Sing acapella Psalm 24:7-10 Scottish Metrical Psalm

 Dear Readers,

Psalm 24 is a very encouraging Psalm. 

Psalm 24

1 The earth is the Lord's, and the fulness thereof; the world, and they that dwell therein.

2 For he hath founded it upon the seas, and established it upon the floods.

3 Who shall ascend into the hill of the Lord? or who shall stand in his holy place?

4 He that hath clean hands, and a pure heart; who hath not lifted up his soul unto vanity, nor sworn deceitfully.

5 He shall receive the blessing from the Lord, and righteousness from the God of his salvation.

6 This is the generation of them that seek him, that seek thy face, O Jacob. Selah.

7 Lift up your heads, O ye gates; and be ye lift up, ye everlasting doors; and the King of glory shall come in.

8 Who is this King of glory? The Lord strong and mighty, the Lord mighty in battle.

9 Lift up your heads, O ye gates; even lift them up, ye everlasting doors; and the King of glory shall come in.

10 Who is this King of glory? The Lord of hosts, he is the King of glory. Selah.

Below, is the singing of Psalm 24:7-10 from the Scottish Metrical Psalter using the tune "Edinburgh".

 Psalm 24:7-10

   7  Ye gates, lift up your heads on high;

         ye doors that last for aye,

      Be lifted up, that so the King

         of glory enter may.

   8  But who of glory is the King?

         The mighty Lord is this;

      Ev'n that same Lord, that great in might

         and strong in battle is.

   9  Ye gates, lift up your heads; ye doors,

         doors that do last for aye,

      Be lifted up, that so the King

         of glory enter may.

  10  But who is he that is the King

         of glory? who is this?

      The Lord of hosts, and none but he,

         the King of glory is.

 

Another video on the singing of Psalm 24:7-10 is:

 

Thanks again for stopping by. Hope you enjoy the singing of Psalm 24:7-10. 

Take care and have a blessed day!

Warm Regards,

Nancie 

(3 December 2024)

God is our Protector : The Lord mighty in battle. (Psalm 24:8)

Dear Reader, 

Thank you for stopping by.

I would like to share with you the following encouraging writing by CH Spurgeon in his devotional "Morning and Evening" for 3 Dec, Evening, that I read:

"The Lord mighty in battle." Psalm 24:8

Well may our God be glorious in the eyes of his people, seeing that he has wrought such wonders for them, in them, and by them. 

For them, the Lord Jesus upon Calvary routed every foe, breaking all the weapons of the enemy in pieces by his finished work of satisfactory obedience; by his triumphant resurrection and ascension he completely overturned the hopes of hell, leading captivity captive, making a show of our enemies openly, triumphing over them by his cross. 

Every arrow of guilt which Satan might have shot at us is broken, for who can lay anything to the charge of God's elect? 

Vain are the sharp swords of infernal malice, and the perpetual battles of the serpent's seed, for in the midst of the church the lame take the prey, and the feeblest warriors are crowned.

The saved may well adore their Lord for his conquests in them, since the arrows of their natural hatred are snapped, and the weapons of their rebellion broken. 

What victories has grace won in our evil hearts! 

How glorious is Jesus when the will is subdued, and sin dethroned! 

As for our remaining corruptions, they shall sustain an equally sure defeat, and every temptation, and doubt, and fear, shall be utterly destroyed. 

In the Salem of our peaceful hearts, the name of Jesus is great beyond compare: he has won our love, and he shall wear it. 

Even thus securely may we look for victories by us. 

We are more than conquerors through him that loved us. 

We shall cast down the powers of darkness which are in the world, by our faith, and zeal, and holiness; we shall win sinners to Jesus, we shall overturn false systems, we shall convert nations, for God is with us, and none shall stand before us. 

This evening let the Christian warrior chant the war song, and prepare for to-morrow's fight. 

Greater is he that is in us than he that is in the world.

The full verse is:

"Who is this King of glory? The Lord strong and mighty, the Lord mighty in battle." Psalm 24:8

(Excerpts from: CH Spurgeon, Morning and Evening, 3 December, Evening. The paragraphing are mine.)

Thank you for stopping by.  Have a blessed day! 

Best Regards,

Nancie 

3 December 2024

The Valley of Vision, a collection of Puritan prayers and devotions, edited by Arthur Bennett.

Dear Reader, 

Thank you for stopping by. 

Recently, I bought a copy of the book "The Valley of Vision", a collection of Puritan prayers and devotions, edited by Arthur Bennett, from Amazon. It is a very encouraging collection of prayers. 

The first prayer itself is entitled "The Valley of Vision" and really uplifting. Below, is what I read:

THE VALLEY OF VISION

LORD, HIGH AND HOLY, MEEK AND LOWLY,

Thou hast brought me to the valley of vision,

    where I live in the depths but see thee in the heights;

    hemmed in by mountains of sin I behold thy glory.

Let me learn by paradox

    that the way down is the way up,

    that to be low is to be high,

    that the broken heart is the healed heart,

    that the contrite spirit is the rejoicing spirit,

    that the repenting soul is the victorious soul,

    that to have nothing is to possess all,

    that to bear the cross it to wear the crown,

    that to give is to receive,

    that the valley is the place of vision.

Lord, in the daytime stars can be seen from the deepest wells,

    and the deeper the wells the brighter thy stars shine;

Let me find thy light in my darkness,

                    thy joy in my sorrow,

                    thy grace in my sin,

                    thy riches in my poverty,

                    thy glory in my valley.

Hope the above puritan prayer has been an encouragement to you, just as it is to me. Thank you for stopping by. Have a blessed day! 

Best Regards,

Nancie 

(19 November 2024)

About me

(This post was first posted on 8 February 2008)

About Me

=========

Hello! Thank you for visiting this blog, dear Reader. Let me share with you a little about myself and God's mercies to me.

My name is Nancie. I am a Chinese Christian living in Singapore. I was led to seek and know the Lord Jesus Christ as my personal Saviour and Lord in 1990 through the instrumentality of two of my ex-colleagues Michael Sing and Daniel Hee when I was working at SATS, Changi Airport, Singapore. My life was radically changed when I became a Christian. I went through many challenges just like everyone else, and have been wonderfully upheld by the Lord Jesus Christ through all the ups and downs in the changing scenes of my life.

In December 2001, I had a severe relapse of asthma and was hospitalized. In year 2002, I took 2 months leaves to recuperate at home. It was during that period of recuperation at home that the Lord used many encouraging Christian articles, sermons and books to minister to me. I was greatly uplifted by the reminders of God's love and faithfulness. The result of it was the design of a website to upload some of my favourite articles and sermons to share with others.

Thank God for the excellent medical care for my asthma by Dr Phoa Lee Lan from Tan Tock Seng Hospital in mid 2002. As I am suffering from mild-persistent asthma, I have to be on low dosage of maintenance medication life long. Now my asthma is under good control.

In Dec 2006, I had a severe relapse of clinical depression. At first I was diagnosed as having Major Depression. But because of the extreme mood swings I experienced, I was diagnosed in late March 2007 to be prone to Bipolar Disorder also known as manic-depressive illness, a brain condition that causes extreme mood swings from very happy or high moods (hypomania) together with lots of energy and creativities and then to very low and depressed moods (clinical depression) with very low level of energy, constant tiredness, etc. During the worst times, I experienced feelings of hopeless and worthlessness to the point of having suicidal thoughts at times. Thank God for preserving me.

I think I have experienced these extreme mood swings since around 1990 ie for over 30 years. But I can only remember more clearly of the 10 or so relapses over the 18 years prior to my diagnosis. These are relapses that occurred just before I became a Christian and then the years after. I could remember them more clearly now because my life was changed significantly after I became a Christian. I have very little memory now of my younger days without Christ.

These episodes in the first 18 years usually lasted for a few months. Different from the normal ups and downs we all experience every now and then, Bipolar Disorder's symptoms are very severe. It is a long term medical condition just like diabetes and hypertension that needs to be carefully managed throughout a person's life.

Through this severe relapse in end 2006, I was led to seek medical and counselling help for the first time, besides praying and reading God's Words plus some other helps. I thank God that after so many years of roller coaster rides with extreme mood swings, I have finally understood the reason behind them. To know that I suffer from this brain medical condition and that it has a name for it, is helping me to learn to manage it better with various resources the Lord Jesus Christ has provided so that I can live for the glory of God and be able to serve Him more effectively.

The medication, by God's grace, is helping to stabilise my mood and enable me be more functional, so that I can continue to seek and serve God. I thank God for Dr Pauline Sim of LP Clinic, Dr Tham and  Dr Chan Lai Gwen of Tan Tock Seng Hospital for their valuable helps in treating my condition.

I am very thankful and indebted to my first Doctor at LP Clinic, Mt Elizabeth Hospital ie Dr Pauline Sim Li Ping. She is a very compassionate, kind and encouraging Doctor. She always assure me that I will get well and not to be discouraged.

She taught me how to recognize early symptoms of relapses, what I can do to get better, how to adjust the dosage of medicine and other matters. She said she wants me to be the co-therapist and know what to do instead of panic or run to the hospital during relapses. Under her guidance I am able manage better.

Currently, I am being followed up by Doctor Chan Lai Gwen at Tan Tock Seng. She  is also a very excellent, kind and compassionate doctor. She works patiently with me as I learn to understand how to manage my condition.

She taught how to recognize early symptoms of relapses, what I can do to get better, how to adjust the dosage of medicine and other matters.

In January 2007, I have received professional help from a group of counsellors who are trained to manage brain disorders such as bipolar, clinical depression, OCD, etc etc and my Pastor also counselled me on spiritual matters. The professional counsellors are trained to use Cognitive Behavioural Therapy (CBT) which is a form of counselling with a focus on understanding how our thoughts affect our behaviours. Bipolar alternates between 2 extreme mood swings ie. mania and depression, and our thoughts and behaviours are shaped by these mania and depression episodes which can at times be very confusing. CBT helps to make sense of some of these confusions, and help to pick up skills to manage these mood swings so that one can be more functional.

I am thankful to God for provided me with a team of very compassionate, kind, understanding and encouraging Christian counsellors at Counselling and Care Centre, Singapore from Jan to Apr 2007. My sessions with my counsellor, Sarah (and her team), were most fruitful and encouraging. Through her counselling sessions, I embarked on a new journey of self-discovery, of knowing God, myself and others better. The benefits I derived from my sessions with Sarah continues to help me as I journey on. I am grateful to Ruth for her counsellings and encouragments between May to June 2007, when she took over from Sarah.

From July to August 2007, I was helped by Dr Spencer Lee and Yvonne Ying of Association of Christian Counsellors of Singapore. Now I am helped by my Pastor's prayers and counsels, and that of some of my elders and brethren in my church, besides doing my own reading and researching on the internet to understand this condition and how best to manage it. I am deeply indebted to the above persons for their valuable prayers, counsels, encouragements and kindness during my most difficult times.

I am now learning to look to God and learning to use a combinations of available means which our Lord has graciously provided to cope with this brain condition. You can read more about these coping means/strategies from the category "My Coping Strategies" on my blog.

With God's help, I am hoping to share my journey of understanding this brain condition and God's mercies to me with you, dear Reader. If you know of anyone suffering the symptoms similar to that of my condition, please do pray for him/her and let him/her know that it is a medical condition that can be treated. Do advise him/her, if possible, to seek professional and medical help, counselling help, some natural remedies and other helps. Do not hesitate to tell him/her about this blog.

Just click on the links in the "Label" box on the right to read my postings.

I thank God for my family Church and some friends - for all their prayers, encouragements, support and kindness. In particular, I am indebted to my dear Pastors ie Pastor JJ Lim, Pastor Linus Chua and my brethren in my church ie Pilgrim Covenant Church  for their unconditional love, prayers, supports, concerns and kind love gifts which enable me to recuperate away from work and also to providentially work on this blog. I realized these are tokens of God's love, mercies and faithfulness to me in this difficult trial. These give me the courage to press on, to look to God daily, and to seek and serve our Lord as He enables me. I am thankful to God for His mercies and lovingkindness to me despite my many sins, failures and weaknesses.

I found it helpful and therapeutic to verbalise my thoughts and feelings and share it with others who can benefit from it. It is my prayers that, God willing, this blog with all its information will be used by our Lord to help others, particularly those who are afflicted in like manner and for their loved ones and friends, just as God has used many information available on the internet for my benefit and comfort as I seek to understand my illness and manage it so that I can live for Him and serve Him.

May the testimonies of God's love and faithfulness, through all the changing scenes of life, will continue to bring glory to Him and some comfort and encouragement to His people.

To God be the glory!

"My flesh and my heart faileth: but God is the strength of my heart, and my portion for ever." Psalm 73:26

Warm Regards,

Nancie

(First posted on 8 February 2008)

Comments:

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4 comments:

Sunday, August 17, 2008 1:46:00 PM

I really appreciated reading how God is working in your life.

Please pray for me, as I will for you!

Love,

Kate.

Reply: Sunday, September 28, 2008 5:32:00 PM

Thanks, Kate. I am remembering you in prayers. Praise and thank God for His goodness and mercies. 

Warm regards,

Nancie

Monday, October 13, 2008 10:30:00 AM

My dear friend Nancie, You are a testimony of God's love & faithfulness and YOU ARE MORE THAN ABLE & MORE THAN A CONQUEROR! Indeed, the strength of your heart and your portion is God even when Bpd & your heart might fail you, He will not!

You have shown us the mercies & goodness of Our Lord as you share with us your story of wellness & your struggles to maintain functioning as close to normal. You have shown us all that it entails to have a complete package of balance with a well qualified team of medical & spiritual counselors.

You demonstrate how wonderful it is to have support of many: loved loves, family, friends & church!

Again this echoes of how necessary it is to share this MISSION with others while serving you as therapy

as you express yourself, your thoughts, your feelings so it benefits others who are suffering

like manner! It benefits us all.

I pray you receive continual encouragement from others as you walk through this with God beside

you! Thank you for allowing us to

view your beginnings to the present![I think this was one of your first posts, right?]

Reply: Monday, October 13, 2008 7:45:00 PM

Peggy, thank you for your encouragements! Yes, this is one of my earliest post :)

All praise and glory be to God for His mercies to me and the way He is enabling me to cope and live for Him and serve Him. Take care!

Warm regards,

Nancie

(This post was first posted on 8 February 2008)

My bipolar disorder blog featured in a newspaper in Singapore

(This post was first posted on 25 January 2011)

Dear Friends,

Thanks for stopping by! Thank God for seeing us through almost a month in this new year.

Several months ago a reporter from a local newspaper here in Singapore, the Straits Times,  approached me for an interview regarding this blog on Bipolar Disorder - More Than Conquerors: (http://www.mylifewithbipolardisorder.com/). She was writing on how blogging help people cope with chronic illnesses and asked if I could share my story so that it can help others.

This interview was published a few days ago in The Sunday Times, 23 January 2011, Lifestyle section, page 9, and thank God for several readers in Singapore who wrote to let me know they appreciate my sharing of my own experiences plus the resources available. They themselves or their loved ones too suffer from bipolar disorder.

♥  I thank God that I can testified of His goodness and mercies to me through this blog. He is the One Who sustains me daily and enable me to cope and live a useful life for Him. Thank God that He is with us through all the changing scenes in life and He is working all things for His glory and our good. He promised that His grace is sufficient for us. He is my greatest comfort, peace and strength daily.

♥  I thank God for my family, my Church brethren and friends who love and accept me, pray for me and support me in my time of need. I am thankful to God for the joy and privilege of being acquainted with several people who are also suffering from bipolar, depression and other chronic illnesses and to be able to pray, support, encourage and learn from one another. I thank God for everyone of you, my dear blogging friends, and for your prayers and encouragements. They mean a lot to me. You have made a great difference in my life and used by God to encourage me and show me His love by your friendship and encouraging notes. You are in my thoughts and prayers too.

I thank God that I am in a community of people who love God and love me, who accepts me in my illness and weaknesses, and continue to extend their love and friendship to me. To the Lord and to all of you I owe a debt I cannot repay.

Thank you once again for all your prayers as I seek to walk with our Lord and serve Him within these limitations. Through your support, prayers and encouragements, God makes blogging therapeutic to me. It not only allows me to share my thoughts and feelings, and journal them as a form of reminder of God's goodness, it also encourages me through your friendships, prayers and encouragements. I am encouraged whenever I remember that there are people who care and are praying for me, and I am not alone.

♥  I am thankful to God that besides my personal sanctification and leading me to know more of His love, grace and mercies daily, He has opened a door of usefulness for me even through this condition and this blog. Since this blog was started in 2008, several readers from different parts of the world have also written to me to share their experiences and to let me know how the resources shared on my blog have helped them.

♥  May God be glorified through this blog. May He continue to use it to help others and their loved ones who are suffering in these ways and in need. Hope our Lord will lead some to come to find peace and comfort in the Lord too.

To God be the glory. Take care.

In His blessed care,

Nancie

25 January 2011

COMMENTS

1 Wendy, January 25, 2011 at 9:59 PM

Nancie,

Wow! That is so exciting that you and your blog were featured in the newspaper! Praise the Lord! May the article be used to glorify the Name of the Lord Jesus and to help others with bipolar to see that they, too, can live productive lives, to the glory of God. You are an awesome example to me of faith, consistency (your blog posts reflect a consistent theme of gratefulness, and praise to our Almighty God!), gratefulness, hopefulness, and perseverance. I love you, my sister in the Lord, and am so grateful to God that I have been able to meet you through blogging, and to call you my friend! It is very fun to see a picture of you, for I have often wondered if I would ever "meet" you in person, and what you would look like. I look forward to seeing you someday, whether here on earth or in heaven! I am very happy for you on this event!

Greatest blessings,

Wendy Gunn

REPLY

Nancie, January 26, 2011 at 6:18 PM

Hi Wendy,

Thank you for sharing the encouraging article on praying. It is a mercy that we can call upon God and offer our praise and thanksgiving to Him for His goodness to us and also to commit our loved ones and all things to Him in prayers. Thank God that our Lord Jesus Christ has opened that way by the sacrifice He made for us upon the cross. And He is our greatest Intercessor and Advocate daily always waiting to present the prayers of those who come to God through Him. This is such an encouragement! Thank and praise our Lord!

Many thanks for your visits, prayers and encouragements. Thanks for your very heart-warming and encouraging comment! It is always so good to hear from you and your comment always make my day :) I thank God that we can "meet" through blogging. You are also a shining example to me of a person who loves the Lord and lives for His glory. I look forward to meet you one day too in person whether here on earth or in heaven! May God continue to shower His love and many blessings upon you. Take care.

Warm regards,

Nancie

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2 Unknown, January 26, 2011 at 12:21 AM

I spent alot of time talking today about bipolar disorder and the help that is available....when accepted.

Blessings to you,

Happy WFW

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3 Joan Hall, January 26, 2011 at 4:21 AM

Nancie:

It certainly is exciting to know of your blog being featured in the newspaper. I thank God for women like you, who are not afraid to share their problems, needs, situations...and through it all you glorify God! I pray that not only many who also face bi-polar will be helped and encouraged, but also that many will come to know the hope we have in Christ.

Blessings to you,

Joan

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4 Donna, January 26, 2011 at 5:25 AM

First congratulations that your blog was featured in the newspaper! And thank you for sharing your verses and graphics today. I am thankful that we have a God who is always there for us, no matter what and His grace is sufficient. Thank you for sharing your journey with all of us. I believe it is helping many people who have the same journey as you.

Blessings to you this WFW!

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5 Mary, January 26, 2011 at 5:29 AM

Praise God that you are able to help others Nancie. Thank you for sharing. And am thankful with you that you are an overcomer!! Blessings to you dear girl.

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6 ozjane, January 26, 2011 at 5:34 AM

Blessings to you.

I am divorced because my ex left me as he spiraled into breakdown.

And I could do nothing but walk through it with God's grace.

He let his intellect guide him as he turned from faith to self help.

Keep looking to Jesus

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7 Spin, January 26, 2011 at 6:54 AM

CONGRATULATIONS!!

Love to you!

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8 Michelle-ozark crafter, January 26, 2011 at 7:43 AM

Hello sweet sister friend! I am glad to see you were featured in the paper. More people need to be aware of what it is like to live as we do. Love and huggles.

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9 marja, January 26, 2011 at 8:12 AM

So neat, Nancie. This is so exciting, isn't it? I hope lots more people find your blog as a result and that they will be helped.

May God bless you.

Love,

marja

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10 lori, January 26, 2011 at 8:18 AM

Wow Nancie....

Just another testimony to how what the enemy intends to use to destroy God uses for GOOD...and your article will touch lives you are never aware of...what a ministry.

Thank you for sharing this...

peace to you on the journey!

lori

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11 Heather Hart, January 26, 2011 at 9:01 AM

How wonderful that your blog was featured! That's awesome!

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12 Alida Sharp, January 26, 2011 at 10:31 AM

Congratulations on your blog being featured in the paper!

And I love the photos with the verses... thank you!

Happy WFW!

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13 Peggy, January 26, 2011 at 2:18 PM

Blessings Nancie and congratulations!

WOW! that is exciting and a great way to share on this to many and also a wonderful photo of you! You are an exemplary blogger of faith and trust and this honors God greatly! You are definitely MORE THAN A CONQUEROR! I know that this will bring glory to God! Your beautiful grateful heart and creative work is a blessing to many!

Your beautiful words to me were such a bright light to my day! Just to see you functioning always blesses me and you are clearly doing much better!

Your photos and scripture verses

truly exalt God at work in you and through you as we pass through the waters, we can rely that He is there...or the fire or the storm or the empty moments... whatever! It is because of your grateful heart that you continue to move two steps forward and hopefully no more backward ones. But I'm thankful that His grace is sufficient for you and me!

You have such a personal witness of God in your triumphs and also in your defeats you hold on to His Word and your heart is ever towards Him! I consider this an honor to know you and love you as my little sister! Your thankfulness is always so beautiful and how evident His Holy Spirit lifts you beyond the weight of bipolar. Your words glorify God as He strengthens you and holds you close! You bring great JOY to my heart and life!

Blogging is therapeutic for all of us, not just people with mental health issues. I accept you and your wise words because of who you are in Christ Jesus! I give Him thanks and praise for defeating and giving you strength to battle the highs and the lows. He is our balance! His Word is our daily medicine and there is healing in His wings! You share much wisdom and knowledge here that many can

receive and use! Not enough people visit and take the time to read, but I have and you know that you are such an enrichment and blessing to me! You encourage me in how you press on and persevere! May God continue to reward you! May this be just the beginning! May all surround you and support you as God continues His good work in us both!

May His blessings reign over you and stir you to continue with passion your artistic and ministry for His Namesake!

Indeed to God be the glory!!!

Love you so much and rejoicing with you,

Peggy

*sending a BIG hug and WOO HOO! Filled with love, peace, and JOY!

Great is Our Lord and greatly to be praised now and forever. Bless you for your beautiful message to me!

I treasure every word!

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14 Georgia, January 26, 2011 at 6:02 PM

wow! i am so proud of you for making this blog and getting published. you do have so much to be thankful for!

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Nancie, January 26, 2011 at 6:28 PM

Hi Lois,

Thanks for sharing about the transforming work of God in our lives. It is such an encouragement and blessed hope that our Lord Jesus Christ not only transformed us into a new person when we trusted in Him but is continuing to transform us daily to be more and more like Him and there is a future transformation when finally we see Him in Heaven one day. We shall enjoy His love and worship together with all His people without hindrances of sin and remaining corruptions. What a blessed hope!

Thank you for stopping by my blog. May God bless your week!

Warm regards,

Nancie

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Nancie, January 26, 2011 at 6:33 PM

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Hi Joan,

I am praying for you and your husband. Thank God for giving you peace. Thank God that He is with us and He gives us peace through all the changing scenes in life. Thanks for your visit and kind encouragements! May God continue to keep you close to Him and fill you with His peace and many blessings. Take care.

Warm regards,

Nancie

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Nancie, January 26, 2011 at 6:39 PM

Hi Donna,

Thank God that we have a God who hears our prayers and answer them in His own time and in His own wonderful ways. Truly our soul can never stop longing for our Lord to fill us with Himself and His love. Our soul is restless until we find our rest in Him. Like you, I too desire a closer walk with the Lord daily. Thank you for sharing with us. Thanks for your visit and encouragements. May God continue to draw you closer to Him and answer your prayers in His wonderful ways. Take care!

Warm regards,

Nancie

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Nancie January 26, 2011 at 6:43 PM

Hi Mary,

Thank our Lord Jesus Christ that we have true freedom in Him! Lovely picture and verse. Thanks for sharing with us. Thanks for your visit and encouragement. It's nice to hear from you. Take care and may God shower His many blessings on you.

Warm regards,

Nancie

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Nancie January 26, 2011 at 6:53 PM

Hi Ozjane,

Truly God is faithful. He hears our prayers and knows what is best. He answers them in His timing and according to His wills. Thanks for your visit and sharing. Take care!

Warm regards,

Nancie

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Nancie January 26, 2011 at 6:57 PM

Hi Spin,

I am praying for you. May God continue to heal you and fill you with His love and grace. Don't give up. Hang in there! He is faithful and He promised His grace is sufficient for us. Thanks for your visit and and encouragement. Take care!

Love to you too,

Nancie

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Nancie January 26, 2011 at 7:00 PM

Hi Michelle,

Slyvia is so cute! Thanks for sharing this sweet picture. It brings a smile to me :) Keep up your good work on the wolf! Glad you are enjoying it. It takes a lot of patience.

Love and huggles to you too,

Nancie

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Nancie January 26, 2011 at 7:04 PM

Marja,

I thank God that He led me to your blog. The Canadian lady mentioned in the newspaper clip was referring to you :) I am so thankful we met through blogging and I have been so blessed by your sharing. Your love for our Lord and His grace in enabling you to live a useful live for Him, is a constant encouragement to me. Your giving of yourself selflessly in helping others at Living Room gives me the motivation to reach out and help others too.

Thank God that He is the One Who sustains us and gives both of us grace to live for Him. May others too come to know the peace and comfort in Him.

Thanks again for all your prayers and encouragements. May God continue to keep you near to Him, bless your walk with Him and make you a blessing to others.

Love to you too,

Nancie

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Nancie January 26, 2011 at 7:08 PM

Hi Lori,

Thanks for sharing the lovely picture and all the encouraging verses. They are such precious reminders of what we are in Christ. May He enable us to live for His glory by His grace. Thanks for your visit and encouragements. Take care.

Warm regards,

Nancie

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Nancie January 26, 2011 at 7:13 PM

Hi Harter,

I am praying for you. Glad you are feeling better. May God continue to restore you. I am so thankful too for the many wonderful people I have met through blogging and all their encouragements. It's such a great blessing that you have the encouragement of the homeschooling mums. Thanks for your visit and encouragement. Take care!

Warm regards,

Nancie

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Nancie January 26, 2011 at 7:16 PM

Hi Alida,

Thank God that He is our Teacher and Guide, and we can look to Him and rest in Him daily! Thanks for your visit and encouragement! Take care.

Warm regards,

Nancie

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Nancie January 26, 2011 at 7:20 PM

Hi Peggy,

Thanks for your visit and encouragements! It is always so nice to hear from you :) Thank you for your many kind words of encouragements! Truly Great is Our Lord and greatly to be praised now and forever!

The verses you shared from James are so encouraging. They are such precious reminders when we go through difficult times. It is a comfort that God is with us through all the changing scenes in life and we can rest in Him and rejoice in Him no matter what we go through. He enables us to grow in Him through the trials in our life and He gives us wisdom and grace to go through them. I thank God for His many goodness and mercies to me as I battle with bipolar and other challenges in my life.

I am so thankful to God that through blogging I have "met" you and many wonderful friends. Thank God for all of you. Thank you so much for all your prayers and encouragements. May God continue to make you a blessing to many.

Take care and blessed New Year to you in 2011!

Love to you too,

Nancie

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Nancie January 26, 2011 at 7:31 PM

Hi Georgia,

Thank God for protecting your husband. I am too for the other families. May they know His mercies and comfort. We may not understand at times why God allows certain things in our life but if we belong to Him, we can have the firm assurance that He loves us and is in total control. When we leave this world we enter into our eternal rest yo enjoy His love and worship Him without hindrance.

Thank God for blessing you with a husband who isn't afraid to serve and protect his community. May God continue to protect him and use him as a good witness for Him. May God keep your family close to Him and bless your family with many blessings. Thanks for your visit and encouragement. Take care!

with Warm regards and prayers,

Nancie

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Comments

14 Pia January 27, 2011 at 12:26 AM

nancie, this is so wonderful! you are able to help believers and non believers alike and you are bringing glory to our Lord. i'm so sure that you brought a smile to His face. I am so happy for you. continue what you are doing because you are honoring God and surely you will be blessed.

praising God along with you!

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15 Nana Jul, January 27, 2011 at 3:58 AM

I think it's amazing that God uses our trials and weaknesses to minister to others! What a great ministry! God bless you HUGE.

Happy TT

Love,

Julie

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16 Kathryn, January 27, 2011 at 5:29 AM

Amen!! So glad that you are able to share your journey and your faith via your blog! Praise God!

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17 becky aka theRAV, January 27, 2011 at 10:19 AM

WOW! That is so cool Nancie! Now you are a celb. LOL Loved the picture. I had sort of pictured you like that in my mind's eye. You look like a professional writer. I doubt I could top everyone else comments that I have read here. They have said it all. I am thankful for crossing paths with your blog; for being your blogging friend as you are mine. It was great to "hear" your voice in your post again. I have missed you. I will try to catch up on older posts. Keep up the good work. You are certainly earning your crown in heaven by doing this blog. Thanks for being such an encourager for me and others. Many, many blessings to you.

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18 Jessica Kramasz, January 27, 2011 at 11:32 AM

Wow! What a wonderful opportunity - Praise the Lord.

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Nancie, January 27, 2011 at 7:02 PM

Hi Pia,

Thank God for providing for your needs. I am so thankful that He provides for me too. Truly He is our Shepherd and we will not lack anything. This is such an encouragement.

Thanks for your visit and many kind words of encouragements! It is so good to hear from you. Thank God that He is the One Who enables me to serve Him in little ways.

Take care and God bless you!

Warm regards,

Nancie

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Nancie January 27, 2011 at 7:07 PM

Hi Julie,

Thank God for blessing you as you seek to serve Him in your various callings! May God continue to use you as an instruments of blessing to many people.

Thanks for your visit and encouragements! It is always so good to hear from you. All praise and glory be to God. Take care. HUGS.

Happy TT

Love,

Nancie

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19 Grantham Lynn January 27, 2011 at 7:11 PM

Oh what a great post. I am so thankful for blogging too. Isn't it amazing that your blog made the news. Some people have talked about how all this internet stuff is kind of evil. But I see over and over how God is using this amazing medium for us to meet and connect and share Him. I think I met you a year or so ago. Did you make book marks? I think you sent me some! It is great to find you again. Thanks for sharing have a Great Friday.

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NancieJanuary 27, 2011 at 7:12 PM

Hi Kathryn,

It is so wonderful of God to use little Joshua. He is such a sweetie :) Indeed God works in many wonderful ways for us daily. It is encouraging to read of how He leads you and work things out for you. Praise God! Thanks for your visit and encouragements. To God be the glory!

Warm regards,

Nancie

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NancieJanuary 27, 2011 at 7:21 PM

Hi Becky,

Thank God for helping you through the week and sending friends to encourage you! These are such precious tokens of love from Him.

Thanks for your visit and many kind words of encouragements! It is always a joy to hear from you and you are truly a Super Encourager! I am so thankful to God that I "met" you through blogging. Isn't He so wonderful to connect us through the internet though we may be separated by seas and mountains? It will be so nice if we can meet in person :) whether here on earth or in heaven one day :)

Take care and many thanks again for your friendship and encouragement. God bless!

Warm regards,

Nancie

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NancieJanuary 27, 2011 at 7:25 PM

Hi Redeemed1,

Amen! It's such a great comfort that God is in control and He is unchanging. So thankful to know that He has seen you through a difficult year. He is faithful and His mercies endures forever. Though we may not always understand why He allows us to go through certain difficulties, but we have no doubt at all of His love, sovereignty and that He is working all things for His glory and our good. Yes, it is awesome to serve our Sovereign, Omnipotent, Immutable God!

Thanks for your visit and encouragements. Take care and God bless you and family.

Warm regards,

Nancie

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NancieJanuary 27, 2011 at 7:33 PM

Hi Sherry (MyJourneyBack),

Thanks for stopping by my blog! Yes, I do know you and it is indeed so good to be in touch again. I have not been blogging regularly and have lost touch with quite a number of bloggers. Thanks for your visit and words of encouragements.

I am so glad you are serving God in such a wonderful ministry to needy. Keep up your good work for our Lord! May God continue to bless you and the team that is doing this great work. Take care and have a blessed weekend!

Warm regards,

Nancie

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20 LS and Happy (Serendipity), January 27, 2011 at 11:33 PM

Hi Nancie!

PTL and congrats! It's amazing what God can do in our lives, isn't it? :-) You certainly have been such a blessing to all of us. I've always been very encouraged and uplifted by your posts as your faith is just like Peter walking on water.

Happy barks her congrats to you too and extra wags ;-)

Have a blessed weekend!

P/s: Love the picture of you in the papers. It certainly captures the very mood!

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Nancie January 28, 2011 at 5:04 PM

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Hi LS and Happy (Serendipity),

Thank you for you encouragements! You are a Super Encourager too! Thank God for His many mercies. He is the One Who gives me grace and strength to live for Him each day, and also peace and joy in simple ways.

You have been a great blessing to me too and I am so thankful to God that we can meet through blogging. Every visit to your blog brings a smile to me. Hugs to you and Happy :)

Blessed weekend to you too!

PS: I am just a very ordinary person. Any average lady is more beautiful than me :)

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21 Lynn, February 2, 2011 at 1:45 PM

Wow Nancie,

I'm just getting over here to read this now and I'm so glad I did. I just see the Lord all over your life and your strong witness to His grace and mercy in your heart.

You are an amazing woman and I long to meet you one day face-to-face. Thank you for your vulnerability and your grace. Hugging you tight. Lynn

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22 Qing, February 7, 2011 at 11:14 PM

Many years back a church friend told me he was suffering from depression but I could not understand what that was. Then it hit me months back and thank God I manage to overcome it quite fast. It seemed to come with a sudden drop in my health.

Then I understood why some depressed people would even seek death to escape from it. I heard that HK celebrity Sammy Cheng suffered fro

About Bipolar Disorder (Manic-depressive illness)

This article is taken from the website of National Institute of Mental Health (NIMH). NIMH said "NIMH publications are in the public domain and may be reproduced or copied without the permission from the National Institute of Mental Health (NIMH). NIMH encourages you to reproduce them and use them in your efforts to improve public health. Citation of the National Institute of Mental Health as a source is appreciated."

Introduction Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in a person's mood, energy, and ability to function. Different from the normal ups and downs that everyone goes through, the symptoms of bipolar disorder are severe. They can result in damaged relationships, poor job or school performance, and even suicide. But there is good news: bipolar disorder can be treated, and people with this illness can lead full and productive lives.

About 5.7 million American adults or about 2.6 percent of the population age 18 and older in any given year,1 have bipolar disorder. Bipolar disorder typically develops in late adolescence or early adulthood. However, some people have their first symptoms during childhood, and some develop them late in life. It is often not recognized as an illness, and people may suffer for years before it is properly diagnosed and treated. Like diabetes or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person's life.

"Manic-depression distorts moods and thoughts, incites dreadful behaviors, destroys the basis of rational thought, and too often erodes the desire and will to live. It is an illness that is biological in its origins, yet one that feels psychological in the experience of it; an illness that is unique in conferring advantage and pleasure, yet one that brings in its wake almost unendurable suffering and, not infrequently, suicide."

"I am fortunate that I have not died from my illness, fortunate in having received the best medical care available, and fortunate in having the friends, colleagues, and family that I do." Kay Redfield Jamison, Ph.D., An Unquiet Mind, 1995, p. 6. (Reprinted with permission from Alfred A. Knopf, a division of Random House, Inc.)

What Are the Symptoms of Bipolar Disorder? Bipolar disorder causes dramatic mood swings—from overly "high" and/or irritable to sad and hopeless, and then back again, often with periods of normal mood in between. Severe changes in energy and behavior go along with these changes in mood. The periods of highs and lows are called episodes of mania and depression.

Signs and symptoms of mania (or a manic episode) include: • Increased energy, activity, and restlessness • Excessively "high," overly good, euphoric mood • Extreme irritability • Racing thoughts and talking very fast, jumping from one idea to another • Distractibility, can't concentrate well • Little sleep needed • Unrealistic beliefs in one's abilities and powers • Poor judgment • Spending sprees • A lasting period of behavior that is different from usual • Increased sexual drive • Abuse of drugs, particularly cocaine, alcohol, and sleeping medications • Provocative, intrusive, or aggressive behavior • Denial that anything is wrong

A manic episode is diagnosed if elevated mood occurs with three or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is irritable, four additional symptoms must be present.

Signs and symptoms of depression (or a depressive episode) include: • Lasting sad, anxious, or empty mood • Feelings of hopelessness or pessimism • Feelings of guilt, worthlessness, or helplessness • Loss of interest or pleasure in activities once enjoyed, including sex • Decreased energy, a feeling of fatigue or of being "slowed down" • Difficulty concentrating, remembering, making decisions • Restlessness or irritability • Sleeping too much, or can't sleep • Change in appetite and/or unintended weight loss or gain • Chronic pain or other persistent bodily symptoms that are not caused by physical illness or injury • Thoughts of death or suicide, or suicide attempts

A depressive episode is diagnosed if five or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.

A mild to moderate level of mania is called hypomania. Hypomania may feel good to the person who experiences it and may even be associated with good functioning and enhanced productivity. Thus even when family and friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into depression.

Sometimes, severe episodes of mania or depression include symptoms of psychosis (or psychotic symptoms). Common psychotic symptoms are hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there) and delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person's usual cultural concepts). Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time. For example, delusions of grandiosity, such as believing one is the President or has special powers or wealth, may occur during mania; delusions of guilt or worthlessness, such as believing that one is ruined and penniless or has committed some terrible crime, may appear during depression. People with bipolar disorder who have these symptoms are sometimes incorrectly diagnosed as having schizophrenia, another severe mental illness. It may be helpful to think of the various mood states in bipolar disorder as a spectrum or continuous range. At one end is severe depression, above which is moderate depression and then mild low mood, which many people call "the blues" when it is short-lived but is termed "dysthymia" when it is chronic. Then there is normal or balanced mood, above which comes hypomania (mild to moderate mania), and then severe mania.

In some people, however, symptoms of mania and depression may occur together in what is called a mixed bipolar state. Symptoms of a mixed state often include agitation, trouble sleeping, significant change in appetite, psychosis, and suicidal thinking. A person may have a very sad, hopeless mood while at the same time feeling extremely energized.

Bipolar disorder may appear to be a problem other than mental illness—for instance, alcohol or drug abuse, poor school or work performance, or strained interpersonal relationships. Such problems in fact may be signs of an underlying mood disorder.

Diagnosis of Bipolar Disorder Like other mental illnesses, bipolar disorder cannot yet be identified physiologically—for example, through a blood test or a brain scan. Therefore, a diagnosis of bipolar disorder is made on the basis of symptoms, course of illness, and, when available, family history. The diagnostic criteria for bipolar disorder are described in the Diagnostic and Statistical Manual for Mental Disorders, fourth edition (DSM-IV).2

Descriptions offered by people with bipolar disorder give valuable insights into the various mood states associated with the illness:

Depression: I doubt completely my ability to do anything well. It seems as though my mind has slowed down and burned out to the point of being virtually useless…. [I am] haunt[ed]… with the total, the desperate hopelessness of it all…. Others say, "It's only temporary, it will pass, you will get over it," but of course they haven't any idea of how I feel, although they are certain they do. If I can't feel, move, think or care, then what on earth is the point?

Hypomania: At first when I'm high, it's tremendous… ideas are fast… like shooting stars you follow until brighter ones appear…. All shyness disappears, the right words and gestures are suddenly there… uninteresting people, things become intensely interesting. Sensuality is pervasive, the desire to seduce and be seduced is irresistible. Your marrow is infused with unbelievable feelings of ease, power, well-being, omnipotence, euphoria… you can do anything… but, somewhere this changes.

Mania: The fast ideas become too fast and there are far too many… overwhelming confusion replaces clarity… you stop keeping up with it—memory goes. Infectious humor ceases to amuse. Your friends become frightened…. everything is now against the grain… you are irritable, angry, frightened, uncontrollable, and trapped.

Suicide Some people with bipolar disorder become suicidal. Anyone who is thinking about committing suicide needs immediate attention, preferably from a mental health professional or a physician. Anyone who talks about suicide should be taken seriously. Risk for suicide appears to be higher earlier in the course of the illness. Therefore, recognizing bipolar disorder early and learning how best to manage it may decrease the risk of death by suicide.

Signs and symptoms that may accompany suicidal feelings include: • talking about feeling suicidal or wanting to die • feeling hopeless, that nothing will ever change or get better • feeling helpless, that nothing one does makes any difference • feeling like a burden to family and friends • abusing alcohol or drugs • putting affairs in order (e.g., organizing finances or giving away possessions to prepare for one's death) • writing a suicide note • putting oneself in harm's way, or in situations where there is a danger of being killed

If you are feeling suicidal or know someone who is: • call a doctor, emergency room, or 911 right away to get immediate help • make sure you, or the suicidal person, are not left alone • make sure that access is prevented to large amounts of medication, weapons, or other items that could be used for self-harm

While some suicide attempts are carefully planned over time, others are impulsive acts that have not been well thought out; thus, the final point in the box above may be a valuable long-term strategy for people with bipolar disorder. Either way, it is important to understand that suicidal feelings and actions are symptoms of an illness that can be treated. With proper treatment, suicidal feelings can be overcome.

What Is the Course of Bipolar Disorder? Episodes of mania and depression typically recur across the life span. Between episodes, most people with bipolar disorder are free of symptoms, but as many as one-third of people have some residual symptoms. A small percentage of people experience chronic unremitting symptoms despite treatment.3

The classic form of the illness, which involves recurrent episodes of mania and depression, is called bipolar I disorder. Some people, however, never develop severe mania but instead experience milder episodes of hypomania that alternate with depression; this form of the illness is called bipolar II disorder. When four or more episodes of illness occur within a 12-month period, a person is said to have rapid-cycling bipolar disorder. Some people experience multiple episodes within a single week, or even within a single day. Rapid cycling tends to develop later in the course of illness and is more common among women than among men.

People with bipolar disorder can lead healthy and productive lives when the illness is effectively treated (see below—"How Is Bipolar Disorder Treated?"). Without treatment, however, the natural course of bipolar disorder tends to worsen. Over time a person may suffer more frequent (more rapid-cycling) and more severe manic and depressive episodes than those experienced when the illness first appeared.4 But in most cases, proper treatment can help reduce the frequency and severity of episodes and can help people with bipolar disorder maintain good quality of life.

Can Children and Adolescents Have Bipolar Disorder? Both children and adolescents can develop bipolar disorder. It is more likely to affect the children of parents who have the illness.

Unlike many adults with bipolar disorder, whose episodes tend to be more clearly defined, children and young adolescents with the illness often experience very fast mood swings between depression and mania many times within a day.5 Children with mania are more likely to be irritable and prone to destructive tantrums than to be overly happy and elated. Mixed symptoms also are common in youths with bipolar disorder. Older adolescents who develop the illness may have more classic, adult-type episodes and symptoms.

Bipolar disorder in children and adolescents can be hard to tell apart from other problems that may occur in these age groups. For example, while irritability and aggressiveness can indicate bipolar disorder, they also can be symptoms of attention deficit hyperactivity disorder, conduct disorder, oppositional defiant disorder, or other types of mental disorders more common among adults such as major depression or schizophrenia. Drug abuse also may lead to such symptoms. For any illness, however, effective treatment depends on appropriate diagnosis. Children or adolescents with emotional and behavioral symptoms should be carefully evaluated by a mental health professional. Any child or adolescent who has suicidal feelings, talks about suicide, or attempts suicide should be taken seriously and should receive immediate help from a mental health specialist.

What Causes Bipolar Disorder? Scientists are learning about the possible causes of bipolar disorder through several kinds of studies. Most scientists now agree that there is no single cause for bipolar disorder—rather, many factors act together to produce the illness.

Because bipolar disorder tends to run in families, researchers have been searching for specific genes—the microscopic "building blocks" of DNA inside all cells that influence how the body and mind work and grow—passed down through generations that may increase a person's chance of developing the illness. But genes are not the whole story. Studies of identical twins, who share all the same genes, indicate that both genes and other factors play a role in bipolar disorder. If bipolar disorder were caused entirely by genes, then the identical twin of someone with the illness would always develop the illness, and research has shown that this is not the case. But if one twin has bipolar disorder, the other twin is more likely to develop the illness than is another sibling.6

In addition, findings from gene research suggest that bipolar disorder, like other mental illnesses, does not occur because of a single gene.7 It appears likely that many different genes act together, and in combination with other factors of the person or the person's environment, to cause bipolar disorder. Finding these genes, each of which contributes only a small amount toward the vulnerability to bipolar disorder, has been extremely difficult. But scientists expect that the advanced research tools now being used will lead to these discoveries and to new and better treatments for bipolar disorder.

Brain-imaging studies are helping scientists learn what goes wrong in the brain to produce bipolar disorder and other mental illnesses.8,9 New brain-imaging techniques allow researchers to take pictures of the living brain at work, to examine its structure and activity, without the need for surgery or other invasive procedures. These techniques include magnetic resonance imaging (MRI), positron emission tomography (PET), and functional magnetic resonance imaging (fMRI). There is evidence from imaging studies that the brains of people with bipolar disorder may differ from the brains of healthy individuals. As the differences are more clearly identified and defined through research, scientists will gain a better understanding of the underlying causes of the illness, and eventually may be able to predict which types of treatment will work most effectively.

How Is Bipolar Disorder Treated? Most people with bipolar disorder—even those with the most severe forms—can achieve substantial stabilization of their mood swings and related symptoms with proper treatment.10,11,12 Because bipolar disorder is a recurrent illness, long-term preventive treatment is strongly recommended and almost always indicated. A strategy that combines medication and psychosocial treatment is optimal for managing the disorder over time.

In most cases, bipolar disorder is much better controlled if treatment is continuous than if it is on and off. But even when there are no breaks in treatment, mood changes can occur and should be reported immediately to your doctor. The doctor may be able to prevent a full-blown episode by making adjustments to the treatment plan. Working closely with the doctor and communicating openly about treatment concerns and options can make a difference in treatment effectiveness.

In addition, keeping a chart of daily mood symptoms, treatments, sleep patterns, and life events may help people with bipolar disorder and their families to better understand the illness. This chart also can help the doctor track and treat the illness most effectively.

Medications Medications for bipolar disorder are prescribed by psychiatrists—medical doctors (M.D.) with expertise in the diagnosis and treatment of mental disorders. While primary care physicians who do not specialize in psychiatry also may prescribe these medications, it is recommended that people with bipolar disorder see a psychiatrist for treatment.

Medications known as "mood stabilizers" usually are prescribed to help control bipolar disorder.10 Several different types of mood stabilizers are available. In general, people with bipolar disorder continue treatment with mood stabilizers for extended periods of time (years). Other medications are added when necessary, typically for shorter periods, to treat episodes of mania or depression that break through despite the mood stabilizer.

• Lithium, the first mood-stabilizing medication approved by the U.S. Food and Drug Administration (FDA) for treatment of mania, is often very effective in controlling mania and preventing the recurrence of both manic and depressive episodes. • Anticonvulsant medications, such as valproate (Depakote®) or carbamazepine (Tegretol®), also can have mood-stabilizing effects and may be especially useful for difficult-to-treat bipolar episodes. Valproate was FDA-approved in 1995 for treatment of mania. • Newer anticonvulsant medications, including lamotrigine (Lamictal®), gabapentin (Neurontin®), and topiramate (Topamax®), are being studied to determine how well they work in stabilizing mood cycles.

• Anticonvulsant medications may be combined with lithium, or with each other, for maximum effect. • Children and adolescents with bipolar disorder generally are treated with lithium, but valproate and carbamazepine also are used. Researchers are evaluating the safety and efficacy of these and other psychotropic medications in children and adolescents. There is some evidence that valproate may lead to adverse hormone changes in teenage girls and polycystic ovary syndrome in women who began taking the medication before age 20.13 Therefore, young female patients taking valproate should be monitored carefully by a physician. • Women with bipolar disorder who wish to conceive, or who become pregnant, face special challenges due to the possible harmful effects of existing mood stabilizing medications on the developing fetus and the nursing infant.14 Therefore, the benefits and risks of all available treatment options should be discussed with a clinician skilled in this area. New treatments with reduced risks during pregnancy and lactation are under study.

Treatment of Bipolar Depression Research has shown that people with bipolar disorder are at risk of switching into mania or hypomania, or of developing rapid cycling, during treatment with antidepressant medication.15 Therefore, "mood-stabilizing" medications generally are required, alone or in combination with antidepressants, to protect people with bipolar disorder from this switch. Lithium and valproate are the most commonly used mood-stabilizing drugs today. However, research studies continue to evaluate the potential mood-stabilizing effects of newer medications. • Atypical antipsychotic medications, including clozapine (Clozaril®), olanzapine (Zyprexa®), risperidone (Risperdal®), quetiapine (Seroquel®), and ziprasidone (Geodon®), are being studied as possible treatments for bipolar disorder. Evidence suggests clozapine may be helpful as a mood stabilizer for people who do not respond to lithium or anticonvulsants.16 Other research has supported the efficacy of olanzapine for acute mania, an indication that has recently received FDA approval.17 Olanzapine may also help relieve psychotic depression.18 • If insomnia is a problem, a high-potency benzodiazepine medication such as clonazepam (Klonopin®) or lorazepam (Ativan®) may be helpful to promote better sleep. However, since these medications may be habit-forming, they are best prescribed on a short-term basis. Other types of sedative medications, such as zolpidem (Ambien®), are sometimes used instead. • Changes to the treatment plan may be needed at various times during the course of bipolar disorder to manage the illness most effectively. A psychiatrist should guide any changes in type or dose of medication. • Be sure to tell the psychiatrist about all other prescription drugs, over-the-counter medications, or natural supplements you may be taking. This is important because certain medications and supplements taken together may cause adverse reactions. • To reduce the chance of relapse or of developing a new episode, it is important to stick to the treatment plan. Talk to your doctor if you have any concerns about the medications.

Thyroid Function People with bipolar disorder often have abnormal thyroid gland function.4 Because too much or too little thyroid hormone alone can lead to mood and energy changes, it is important that thyroid levels are carefully monitored by a physician.

People with rapid cycling tend to have co-occurring thyroid problems and may need to take thyroid pills in addition to their medications for bipolar disorder. Also, lithium treatment may cause low thyroid levels in some people, resulting in the need for thyroid supplementation.

Medication Side Effects Before starting a new medication for bipolar disorder, always talk with your psychiatrist and/or pharmacist about possible side effects. Depending on the medication, side effects may include weight gain, nausea, tremor, reduced sexual drive or performance, anxiety, hair loss, movement problems, or dry mouth. Be sure to tell the doctor about all side effects you notice during treatment. He or she may be able to change the dose or offer a different medication to relieve them. Your medication should not be changed or stopped without the psychiatrist's guidance.

Psychosocial Treatments As an addition to medication, psychosocial treatments—including certain forms of psychotherapy (or "talk" therapy)—are helpful in providing support, education, and guidance to people with bipolar disorder and their families. Studies have shown that psychosocial interventions can lead to increased mood stability, fewer hospitalizations, and improved functioning in several areas.12 A licensed psychologist, social worker, or counselor typically provides these therapies and often works together with the psychiatrist to monitor a patient's progress. The number, frequency, and type of sessions should be based on the treatment needs of each person.

Psychosocial interventions commonly used for bipolar disorder are cognitive behavioral therapy, psychoeducation, family therapy, and a newer technique, interpersonal and social rhythm therapy. NIMH researchers are studying how these interventions compare to one another when added to medication treatment for bipolar disorder.

• Cognitive behavioral therapy helps people with bipolar disorder learn to change inappropriate or negative thought patterns and behaviors associated with the illness. • Psychoeducation involves teaching people with bipolar disorder about the illness and its treatment, and how to recognize signs of relapse so that early intervention can be sought before a full-blown illness episode occurs. Psychoeducation also may be helpful for family members. • Family therapy uses strategies to reduce the level of distress within the family that may either contribute to or result from the ill person's symptoms. • Interpersonal and social rhythm therapy helps people with bipolar disorder both to improve interpersonal relationships and to regularize their daily routines. Regular daily routines and sleep schedules may help protect against manic episodes. • As with medication, it is important to follow the treatment plan for any psychosocial intervention to achieve the greatest benefit.

Other Treatments • In situations where medication, psychosocial treatment, and the combination of these interventions prove ineffective, or work too slowly to relieve severe symptoms such as psychosis or suicidality, electroconvulsive therapy (ECT) may be considered. ECT may also be considered to treat acute episodes when medical conditions, including pregnancy, make the use of medications too risky. ECT is a highly effective treatment for severe depressive, manic, and/or mixed episodes. The possibility of long-lasting memory problems, although a concern in the past, has been significantly reduced with modern ECT techniques. However, the potential benefits and risks of ECT, and of available alternative interventions, should be carefully reviewed and discussed with individuals considering this treatment and, where appropriate, with family or friends.19 • Herbal or natural supplements, such as St. John's wort (Hypericum perforatum), have not been well studied, and little is known about their effects on bipolar disorder. Because the FDA does not regulate their production, different brands of these supplements can contain different amounts of active ingredient. Before trying herbal or natural supplements, it is important to discuss them with your doctor. There is evidence that St. John's wort can reduce the effectiveness of certain medications.20 In addition, like prescription antidepressants, St. John's wort may cause a switch into mania in some individuals with bipolar disorder, especially if no mood stabilizer is being taken.21 • Omega-3 fatty acids found in fish oil are being studied to determine their usefulness, alone and when added to conventional medications, for long-term treatment of bipolar disorder.22

A Long-Term Illness That Can Be Effectively Treated Even though episodes of mania and depression naturally come and go, it is important to understand that bipolar disorder is a long-term illness that currently has no cure. Staying on treatment, even during well times, can help keep the disease under control and reduce the chance of having recurrent, worsening episodes. Do Other Illnesses Co-occur with Bipolar Disorder? Alcohol and drug abuse are very common among people with bipolar disorder. Research findings suggest that many factors may contribute to these substance abuse problems, including self-medication of symptoms, mood symptoms either brought on or perpetuated by substance abuse, and risk factors that may influence the occurrence of both bipolar disorder and substance use disorders.23 Treatment for co-occurring substance abuse, when present, is an important part of the overall treatment plan.

Anxiety disorders, such as post-traumatic stress disorder and obsessive-compulsive disorder, also may be common in people with bipolar disorder.24,25 Co-occurring anxiety disorders may respond to the treatments used for bipolar disorder, or they may require separate treatment. For more information on anxiety disorders, contact NIMH (see below).

How Can Individuals and Families Get Help for Bipolar Disorder? Anyone with bipolar disorder should be under the care of a psychiatrist skilled in the diagnosis and treatment of this disease. Other mental health professionals, such as psychologists, psychiatric social workers, and psychiatric nurses, can assist in providing the person and family with additional approaches to treatment.

Help can be found at: • University—or medical school—affiliated programs • Hospital departments of psychiatry • Private psychiatric offices and clinics • Health maintenance organizations (HMOs) • Offices of family physicians, internists, and pediatricians • Public community mental health centers

People with bipolar disorder may need help to get help. • Often people with bipolar disorder do not realize how impaired they are, or they blame their problems on some cause other than mental illness. • A person with bipolar disorder may need strong encouragement from family and friends to seek treatment. Family physicians can play an important role in providing referral to a mental health professional. • Sometimes a family member or friend may need to take the person with bipolar disorder for proper mental health evaluation and treatment. • A person who is in the midst of a severe episode may need to be hospitalized for his or her own protection and for much-needed treatment. There may be times when the person must be hospitalized against his or her wishes. • Ongoing encouragement and support are needed after a person obtains treatment, because it may take a while to find the best treatment plan for each individual. • In some cases, individuals with bipolar disorder may agree, when the disorder is under good control, to a preferred course of action in the event of a future manic or depressive relapse. • Like other serious illnesses, bipolar disorder is also hard on spouses, family members, friends, and employers. • Family members of someone with bipolar disorder often have to cope with the person's serious behavioral problems, such as wild spending sprees during mania or extreme withdrawal from others during depression, and the lasting consequences of these behaviors. • Many people with bipolar disorder benefit from joining support groups such as those sponsored by the National Depressive and Manic Depressive Association (NDMDA), the National Alliance for the Mentally Ill (NAMI), and the National Mental Health Association (NMHA). Families and friends can also benefit from support groups offered by these organizations. For contact information, see the "For More Information" section at the back of this booklet.

What About Clinical Studies for Bipolar Disorder? Some people with bipolar disorder receive medication and/or psychosocial therapy by volunteering to participate in clinical studies (clinical trials). Clinical studies involve the scientific investigation of illness and treatment of illness in humans. Clinical studies in mental health can yield information about the efficacy of a medication or a combination of treatments, the usefulness of a behavioral intervention or type of psychotherapy, the reliability of a diagnostic procedure, or the success of a prevention method. Clinical studies also guide scientists in learning how illness develops, progresses, lessens, and affects both mind and body. Millions of Americans diagnosed with mental illness lead healthy, productive lives because of information discovered through clinical studies. These studies are not always right for everyone, however. It is important for each individual to consider carefully the possible risks and benefits of a clinical study before making a decision to participate.

In recent years, NIMH has introduced a new generation of "real-world" clinical studies. They are called "real-world" studies for several reasons. Unlike traditional clinical trials, they offer multiple different treatments and treatment combinations. In addition, they aim to include large numbers of people with mental disorders living in communities throughout the U.S. and receiving treatment across a wide variety of settings. Individuals with more than one mental disorder, as well as those with co-occurring physical illnesses, are encouraged to consider participating in these new studies. The main goal of the real-world studies is to improve treatment strategies and outcomes for all people with these disorders. In addition to measuring improvement in illness symptoms, the studies will evaluate how treatments influence other important, real-world issues such as quality of life, ability to work, and social functioning. They also will assess the cost-effectiveness of different treatments and factors that affect how well people stay on their treatment plans.

The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) is seeking participants for the largest-ever, "real-world" study of treatments for bipolar disorder. To learn more about STEP-BD or other clinical studies, see the Clinical Trials page on the NIMH Website http://www.nimh.nih.gov, visit the National Library of Medicine's clinical trials database http://www.clinicaltrials.gov, or contact NIMH.

For More Information Bipolar Disorder Information and Organizations from NLM's MedlinePlus (en Español)

Addendum to Bipolar January 2007 Aripiprazole (Abilify) is another atypical antipsychotic medication used to treat the symptoms of schizophrenia and manic or mixed (manic and depressive) episodes of bipolar I disorder. Aripiprazole is in tablet and liquid form. An injectable form is used in the treatment of symptoms of agitation in schizophrenia and manic or mixed episodes of bipolar I disorder.

If you have questions regarding these guidelines and use of NIMH publications, please contact the NIMH Information Center at 1-866-615-6464 or at nimhinfo@nih.gov.

Updated: 01/24/2007 

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Thank God for the above helpful article.

By God's grace,
Nancie
12 Feb 2008