Helping a family member or friend with bipolar disorder
Dealing with the ups and downs of bipolar disorder can be difficult—and not just for the person with the illness. The moods and behaviors of a person with bipolar disorder affect everyone around—especially family members and close friends. During a manic episode, you may have to cope with reckless antics, outrageous demands, explosive outbursts, and irresponsible decisions. And once the whirlwind of mania has passed, it often falls on you to deal with the consequences. During episodes of depression, you may have to pick up the slack for a loved one who doesn’t have the energy to meet responsibilities at home or work.
The good news is that most people with bipolar disorder can stabilize their moods with proper treatment, medication, and support—and you can play a significant role in his or her recovery. Often, just having someone to talk to can make all the difference to your loved one’s outlook and motivation.
Here are some other ways you can help:
- Learn about bipolar disorder. Learn everything you can about the symptoms and treatment options. The more you know about bipolar disorder, the better equipped you’ll be to help your loved one and keep things in perspective.
- Encourage the person to get help. The sooner bipolar disorder is treated, the better the prognosis, so urge your loved one to seek professional help right away. Don’t wait to see if the person will get better without treatment.
- Be understanding. Let your friend or family member know that you’re there if he or she needs a sympathetic ear, encouragement, or assistance with treatment. People with bipolar disorder are often reluctant to seek help because they don’t want to feel like a burden to others, so remind the person that you care and that you’ll do whatever you can to help.
- Be patient. Getting better takes time, even when a person is committed to treatment. Don’t expect a quick recovery or a permanent cure. Be patient with the pace of recovery and prepare for setbacks and challenges. Managing bipolar disorder is a lifelong process.
The importance of support in bipolar disorder recovery
People with bipolar disorder do better when they have support from family members and friends. Those whose loved ones are involved and supportive tend to recover more quickly, experience fewer manic and depressive episodes, and have milder symptoms.
Bipolar disorder and the family
Living with a person who has bipolar disorder can cause stress and tension in the family. On top of the challenge of dealing with symptoms and their consequences, family members often struggle with feelings of guilt, fear, anger, and helplessness. Ultimately, the strain can cause serious relationship problems. But families can successfully deal with bipolar disorder if they learn to accept the illness and its difficulties.
When you’re feeling frustrated or guilty, it’s important to remember that bipolar disorder isn’t anyone’s fault.
Accepting bipolar disorder involves acknowledging that things may never again be “normal.” Treatment can make a huge difference for your loved one, but it may not take care of all symptoms or impairments. To avoid disappointment and resentments, it’s important to have realistic expectations. Expecting too much of your family member is a recipe for failure. On the other hand, expecting too little can also hinder recovery, so try to find a balance between encouraging independence and providing support.
Tips for coping with bipolar disorder in the family
- Accept your loved one’s limits – People with bipolar disorder can’t control their moods. They can’t just snap out of a depression or get a hold of themselves during a manic episode. Neither depression nor mania can be overcome through self-control, willpower, or reasoning. Telling a person to “Stop acting crazy” or “Look on the bright side” won’t help.
- Accept your own limits – You can’t rescue a person with bipolar disorder, nor can you force someone to take responsibility for getting better. You can offer support, but ultimately, recovery is in the hands of the person with the illness.
- Reduce stress – Stress makes bipolar disorder worse, so try to find ways to reduce stress in your loved one's life. Ask how you can help and volunteer to take over some of the person’s responsibilities if needed. Establishing and enforcing a daily routine—with regular times for getting up, having meals, and going to bed—can also reduce family stress.
- Communicate openly – Open and honest communication is essential to coping with bipolar disorder in the family. Share your concerns in a loving way, ask the person how he or she is feeling, and make an effort to truly listen—even if you disagree with your loved one or don’t relate to what’s being said.
Supporting a person with bipolar disorder
What you can say that helps:
Adapted from: The Depression and Bipolar Support Alliance
Aside from offering emotional support, the best way to help someone with bipolar disorder is by encouraging and supporting treatment. However, people with bipolar disorder tend to lack insight into their condition, so it’s not always easy to get them to a doctor. When they’re manic, they feel great and don’t realize there’s a problem. When they’re depressed, they may recognize something’s wrong, but lack the energy to seek help.
If your loved one won’t acknowledge the possibility of bipolar disorder, don’t argue about it. The idea may be frightening to the person, so be sensitive. Suggest a routine medical checkup instead, or a doctor’s visit for a specific symptom, such as insomnia, irritability, or fatigue (you can call ahead to tell the doctor of your bipolar disorder concerns).
Things you can say that might help:
- Bipolar disorder is a real illness, like diabetes. It requires medical treatment.
- You’re not to blame for bipolar disorder. You didn’t cause it. It’s not your fault.
- You can feel better. There are many treatments that can help.
- When bipolar disorder isn’t treated, it usually gets worse.
Once your friend or family member agrees to see a doctor, you can help by being a partner in treatment. Your support can make a big difference in treatment success, so offer to be involved in any way the person with bipolar disorder wants or needs.
Things you can do to support a loved one’s bipolar disorder treatment:
- Find qualified doctors and therapists
- Set up appointments and go along
- Offer your insight to the doctor
- Monitor your loved one’s moods
- Learn about the person’s medications
- Track treatment progress
- Watch for signs of relapse
- Alert the doctor to problems
Encourage the person to take bipolar disorder medication
Medication is the cornerstone of treatment for bipolar disorder, and most people need it to regulate their moods and avoid relapse. Despite the need for medication, many people with bipolar disorder stop taking it. Some quit because they’re feeling better, others because of side effects, and still others because they enjoy the symptoms of mania. People who don’t think they have a problem are particularly likely to stop taking medication.
You can help a person with bipolar disorder stay on track by emphasizing the importance of medication and making sure all prescriptions are being taken as directed. Also encourage the person to speak to the doctor about any bothersome side effects. Side effects can be very unpleasant if the dose of the medication is too low or too high, but a change in medication or dosage may solve the problem. Remind the person that abruptly stopping medication is dangerous.
Even if a person with bipolar disorder is committed to treatment, there may be times when symptoms get worse. Take action right away if you notice any troubling symptoms or mood changes. Point out the emerging bipolar symptoms to your loved one and alert the doctor. With swift intervention, you may be able to prevent an episode of mania or depression from developing fully.
Mania warning signs and symptoms:
- Sleeping less
- Elevated mood
- Speaking rapidly
- Increase in activity level
- Irritability or aggression
Depression warning signs and symptoms
- Fatigue and lethargy
- Sleeping more
- Trouble concentrating
- Loss of interest in activities
- Withdrawing from others
- Change in appetite
If relapse can’t be prevented, there are things you can do to cope during a manic or depressive episode.
- Don’t take bipolar symptoms personally. When in the midst of a bipolar episode, people often say or do things that are hurtful or embarrassing. When manic, they may be reckless, cruel, critical, and aggressive. When depressed, they may be rejecting, irritable, hostile, and moody. It’s hard not to take such behaviors personally, but try to remember that they’re symptoms of a mental illness, not the result of selfishness or immaturity.
- Be prepared for destructive behaviors. When manic or depressed, people with bipolar disorder may behave in destructive or irresponsible ways. Planning ahead for how to handle such behavior can help. When your loved one is well, negotiate a treatment contract that gives you advance approval for protecting him or her when symptoms flare up. Agree on specific steps you’ll take, such as removing credit cards or car keys, going together to the doctor, or taking charge of household finances.
- Know what to do in a crisis. It’s important to plan ahead for times of crisis so you can act quickly and effectively when it occurs. Having a crisis plan can help. Make sure to include a list of emergency contact information for doctors, therapists, and other loved ones who will help. Also include the address and phone number of the hospital you will take the person to if necessary.
- Call 911 (or your country’s emergency services number) in an emergency. If a person with bipolar disorder is suicidal or violent, don’t try to handle the situation alone. If you’re worried that your loved one may hurt you, get to safety and then call the police. If the person is suicidal, don’t leave him or her alone. Call for an ambulance and stay with the person until it arrives.
Supporting someone who is manic
- Spend time with the person. People who are manic often feel isolated from other people. Spending even short periods of time with them helps. If the person has a lot of energy, walk together, which allows the person to keep on the move but share your company.
- Answer questions honestly. However, do not argue or debate with a person during a manic episode. Avoid intense conversation.
- Don’t take any comments personally. During periods of high energy, a person often says and does things that he or she would not usually say or do, including focusing on negative aspects of others. If needed, stay away from the person and avoid arguments.
- Prepare easy-to-eat foods and drinks (such as peanut butter and jelly sandwiches, apples, cheese crackers, and juices), because it is difficult for the person to sit down to a meal during periods of high energy.
- Avoid subjecting the person to a lot of activity and stimulation. It is best to keep surroundings as quiet as possible.
- Allow the person to sleep whenever possible. During periods of high energy, sleeping is difficult and short naps may be taken throughout the day. Sometimes the person feels rested after only 2 to 3 hours of sleep.
Adapted from: The Palo Alto Medical Foundation
It's easy to neglect your own needs when you're supporting someone else. But if you don't take care of yourself, you run the risk of burnout. To cope with the stress of caring for someone with bipolar disorder, you have to take care of yourself both emotionally and physically.
- Focus on your own life. Supporting your loved one may involve some life adjustments, but make sure you don't lose sight of your own goals and priorities. Don't give up friendships, plans, or activities that bring you joy.
- Seek support. Dealing with a loved one's mental illness can be painful and isolating. Make sure you're getting the emotional support you need to cope. Talk to someone you trust about what you're going through. It can also help to get your own therapy or join a support group.
- Set boundaries. Be realistic about the amount of care you're able to provide without feeling overwhelmed and resentful. Set limits on what you're willing and able to do, and stick to them. Letting bipolar disorder take over your life isn't healthy for you or your loved one.
- Manage stress. Stress takes a toll on the body and mind, so find ways to keep it in check. Make sure you're eating right and getting enough sleep and exercise. You can also keep stress under control by practicing relaxation techniques such as meditation.
- Ask for help. If your friend or family member needs more assistance than you can give, ask for help from others. Turn to other relatives or close friends, or contact one of the organizations listed under Resources section below.
Resources & References
Helpguide’s Yellow Pages
Resources for public assistance, social services, and other health and human services.
Helping a friend or family member with bipolar disorder
Helping a Friend or Family Member with Depression or Bipolar Disorder – Advice for friends and family members on how to help and support a person with bipolar disorder. (Depression and Bipolar Support Alliance)
What Can Family and Friends Do to Help? (PDF) – Tips for helping and supporting a loved one through bipolar disorder treatment and recovery. (Mood Disorders Society of Canada)
Helping Someone During a Manic Episode – Offers tips on dealing with a loved one when they’re having a manic episode. (Palo Alto Medical Foundation)
Coping with a loved one’s bipolar disorder symptoms
The Role of Family and Friends in a Bipolar Person's Life – Article on how to support a person with bipolar disorder and cope with challenging symptoms. (HealthyPlace.com)
Beating the Marriage Odds – Learn how marriages involving bipolar person can stay strong by sharing responsibility, planning ahead, and setting boundaries. (National Alliance on Mental Illness)
Supporting bipolar disorder treatment in a family member or friend
Tools for Everyone – Download a sample mood chart and a bipolar disorder treatment contract, and find information on how to use them to help your friend or family member. (Massachusetts General Hospital Bipolar Clinic & Research Program)
How to Help Someone in a Crisis – Guide to handling a bipolar disorder crisis, including what to say and do and how to get a loved one to check in to a hospital voluntarily. (Depression and Bipolar Support Alliance)
Bipolar disorder in children and teens
About Pediatric Bipolar Disorder – Guide to the specific signs and symptoms of bipolar disorder in children and adolescents. Includes information on diagnosis and treatment. (Child and Adolescent Bipolar Foundation)
Young and Bipolar – Magazine article discusses bipolar disorder in children and teens, signs of manic and depression, and why the disease is striking earlier. (Time Magazine)
The Storm in My Brain: Kids and Mood Disorders – This introduction to mood disorders includes drawings by children suffering from bipolar disorder and tips for parents. (Depression and Bipolar Support Alliance)
TeensHealth: Bipolar Disorder – Article for teens discusses the signs, symptoms, causes, and treatment of bipolar disorder, or manic depression. (Nemours Foundation)
Finding local support for bipolar disorder
In the U.S.:
- National Alliance on Mental Illness (or call 1-800-950-NAMI)
- U.S. Support Group Locator – Directory of depression/bipolar disorder support groups in the United States. (Depression and Bipolar Support Alliance)
- Support Groups Outside the U.S. – Depression/bipolar disorder support groups located outside the United States. (Depression and Bipolar Support Alliance)
UK Bipolar Support Groups – Find your nearest self-help support groups in the UK. (Bipolar UK)
- Support Groups in Australia – Lists support groups for bipolar disorder in the different territories of Australia. (Black Dog Institute)
- Support Groups in Canada – Find a bipolar disorder support group in Canada. (Canadian Mental Health Association)