How To Help And Support Someone With Bipolar

A recent study¹ by the National Institute on Mental Health (NIMH) reported that about 7 million (2.8%) US citizens suffer from bipolar disorder. As the caregiver, family member, or friend of someone with bipolar disorder, there are various ways that you can help them cope and manage their symptoms. 

What is bipolar disorder?

Bipolar disorder² is a mental illness that causes significant changes in your moods, energy levels, and ability to function normally. It is also referred to as a manic-depressive illness. When you are diagnosed with bipolar disorder, it means that you have had many episodes of high or low mood/energy levels for at least a year. The periods of staying at the lows and highs should also have lasted for more than a week for the diagnosis to be appropriate.

Symptoms of bipolar disorder

The following are the symptoms that help to identify bipolar disorder:

• Depressed mood or loss of interest in life

• Feeling immensely slowed down, agitated, or unusually restless (manic symptoms)

• Having problems with sleep 

• Cycles of  extremely high hyperactivity or exceedingly low energy levels

• Psychosis (hallucinations or delusions)

• Rapid speech

• Racing thoughts

• Impulsive behaviors, using poor judgment

• Engagement in risky behaviors; sexual promiscuity or substance use 

• Euphoria

• Suicidal thoughts

• Trouble concentrating

• Intense fatigue

Types of bipolar disorder

Bipolar disorder is generally broken up into four types³; bipolar I and II, Cyclothymic, and unspecified bipolar disorders.

Bipolar I

This is the most severe type of bipolar disorder. An individual diagnosed with bipolar 1 must have had one or more manic episodes and at least one major depressive episode, including mixed episodes. Individuals experiencing extreme mania often require hospitalization.

Bipolar II

Individuals with bipolar II experience hypo-manic episodes. Hypo-mania is a milder form of mania.

Cyclothymic

Individuals with cyclothymic disorder have long periods of hypomania and mild depression. These individuals do not require hospitalization, but often seek therapeutic intervention for their symptoms.

Unspecified bipolar disorder

If you have manic episodes but do not meet the criteria for bipolar I, you are diagnosed with an unspecified type of bipolar disorder. If your doctor thinks that your symptoms fit the diagnosis of bipolar disorder but cannot determine your specific type, you will be diagnosed with unspecified bipolar disorder.

Causes of bipolar disorder

As with many diseases, bipolar disorder is thought to have multiple causes. The exact cause of bipolar disorder remains unknown, but some risk factors contribute to the development of this illness in specific individuals.

Below are the possible risk factors⁴ for developing bipolar disorder:

Genetics

Your risk of developing this disorder is increased if you have family members with bipolar disorder. In fact, your chances of having the illness are 10 times greater if a close relative such as a parent or sibling has been diagnosed with bipolar disorder.

Brain structure/function

Studies⁵ have linked changes in brain structure or function to bipolar disorder. One study⁶ found that children with bipolar disorder had abnormalities in their right parietal lobe, a region of the cerebral cortex involved in attention.

Another study⁷ reported lower levels of metabolites (products produced by metabolism) in various areas of the brains of individuals with bipolar disorder compared to controls.

Psychosocial factors

Psychosocial factors, such as a history of abuse or a difficult life situation, may contribute to the development of bipolar disorder. The stress of having children, family problems, and even working too hard can undoubtedly affect someone's moods and may prove to be risk factors for the development of bipolar disorder.

For example, individuals living in poverty are at increased risk of developing psychiatric issues, such as depression and substance abuse disorders. This suggests that psychosocial factors play an essential role in mental illness.

Substance abuse

Individuals who abuse substances, including alcohol, amphetamines, cocaine, and marijuana, have been linked with mania/hypomania (elevated moods). These substances affect the brain's neurotransmitters, chemicals that carry signals between nerve cells.

Research shows that when neurons become over-stimulated by drugs or alcohol, they may produce excess serotonin. This can lead to changes in mood, contributing to the development of bipolar disorder.

For example, cocaine stimulates dopamine release, which produces feelings of pleasure and excitement, while elevated serotonin may be responsible for feelings of aggression or irritability.

Other illnesses

Several neurological conditions, including epilepsy, traumatic brain injury, and stroke, can cause symptoms that resemble bipolar disorder. Drugs such as steroids and lithium used to treat medical conditions like arthritis or mood disorders can also induce manic episodes in vulnerable individuals.

The stages of treatment for bipolar disorder

There is no known cure for bipolar disorder, and it can be a recurring illness throughout an individual's lifetime. To live a healthier life, patients with this condition will need various clinical management practices⁸, which include taking recommended medications and combining them with therapies.

Medications are used to bring about acute stabilization during manic or depressive episodes. On the other hand, specific therapies are effective in preventing recurrences of episodes and helping patients maintain a healthy lifestyle.

Medications

Bipolar disorder can be successfully treated with a combination of medication and therapy. There are different types of medication used to treat the illness. They include:

Mood stabilizers

Mood stabilizers, such as lithium and valproic acid (Depakote)⁹, help prevent mood episodes. Other medications in this class include carbamazepine (Tegretol)¹⁰, lamotrigine (Lamictal)¹¹, and gabapentin (Neurontin)¹².

Antipsychotics

Antipsychotics¹³ reduce the severity of manic or psychotic symptoms. These drugs are particularly effective in reducing manic episodes and were once known as major tranquilizers. Antipsychotic medications are also used to treat schizophrenia and psychotic disorders. 

Antidepressants

Antidepressants are the primary drugs used in the treatment of depression associated with bipolar disorder. These include monoamine oxidase inhibitors (MAOIs), tricyclics, atypical antidepressants, and selective serotonin reuptake inhibitors (SSRIs)¹⁴.

Treatment options

Several therapies¹⁵ are effective in the treatment of bipolar disorder. They include:

Psychotherapy

Also referred to as "talk therapy" or supportive counseling, psychotherapy can include a variety of techniques, including cognitive-behavioral and interpersonal therapies that promote healthy lifestyle choices and behaviors.

Cognitive behavior Therapy (CBT)

CBT helps patients learn how to identify early warning signs of manic episodes so they can take steps, through therapy and medications, to manage their moods more effectively.

Interpersonal Therapy (IPT)

IPT focuses on improving interpersonal relationships by identifying problems people face with loved ones or co-workers, clarifying feelings, and resolving disputes.

Family-focused therapy

This type of therapy teaches family members how to take an active role in their relative's treatment by helping them understand the illness, recommend medications, monitor side effects, and encourage compliance with treatment. Family therapy may also help reduce depression among patients with a co-occurring depressive disorder or teach family members to recognize the signs of a relapse.

Electroconvulsive therapy (ECT)

ECT is typically used in more severe cases or when other therapies have failed. It involves sending an electrical current through the brain while the patient is under general anesthesia. This treatment has been shown to normalize brain chemistry and reduce depressive symptoms in patients with bipolar disorder.

Lifestyle changes

People with bipolar disorder may benefit from the following lifestyle changes:

• Establishing a regular sleep schedule

• Reducing stress

• Abstaining from alcohol and recreational drugs

• Practicing good nutrition

• Exercising regularly

• Getting sufficient sunlight exposure (vitamin D)

• Managing weight by eating well and exercising

How to help someone with bipolar disorder

The following are some things you can do that will be helpful to an individual living with bipolar disorder.

Take bipolar disorder seriously

Bipolar disorder is a severe mental illness that requires treatment. Although you may feel frustrated and helpless, try not to take out your anger on the individual with bipolar disorder. That will likely make things worse.

Educate yourself

Educate yourself about the symptoms and triggers of this disorder, as well as the treatments available. This information will help you speak knowledgeably about bipolar disorder with the individual, without making them feel judged or embarrassed.

Reach out to other family members

If possible, reach out to the immediate family of the individual. Depending on your relationship with them, be open and honest about bipolar disorder. The more family members know, the better equipped they'll be to support and care for their loved one with bipolar disorder.

Connect the individual with appropriate resources

People with bipolar disorder can benefit from connecting and communicating with others who have similar experiences. For example, by talking to someone else who has the condition, you can learn about specific coping strategies that have helped them.

You can also refer them to websites, organizations, support groups, blogs, and online communities that provide a supportive environment. Searching on Google or YouTube for people posting first-person videos describing their experiences with bipolar disorder may also be helpful.

Be supportive

Bipolar disorder can be unpredictable. During both manic and depressive episodes, the individual may need guidance from a mental health professional. You can be their support system by being a stable, reliable presence in their lives.

Avoid mood-altering substances

Avoid using drugs and alcohol¹⁶ around someone with bipolar disorder. The effects of substances such as marijuana and psychedelics, such as LSD and psilocybin¹⁷ mushrooms, can mimic the symptoms of bipolar disorder and trigger a manic episode.

Be discreet

People with bipolar disorder usually want to keep their illness private. While you may be tempted to share the individual's condition with others, ask first if they would like you to.

How to interact with someone with bipolar

Be patient

While you may be frustrated by the individual's behavior, try not to lose your cool. Remember that the individual is dealing with a severe mental illness, and they may react irrationally if you become angry or hostile.

Provide structure

Bipolar disorder can cause a person to behave erratically and impulsively. Try to create a structure for the person by setting clear rules and expectations. However, avoid being too strict on them to ensure you don’t make them feel too confined.

Find good role models

Human examples are always better than rules when it comes to shaping behavior. Talk to the person about the adults they admire and the behaviors and traits you admire in them.

Provide a balance

Help the individual to identify activities that they enjoy and try to engage them in topics that relate to those activities. If the person is often overwhelmed with mood swings and feelings of depression, find something calming to do together, such as listening to music or hiking.

Communicate

When the individual feels stable, sit down with them and have an open conversation about bipolar disorder. Discuss the challenges that they are facing and suggest a few coping strategies that might help.

Listen

Make time for the person to share their thoughts and feelings with you. This can help them to cope with their illness and will also strengthen the bond between you both.

Helpful hints for family members on how to deal with bipolar people

Be understanding

Accept that the individual's behavior is not intentional or malicious but rather the result of a medical condition. As a member of their family, you may find yourself feeling frustrated, angry, and confused. This is a normal reaction to a problematic situation, and it's okay to feel that way.

Encourage treatment

If the individual with bipolar disorder is not currently taking medication or seeing a therapist, encourage them to do so. This will help them manage their illness and prevent future mood swings from becoming extreme enough to cause significant problems.

Visit them when hospitalized

If the individual is hospitalized in a mental health facility, take time to visit them. This will let them know that you are concerned about their well-being and give you a chance to monitor their progress. During the visits, ensure you have a word with their nurse or doctor. Ask how their treatment is going and what you can do to help.

Stay positive

Be optimistic about the individual's future. Depression and mania may be a part of their life for many years to come, but with treatment, they can learn how to self-manage their condition and live a more stable life.

Maintain an open line of communication

Give the person plenty of opportunities to talk about their condition and be receptive to what they have to say. They should be able to access you as a support system and share their experiences and feelings with you.

Make necessary lifestyle changes

Adjust your own life to accommodate the individual's needs. For example, if they are going through a manic episode and want to attend a party with friends, explain why this might not be a good idea. Instead, offer to accompany them to a more low-key event or hang out at your house.

Find support for them

Talk to other family members and friends about how you can help the individual. Bipolar treatment should be a collective and shared responsibility. As such, everyone ought to be on the same page in supporting the family member with bipolar disorder.

Give them space

Don't bombard the individual with questions, concerns, or advice. This can be overwhelming and serve as a trigger for negative emotions. Alternatively, offer to listen when they are ready to talk. If the person is in a manic episode, avoid trying to reason with them or give them advice. Do not take their unusual behavior personally. After the manic episode, try to have a discussion with them about what happened and how you might have contributed to the situation.

Keep calm

Don't react with panic or frustration if the person has an outburst of anger, especially if they have a manic episode. By doing so, you might torment them further, contributing to the severity of your next argument. If they are yelling at you, try to keep a level head and respond calmly.

Identify triggers and risk factors

Some people with bipolar disorder may not realize that certain activities or substances trigger their manic episodes. As a family, try talking to the individual to identify any triggers that cause them to behave erratically. If they are hostile, determine who in the family is close to them to do the talking on your behalf.

How to talk to someone with bipolar disorder

Be an active listener

Allow the person to speak and try your best to listen. Don't interrupt them or give unsolicited advice. As a listener, you can take their feelings seriously and validate them as a person.

Be honest

Be honest about yourself and your feelings. People with bipolar disorder are often hypersensitive to the moods of others, so telling a big or small lie can be a trigger for a manic episode.

Focus on how you can help

Always maintain an "I am here for you" tone while addressing them. Raise the topic of their mental health only when you are fully aware that they are in a meeting state of mind. By doing so, you can help them open up and feel comfortable speaking about their condition.

Validate their feelings and experiences

You could validate them with statements such as, "I can see why you feel that way" or "I would feel the same if I were in your shoes." By doing so, you are offering them emotional support and letting them know they are not invisible.

Leave the door open to future conversations

Make sure to end your conversation on a positive note, leaving them with a sense of hope that you will talk again soon. This is an excellent time to remind the person that you are there for them if they are ready to speak.

Be mindful of your non-verbal cues

Nervous gestures such as constantly wringing your hands or looking away from their eyes can make them feel uncomfortable. Try to keep calm, breathe, and maintain eye contact while talking to them.

What not to say to someone with bipolar disorder

• Don't tell them to "snap out of it." 

• Avoid asking questions or making statements that may open a door for an argument or debate. For example, "Do you think it's just people out there hurting you?"

• Avoid giving advice or telling them what to do; avoid saying things like, "You're just overreacting" or "Just calm down."

• Don't ask questions that may be interpreted as judgmental, e.g., "Why haven't you been taking your medication?"

• Don't gossip about them to another person with bipolar disorder. Talking about another person's behavior is different from talking about the illness/disorder itself. Bipolar Disorder cannot be "caught" or passed on to others.

How to help someone with bipolar disorder get help

• Educate yourself and learn more about the illness/disorder, including the triggers and how to respond. Knowing this information may also help you understand why they react or behave the way they do during an episode.

• Discover creative ways to remind them to take their medication. For example: Relate medication-taking time with a favorite television program or snack, like "Remember to take your meds at 7 pm when The Office comes on."

• Ask if you can do anything to help make the task of filling prescriptions easier. For example, getting multiple refills at once or transferring information from one storage device to another

• Find out if you can help with managing their finances or paperwork

• Help them create a realistic schedule such as alarms, lists, and a calendar schedule for themselves to manage time wisely.

The lowdown

Bipolar disorder can be a chronic, life‐affecting illness. Therefore, to better support and help a loved one, educate yourself about the disorder, including its triggers and how to handle it. A slight difference in response from those around someone with bipolar can have a significant impact. As such, the key is to listen, be understanding, supportive, and avoid judgmental statements or assumptions. Treat the person with respect and be there for them.