How to Help Someone with Bipolar Disorder

Signs and Symptoms of Bipolar Disorder

Bipolar disorder is characterized by fluctuating mood swings that can be described as “manic” (or “hypomanic”) or “depressed.” The consequence is severe impairment in sufferers. Mania can involve a dramatic decrease in sleep, inflated self-esteem, racing thoughts, distractibility, irritability, risk behaviors. Severe mania can also include psychotic symptoms, such as seeing or hearing things that are not there or having delusional beliefs. “Hypomania” is the term that describes mania when it is shorter and less severe (not psychotic), causing less disruption.

Mania is sometimes described as the “high” of bipolar disorder—this can be misleading, because manic symptoms can be very uncomfortable and not in the least pleasurable—with depression operating as the flip side or “low” of bipolar disorder. Loss of interest and pleasure in previous people or activities you once enjoyed, feeling hopeless, problems with concentration, anger and irritability, weight and appetite changes, sleep problems, fatigue, and recurring thoughts of death or suicide are all symptoms of bipolar depression, if these symptoms last more than two weeks.

Types of Bipolar Disorder

Bipolar disorder is a complex disease to treat. One reason is that it comes in various forms:

• Bipolar I – Defined by at least one manic episode lasting at least a week and usually a depressive episode
• Bipolar II – When one hypomanic and one depressive episode occur, but no mania; also defined by a higher frequency of depressive episodes.
• Cyclothymia – Hypomanic and depressive symptoms that last over two or more years (one year for youth)

The Link Between Bipolar Disorder and Substance Abuse

Among people with bipolar disorder, substance abuse and addiction are incredibly common: 56 percent of those who suffer from the illness also had a lifetime substance use disorder, according to a 2005 study in Addiction Science & Clinical Practice. While bipolar disorder on its own has a high mortality rate—the condition reportedly accounts for one out of four suicides in the U.S.—drug and alcohol abuse only amplify the health risks. In situations where a person is bipolar and using drugs and/or alcohol to self-medicate their symptoms, timely intervention from a friend or loved one can be all they need to get much-needed treatment for their underlying disorder and the co-occurring substance abuse. Knowing how to help someone with bipolar disorder is therefore of life-saving importance— starting with what we know does help people with bipolar disorder.

Help for Bipolar Disorder – What to Know

What we know is that bipolar disorder is treatable and usually manageable with medication, as part of a comprehensive treatment approach that includes therapy and other elements of a healthy lifestyle. With respect to medication, so-called mood stabilizers—medications that even out the mood swings, causing them to be less severe and destabilizing—help to reduce the chances of relapse (another manic and depressive episode). Research has shown that in the absence of a mood stabilizer, these episodes are far more likely to occur and occur at a higher frequency. A psychiatrist who regularly treats bipolar patients put it this way: “Staying on a mood stabilizer is like wearing a seatbelt. Statistically, you’re lowering your chances of having another relapse.”

Medications for Bipolar Disorder

The gold standard for treatment, then, (once a diagnosis of bipolar disorder has been made), is long-term maintenance on one of these commonly prescribed mood stabilizers:

• Lithium (also known as Eskalith or Lithobid), which, as the first mood stabilizer to have been approved by the FDA in the 1970’s, has been around the longest in this class of drugs.
• Lamotrigine (or Lamictal), an anticonvulsant drug that, in addition to treating seizures is said to be effective at treating depressive symptoms.
• Valproic acid or divalproex sodium (a.k.a. Depakote), which was approved by the FDA in 1995 for treating mania.
• Other anticonvulsant medications: gabapentin (Neurontin), topiramate (Topamax), and oxcarbazepine (Trileptal).

Often atypical antipsychotic medications are used in combination with a mood stabilizer, in order to relieve insomnia (a common symptom of bipolar disorder) and other manic and depressive symptoms. Atypical antipsychotics include the following medications:

• Olanzapine (Zyprexa), which is used in pill or injection form in combination with an antidepressant to relieve the symptoms of severe mania or psychosis.
• Aripiprazole (Abilify), which is used to treat manic or mixed episodes that involve both mania and depression.
• Quetiapine (Seroquel), risperidone (Risperdal) and ziprasidone (Geodon) are
• used to relieve the symptoms of manic episodes.

Therapies for Bipolar Disorder

If medication is one essential component of the healthy management of this chronic disease, psychotherapy is the other— and, in particular, intensive psychotherapy. Research funded by the National Institutes of Health has found that intensive psychotherapy dramatically sped up the recovery of bipolar patients. The researchers concluded that patients who received intensive psychotherapy were more likely to get better faster and stay better, in contrast to patients who received only a few sessions.

Therapies that are evidenced to improve treatment outcomes for bipolar disorder—alongside medication—include:

• Family therapy – Bipolar disorder can strain relationships with immediate family that live with the patient. Family therapy helps family members improve their communication and develop better problem solving and other coping devices.
• Cognitive behavioral therapy (CBT) – CBT aims to change negative thoughts, emotions and behaviors, by addressing thought distortions and finding ways to replace unhealthy thinking.
• Dialectical behavioral therapy (DBT) – DBT seeks to improve a patient’s quality of life by imparting them with key skills that can help them better manage their moods, develop greater self-control in the face of distressing thoughts, and be mindfully present to situations in daily life.
• Interpersonal and social rhythm therapy – The psychotherapeutic focus is just what the name implies: addressing relationship problems and building a healthy daily routine, including with sleep/wake cycles.

Other Key Ingredients of a Comprehensive Treatment Plan

Medication and therapy are key building blocks of better health for anyone with bipolar disorder— but they are not the only things that improve health and quality of life for people with this very serious condition. Other key ingredients of a comprehensive treatment plan can include:

• Strong social support (meaningful relationships with friends, family and/or a regular support group)
• Exercise
• A healthy diet
• Meaningful activities (work, volunteer or family-related)

How I Can Help a Friend or Loved One with Bipolar Disorder

Now that you know what is proven to support the health and quality of life of people with bipolar disorder, you are already more prepared to know how to help them. Here are some other pointers to keep in mind:

• Take care of yourself. This is critical if you live with and are regularly caring for someone with bipolar disorder. Your loved one has a serious health condition like other serious and potentially life-threatening physical sicknesses. It is therefore impossible to live with bipolar disorder and not struggle with multiple challenges in daily life, whether these be social, physical or psychological. This reality can be hard to live with on an ongoing basis, if you’re a caregiver or loved one— so one of the best ways to help your family member with bipolar disorder is to engage in good self-care, by practicing a healthy lifestyle, finding time for yourself and friends, maybe joining a support group.
• Educate yourself regarding bipolar disorder. A great way to do this and simultaneously offer support to your loved one is to ask them to share their experience of bipolar disorder with you. Chances are they know a lot about their condition and what treatments have or have not worked. By listening to their experience and perspective, you also convey that you value them, that their experience is valid and important, and that you have something to learn from them.
• Invite them to coffee or to do things you both enjoy. Bipolar disorder can come with a lot of self-stigmatization, which is compounded when someone is suffering from depression and an accompanying loss of interest in people. The tendency can be to self-isolate out of fear of being around others. But by communicating that you enjoy your friend or loved one’s company—regardless of their diagnosis or the fact that they feel miserable—you are encouraging them and letting them know they have your support. Even if they don’t take up your offer, they will be so thankful.
• Support their treatment plan. If they have found a medication that is working for them and have a good fit of therapist who they are regularly seeing, applaud them for taking care of their health. If they haven’t found the right medication, or feel stuck in a therapy arrangement that isn’t really working, encourage them to stay patient and actively engaged with their treatment. Encourage them to advocate for the right medication with their psychiatrist— and to not give up, no matter how long it may take to get on the right medicine. If they express a desire to get off their mood stabilizer medication, encourage them to stay on it or find a better one that is easier to tolerate.
• Don’t judge or try to fix their problem for them. Be available for the times when your friend or loved one may need to talk. What they most need is a non-judgmental listening ear. They know you can’t fix their problem, and they don’t want you to. There may also be days when that someone who is bipolar is having suicidal thoughts. Let them know that you want them to tell you when they are thinking about suicide. Always know, too, that if you’re concerned about your friend, you can call the Suicide Prevention Lifeline at 1-800-273-TALK (8255) for advice. Often the best way to help a friend who is suicidal is to be available to them as a listening ear. Just knowing they are not alone can be the thing that protects them from suicide. That said, if someone who is bipolar says they are thinking about suicide and want to end their life, urge them to go to the nearest psychiatric hospital or emergency room— and insist on going with them.
• Emphasize the positive: that there is hope and your friend/loved one can find recovery. Bipolar disorder is a complex illness to treat, often requiring a trial and error approach with medications that can cause difficult side effects and make daily life seem overwhelming. Bipolar depression can also persist for weeks and months, causing enormous suffering and hopelessness that can seem impossible to tolerate. Suicidal thoughts are not uncommon in this phase of the illness. What your friend/loved one may need most, then, are reminders of what they can hope for or look forward to. If they’re still struggling today, let them know that one day things are going to be better.
• Be patient. Remember that this person has a severe mental illness and is living with its effects daily, facing adversities that most people without mental illness don’t have to deal with. While it may be tempting to think they could just snap out of one of their moods, the reality is they can’t just do that. Be accepting of where they are. After all, with any physical disease, you can’t just “will” yourself to feel better. The same is true for bipolar disorder. (The fact that it is a mental disorder does not make it any less of a bona fide medical problem than physical illnesses.)

For information related to bipolar disorder, check out the following articles:

1. Dual Diagnosis: How Treatment for Co-Occurring Disorders Improves Recovery Outcomes
2. Common Co-Occurring Disorders Associated with Addiction
3. The Power of Friendship in Recovery: How Social Support Improves Treatment Outcomes