mood swings. And for women with bipolar disorder, it can feel like too much to hold at once.

The Culture You're Doing This In Matters

The culture you live in shapes how you experience perimenopause — not just emotionally, but physically.

Research has found that women in some non-Western cultures move through this transition very differently. In certain Indigenous cultures and in parts of Asia and Latin America, the transition to elder womanhood brings increased status, respect, and social power. The woman who has lived long enough to reach this phase is valued for her wisdom, not sidelined for her age. Studies have found that women in these cultural contexts report significantly fewer negative symptoms — and in some cases, almost none at all.

Western culture tends to work in the opposite direction. It prizes youth, productivity, and a particular kind of female visibility that fades with age. Women in midlife are frequently made to feel irrelevant, invisible, or "past it" — by media, by medicine, and sometimes by the people closest to them. Menopause has historically been treated as a medical problem to be managed rather than a transition to be honored.

That cultural messaging is not neutral. When a woman moves through perimenopause in an environment that treats it as a decline rather than a crossing, the psychological weight of that adds real suffering on top of the biological reality.

This doesn't mean your symptoms aren't real or that attitude alone determines experience — especially when bipolar disorder is part of the picture. But it does mean that some of what feels personal — the shame, the invisibility, the sense that you are somehow failing at this — is not coming from inside you. It's coming from a culture that hasn't learned to value what this transition actually is.

You are not declining. You are crossing a threshold that many other cultures have always honored.

"I Don't Feel Like Myself"

One of the most painful parts of perimenopause — and one that intersects directly with bipolar disorder — is feeling caught in between. You're no longer fully who you were. You're not yet who you're becoming. You're in the middle, and the middle is uncomfortable.

"I don't feel like myself" is one of the most common things women say during this time. And it's true — the self is genuinely in transition.

This matters for bipolar disorder because big life transitions are known triggers for mood episodes. When your sense of identity, your roles, and your daily rhythms are all shifting at once, it activates a brain that's already sensitive to disruption. Add hormonal chaos on top of that, and you have a powerful combination pulling at your stability from multiple directions at once.

Identity shifts during perimenopause can look like:

• Feeling disconnected from your old self — like she belonged to someone else's life

• Questioning roles and responsibilities you never questioned before

• Losing confidence that used to feel solid

• Rethinking your career, relationships, or the way you've been living

• Wanting more authenticity and less people-pleasing

• Grieving younger versions of yourself or paths not taken

The grief (or excitement or ‘liminal space’ or the ‘being with’) of perimenopause isn't only about getting older. It's about losing a self you knew — and not yet knowing the one being born.

For women with bipolar disorder, this hits differently. You've already lived through episodes when your thoughts, feelings, and behavior didn't feel like your own. The question of "who am I, really?" isn't abstract — it's something you've wrestled with before. Perimenopause can bring it back with new force.

It Starts in the Brain — Not the Ovaries

Most people think of perimenopause as something happening in the ovaries. But it actually starts in the brain.

The pituitary gland — a small but powerful gland at the base of the brain — is part of the system that controls reproductive hormones. During perimenopause, as the ovaries begin winding down, the pituitary works harder and harder to compensate, sending out increasing hormonal signals trying to get the ovaries to respond.

But the pituitary doesn't only regulate reproduction. It sits right next to the parts of the brain that control mood, sleep, stress, and temperature. When it's in overdrive, those systems feel it too.

For someone with bipolar disorder, this is significant. Bipolar disorder already involves sensitive, sometimes dysregulated brain chemistry. Perimenopause isn't a hormonal storm happening somewhere distant in the body — it's happening inside the same brain that's already working hard to stay stable.

It's not two separate problems running side by side. It's one disruption landing directly on top of another.

Why Bipolar and Perimenopause Amplify Each Other

Estrogen affects serotonin, dopamine, and norepinephrine — the brain chemicals central to bipolar disorder. When estrogen surges and crashes erratically, it destabilizes the same systems your brain already struggles to keep in balance.

Progesterone has a naturally calming effect on the brain — similar to the way anti-anxiety medications work. When progesterone drops, anxiety rises, sleep gets worse, and the nervous system sits closer to the edge.

Poor sleep then becomes its own problem. Sleep disruption is one of the most reliable triggers for bipolar mood episodes. Night sweats wake you up. Hormonal anxiety keeps you awake at 3 am. And when you're not sleeping, everything else gets harder to manage. It becomes a cycle: hormones disrupt sleep, poor sleep triggers episodes, and episodes worsen sleep.

The symptoms of both conditions also overlap so much that it can be genuinely hard to know what's driving what on any given day!

Both bipolar disorder and perimenopause can cause mood swings, poor sleep, irritability and rage, fatigue, anxiety, brain fog, and a feeling of not being yourself. When both are happening at once, these symptoms don't just add up — they multiply.

Rage — Let's Talk About It

Perimenopausal rage is real. Bipolar rage is real. When both are happening at the same time, the intensity can feel terrifying.

Rage is also one of the hardest to experience because it almost always follows with shame. When anger comes fast, and we lose control of our words and actions, most women eventually turn on themselves once the dust settles and ask themselves, "What is wrong with me?" Why can't I control this?

That reaction is understandable. It's also not fair to yourself.

Here's what's actually happening: fluctuating estrogen lowers the brain's threshold for firing the threat response. The part of the brain that detects danger becomes hair-trigger sensitive. The result is a nervous system that is genuinely more reactive — not because of your personality, but because of your neurochemistry right now.

Bipolar disorder adds another layer. During mood episodes — especially mixed states and dysphoric hypomania or irritable depression— the part of the brain responsible for pausing before reacting goes offline. Anger that might be a two out of ten when you're stable can become an eight or nine when you're symptomatic.

When both are happening at once, you're dealing with a brain that is simultaneously more reactive and less able to regulate itself.

The intensity of the anger is real — and it is not the same thing as your character. You can be a kind, self-aware person who has worked hard on yourself and still have rage move through you like a wave. That's not who you are. That's what your brain is dealing with right now.

One more important thing: a sudden increase in rage — especially if it feels different from your usual emotional range — can be an early warning sign of a mood episode, particularly a mixed state.

In the moment, a few things that can help:

• Breathe out longer than you breathe in. A long exhale directly activates the body's calming response. Even three or four slow breaths can take the edge off.

• Get cold water on your skin. Wrists, face, or the back of the neck. It interrupts the physical heat of a rage response quickly.

• Leave the room if you can. Removing yourself before you escalate is not avoidance — it's smart regulation.

• Move your body. A fast walk, even just to the end of the street and back, burns off the stress hormones fueling the anger.

• Name it internally. Simply thinking "this is rage, this is neurological, this will pass" can create just enough distance to keep it from taking over completely.

For a much deeper dive into perimenopausal anger and rage — including what drives it, why it's so common, and how to work with it — I'll be covering this in a dedicated post soon. It deserves its own full conversation.

Depression — The Symptom That Hides in Plain Sight

Rage tends to announce itself. Depression is quieter — and in many ways, harder to catch.

Research shows that women are significantly more likely to experience depression during perimenopause than at any other point in their adult lives. For women already living with bipolar disorder, that risk is even higher. The same hormonal fluctuations that destabilize mood upward can just as easily pull it downward — sometimes within the same week, or even the same day.

Perimenopausal depression doesn't always look the way people expect depression to look. It often shows up as:

• Exhaustion that sleep doesn't fix

• A flatness or emptiness that's hard to name

• Losing interest in things that used to matter

• Feeling like you're going through the motions

• Increased anxiety alongside low mood

• A short fuse — irritability that sits right on top of sadness

• A sense that you've lost yourself, and don't particularly care about finding her

That last one is easy to mistake for the identity shifts of perimenopause. And sometimes it is. But when the feeling of disconnection from yourself starts to feel heavy, hopeless, or persistent — that's worth paying close attention to.

For women with bipolar disorder, depressive episodes during perimenopause carry a specific risk worth knowing about. If you seek help for depression from a provider who doesn't specialize in bipolar disorder, there is a real possibility of being prescribed an antidepressant without adequate mood stabilizer coverage. In bipolar disorder, antidepressants used alone can trigger hypomania, mania, or rapid cycling. This is not a reason to avoid treatment — it is a reason to make sure whoever is treating your depression understands your full diagnosis.

The exhaustion of perimenopause also deserves its own mention here. The fatigue can be profound — a bone-deep tiredness that doesn't respond to rest. It can be hard to know whether what you're feeling is depression, hormonal exhaustion, the aftermath of disrupted sleep, or all three at once. You don't necessarily need to figure out which one it is. But you do need to tell someone. Fatigue this deep affects everything — your mood, your cognition, your ability to cope, your relationships. It is not something to push through alone.

If depression is part of your picture, these are the most evidence-supported things you can do:

• Move your body every day. Exercise is one of the most effective interventions for depression we have — comparable to medication in mild to moderate cases. It doesn't need to be intense. A 20 to 30-minute walk counts. Consistency matters far more than effort.

• Eat regular meals. Skipping meals, blood sugar crashes, and poor nutrition all worsen depression and fatigue. Protein at every meal, reduced sugar, and eating at regular intervals give your brain the stable fuel it needs to function.

• Keep a consistent sleep and wake time — even on bad nights. A regular sleep schedule is one of the most powerful regulators of mood in bipolar disorder. Even if sleep is broken or poor, getting up at the same time every day helps anchor your body's rhythms.

• Stay socially connected — even when you don't want to. Depression pulls toward isolation, and isolation feeds depression. You don't need to be social in a big way. A text, a short phone call, a coffee with one person — small connections count and genuinely help.

• Get outside and into natural light. Light exposure, especially in the morning, directly regulates the brain chemicals involved in both mood and sleep. Even ten minutes outside in the morning makes a measurable difference over time.

• Tell your prescriber explicitly. Don't let depressive symptoms during perimenopause get attributed to just one cause. Make sure your provider understands both are in play.

• Don't normalize exhaustion. Fatigue that is significantly affecting your daily functioning is worth investigating and treating — not just pushing through.

Depression during this phase is common, it is treatable, and it is not a sign that your illness has permanently worsened. It is a sign that your brain and body need more support right now — and that asking for that support is the right move.

Watch for Mixed States

One important warning: perimenopause increases the risk of mixed states — episodes where depression and hypomania or mania happen at the same time. These are often the most confusing and distressing episodes to experience, and rage is frequently right at the center of them.

If you notice agitation alongside low mood, racing thoughts paired with exhaustion, or anger that feels qualitatively different from your usual range — reach out to your prescriber. Don't wait for it to get cleaner or more obvious. Mixed states move fast.

Take the identity transition seriously

Herbalist and women's health advocate Susun Weed has written extensively about this crossing. In her Wise Woman tradition, the woman moving through perimenopause is not declining — she is being initiated. The discomfort, the dissolution of the old self, the rage, the grief — in her framework, these aren't signs that something is going wrong. They are the transition working exactly as it should. The old self is being composted so something truer can grow.

Weed's provocation is worth sitting with: change your life, or your body will change it for you. The symptoms of perimenopause, she suggests, are often the body's way of demanding a reckoning that has been put off too long. The things that no longer fit — the roles, the relationships, the ways of being that were never truly yours — the body starts to reject them. Working with that process, rather than fighting it, is where the real transformation lives.

Use this time to honestly look at what's working in your life and what isn't. What brings you real joy? What is quietly exhausting you?

let it move through

There is a misconception about stability that is worth naming before we close. Stability does not mean calm. It does not mean the absence of turbulence, difficulty, or pain. In fact, some of the most stable things in nature are also the most constantly in motion — just like a river. A river is never still, and yet a river with a deep, strong bed always knows where it is going, no matter how rough the surface gets.

That is the kind of stability that is possible during this time. Not the absence of chaos, but a deepening of the riverbed beneath it. Your values. Your self-knowledge. The things you have learned, often the hard way, about who you are and what you need. The practices that bring you back to yourself. These are the riverbed. They don't stop the water from moving. They give it somewhere to go.

Perimenopause and bipolar disorder will both, at times, make the surface of that river very rough. There will be times when the turbulence and strong currents feel all consuming. But the riverbed is still there. You have been building it, probably without realizing it, for years.

The work of this transition is not to become someone totally new. It is to go deeper into who you already are — to find the parts of yourself that are solid enough to hold the chaos, wise enough to learn from it, and strong enough to carry you through to the other side.

For more information on how I can support you during this fruitful (and at times excruciating) time, contact me. I’d love to hear from you.

This article is for educational purposes and is not a substitute for personal medical or psychiatric care. If you're in a mental health crisis, please contact your care team or call or text 988.

When Depression Hits Like a Giant Wave: What's Going On and How to Come Up Again

You Didn't See It Coming

Maybe you woke up one morning and immediately knew the depression was back. Or maybe it crept in so slowly that by the time you noticed, you were already under. Either way, depression can arrive like a giant wave — and once it hits, it can knock you so far down that getting back up feels nearly impossible.

If you're reading this from that place right now, I want you to know something first: you are not broken and there is hope. This is an illness. It often is cyclical. It’s not a character flaw. It is not weakness.

So let's talk about what's actually happening — and what you can do about it.

What Depression Actually Does to Your Brain and Body

Depression isn't just sadness. That's one of the biggest misunderstandings about it.

When a depressive episode hits, your brain chemistry is genuinely disrupted. Key neurotransmitters — serotonin, dopamine, and norepinephrine — are out of balance. This affects everything: your mood, your energy, your sleep, your ability to concentrate, and even your physical body.

Here's what that can look and feel like:

• A heaviness in your body that no amount of sleep seems to fix

• The inability to feel pleasure in things that used to bring you joy — this is called anhedonia, and it's one of depression's most disorienting symptoms

• Slowed thinking — like your brain is moving through mud

• Negative thoughts that feel completely true, even when they aren't — one of depression's cruelest tricks is making its lies feel like facts

• Irritability or anger that feels out of proportion— depression doesn't always look like sadness; for many people it shows up as a short fuse, frustration, or a simmering rage that's hard to explain

• Physical symptoms — headaches, digestive issues, aching muscles

• Withdrawing from people, even people you love

This is your brain short circuiting.

Why Pulling Yourself Out Feels So Hard

Here's the cruel irony of depression: the very things that would help you feel better are the things that feel most impossible to do, or that you are resistant to do.

Exercise helps — but you can barely get off the couch. Connecting with someone helps — but you feel like a burden. Getting outside helps — but the weight of it all is too much.

This is why "just push through it" or "think positive" advice is so frustrating and unhelpful. Depression physically changes how your brain functions. It's not about motivation or mindset. It's biology.

And knowing why it's so hard can actually be the first step toward being gentler with yourself — which, it turns out, is where healing often begins.

Why Depression Often Comes Back — and What Sets It Off

For many people, depression isn't a one-time event. It's cyclical. It comes, it lifts, and then — sometimes out of nowhere, sometimes very predictably — it comes back again.

This is one of the hardest things to sit with: you've been through this before. You know the way out. And yet here you are again. The voice that says I'll never escape this — that's the illness talking, not reality. That can bring its own layer of grief, shame, and exhaustion on top of the depression itself.

But understanding why it cycles can make the return feel less like a personal failure and more like what it actually is — a predictable pattern of an illness that has triggers.

Stress: A Very Common igniter

Stress and depression have a well-documented relationship. Chronic stress raises cortisol — your body's primary stress hormone — and over time, elevated cortisol can disrupt the very neurotransmitters that regulate your mood. When life piles on — work pressure, relationship strain, financial worry, loss — your brain's resilience gets worn thin, and a depressive episode can follow.

The tricky part is that stress can start to feel like I normal. We may miss the signs that we’re getting really stress. We often adapt, push through, cope, keep going. Until we can't.

For Women: Hormones Are a Real Factor

If you're a woman and you've noticed your depression and mood shifts tend to spike at certain times — around your period, after pregnancy, during perimenopause — you are not imagining things.

Estrogen and progesterone directly influence serotonin levels in the brain. When these hormones fluctuate — which they do considerably across the menstrual cycle, postpartum, and through the transition into menopause — so can your mood. This is why conditions like PMDD (premenstrual dysphoric disorder) and postpartum depression exist, and why some women find their depressive episodes track closely with hormonal shifts.

This doesn't mean your depression is "just hormones" or somehow less real. It means your brain is particularly sensitive to these chemical changes — and that's important information for how you and your treatment team approach your care.

"Faking It Till You Make It" Has a Limit

Ah the crash or the collapse that comes after a long stretch of holding it together.

Many people with depression become remarkably skilled at functioning on the surface — showing up, getting through the day, keeping up appearances — while quietly running on empty underneath. There's even a name for it: high-functioning depression. You look fine. You may even feel okay-ish some of the time. But you're spending reserves you're not replenishing.

Eventually, the mask gets too heavy. The effort of maintaining that gap between how you feel and how you present is exhausting in its own right. And when the crash comes, it can feel sudden and confusing — I was doing so well — even though the buildup had been happening for a long time.

This is one of the reasons early support matters so much. You don't have to wait until you're flattened to ask for help.

The gut-brain connection is real

Your digestive system and your brain are in constant conversation. Researchers call it the gut-brain axis, and it's one of the more fascinating — and clinically relevant — areas of mental health research right now.

Here's why it matters for depression. Your gut is home to trillions of microorganisms — bacteria, fungi, and other microbes — that collectively make up your gut microbiome. This ecosystem does far more than digest your food. It helps produce neurotransmitters, including roughly 90% of the body's serotonin. It regulates your immune system. And when it's out of balance — through poor diet, chronic stress, illness, antibiotics, or disrupted sleep — the effects can ripple all the way to your mood.

When the gut microbiome is disrupted, it can trigger inflammation — not just in your body, but in your brain. Neuroinflammation is now recognized as a significant contributor to depression. Inflammatory signals can interfere with the very neurotransmitter systems that regulate mood, and research consistently shows that people experiencing depression often have elevated inflammatory markers in their blood.

Think of it this way: chronic stress depletes the gut. A depleted gut ramps up inflammation. Inflammation disrupts brain chemistry. Brain chemistry disruption deepens depression. And depression, in turn, disrupts sleep, appetite, and stress response — which further impacts the gut. It's a cycle that feeds itself, which is part of why depression can be so hard to shake without support.

This doesn't mean you need to overhaul your entire diet or take a shopping cart full of supplements. But it does mean that things like eating more whole foods, reducing ultra-processed foods, getting adequate sleep, and managing stress aren't just "wellness tips" — they're actions that directly affect the biological environment in which your mood lives.

This is also why a whole-person approach to treating depression matters. What you eat, how you sleep, how much you move, and how much chronic stress you're carrying are all part of the picture — not separate from your mental health, but deeply intertwined with it.

What You Can Actually Do—Even When Everything Feels Impossible

I want to offer something practical here — not a 10-step list that feels overwhelming, but a few real, manageable places to start.

1. Start Smaller Than You Think You Should

When you're depressed, a goal like "go to the gym" can feel as daunting as climbing Everest. So we shrink it. Not to the gym — to finding a system to set your gym clothes out.

This isn't giving up. This is working with your brain instead of against it. Small actions create small wins. Small wins create momentum. And momentum is everything when you're fighting your way back up.

2. start a routine

Depression disrupts your biological rhythms — your sleep-wake cycle, your appetite, your energy patterns. One of the most stabilizing things you can do is keep a basic structure to your day, even if it's minimal.

Wake up at the same time (easier said than done). Eat one thing a day that is nutritious. Step outside, even briefly. Drink your water. These anchors help regulate your nervous system in ways that go deeper than they might appear.

3. Don't Isolate, Even When You Want To

Depression will tell you that no one wants to hear from you, that you're too much, that you should handle this alone. This is the illness talking — not the truth.

You don't have to have a deep conversation. You could start by exchanging a couple words to a cashier (yeah you’ll have to find a non self-checkout). Even small contact — a text, a walk with someone, sitting near another human being — can interrupt the cycle of isolation that depression feeds on.

One of the most powerful forms of connection when you're depressed is being around people who truly get it — not because they read about it, but because they've lived it. That's exactly what peer support groups offer.

DBSA (Depression and Bipolar Support Alliance) runs free online and in-person support groups specifically for people living with depression and bipolar disorder. The groups are peer-led, meaning the person facilitating the meeting has their own lived experience with a mood disorder. There's no pressure to talk. You can just listen. And something shifts when you hear someone else describe exactly what you've been feeling — the isolation lifts a little, and so does the shame. You might be nervous at first to join. That’s ok, just know you are doing this so you don’t have to feel so bad.

DBSA has over 450 groups across the country, and their online groups are available to anyone, anywhere. You can find a group at dbsalliance.org/support.

4. Notice the Narrative Your Brain is Spinning

Depression is a story-teller, and it is not a reliable one. It tells you nothing will ever change, that this is just who you are, that you're a burden to everyone around you and you are a horrible friend, parent, etc.. It speaks with total confidence. It feels true in your bones.

But here's something worth writing on a sticky note and putting somewhere you'll see it: don't believe everything you think. And the corollary to that: feelings aren't facts. Feeling worthless doesn't make you worthless. Feeling like things will never get better doesn't mean they won't. Feeling like a burden doesn't mean you are one.

This is the illness talking. Depression distorts perception — that's not a metaphor, it's neuroscience. A depressed brain is literally filtering reality through a negative lens.

When you notice these thoughts, try labeling them: "That's a depression thought." You don't have to argue with them or replace them with forced positivity. Just creating a tiny bit of distance between you and the thought can help. You are not your depression, and your depression is not the truth.

5. Get Support — Professional Support

I want to be direct here: depression responds very well to treatment. Therapy, and sometimes medication, can genuinely change the trajectory of what you're experiencing.

This isn't a sign that you've failed. It's a sign that you're taking your brain as seriously as you'd take any other organ in your body. You wouldn't try to muscle through a broken leg. Depression deserves the same care.

Free Resources — You Don't Have to Figure This Out Alone

Support doesn't have to start with therapy. Here are a few free places to turn when you need connection or information right now:

• DBSA Online Support Groups — Free peer-led groups for depression and bipolar disorder, available online from anywhere. dbsalliance.org/support

• DBSA In-Person Chapter Groups — Find a local group near you. dbsalliance.org/chapters

• 988 Suicide & Crisis Lifeline — Call or text 988 any time, day or night, if you're in crisis or just need to talk.

• Crisis Text Line — Text HOME to 741741 to connect with a trained crisis counselor by text.What

What About When It's Really Bad?

If your depression has brought you to a place where you're having thoughts of suicide or self-harm, please reach out for help right now.

You can call or text 988 (the Suicide and Crisis Lifeline) any time, day or night.

This kind of darkness can feel permanent — but it isn't. And you don't have to face it alone.

The Wave Will Not Last Forever

Here's what I know after 15 years of working with people in the depths of depression: the wave does not last forever.

It feels permanent. Depression makes everything feel permanent. But people do come back up. With the right support, the right tools, and time — the weight lifts. Life becomes livable again. Sometimes even more than that.

You deserve support right now, not once you've "earned" it by trying hard enough on your own.

If you're in Colorado or California and you're ready to explore what that support could look like, I'd love to connect. You can book a free 15-minute consultation here.

You don't have to keep treading water alone.

Amanda Rebel, LMFT, is a Denver-based therapist specializing in bipolar disorder, depression, and anxiety. She sees clients in Colorado and California via telehealth.

Two Steps Forward, One To One Hundred Steps Back: Understanding the Cyclical Nature of Bipolar Disorder

There's a particular kind of discouragement that people with bipolar disorder experience. Things are going well — you're sleeping, you feel good, you feel like you’re making progress. And then, without warning (or sometimes with warnings that don’t seem like warnings), a mood episode arrives. Depression descends, or the restless edge of hypomania creeps in, or the anger outburst sends you and another spiraling— and in that moment, or after you regain some balance, it's easy to believe you're back at square one. Yet again, destruction has been wrought. That you suck, you are to blame for others’ pain. That this will never change. That all the work you did meant nothing.

But here's what the research — and lived experience — actually tells us: if you are working on your mental health, you didn’t destroy all growth. And understanding why setbacks happen is one of the most important tools you have for navigating them—and for making the cycles less intense and damaging.

Two Steps Forward, One Step Back — Is Not Starting Over

When a mood episode follows a period of stability, the brain's negativity bias will try to convince you that everything you built has collapsed. That the good stretch was a fluke, and this — the episode and the aftershocks— is the truth of your life.

It isn't.

Stability leaves marks. A week, two weeks, a month, six months of consistent sleep, showing up to relationships, managing stress thoughtfully, seeing how the illness impacts ourselves and others, working on taking ownership of our behaviors — that doesn't vanish when an episode arrives. An episode interrupts your stability; it doesn't erase it.

There's also something meaningful that grows quietly through the experience of navigating episodes over time. Each time you move through one — recognize it, get support, come back — you add to what researchers call illness self-efficacy: your own felt sense of "I've been here before, and I found my way out." People who have managed multiple episodes often become faster at spotting early warning signs, less derailed by fear of future episodes, and more confident about reaching out for help. The illness doesn't get easier necessarily — but your relationship with it can.

It's also worth knowing about something called the kindling effect. Research suggests that early in the course of bipolar disorder, mood episodes are more often triggered by identifiable external stressors — a major life event, a period of sleep loss, a relationship crisis, or a hormonal change. Over time, however, episodes can begin to occur with less obvious triggers, as if the brain becomes more sensitized to cycling on its own. This can feel deeply unfair, and it is. But it also makes the case — strongly — for consistency in the things you can influence: sleep, routines, stress management, and staying connected to treatment even during the good stretches. The goal of that consistency isn't to prevent all episodes. It's to raise the threshold. To give your brain less to work with. To make the symptoms less intense and your life more manageable.

Coming back from an episode, even a hard one, is not starting over. It's continuing — with more information than you had before. Each day truly can be a new beginning.

Why Bipolar Disorder Moves in Cycles

Bipolar disorder is, at its biological core, a cyclical illness. This is not a metaphor — it's neurophysiology. Research consistently shows that bipolar disorder involves dysregulation in the brain's circadian and mood-regulatory systems, including disruptions in how the brain processes dopamine, serotonin, and norepinephrine across time. These systems don't run in a straight line. They oscillate.

Studies on bipolar disorder's course — including landmark longitudinal research like the NIMH Collaborative Depression Study and the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) — have found that even with treatment, mood episodes remain part of the illness for most people. This is not a treatment failure. This is the nature of the illness being treated.

Episodes are periodic — they come and go. Your trajectory is the longer arc: where you are this year compared to last year, whether episodes are shorter, less severe, or further apart.

Accepting that bipolar is a cyclical illness isn't resignation. It is the reality of the situation. People who understand their illness tend to respond to setbacks with problem-solving rather than despair. With self-love rather than the shame spiral (but the shame spiral is so real and common. More on that topic in another blog). They know it's a wave, not a wall.

Where Hope Lives: Long-Term Stability Is Real

It's important to say this plainly: long-term, sustained stability is possible with bipolar disorder.

Research on bipolar outcomes over 10–20 year periods shows significant variability: some people experience frequent episodes, while others achieve what researchers call "sustained euthymia" — extended periods of stable mood. Factors associated with better outcomes include consistent medication adherence, strong social support, early intervention for emerging episodes, and structured daily routines (more on that below).

The most hopeful framing is not "maybe I'll be free of this" but rather: the gap between episodes can grow. Episodes can become less severe. The time it takes to recover can be shortened. You can build a life that is full and meaningful within the rhythm of a cyclical illness — and many people do.

Three Places to Look When You're Ready to Adjust

After an episode or during a stable period when you want to be more intentional, there are three areas worth examining.

1. Your Routines

Bipolar disorder is highly sensitive to rhythm disruption. Research on social rhythm therapy (SRT) — developed specifically for bipolar disorder — shows that stabilizing the timing of daily activities (sleep, meals, exercise, social contact) helps regulate the biological clocks that drive mood cycling.

Ask yourself:

• Is my sleep timing consistent, even on weekends?

• Am I eating at regular intervals, or skipping meals?

• Do I have a wind-down period before bed, or am I transitioning directly from stimulation to sleep?

• Is there anything in my schedule that regularly disrupts sleep — travel, late-night socializing, screen time?

Small, sustainable tweaks matter more than big overhauls. If you're going to bed at wildly different times each night, even shifting toward a 30-minute window of consistency can be meaningful. Yes, it can be seen as rigid, and sometimes that tight of a structure is exactly what our bodies and minds need.

2. Your Relationships

Relationships are both a protective factor and a potential stressor or trigger in bipolar disorder. Research consistently identifies social support as one of the strongest predictors of better outcomes — yet interpersonal stress is also among the most common triggers for mood episodes.

It's worth reflecting:

• Are there relationships in your life that feel destabilizing? High-conflict, unpredictable, or emotionally exhausting?

• Are there relationships you've been pulling away from during episodes that might benefit from a gentle reconnection?

• Have you been honest with the people closest to you about what support actually looks like for you? Can you articulate what you need, and from whom?

This isn't about cutting people off or restructuring everything. It's about noticing the relational landscape and asking whether it supports your stability or works against it—or if it’s some combination of both. Sometimes a single honest conversation — this is what I need from you when I'm not well — changes the dynamic entirely.

3. Your Stress Load

Stress is one of the most reliably documented triggers for mood episodes in bipolar disorder. Both the number of stressors and how you process them matter.

Some questions to sit with:

• Are you taking on more than your current capacity allows?

• Are there chronic stressors — a job, a living situation, a relationship dynamic — that have become normalized but are still wearing you down?

• Do you have regular, reliable ways to discharge stress (movement, time in nature, creative expression, rest)?

• Are you saying yes to things out of obligation or fear when your body is asking for less?

Managing stress with bipolar disorder isn't about avoiding all difficulties. It's about keeping your total load within a range that doesn't push your nervous system toward destabilization. That range will be different from someone without bipolar disorder — and acknowledging that isn't weakness. It's calibration.

Holding Both Things at Once

The hardest thing about living with a cyclical illness is learning to hold two truths simultaneously: this is hard, and I am not going backward. Episodes are painful and disorienting. They are also, for most people, temporary — and survivable — and sometimes even informative. They can show you where a routine slipped, where you were overextended, where you needed rest you didn't give yourself. And I cannot emphasize enough how important it is to have a group, a person, and probably professionals you click with who can support you with all of this.

You are not a person who keeps failing. You are a person living with an illness that moves in cycles, learning to read those cycles more clearly over time, building a life that can flex and recover.

Two steps forward, one step back — is still, unmistakably, forward.

You don’t have to manage this alone. Reach out to see if I can provide that support towards stability.

And remember, the world needs you.

When Your Bipolar Teen Has Suicidal Thoughts: How to Talk, Listen, and Provide Support

September is suicide prevention awareness month, and for good reason. Research suggests that roughly one in four children and adolescents with bipolar disorder are at high risk for suicide attempts, and about half to 57% experience suicidal thoughts (Hauser et al., 2013). This can be common and frightening, not only to read about, but also to be the person feeling suicidal or the person seeing the warning signs. When a child or teen is having thoughts of suicide or showing warning signs, it’s natural for loved ones to feel scared, ‘frozen,’ or unsure about what to say. Many caregivers worry about saying the wrong thing or making things worse, but research shows that speaking openly about suicide does not plant the idea in a young person’s mind (Dazzi et al., 2014). In fact, asking directly can actually bring relief to a teen. It gives them permission to speak openly instead of keeping everything inside and helps them feel supported in what they’re going through.

Starting the Conversation

Simple phrases to start the conversation could be, “Are you ok?” or “You seem sad lately, how can I help?” Let your child or teen know you care about them, want them to feel safe, and that you are here for them no matter what. Put your focus on understanding their world. Ask follow-up questions such as "Can you tell me more about that?" or "Help me understand what that experience was/is like for you" or "I notice you've been struggling with so much lately. Have there been times when the pain felt so intense that you've considered hurting yourself or ending your life?”

Try to use open-ended questions that invite deeper conversation rather than yes-or-no responses. When teens share difficult experiences, validate their feelings by saying things like "That is tough. When that happened to you, how did it make you feel?" Resist the natural parental urge to immediately offer well-intentioned fixes or advice, as this often shuts down further communication.

When Your Teen Isn't Ready to Talk

Don't force the conversation if your child is resistant or shuts down. Instead, leave the door open by saying something like "I'm here whenever you want to talk, and I’m here to listen" or "No matter what you’re going through, my support and love for you will never change, and there’s no problem too big that we can’t get through."

Often, teens open up during unexpected moments - while driving together, during shared activities, or sitting side-by-side rather than in formal face-to-face conversations. When they do start sharing, listen, let them talk. If they begin to tell you things that are upsetting, remain calm, even if you feel extremely upset. Remind yourself that you can ‘lose it’ at another time. Avoid immediately jumping to solutions or saying "You should have..." or "Why didn't you..." These responses can make them feel unheard and less likely to continue opening up. Let them know you’ll help them get the support they need to get through this challenging time and that they aren’t alone in this.

It is also important to know the common warning signs indicating your teen may be having suicidal thoughts. However, when a teen lives with bipolar disorder, some of these warning signs are also symptoms of their mood fluctuations or episodes. That said, again, if something feels off, different, or more extreme than their typical symptoms, consider that it may be an expression of a more severe issue.

Warning Signs

• Suicide Threats - Verbal statements like "I'd be better off dead," "I won't be bothering you much longer," "You'll be better off without me around," "I hate my life," or "I am going to kill myself." However, suicide threats are not always verbal, so if you sense something is very ‘off’, trust that.

• Depression - Low energy, sleeping too much, too little or having insomnia. Isolating more, talking less, spending much more time alone and/or in their room.

• Becomes Suddenly Cheerful after Being Depressed

• Anger, Increased Irritability - Exhibiting unusually irritable behavior, more impulsive, taking unnecessary risks.

• Lack of Interest - Suddenly losing interest in sports or hobbies they used to enjoy, such as a team captain no longer wanting to participate, a dancer leaving their team, or a music-loving friend quitting band, lack of response to praise.

• Sudden Increase/Decrease in Appetite - Dramatically eating less than usual, skipping meals, or eating noticeably more without adding additional exercise to their routine.

• Sudden Changes in Appearance - Not dressing as they typically would or showing lack of personal hygiene.

• Dwindling Academic Performance - Model students suddenly failing classes or not turning in assignments; lack of concern for school, classes, and grades; grades dropping suddenly.

• Preoccupation with Death and Suicide - Writing essays and poems about death; creating artwork or drawings depicting death; making social media posts and comments about death; talking frequently about death or dying, may express ‘strange’ thoughts.

• Previous Suicide Attempts - Youth who have attempted suicide are eight times more likely to make another attempt, with one out of three suicide deaths not being the individual's first attempt.

Finding Support—for Them and for You

Peer support can be invaluable. The Depression and Bipolar Support Alliance (DBSA) offers free peer-led groups for parents and caregivers of youth under 17, for young adults 18+, and newly diagnosed families. Visit DBSAlliance.org to learn more.

For crisis situations:

• 988 Suicide & Crisis Lifeline (U.S.): Call or text 988 to reach trained counselors who can assess risk, listen with empathy, and help create a safety plan. They also support concerned parents or friends. The 988 hotline links callers to skilled crisis intervention specialists who are equipped to evaluate suicide risk levels, offer compassionate support, and collaborate on creating protective measures. Using your area code, the system routes your call to nearby crisis response centers that are part of a comprehensive national network. These professionals can assist concerned family members and friends, and when your teenager gives permission, they'll also engage directly with your child to provide counseling and helpful resources.

• Text ‘TALK’ to 741741to message with a trained counselor.

• Safe2Tell: An anonymous tip line available in Colorado and some other states where students and community members can report safety concerns for themselves or others and get connected to help. Visit safe2tell.org to learn more.

• 911: Calling 911 is best for situations when they are in need of immediate hospitalization.

  Self-harm (like cutting) can sometimes—but not always—indicate suicidal thinking. It’s often used as a coping mechanism for emotional pain. Encourage healthier coping skills, remove access to dangerous items, and respond without shaming. If they are open to meeting with a counselor or therapist, help them find one they feel comfortable opening up to.

Taking Action at Home

Creating a safe environment is a cornerstone of suicide prevention:

• Lock up or remove firearms. Guns are the most lethal method of suicide (Shenassa et al., 2003). Store ammunition separately.

• Secure medications and hazardous items. Keep all meds—including over-the-counter pain relievers—in a locked cabinet. Give only one dose at a time if necessary. Lock up sharp objects and toxic chemicals.

• Create a safety plan. Many caregivers find it helpful to create (with their teen) a written contract where teens agree to tell caregivers when they begin having thoughts of hurting themselves (self-harm). In return, parents promise to interrupt these symptoms with support rather than criticism or blame. This support might range from simple activities like sharing a meal together and talking, to higher-level stabilization steps such as taking them to the emergency room for a risk assessment and possible inpatient stay. The key element is ensuring your teenager understands they can turn to you without fear of judgment during their most vulnerable moments. A plan may also list their unique warning signs, coping strategies, supportive people to contact, professional resources (like 988), and steps to reduce access to lethal means. Download a free template here.

Remember, you are not alone in this—and neither is your teen. If you’d like to talk more or have other questions about suicide prevention, don’t hesitate to reach out.

The Critical Importance of Sleep Routines For Bipolar

If you're living with bipolar disorder, or think you may be, you've likely had poor quality sleep for a lot of your life. Whether it’s difficulty falling asleep, difficulty staying asleep, needing too much sleep, or too little sleep, these rhythms do impact your mood cycles. What you might not realize is just how profound this connection truly is—and how establishing a consistent sleep routine can become one of your most powerful tools for managing your condition.

The Sleep-Bipolar Connection

The relationship between sleep and bipolar disorder is biological. In fact, it is a biological vulnerability—we are vulnerable to mood episodes if our sleep is not good and not consistent. Sleep disruption is both a trigger and a symptom of mood episodes, which is why it is important to understand the concept of circadian rhythms.

Your body has an internal clock that tells you when to feel sleepy and when to feel alert—this is called your circadian rhythm. In people with bipolar disorder, this internal clock doesn't work as smoothly as it should, and may have a different clock. Many people who live with a mood disorder are ‘owls’, they prefer to go to bed later and wake up later than those ‘morning birds’. Also, brain scans show that the specific brain areas responsible for keeping our sleep schedule on track are different in people with bipolar disorder. Because of this built-in vulnerability, even small changes to your sleep—like staying up one hour later than usual—can trigger a mood swing.

Key considerations:

• Missing just one night of sleep can be enough to trigger a manic or hypomanic episode

• When your sleep schedule is all over the place, it takes longer to bounce back from depressive or hypo/manic episodes

• Your body's natural production of melatonin (the sleep hormone) and your internal temperature regulation work differently when you have bipolar disorder

• Changes to your daily routine—like back-to-school time—can trigger an episode because the sleep schedule is probably changing.

• Interpersonal Social Rhythm Therapy (IPSRT) recognizes that mood stability in bipolar disorder depends heavily on the regularity of daily rhythms, particularly sleep. Developed by Dr. Ellen Frank and her colleagues, IPSRT is based on the social zeitgeber theory—the idea that social cues help regulate our biological clocks.

This therapy focuses on identifying and stabilizing five key daily rhythms:

• Sleep and wake times

• Meal times

• Exercise timing

• Social interactions

• Daily activities and routines

Research shows that IPSRT can significantly extend the time between mood episodes and improve overall functioning when combined with medication management.

Practical Sleep Hygiene Strategies from IPSRT

1. Master Your Sleep-Wake Schedule

Track your sleep and wake times daily, aiming for consistency within 30 minutes, even on weekends.

Action steps:

• Set a fixed wake time that allows for 7-9 hours of sleep

• Use a sleep diary or app to monitor patterns

• Avoid "catching up" on sleep with sleep-ins

• If you must adjust your schedule, do so gradually in 15-minute increments

2. Create Consistent Pre-Sleep Routines

Establish consistent routines that signal to your body it's time to wind down.

Action steps:

• Begin your routine 60-90 minutes before desired sleep time

• Include relaxing activities

• Dim lights progressively (consider blue light blocking glasses)

• Keep electronic devices out of the bedroom

• Practice the same routine every night, regardless of how you feel

3. Optimize Your Sleep Environment

Your bedroom should consistently promote rest and be associated only with sleep.

Action steps:

• Maintain a cool temperature (65-68°F/18-20°C)

• Invest in blackout curtains or an eye mask

• Use white noise or earplugs to minimize disruptions

• Remove work materials, TVs, and stimulating items from the bedroom

• Consider a sunrise alarm clock to support natural circadian rhythms

4. Regulate Light Exposure

Light is the most powerful circadian rhythm regulator, so timing matters enormously.

Action steps:

• Get bright light exposure within 30 minutes of waking (outdoors if possible)

• Aim for 10,000 lux light therapy if morning sunlight isn't available

• Dim lights 2-3 hours before bedtime

• Avoid screens 1 hour before sleep, or use blue light filters

• Keep your bedroom completely dark during sleep hours

5. Monitor and Stabilize Social Rhythms

Social activities and daily routines act as external cues that help regulate internal biological rhythms.

Action steps:

• Eat meals at consistent times daily

• Avoid isolating—the right social connections are stabalizing

• Maintain work and exercise routines at similar times

• Track the timing of your routines and activities to help maintain consistency

• Plan ahead for schedule disruptions and build in recovery time; if you are, for example, traveling to attend a wedding, schedule time after the event to recover from the changes

6. Develop Early Warning Systems

Recognize sleep pattern changes as early indicators of mood shifts.

Action steps:

• Note when you need less than 6 hours of sleep and feel energetic

• Track periods when you can't fall asleep despite feeling tired

• Monitor oversleeping or difficulty getting out of bed

• Share these patterns with your therapist, doctor, etc…

• Create a plan to resume getting good sleep—having a professional who understands how to support people with sleep hygiene can be very helpful

Managing Sleep During Different Mood States

During Depression:

• Resist the urge to stay in bed all day

• Get outside, get moving

• Engage in gentle morning activities even if motivation is low

• Maintain consistent meal times and eat nourishing foods

During Hypomania/Mania:

• Stick to your bedtime routine even if you don't feel tired

• Use relaxation techniques like progressive muscle relaxation

• Avoid stimulating activities in the evening

• Consider speaking with your doctor about temporary sleep aids

• Remove potential triggers from your environment

During Mixed States:

• Focus on safety and basic sleep hygiene

• Use grounding techniques if racing thoughts prevent sleep

• Maintain your routine even if sleep quality is poor

• Prioritize professional support during these challenging periods

Building Your Personalized Sleep Plan

Creating lasting change requires a personalized approach. Consider these steps:

1. Assess your current patterns using a sleep diary for 2-3 weeks

2. Identify your most problematic areas (timing, environment, routine, etc.)

3. Start with one change at a time to avoid overwhelming yourself

4. Track your mood alongside sleep patterns to see connections

5. Work with your healthcare team to integrate sleep hygiene with your overall treatment plan

6. Be patient with setbacks - rhythm disruption is part of bipolar disorder, not a personal failure

The Bottom Line

For people with bipolar disorder, getting good sleep isn't a luxury—it's a necessity. The evidence is clear: consistent sleep routines can dramatically improve mood stability, reduce episode frequency, and enhance overall quality of life. While establishing these patterns requires commitment, patience, and support, the investment in your sleep routine may be one of the most impactful things you can do for your mental health.

Sticking to sleep routines isn’t easy. It can be tempting to keep scrolling, watch one more show, or keep reading that book you can’t put down. But remember how much suffering comes with a mood swing. If you’re having trouble with sleep, you aren’t alone!

Your circadian rhythms may be more sensitive than others, but this also means they can be powerful allies in your journey toward stability. And you don’t have to go it alone. There is support out there to develop healthier sleep patterns. Reach out to understand more about how I can help support your sleep changes.

From Expectations to Acceptance: Redefining Success When Parenting a Bipolar Teen

Acceptance is a key action in parenting a bipolar teen

When a teenager receives a bipolar diagnosis or is experiencing major mood swings, many parents want to know what parenting strategies actually work. The natural inclination is to rely on traditional parenting approaches, which include setting clear expectations, maintaining consistent consequences, establishing firm boundaries, and believing that with enough structure and determination, any challenge can be overcome. While all teens naturally struggle with rules and boundaries as part of their development, bipolar teens face these same challenges plus the added complexities of mood episodes, executive function difficulties, and neurological differences. Traditional parenting methods that lean into a more authoritative style often create more friction and can even worsen bipolar symptoms.

The shift from expectations to acceptance isn't about lowering standards or giving up hope; it's about embracing a new perspective. It's about learning to parent the child you have. We must parent differently since our child’s needs are different.

Why Traditional Parenting Falls Short

Most parenting advice assumes a neurotypical developing brain—one that responds predictably to rewards, consequences, and logical reasoning. But when you're parenting a bipolar teen, you're working with a brain that experiences dramatic shifts in mood, energy, and cognitive function that are largely beyond their conscious control.

Traditional approaches often fail because they don't account for the reality that your teen's capacity can change dramatically from day to day, or even hour to hour. The expectations we set during their stable periods may become impossible burdens during depressive episodes or overwhelming pressures during manic phases.

When we insist on consistency in a world where their internal experience is inherently inconsistent, we inadvertently set both ourselves and our teens up for failure. The result is often increased shame, stress, frustration, overwhelm, and family conflict—exactly the opposite of what we're trying to achieve.

Understanding Natural Development vs. Forced Growth

Every child develops skills at their own pace, but this is especially true for teens with bipolar disorder. Their developmental trajectory isn't linear—it's more like a spiral, with periods of growth, regression, and plateau that don't follow typical timelines.

Effective parenting involves recognizing that skill development occurs naturally when the right conditions are present. Instead of pushing our teens to meet arbitrary milestones, we create environments that foster natural growth and development. Some examples:

• Acknowledging that executive function skills may develop later than in neurotypical peers

• Recognizing that emotional regulation takes longer to master when you're dealing with mood episodes, changes in medication, or significant stressful events

• Understanding that social skills might need to be rebuilt after each major mood cycle

• Accepting that academic progress may be uneven and require accommodations

• Remembering that your child is not deliberately trying to ____, it is their illness talking

This doesn't mean we have no expectations or structure. Rather, we adjust our expectations to match our teen's current capacity while maintaining hope for future growth, because growth is possible.

Meeting Them Where They Are

Effective bipolar parenting starts with a fundamental question: "What is my teen actually capable of right now, in this moment?" This requires us to become skilled observers of our children's states and to separate their core identity from their current symptoms, as well as separating our expectations of what they ‘should’ do or how they ‘should’ be.

During a depressive episode, "capable" might mean getting out of bed and eating one meal. During hypomania, it might mean channeling their energy into creative projects while maintaining basic safety boundaries. During stable periods, capabilities expand, but we learn not to assume this expansion will be permanent.

This approach requires tremendous flexibility from parents. We must learn to read the subtle signs of mood shifts and adjust our expectations accordingly, as well as know (as much as possible) what steps to take when they have symptoms. It means, for example, having different sets of house rules for different mental health states, not as a way of excusing behavior, but as a way of working with their neurobiological reality.

Examples of Practical Parenting Strategies

Create Flexible Structure: Instead of rigid rules, develop frameworks that can bend without breaking. For example, "homework gets done" might become "we check in about school daily and problem-solve together when you're struggling."

Focus on Effort and Understanding: Respond to your teen’s behaviors with empathy, compassion, and love. Use your energy to advocate for their well-being.

Develop Symptom-Specific Plans: Collaborate with your teen when they are well to create structure and support for various mood states.

Model Emotional Regulation: When your teen is in crisis, your calm presence is more valuable than your advice or consequences. Save the processing for when they're regulated.

Separate the Person from the Disorder: Help your teen understand that having limitations during mood episodes doesn't define their worth or potential.

The Paradox of Acceptance

When parents stop fighting their teen’s bipolar symptoms and start working with them, everything changes. Acceptance doesn't mean resignation—it means clearly looking at things for what they are.

When we accept that mood episodes are part of our teen's experience rather than failures to overcome, we can focus our energy on building resilience, developing coping strategies, and strengthening our relationship with them. We become partners in managing a chronic condition rather than adversaries fighting over unmet expectations.

This shift often leads to better outcomes than traditional approaches because it reduces the shame and pressure that can exacerbate mood symptoms. When teens don't have to carry the additional burden of disappointing their parents, they have more energy available for actual healing and growth.

Building Long-Term Success

Effective parenting isn't about the immediate moment—it's about raising a young adult who understands their condition, knows their triggers and early warning signs, and has developed personalized strategies for managing their mental health.

By modeling acceptance rather than frustration, we teach our teens to extend the same compassion to themselves. We show them that having bipolar disorder doesn't make them broken or less worthy of love and respect.

The skills that develop from this approach—self-awareness, emotional flexibility, self-advocacy, and realistic goal-setting—serve them far better in adulthood than rigid adherence to external expectations ever could.

A Different Kind of Hope

Parenting with acceptance doesn't mean giving up on your teen's potential. It means recognizing that their path to reaching that potential may look different from what was originally envisioned. The destination might be the same—a capable, independent, fulfilled adult—but the route requires different maps.

Some days, acceptance means celebrating small victories. Other days, it means sitting with disappointment without making it the teen's responsibility to fix parental feelings. Always, it means choosing relationship over being right, connection over control.

This journey teaches parents that teens don't need to be fixed—they're not broken. They need to be seen clearly, loved completely, and supported as they learn to navigate a world that isn't always designed for brains like theirs.

In letting go of who parents think their teen should be, they can discover who their teen actually is. And that person is always remarkable.

For more information on effective parenting tips, contact me, or check out my parenting program: www.parentyourbipolarchild.com

Beyond Words: How Expressive Arts Therapy Can Deepen and Support Your Ketamine Journey

Why Art Therapies and Ketamine Work So Well Together

Here's what makes this combination so powerful: both ketamine and creative expression tap into the same non-ordinary states of consciousness. Both can bypass our usual mental defenses, such as those parts that are often dominated by analyzing, judging, and trying to make everything make sense.

During ketamine sessions, our defenses are often lowered, and we access parts of ourselves that aren't available during the day-to-day. This experience parallels what can happen when we’re engaged in a fulfilling creative process.

For example, someone may have a picture, image, or dream-like experience come up during a ketamine journey. Say someone had the imagery or feeling of being underwater, unable to reach the surface. Rather than limiting this to verbal processing, that person could begin sculpting with clay, creating figures breaking free from the water, or a cocoon, or any other object that symbolizes the water. With each piece, this person isn’t just remembering their session; they are also continuing the work their psyche had begun, and they are finding a strength-based action (figures breaking free) to what very well may have been a difficult journey. Perhaps this then leads the person to discuss how their body feels when they create figures breaking free, thus continuing the work of integrating and making new meaning. This process also helps us establish an ongoing relationship with ourselves and our healing process, which we can access independently.

The Neuroscience That Backs This Up

Recent neuroimaging studies give us some fascinating insights. Ketamine primarily works on the brain's default mode network—that's the area responsible for rumination, self-criticism, and those repetitive thought patterns many of us are familiar with. When ketamine quiets that network down, space opens up for new neural connections.

At the same time, expressive arts therapy activates the brain's creative networks—the right hemisphere's visual-spatial centers and the corpus callosum, which facilitates communication between both sides of the brain. Dr. Michael Mithoefer refers to this as "bilateral integration," which means that we're not just thinking differently—we're experiencing ourselves and life differently; much deeper work than just thinking.

When you combine these approaches, you're essentially giving those new neural pathways formed during ketamine sessions a means to strengthen and remain intact. Instead of insights fading back into old patterns, they become embodied, visual, and tangible.

How This Actually Works in Practice

Based on clinical experience, here's what tends to be effective in ketamine-arts integration:

Capturing What Can't Be Said People often emerge from their ketamine journey with profound realizations that are beyond words (ineffable). They commonly express frustration with the limitations of language when trying to convey their experience. Art becomes their way of preserving those wordless knowings—the feelings, the body sensations, the sudden understanding that lives deeper, or beyond, language.

Building Their Personal Healing Map The imagery and symbols that appear during ketamine sessions typically aren't random occurrences. They often represent communications from the unconscious, pointing toward what needs attention in the healing process. When we create art or find ways to express the information, we are essentially building our own roadmap for integration. Noticing what comes up when we engage in an art process can deepen the ketamine experience.

Making Sense of the Difficult Sessions Not every ketamine experience feels positive or enlightening. People do encounter painful memories, difficult emotions, or confusing material. Creative practices provide a way to be with these challenging sessions without the immediate pressure to understand or resolve them. With a trained art therapist, there are creative processes that can calm people if they are very dysregulated coming out of the ketamine journey. And often, what initially seemed negative or unhelpful reveals its therapeutic value through the creative process. Engaging in a creative activity with a trained therapist can increase feelings of safety, balance, and regulation after a difficult journey.

Getting Past Creative Resistance It’s very common to be hesitant to engage in a creative activity, often due to past experiences where someone was told they weren't artistic or they got the messaging that creativity wasn't valuable or as important as other things. These beliefs can create resistance to anything non-linear or intuitive. Interestingly, ketamine naturally softens these limiting beliefs, making treatment an optimal time to reconnect with innate creative capacities.

Working with Whatever Therapy Model You Use Arts integration adapts well to various therapeutic approaches. Whether you're also engaging in IFS, ACT, CBT, or other modalities, creative elements can be woven into existing frameworks. Art becomes a bridge that connects ketamine insights with the existing therapeutic approach.

Practical Guidance

Research suggests that timing plays a significant role in integration work effectiveness. Here's what tends to work well:

Before the Session Gentle, opening activities work best—perhaps going for a walk and picking objects that you like, and playing around with placing this objects in different places to enjoy looking at—and perhaps writing down why these objects ‘called’ to you. Is it the smoothness of a stone that is comforting? The leaf that had a beautiful shape that is engaging to look at? This sensory and creative activity is designed to engage you in a way that feels safe and bypasses the need for words or logic, allowing you to open up to the present moment.

Right After the Journey: This is when we are still in the liminal space. In my office, I have collage materials, including lots of magazines, calendars, and other images cut out, which clients can look at and choose from. They may select some pictures that express the journey; they may also choose an image that symbolizes how they are feeling in that moment. They may pick an image that will support them over the next few days. This form of externalizing what is internal can serve as an anchor as they go back home to their lives.

Continued Integration: Depending on the individual's needs and preferences, I may offer guided imagery, ritual, writing, drawing, movement, or sound activities to help them continue processing the content that emerged during the journey and work on any other themes, issues, or goals they have.

Ongoing Practice: Even brief periods of creative engagement can help maintain active neural pathways. Many clients develop their own rituals—drawing while listening to music, keeping a visual journal alongside regular journaling, creating poetry, the ideas are endless!

Matching Methods to the person

People process information in various ways, and meeting people where they are is incredibly important.

For visual processors: Painting, drawing, collage, photography.

For kinesthetic learners: Movement, dance, working with clay, sculpture. If ketamine helped someone feel more connected to their body, these approaches can help anchor that embodied awareness.

For auditory processors: Music, sound exploration, creating playlists. Some people develop enhanced musical sensitivity during treatment—exploring sound as a healing tool can be especially meaningful.

For verbal processors: Creative writing, poetry, storytelling. This bridges someone’s comfort with words and the more symbolic, metaphorical material that often emerges during sessions.

Working Through Creative Resistance

Resistance to creative activities is extremely common, with many expressing that they're not artistic. This resistance often stems from childhood experiences where creativity was criticized or devalued compared to academic subjects. These experiences can create the same kind of mental rigidity that contributes to depression and anxiety patterns.

Ketamine therapy can help to start breaking up limiting beliefs. The inner critic that usually evaluates creative attempts as inadequate may become quieter during and after treatment. The perfectionism that would normally shut down creative exploration may becomes less dominant. This makes ketamine treatment an opportune time to reconnect with natural creative capacities that existed before external criticism took hold.

Expressive art therapy isn't aboutcreating aesthetically pleasing art—a product. Rather, it's about honoring the communications emerging from the unconscious mind—a process. A simple scribble, drawing or sketch that captures how someone felt during a session has significantly more therapeutic value than any technically perfect piece that doesn't connect to their inner experience.

What Success Actually Looks Like

Traditional therapy metrics don't always capture what happens when ketamine is integrated with arts therapy. Different markers tend to be more relevant:

Peopl often develop an enhanced ability to access and name emotions that previously felt overwhelming or vague. They typically begin treating themselves—and their creative expressions—with increased kindness and less self-criticism. When difficult feelings arise during art-making, many develop improved capacity to stay present with the experience rather than shutting down or becoming avoidant. Having a trained arts therapist is vital to guide and support a person engaged in any form of art therapy.

Perhaps most importantly, there's often evidence of what could be called "sustained neuroplasticity"—insights from sessions continue to evolve and deepen through ongoing creative practice.

Moving Forward

If you're already working with ketamine therapy or considering engaging with this medicine, I'd encourage you to think about integration as seriously as you think about the sessions themselves. Every ketamine experience without proper integration is a missed opportunity to help you maximize the healing potential.

The combination isn't just additive—it's exponential. When clients give their insights form through creative expression, they're not just remembering their healing; they're continuing to live it, develop it, and let it transform how they move through the world.

Ready to Explore This Integration?

I'd love to talk with you about how expressive arts therapy might fit into your ketamine therapy. Whether you're curious about it, want to discuss specific challenges you are having, or are wondering how to incorporate this modality into your current preparation or integration.

Your experiences deserve to be honored, preserved, and woven into the life your are living, or the life you want to live.

Let's connect: Contact me to learn more.

Because healing isn't just about getting back to where you were—it's also about re-discovering who you are.

Managing Bipolar Aggression

Bipolar disorder is a complex mental health condition characterized by extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). Many people living with bipolar experience aggression or irritability that can be hard to control. This blog post explores strategies for understanding and managing this intense mood state.

Understanding Bipolar Aggression

Aggression in bipolar disorder is not simply "bad behavior" but a symptom of the illness.

For example, when someone is experiencing a hypomanic/manic episode, everything can feel amplified. Small irritations can trigger intense anger and aggression that doesn't match the situation.

That’s the illness speaking.

Research suggests that aggression in bipolar disorder can be linked to:

• Neurochemical imbalances during mood episodes

• Overwhelming sensory stimulation during mania

• Frustration from racing thoughts and inability to express them clearly

• Sleep disruption, which worsens irritability

• Medication side effects or withdrawal

Recognizing Early Warning Signs

Many people with bipolar disorder develop awareness of their personal warning signs that aggression may be building. Identifying these signs as soon as possible can help prevent escalation.

Signs that aggression is on its way may include: getting easily annoyed, being in a bad mood for no reason, having trouble not reacting to things, feeling anxious/on edge, speaking quickly, interrupting people, and making little things become intolerable big things.

More early warning signs include:

• Increased irritability over minor issues

• Feeling overwhelmed by sensory input (lights, sounds, crowds)

• Racing thoughts and difficulty concentrating

• Decreased need for sleep

• Feeling "on edge" physically

• Clenched jaw or fists, shallow breathing

• Pacing or restless movement

Management Strategies

1. Finding the Right Medication and staying on it

For many, the foundation of managing bipolar symptoms, including aggression, is staying consistent with medication and any other integrative medicines.

Medication strategies include:

• Working closely with providers to find the right medication(s)

• Using pill organizers and reminders

• Tracking side effects to discuss with healthcare providers

• Never stopping medications abruptly

• Communicating with providers about side effects and skipped doses

2. Having supportive environments

Creating (and leaving) environments that minimize triggers can significantly reduce aggression.

Certain environments are a setup for irritability and aggression. Plan ahead to either avoid these situations during vulnerable periods or have a solid exit strategy.

Environmental strategies include:

• Creating a calm home environment with reduced stimulation and clutter

• Identifying and limiting exposure to known triggers

• Having a quiet space to retreat to when feeling overwhelmed

• Find what works: noise-cancelling headphones, music that balances, reading that calms—anything that calms the nervous system

• If possible, take things off the to-do list and simplify the day-to-day

3. Sleep Health

Sleep is a non-negotiable. One night of poor sleep can trigger irritability, but two or three can send some into a full hypo or manic episode with aggression as an ingredient. Protect your sleep schedule like it's medicine—because it is.

Sleep strategies include:

• Maintaining consistent sleep and wake times

• Creating a relaxing bedtime routine

• Limiting screen time before bed

• Making the bedroom comfortable and only for sleep

• Using relaxation techniques to help with falling asleep

• Communicating with loved ones about the importance of not disrupting sleep

4. Physical Outlets for Energy

Physical activity can help channel the intense energy that sometimes manifests as aggression during an episode.

When you feel that energy building up and know it could turn into aggression, find a way to release it.

Physical outlet strategies include:

• Regular exercise appropriate to current energy levels

• Intense workouts when feeling manic energy building

• Yoga and stretching for physical and mental tension

• Martial arts with a focus on discipline and control

• Dancing or other rhythmic movement

• Safe physical activities like punching pillows or stress balls

5. Communication Plans

Having predetermined communication strategies can help during periods of increased irritability.

Establish and create a system with your family, friends, and/or partner when you are stable. Preparing ahead of time for handling aggression when loved ones are around can be immensely helpful.

Communication strategies include:

• Creating code words or signals with trusted people

• Practicing phrases to use when needing space

• Establishing communication breaks during heated moments

• Writing letters or emails when verbal communication is difficult

• Using "I feel" statements rather than accusatory language

• Being honest about symptoms with close support people

6. Mindfulness and Grounding Techniques

Learning to recognize and interrupt escalating emotions through mindfulness can be powerful.

Meditation may feel impossible at first with racing thoughts. But starting with just one minute of focused breathing can grow into a practice that helps someone recognize when emotions are spiraling and can bring them back to center.

Mindfulness strategies include:

• Brief meditation practices (even 1-5 minutes can help)

• Body scan exercises to identify physical tension

• Grounding techniques using the five senses

• Deep breathing exercises

• Progressive muscle relaxation

• Mindful walking or movement

7. Therapy and Skills Development

Working with mental health professionals to develop specific skills for managing aggression is invaluable.

Having a non-judgmental person who isn’t a family member or friend, and who has specialized training,

Therapy approaches that help include:

• Cognitive Behavioral Therapy (CBT)

• Dialectical Behavior Therapy (DBT)

• Interpersonal and Social Rhythm Therapy

• Anger management techniques

• Family therapy to improve support systems

• Group therapy with others who understand

8. Crisis Planning

Having a predetermined plan for crisis situations provides security and clear direction.

Having those steps written down when someone is well means they don't have to figure it out during a crisis.

Elements of a good crisis plan include:

• Contact information for treatment providers

• List of current medications

• Warning signs that indicate escalation

• Specific interventions that have worked in the past

• Clear steps for loved ones to follow

• When to go to the hospital

• Preferences for treatment if hospitalization becomes necessary

Supporting Someone Experiencing Bipolar Aggression

For those supporting someone with bipolar disorder, understanding is crucial.

Many people who love someone with bipolar have learned not to take the aggression personally. It's the illness, not the person they love. And, setting boundaries while still being supportive is a delicate balance, but it is worth the effort.

Support strategies include:

• Educating yourself about bipolar disorder

• Recognizing symptoms versus the person

• Setting and maintaining healthy boundaries

• Avoiding arguments during mood episodes

• Having your own support system

• Knowing when to step back for safety

• Encouraging treatment adherence without policing

When to Seek Immediate Help

Sometimes professional intervention is necessary. Warning signs include:

• Threats or actions of self-harm or suicide

• Physical aggression toward others

• Inability to care for basic needs

• Psychotic symptoms (hallucinations or delusions)

• Severe impairment in functioning

• Substance use that worsens symptoms

Conclusion

Managing bipolar aggression requires a multifaceted approach involving medical treatment, personal strategies, and support systems.

Having bipolar disorder doesn't mean being defined by aggression or other symptoms. With the right treatment plan and management strategies, many people lead balanced, fulfilling lives. The work is ongoing, but it gets easier with time and proper support.

By sharing these experiences and strategies, I hope to provide both practical help for those managing bipolar aggression and greater understanding for those who support them. Remember that each person's experience with bipolar disorder is unique, and finding the right combination of strategies takes time and patience.

For more information on bipolar and how I may be of help, contact me. You are not alone!

Parenting Tips: Preventing Your Teen's Mania from Escalating

When you notice the first signs of a potential manic episode in your teenager with bipolar disorder, quick and strategic steps can help prevent escalation. This critical window for action is supported by extensive research in adolescent bipolar management. Here's what the research shows works best:

Understanding the Escalation Timeline

Most manic episodes don't appear suddenly but develop over 2-4 days. This crucial window gives parents an opportunity to implement preventive strategies.

A 2019 study found that 85% of manic episodes in adolescents showed prodromal (early warning) symptoms before full mania developed. The most reliable early indicators include:

• Sleep disturbances (especially needing less sleep)

• Increased energy and goal-directed activity

• Unusual talkativeness or pressured speech

• Irritability, anger, and rage that is disproportionate to circumstances

Evidence-Based Immediate Interventions

1. Prioritize Sleep

According to research published in the American Journal of Psychiatry, sleep disruption is both a trigger and symptom of mania, creating what can feel like an endless loop when the episode is happening.

What the research shows works:

• Creating a completely dark, cool sleeping environment

• Removing all electronics from the bedroom (blue light disrupts melatonin production)

• Implementing a consistent 30-minute wind-down routine

• Temporary use of physician-prescribed sleep aids—good to have ahead of time to use right away

A University of Pittsburgh study demonstrated that adolescents who maintained regular sleep patterns had 40% fewer manic episodes than those with irregular sleep.

2. Reduce Environmental Stimulation

Reducing overstimulation can prevent the escalation of hypomanic/manic symptoms.

Consider these approaches:

• Create a "low-stimulation zone" in your home with dimmed lights, minimal noise, and reduced visual clutter

• Limit social interactions to small, structured settings

• Temporarily reduce academic and extracurricular demands—talk with the school right away

• Implement a "technology diet," reducing screen time by at least 70% (hard to do! Do your best!)

Research from Stanford University found that reducing environmental stimulation during prodromal (early) manic phases decreased the likelihood of full mania by 65% in adolescents.

3. Medication Adherence and Adjustment

A review in the Journal of Child and Adolescent Psychopharmacology found that not taking meds was responsible for 62% of manic relapses in teens.

Evidence-based medication management:

• Try for 100% adherence to prescribed medication regimens (often teens resist taking their meds, that’s a blog post in itself)

• Contact the psychiatrist/prescriber immediately about the potential need for temporary dosage adjustments

• Use medication tracking apps with reminders and any other way to stay on top of the medication schedule

• Watch for and immediately report any concerning side effects that might lead to non-compliance

Research shows that rapid medication adjustments during prodromal (early) phases can prevent full manic episodes in up to 78% of cases. Call the doc!

4. Implement Stress Reduction Techniques

A 2020 meta-analysis found that specific stress-reduction techniques can effectively interrupt the progression from hypomania to mania.

Helpful techniques:

• Progressive muscle relaxation (shown to reduce autonomic arousal). Videos and scripts are easily available online

• Guided imagery focused on calming scenes—Google ‘calm happy place guided imagery’

• Breathing exercises using the 4-7-8 method (inhale 4 counts, hold 7 counts, exhale 8 counts)

• Brief (10-15 minute) mindfulness meditation sessions

These approaches have been shown to reduce cortisol levels, which can help interrupt the brain/body cascade that fuels manic escalation.

Family Communication Strategies That Prevent Escalation

Research from UCLA's Child and Adolescent Mood Disorders Program demonstrates that specific communication approaches can either prevent or accelerate manic episodes.

Evidence-based communication techniques:

• Maintain a low emotional expression environment (research shows high emotional expression increases relapse risk by 90%). Try to stay calm and grounded when emotions run high

• Use brief, clear sentences with concrete language

• Avoid multiple-step instructions or complex explanations

• Implement the "stop, observe, verify, respond" communication framework

Timing of Professional Intervention

Research from Johns Hopkins University established specific symptoms for when to seek immediate professional help:

• Sleep reduction of more than 25% over two consecutive nights

• High-energy activity that cannot be redirected

• Speech that becomes difficult to interrupt

• Emergence of any unusual beliefs or perceptions

Studies show that emergency intervention at these specific thresholds prevents hospitalization in 70% of cases.

The Critical Role of Routine Maintenance

A 5-year longitudinal study published in Bipolar Disorders demonstrated that maintaining strict routines during prodromal (early) phases significantly reduced mania from getting worse.

Research-supported routine elements:

• Mealtimes should occur within the same 30-minute window each day

• Morning and evening routines should follow identical sequences

• Physical activity should be maintained but shifted toward rhythmic, predictable exercises rather than competitive or intensive workouts

• Social interactions should follow familiar patterns with familiar people

This structured approach has been shown to help stabilize circadian rhythms, which play a crucial role in mood regulation.

Parent Self-Regulation Techniques

Research from the University of Michigan found that parents’ emotional states significantly impact the trajectory of adolescent manic symptoms.

Parent coping strategies:

• Implement personal "emotional thermometer" checks every 2-3 hours

• Use pre-planned respite care arrangements to prevent parental burnout—have helpers who can help when needed (may take some time to create this)

• Practice 5-minute calming techniques before interactions during challenging periods

• Maintain personal therapy or support group attendance even during crisis periods

Studies show that parent emotional regulation is a very important piece to contain and prevent mania from escalating; even more helpful than many direct interventions with your teen.

Conclusion: The Science of Prevention

The research is encouraging: parents can play an important role in containing the mania with proper knowledge and timely intervention. A structured approach that focuses on sleep, environment, medication, communication, and routine has been shown to prevent full manic episodes in up to 80% of vulnerable adolescents!

Each action you can do during the prodromal (early) phase can really help prevent escalation. Your informed, calm response during these critical windows doesn't just manage the current episode, it helps build your teen's lifelong capacity for mood management. Thank you for all you do to support your teen. It is so important.

For more information on how I can support, contact me or check out my coaching site: https://www.parentyourbipolarchild.com

When Traditional Parenting Fails: 5 Specialized Techniques for Raising Teens with Bipolar Disorder

Parenting a teenager with bipolar disorder brings the kind of challenges that can leave most parents feeling exhausted, overwhelmed, and, at times, hopeless.

But there is hope. Let’s look at five strategies that can specifically help parents be more effective when dealing with the complicated challenges of parenting a bipolar teen

1. Create an Environment of Consistency

Teens with bipolar disorder need stability more than most, yet the illness itself can create chaos and throw routines out the window. However, establishing consistent routines creates a foundation that can withstand the mood storms.

What works:

• Maintain regular sleep schedules—even on weekends and holidays

• Create visual schedules that clearly outline daily expectations

• Establish consistent meal times with mood-stabilizing nutrition

• Help your teen stay medication compliant

• Keep therapy and doctor appointments

Another way to think about it: what are essential routines that remain unchanged, even when your teen is dysregulated? Can you think of 3 ‘stability anchors’ that can remain consistent, while the other routines can be flexible, depending on your teen’s mood?

2. Master the Art of Strategic Disengagement

Many parents instinctively try to reason with their teen during manic or depressive episodes, often leading to escalation and frustration on both sides. Learning when and how to strategically disengage can be part of a prevention plan as well: not making things worse.

What works:

• Recognize early warning signs of mood episodes

• Create a family code word that signals "we need to pause this conversation."

• Develop pre-planned responses for heated moments

• Identify which issues truly require immediate addressing versus those that can wait

• Practice neutral body language and tone during provocative moments

Reasoning with a teen who is in the throes of a full-on manic episode is like trying to negotiate with a hurricane. Instead, ensure safety, minimize stimulation, and wait for the storm to pass, and their mood to move towards stability, before addressing behavior.

Strategic disengagement isn't avoidance—it's recognizing when productive communication isn't possible and temporarily shifting to maintenance mode until your teen can engage effectively.

3. Separate the Teen from the Disorder

One of the most powerful shifts parents can make is learning to distinguish between their teen's identity and their bipolar symptoms. This mental separation helps maintain your connection while still addressing problematic behaviors. And yes, sometimes it can feel like we don’t know who our child is anymore—and perhaps these tips can help you reconnect to their uniqueness.

What works:

• Use language that externalizes the disorder ("the bipolar is making things difficult today" versus "you're being difficult")

• Explicitly acknowledge the difference between the person and the condition

• Celebrate your teen's unique strengths that exist independently of their diagnosis

• Create space for interests and activities unrelated to mental health

• Maintain memories and photos of stable periods as reminders during difficult phases

You may enjoy creating a scrapbook, filling it with images and stories that capture your teen’s true personality. During difficult episodes, you, or both you and your child, can look through it together, reinforcing that the bipolar symptoms didn't define him.

This separation helps your teen develop a healthy identity beyond their diagnosis while giving you an emotional anchor during turbulent times.

4. Lead with Validation

Teens with bipolar disorder often feel very misunderstood. Their emotional experiences are intense and often overwhelming, and they frequently lack the vocabulary to express their feelings well. Validation creates a bridge that makes productive communication possible.

What works:

• Acknowledge emotions before addressing behaviors ("I can see you're feeling overwhelmed. That must be really hard.")

• Use reflective listening techniques to ensure your teen feels heard

• Avoid dismissive phrases like "calm down" or "it's not that bad."

• Create an emotions vocabulary—list together to help identify feelings

• Set aside regular check-in times when their mood is stable

One effective technique is the "validation sandwich"—starting and ending conversations with validation while placing any necessary correction or boundary-setting in the middle. This approach helps your teen feel secure enough to actually hear and process your guidance.

Remember that validation doesn't mean agreeing with inappropriate behavior—it means acknowledging the underlying emotions that drive that behavior.

5. Develop a Customized Crisis Response Plan

Despite all the ways to support, help, and learn, crisis situations will arise (if they haven’t already). Having a clear, documented plan creates a roadmap when emotions and stress might otherwise cloud judgment.

What works:

• Create a written document outlining specific steps for different scenarios

• Include contact information for treatment providers, emergency services, and support people

• Define clear criteria for when to seek emergency intervention

• Outline roles for each family member during a crisis

• Practice the plan during periods of stability

• Review and update the plan regularly with your teen's input

One idea is to create a color-coded system—green for stable days, yellow for emerging symptoms, and red for crisis situations. Each color has its own protocol, and everyone in the family (including other siblings) understands what actions to take at each level.

A crisis plan reduces panic and promotes faster, more effective responses when quick action is needed.

There is Hope

Implementing these five strategies won't eliminate all challenges, but they provide a framework that helps many families move from constant crisis management to proactive parenting. The goal isn't perfect stability—it's creating an environment where your teen can learn to manage their condition while still experiencing the normal developmental growth of adolescence.

Remember that effective parenting of a bipolar teen requires tremendous resilience and self-compassion. Your willingness to learn and adapt specific techniques to your teen's needs is already a powerful step toward helping them build a stable, fulfilling future.

To learn more about my psychotherapy practice, contact me. To learn more about my parenting program for parents challenged with raising bipolar teens, check out my website: www.parentyourbipolarchild.com

Ketamine-Assisted Therapy: A New Frontier for Bipolar II Disorder

Bipolar II disorder basically differs from Bipolar in the severity of the elevated mood states. While people with Bipolar I experience full manic episodes, those with Bipolar II experience hypomania—elevated mood states that are less severe but still disruptive. However, what often makes Bipolar II so challenging is that people typically spend much more time in depressive states than in hypomanic ones.

These depressive episodes can last months or even years, and they frequently don't respond well to standard treatments. The traditional approach of combining mood stabilizers with antidepressants carries the risk of triggering hypomanic episodes or rapid cycling between mood states.

These treatment challenges leaves many people with Bipolar II feeling trapped between inadequate relief from depression and the risk of worsening their overall condition.

Enter Ketamine: A Different Approach

Ketamine, originally developed as an anesthetic, has emerged as a groundbreaking treatment for depression. Unlike traditional antidepressants that primarily target serotonin, norepinephrine, or dopamine systems, ketamine works through a different mechanism: the glutamate pathway.

When administered in controlled, subanesthetic doses, ketamine appears to rapidly repair neural connections damaged by chronic stress and depression. This process, known as synaptogenesis, essentially helps the brain rebuild itself.

What makes ketamine helpful for Bipolar II depression is how fast it can help. While conventional antidepressants may take weeks to show benefit, ketamine can produce significant mood improvements within hours or days.

Promising Research for Bipolar Depression

Research specifically examining ketamine's effects on bipolar depression is still evolving, but early findings are encouraging:

• A 2012 study published in the journal Biological Psychiatry found that a single ketamine infusion produced a rapid antidepressant effect in patients with treatment-resistant bipolar depression.

• A 2017 review in the Journal of Clinical Psychiatry indicated that ketamine demonstrated rapid and robust antidepressant effects in bipolar depression without triggering manic symptoms when used in conjunction with mood stabilizers.

• More recent studies suggest that ketamine may temporarily reduce suicidal thoughts, a critical benefit given the elevated suicide risk in bipolar disorder.

Perhaps most importantly, ketamine appears to have a lower risk of triggering hypomania or mania compared to traditional antidepressants when properly administered and monitored—addressing one of the core challenges in treating Bipolar II depression.

Beyond the Medication: The Therapy Component

What truly differentiates modern ketamine treatment approaches is the integration of psychotherapy. This combined approach—ketamine-assisted therapy—leverages both ketamine's neurochemical effects and the psychological processing that can occur during and after treatment, leading to deeper change, healing and growth.

During ketamine sessions, many patients experience:

• Increased psychological flexibility, loosening of depressive thoughts

• Enhanced perspective on persistent negative thought patterns

• Less fixation on being depressed, feeling guilt about being depressed, and hopelessness

• Greater emotional openness and receptivity to therapeutic interventions, more hopeful and often more energized

These qualities create a unique therapeutic window where individuals can process emotions and experiences differently. When combined with a skilled, properly trained therapist, this can lead to insights and breakthroughs that may take years in traditional talk therapy realms.

Important Considerations

While the potential benefits of ketamine-assisted therapy for Bipolar II are significant, several important considerations must be addressed:

1. Medical screening and monitoring: Ketamine treatment requires thorough medical screening and follow up appointments with the prescriber.

2. Integration with mood stabilizers: Ketamine treatment for bipolar depression should generally be used as an adjunct to, not a replacement for, mood-stabilizing medications.

3. Individualized approach: Response to ketamine varies significantly between individuals, and treatment protocols must be tailored accordingly.

4. Therapeutic context: Appropriate and effective psychotherapy is crucial for maximizing benefits and processing the experiences that emerge during dosing sessions.

5. Insurance and accessibility: Many insurance plans still don't cover ketamine for depression, creating possible financial barriers to access.

As research continues and clinical experience grows, ketamine-assisted therapy represents one of the most promising developments for treatment-resistant bipolar depression in decades. Its novel mechanism of action, rapid effects, and potential for deeper therapeutic processing open new possibilities for those who have struggled with inadequate relief from conventional approaches.

I am excited to offer this modality to people who have lived with depression for far too long. Contact me today to talk more about how ketamine-assited therapy may help you.

5 Positive Steps to Take After a Bipolar Disorder Diagnosis

Receiving a bipolar diagnosis is never easy. While it might be a relief to finally have answers to your symptoms, behaviors, and mood episodes, the diagnosis can cause even more questions. Will you be stigmatized by society? Will you lose your identity when you go through treatment? Is there a way to heal? Here are the first steps you can take.

1. Read up on Bipolar Disorder

Understanding your disorder will help you control it. Learn about how and why the brain cycles between depression and mania (or hypomania) and the symptoms that go along with these shifts. Look for psychiatric and psychological resources online and in print. And while books written by mental health professionals are always good to have, consider also reading memoirs by people who actually have bipolar disorder. You might get started with An Unquiet Mind by Kay Redfield Jamison, Another Kind of Madness by Stephen P. Hinshaw, or even the graphic memoir Marbles written and illustrated by Ellen Forney. These personal stories can hold up a mirror to your own life—getting inside the minds of other people who have gone through what you’re experiencing will help you make more sense of your disorder.

2. Enlist Your Loved Ones

You might not be ready to tell the entire world you’re bipolar just yet. But look around at your friends and family: are there a few close people you can trust? It’s important right now to not feel isolated. Confide in your loved ones and don’t be afraid to ask for help. You might even have people in your inner circle who have gone through the same thing. Maybe somebody close to you also has bipolar disorder, anxiety, depression, post-traumatic stress disorder, or an eating disorder, meaning they can give advice and share their stories too. Being honest about your struggles can make your bonds even stronger.

3. Be Kind to Yourself

The road to healing after a diagnosis is a long one. It’s okay to feel confused, frustrated, angry, ashamed, or hopeless sometimes. You’ll have good days and bad days. What’s most important is that you make a conscious effort to understand your disorder and how it affects you presently and has in the past. Make sure to keep looking forward and practice self-compassion along the way. You don’t need an inner voice criticizing yourself for not getting treatment earlier, or having setbacks along your healing journey. Celebrate your successes—get excited when you consistently take your medication, go to therapy, or eat healthier.

4. Start New Healthy Routines

A diagnosis can be destabilizing. Chaos is terrible for mood disorders—when you feel unmotivated to keep to a routine and take care of your mental health, you might slip into depression or mania. Focus on getting regular sleep, eating balanced meals, and cleaning up your living space. Be sure to get exercise regularly, especially if that means being outside. When you’re stressed, get into a practice of mindfulness and deep breathing to calm your nerves. You might also find space in your routine to attend support groups, either in-person or online. Having a consistent obligation that connects you with other people is good for your mental health.

5. Create a Treatment Plan

To manage bipolar disorder, you need a long-term treatment plan developed by you and a mental health professional. Together you can decide on the appropriate mood stabilizers, antidepressants, or anti-psychotics to treat your disorder. It’s also important to include therapy in your treatment plan. Connect with a therapist who specializes in bipolar disorder. You may benefit from cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), interpersonal therapy (IT), or another approach. With a long-term view, you’ll set yourself up for success even in the face of a bipolar diagnosis.

To find out more about how therapy can help those with a recent bipolar diagnosis, please reach out to me. Book a consultation today and we’ll get started on a management plan that works for you.

Can Ketamine Assisted Psychotherapy Help Manage Depression?

Ketamine was originally developed as an anesthetic and has been used in medicine since the ’60s. But over the past two decades, researchers have discovered that ketamine is also able to relieve depressive symptoms when given in controlled, therapeutic doses. Unlike traditional antidepressants, which often take weeks to show results, ketamine can alleviate depressive symptoms within hours. This has led to growing interest in its potential as a treatment for depression, especially for those who have not responded well to more conventional therapies and medications.

How does ketamine affect the brain?

Depression is often associated with a reduction in the availability of neurotransmitters like serotonin and dopamine. Ketamine acts on a different neural pathway—the glutamate system. Glutamate is a neurotransmitter involved in many brain functions, including mood regulation and cognitive flexibility.

Ketamine is believed to stimulate the production of glutamate, which in turn promotes the growth of new neural connections in the brain. This process can help “reset” the brain’s neural circuitry, which reduces depressive symptoms quickly.

Ketamine also appears to reduce the activity of the brain’s default mode network (DMN), a system associated with self-referential thinking. Overactivity in the DMN has been linked to rumination, a common symptom of depression where someone gets trapped in negative thought patterns. By quieting this network, ketamine may help break this cyclical thinking.

What is ketamine-assisted psychotherapy?

In this approach to therapy, ketamine is used not as a standalone drug, the way we might use traditional antidepressants. The idea is that the altered state of consciousness induced by ketamine can open up new avenues for therapeutic exploration. This allows patients to access and process emotions and memories that might otherwise be difficult to confront.

Ketamine-assisted psychotherapy typically involves a series of sessions in which the patient receives a controlled dose of ketamine. The patient then has a therapy session with a licensed psychotherapist who’s trained in working with altered states of consciousness.

These sessions can be deeply introspective and emotionally intense, but they also offer an opportunity to heal deep wounds. Patients report feeling more open, less guarded, and more able to explore painful emotions without the overwhelming sense of fear or despair that might accompany them in a sober state. For many, this allows for breakthroughs in therapy that can lead to long-lasting changes in their mental health.

Who can benefit from ketamine-assisted psychotherapy?

Ketamine-assisted psychotherapy is not for everyone. It’s generally recommended for people with treatment-resistant depression, meaning they have tried at least two other antidepressants without significant improvement. Those with conditions like post-traumatic stress disorder (PTSD), anxiety, and even chronic pain can also benefit from this treatment.

However, it’s important to note that ketamine is a powerful drug and is not without risks. While it’s generally well-tolerated in a controlled clinical setting, some patients may experience side effects such as dissociation (feeling disconnected from reality), nausea, or an increase in blood pressure. Ketamine also has a history of being used recreationally, and there’s potential for abuse if not administered responsibly.

What does the research say?

The research on ketamine for depression is still in its early stages, but the results so far are promising. Several studies have shown that ketamine can rapidly reduce depressive symptoms, even in patients who have not responded to other treatments. In some cases, the effects of a single ketamine session can last for several weeks, though most patients require a series of treatments to maintain the benefits.

Finding a Therapist

Ketamine-assisted psychotherapy should only be conducted under the supervision of trained medical professionals in a clinical setting. If you have treatment-resistant depression and you’re looking for another method, consult a therapist licensed in ketamine-assisted psychotherapy today.

To learn more about how ketamine can help those with treatment-resistant depression, please reach out to us.

Understanding the Thought Process of a Bipolar Person

Bipolar disorder is a mood disorder characterized by shifts from periods of highs (mania or hypomania) to lows (depression). Media and popular culture is full of misconceptions about people with bipolar disorder. Understanding the thought process of someone with bipolar disorder is important not only for those living with the condition but also for their loved ones, friends, and colleagues.

What is Bipolar Disorder?

Bipolar disorder has several classifications including bipolar I, bipolar II, and cyclothymic disorder. While the symptoms between the three can vary widely, the main features of bipolar disorder are manic or hypomanic episodes and depressive episodes, which can last for days, weeks, or even months.

• Mania involves a period of abnormally elevated mood, energy levels, and activity. During mania, a person may experience grandiose thoughts, a decreased need for sleep, rapid speech, racing thoughts, impulsivity, and risky behavior.

• Hypomania is a less severe form of mania. The symptoms are milder and might not significantly impair daily functioning, but are still noticeable.

• Depression in bipolar disorder is similar to major depressive episodes, characterized by feelings of sadness, hopelessness, fatigue, and a loss of interest in activities and social interactions.

The Thought Process in Manic Episodes

During manic episodes, a person’s thoughts can race at an incredible speed. Their mind will jump from one idea to another without much logical connection. This rapid thought process is known as the “flight of ideas.” It can make a conversation with someone experiencing mania feel chaotic and difficult to follow.

A common feature of mania is grandiosity. People with mania may believe they are invincible, capable of extraordinary feats, or destined for greatness. These thoughts can drive them to take on big projects or make impulsive decisions that seem brilliant at the moment but are likely unrealistic. For example, someone in a manic state might decide to start a new business, quit their job, or engage in risky financial investments without considering the consequences.

The Thought Process in Depressive Episodes

On the other end of the spectrum, depressive episodes are a stark contrast to mania’s energy. During depression, thoughts can become slow, dark, self-critical, and pessimistic. The mind might be consumed with feelings of worthlessness, guilt, and hopelessness. Unlike the creative, expansive thoughts of mania, depressive thoughts get stuck on past failures and perceived flaws.

A person with bipolar disorder often experiences cognitive distortions during a depressive episode. These are irrational thoughts that reinforce negative thinking. For example, they might see situations in black-and-white terms, believing that if they are not perfect, they are a complete failure. Another common distortion is catastrophizing, where they may imagine the worst possible outcomes of a situation, no matter how unlikely they are.

The Role of Mixed Episodes

Some people with bipolar disorder may have mixed episodes, meaning they have symptoms of both mania and depression at the same time. This can lead to a distressing, confusing thought process where the person feels both agitated and hopeless simultaneously. The co-occurrence of high energy with depressive thoughts can increase the risk of dangerous impulsive behaviors, including self-harm or suicide.

Supporting Someone with Bipolar Disorder

Understanding the complicated emotional and mental processes is the first step to helping your loved one. You can also:

• Continue educating yourself about bipolar disorder, including its signs, causes and treatments.

• Allow the person to express their thoughts and feelings without interrupting or dismissing their experiences.

• Be patient and compassionate as they move through their mood swings.

• Encourage them to seek professional help.

Bipolar disorder requires treatment from mental health professionals. Typically, after diagnosis, a person will need to take mood stabilizers or other medications and seek psychotherapy.
To learn more about how to support those with bipolar disorder, please reach out to us.

The Benefits of Ketamine Assisted Therapy for Depression

Depression can be an all-consuming mental health condition. You might be more familiar with its traditional treatment methods. Most people respond well to prescription antidepressants, therapy, and lifestyle changes. However, some struggle with treatment-resistant depression, meaning the go-to options for healing depression don’t work for them. In recent years, ketamine-assisted psychotherapy (KAP) has become a viable option for those who need less conventional treatments for their depression. Here’s how it works and how you can benefit.

How Ketamine Changes the Brain

Ketamine, originally developed as an anesthetic in the 1960s, has gained attention in the psychiatric field for its antidepressant effects. Ketamine works by modulating the brain’s glutamate system, a neurotransmitter involved in mood regulation, cognition, and neural plasticity. By blocking NMDA (N-methyl-D-aspartate) receptors, ketamine helps release more glutamate, which in turn stimulates the growth of new neural connections. This neuroplasticity is thought to be behind ketamine’s rapid antidepressant effects. It helps “reset” the brain and form new neural pathways that may have been lost during long-term depression.

What Happens in a KAP Session?

During a KAP session, patients are typically given a low dose of ketamine under the careful supervision of healthcare providers. It can be ingested through a nasal spray, oral tablet, or IV infusion. Since the dissociative effects of ketamine can lead to altered states of consciousness, the patient should feel more open to introspection and processing their feelings. After the infusion, a trained therapist guides the patient through their ketamine experience by helping them navigate their thoughts and emotions. This is called integration—the therapist opens a dialogue to make sense of the patient’s insights that arose during their ketamine infusion session. They can then go on to integrate these discoveries into their daily life through better communication, healthier coping skills, and a stronger sense of self.

Benefits of KAP

• It strengthens neural pathways

The neuroplastic effects of ketamine help the brain form new connections. This builds resilience against future depressive episodes (and may stop their recurrence altogether). The therapy part of KAP also helps a person understand their emotions, develop healthy coping skills, and process negative experiences. These all give the brain a greater ability to deal with life’s stressors and stay mentally healthy.

• It works quickly

Compared to other medications and therapies, KAP can alleviate symptoms of depression quite fast. Many patients report feeling relief within a few hours rather than a few weeks or months. For those who have felt trapped by their depression, this fast-acting treatment can be life-changing.

• It reduces suicidal ideation

For those at a high risk of suicide, ketamine can be a great treatment option. Some antidepressants have suicidal ideation as a potential side effect (and can take weeks to begin working). Since ketamine works quickly and doesn’t have the potential for suicidal side effects, ketamine therapy can be lifesaving.

• It encourages big breakthroughs

Some people may take months or years to work up to certain topics during traditional therapy. However, the ketamine-induced altered state of consciousness can help a person access and process feelings and memories that may be difficult to deal with in a typical therapeutic setting.

Potential Drawbacks

While KAP has many benefits, it’s important to recognize that it’s not a one-size-fits-all solution. Ketamine does have side effects and potential drug interactions, so it may not work for people on certain medications. Also, it should only be administered by qualified professionals in a controlled setting, since ketamine has the potential for misuse and addiction.

Are you living with treatment-resistant depression?

If you’re one of the many people who haven’t found the right treatment for your depression, you still have options. To try KAP, talk to a licensed therapist trained in ketamine therapy. Together, you can discuss a treatment plan and determine whether KAP is right for you.

To find out more about the benefits of ketamine-assisted psychotherapy for those with depression, please reach out to me.

10 Tips to Reduce and Manage Anxiety

Anxiety affects millions of people worldwide. In our fast-paced society, we often promote behaviors that actually increase anxiety. However, there are small steps you can take to help combat this condition. Here are ten concrete steps you can take toward managing your anxiety responses.

1. Practice Mindfulness

Study after study has shown how effective mindfulness can be against anxious thoughts. It helps you focus on the present moment instead of worrying about the future or past. Start with just a few minutes each day, using guided meditation apps or focusing on your breath. Allow your thoughts to pass through you and simply notice them. Focus on your bodily sensations. Over time, regular mindfulness practice can rewire your brain to respond more calmly to stress.

2. Stay Active

Exercise is one of the most effective natural remedies for anxiety. Physical activity releases endorphins, which are our natural mood elevators. Aim for at least 30 minutes of moderate exercise, such as yoga or jogging, most days of the week. An even better practice is to get outside into nature by hiking, walking in the park, or visiting nature preserves. Breathing fresh air and being part of the natural world will ease your mind.

3. Eat Healthy

A balanced diet rich in fruits, vegetables, lean proteins, and whole grains can help stabilize your mood and energy levels. Avoid too much caffeine and sugar, which can make anxiety worse. Instead, choose foods rich in omega-3 fatty acids, such as salmon and walnuts, which have been shown to reduce anxiety.

4. Get Enough Sleep

Sleep is crucial for mental health. Establish a regular sleep schedule by going to bed and waking up at the same time every day. Create a calming bedtime routine, such as reading a book or taking a warm bath, to signal to your body that it’s time to wind down.

5. Limit Alcohol Intake

While it may be tempting to use alcohol to calm your nerves, it can actually increase anxiety over time. Alcohol can disrupt sleep and affect your mood. Reducing or eliminating alcohol from your life can significantly reduce your anxiety.

6. Practice Deep Breathing

Deep breathing exercises can quickly reduce anxiety by helping you focus on your breath and relax your body. One effective technique is the 4-7-8 method: inhale deeply for four seconds, hold for seven seconds, and exhale slowly for eight seconds.

7. Keep an Active Social Life

Spending time with friends and family can provide emotional support, reduce feelings of isolation, and improve your mood. Make an effort to maintain regular contact with loved ones, whether through in-person visits, phone calls, or video chats.

8. Break Up Your Goals

Anxiety can make even simple tasks seem overwhelming. To combat this, set realistic goals for yourself and break larger tasks into smaller, more manageable steps. This way you’ll feel more in control of your goals. Celebrate every accomplishment to build up your confidence.

9. Learn to Say No

Taking on too many responsibilities can increase anxiety and lead to burnout. Recognize your limits and learn to say no when you can. Prioritize your own tasks and focus on what truly matters by setting healthy boundaries.

10. Seek Professional Help

Some people are unable to manage their anxiety on their own. Whether your anxiety is more general or is linked to specific situations (for example, phobias, intrusive thoughts, or obsessions), you may need a consultation with a mental health professional. Your best treatment may include therapy, anti-anxiety medications, or a combination of the two. It’s also important to determine (or rule out) other co-occurring issues, such as trauma. In therapy, you’ll learn the root cause of your anxiety, how to cope with stressful situations, and how to build your resilience.
To find out more about how therapy can help you reduce your anxiety, please reach out to us.