How can i help someone with bipolar disorder

Helping Someone with Bipolar Disorder

How can you help someone 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. It can put a strain on your relationship and disrupt all aspects of family life.

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. Your patience, love, and understanding can play a significant part in your loved one’s treatment and recovery. Often, just having someone to talk to can make all the difference to their outlook and motivation.

But caring for a person with bipolar disorder can also take a toll if you neglect your own needs, so it’s important to find a balance between supporting your loved one and taking care of yourself.

Other ways to help someone with bipolar disorder

You can also support your loved one by:

Learning 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.

Encouraging 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 they will get better without treatment.

Being understanding. Let your friend or family member know that you're there if they need 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.

Showing patience. 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. They 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 home. On top of the challenge of dealing with your loved one's 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 there are better ways to cope.

The first step to successfully dealing with bipolar disorder is for families to learn to accept the illness and its difficulties. When you're feeling frustrated or guilty, 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 can be a recipe for failure. On the other hand, expecting too little can also hinder their recovery, so try to find a balance between encouraging independence and providing support.

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Tips for coping with bipolar disorder in the family

Accept your loved one's limits. Your loved one 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. So telling your loved one to “Stop acting crazy” or to “Look on the bright side” won't help.

Accept your own limits. You can't rescue your loved one with bipolar disorder, nor can you force them 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 your loved one how they're 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:

“You're not alone in this. I'm here for you.”
“I understand that it's your illness that causes these thoughts and feelings.”
“You may not believe it now, but the way you're feeling can and will change.”
“I may not be able to understand exactly how you feel, but I care about you and want to help and support you.”
“You are important to me. Your life is important to me.”

Convincing a person with bipolar disorder to see a doctor

Aside from offering emotional support, the best way to help your loved one with bipolar disorder is by encouraging and supporting treatment. Often, that can be more of a challenge than it sounds. Since people with bipolar disorder tend to lack insight into their condition, it's not always easy to get them to a doctor. When your loved one is manic, they feel great and don't realize there's a problem. When your loved one is depressed, they may recognize something's wrong, but often 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 them, so be sensitive. Suggest a routine medical checkup instead, or a doctor's visit for a specific symptom, such as insomnia, irritability, or fatigue—then privately call ahead to tell the doctor of your concerns about bipolar disorder.

[Read: How to Help Someone with Mental Illness Accept Treatment]

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.”

Supporting a loved one during bipolar disorder treatment

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 their treatment success, so offer to be involved in any way your loved one 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 insights to the doctor.
Monitor your loved one's moods.

Learn about their medications.
Track treatment progress.
Watch for signs of relapse.
Alert the doctor to problems.

Encourage your loved one 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 yet 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 your loved one stay on track by emphasizing the importance of medication and making sure they take all prescriptions as directed. Also encourage your loved one to speak to their 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 your loved one that abruptly stopping medication is dangerous.

Watch for warning signs of bipolar disorder relapse

Even if your loved one with bipolar disorder is committed to treatment, there may be times when their 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
Restlessness

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

Coping with mania and depression: Tips for family and friends

If it's not possible to prevent your loved one relapsing, 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, your loved one 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 your loved one's 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 them 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 friends or family members who will help. Also include the address and phone number of the hospital where you'll take your loved one if necessary.

Call 911 (or your country's emergency services number) in an emergency. If your loved one 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 your loved one is suicidal, don't leave them alone. Call for an ambulance and stay with your loved one until it arrives.

Supporting someone who is manic

Spend time with your loved one. People who are manic often feel isolated from other people. Spending even short periods of time with them helps. If your loved one has a lot of energy, walk together. This allows your loved one to keep on the move but still share your company.
Answer questions honestly. However, do not argue or debate with someone during a manic episode. Try to avoid intense conversation.
Don't take any comments personally. During manic episodes, your loved one may say or do things that are out of character, including focusing on negative aspects of others. Try to avoid arguments.
Prepare easy-to-eat meals and drinks. It's often difficult for someone who is manic to sit down to a meal, so try offering them sandwiches, apples, cheese crackers, and juices, for example.
Avoid subjecting your loved one to a lot of activity and stimulation. It's better to keep surroundings as quiet as possible.
Allow your loved one to sleep whenever possible. During periods of high energy, sleeping is difficult but short naps taken throughout the day can help. Sometimes a person who is manic may feel rested after only a few hours of sleep.

Taking care of yourself when a loved one has bipolar disorder

It's easy to neglect your own needs when you're supporting someone with a mental illness. But if you don't take care of yourself, you run the risk of burnout—and that won't help you or your loved one. When you take care of yourself both emotionally and physically, you'll be able to better cope with the stress of caring for someone with bipolar disorder and have the energy you need to support your loved one's recovery.

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 a bipolar disorder support organization.

Hotlines and support

In the U. S.
Find DBSA Support Groups or call the NAMI Helpline for support and referrals at 1-800-950-6264
UK
Find a Support Group in the UK or call the Mind Infoline at 0300 123 3393
Australia
Find Support Groups in Australia or call the SANE Help Centre at 1800 18 7263
Canada
Find Help in Canada or call the Mood Disorders Society at 519-824-5565
India
Call the Vandrevala Foundation Helpline (India) at 1860 2662 345 or 1800 2333 330

Last updated or reviewed on February 23, 2023

How to Help Someone With Bipolar Disorder

Written by WebMD Editorial Contributors

Very often in bipolar disorder, people with hypomania may not realize it's a problem. They may even enjoy it, finding it to be a productive time. Or they may fear that taking medicine will make them depressed and they'll miss feeling good. Others struggle with depression, not getting the help that could relieve their suffering.

Although there's no easy solution, these tips may help.

Learn. Read information from reputable websites, books, and articles that explain the condition. The more you know, the better.

Listen. Pay attention to what your loved one has to say. Don't assume that you know what they are going through. Don’t dismiss all of their emotions and feelings as signs of their illness. Someone with bipolar disorder may still have valid points.

Notice their symptoms. They may not be able to see it as clearly as you do when their bipolar symptoms are active. Or they may deny it. When you see the warning signs of mania or depression, you can try to make sure they get help ASAP.

Do things together. People who are depressed often pull away from others. So encourage your friend or loved one to get out and do things they enjoy. Ask them to join you for a walk or a dinner out. If they say no, let it go. Ask again a few days later.

Make a plan. Because bipolar disorder can often be an unpredictable illness, you should plan for bad times. Be clear. Agree with your loved one about what to do if their symptoms get worse. Have a plan for emergencies. If you both know what to do and what to expect of each other, you'll feel more confident about the future.

Stick to a schedule. If you live with someone who has bipolar disorder, encourage them to stick to a schedule for sleep and other daily activities. Some research shows that it’s helpful to have a regular routine. The person will still need medicine and counseling, but look for everyday things, like exercise and a healthy diet, that supports their overall health.

Express your own concerns. Since your loved one's behavior can have a huge effect on you, it’s OK to discuss. Don’t blame the other person or list all of their mistakes. Instead, focus on how their actions make you feel and how they affect you. Since this can be really hard to do, you might find it easiest to talk about it together with a therapist.

Take care of yourself. As intense as your loved one’s needs may be, you count, too. It’s important for you to stay healthy emotionally and physically.

Do things that you enjoy. Stay involved with other people you’re close to -- social support and those relationships mean a lot. Think about seeing a therapist on your own or joining a support group for other people who are close to someone who has bipolar disorder.

Encourage them to stick with treatment. Your loved one needs to take their bipolar medication and get regular checkups or counseling.

Getting Someone to Seek Help for Bipolar Disorder

For a variety of reasons, people with bipolar disorder won't go to a doctor for help. They shrug off a friend or family member's concern. Others view their illness as a distraction or a weakness, and they don't want to give in to it. Still others put their health at a very low priority compared with other things in their lives.

Often, fear is the reason for not seeing a doctor. That's especially true if there is a family history of emotional problems. People in denial are protected from their worst fears. They can stay comfortable in their everyday routines -- even though relationships and careers can be at stake.

If you're concerned about a loved one who could have bipolar disorder, talk to them about seeing a doctor. Sometimes, simply suggesting a health checkup is the best approach. With other people, it works best to be direct about your concern regarding a mood disorder. Include these points in the discussion:

It's not your fault. You have not caused this disorder. Genetics and stressful life events put people at greater vulnerability for bipolar disorder.
Millions of Americans have bipolar disorder. It can develop at any point in a person's life -- though it usually develops in young adulthood -- and is responsible for enormous suffering.
Bipolar disorder is a real disease. Just like heart disease or diabetes, it requires medical treatment.
There's a medical explanation for bipolar disorder. Disruptions in brain chemistry and nerve cell pathways are involved. The brain circuits -- those that control emotion -- are not working the way they should. Because of this, people experience certain moods and energy levels more intensely, for longer periods of time, and more frequently.
Good treatments are available. These treatments have been tested and found to be effective for many, many people with bipolar disorder. Medications can help stabilize your moods. Through therapy, you can discuss feelings, thoughts, and behaviors that cause problems in your social and work life. You can learn how to master these so you can function better and live a more satisfying life.
By not getting treatment, you risk having worse mood episodes -- and even becoming suicidal when depressed. You risk damaging your relationships with friends and family. You could put your job at risk. And your long-term physical health can also be affected, since emotional disturbances affect other systems in the body. This is very serious.

Trust is crucial in shaking someone's denial and in motivating them to get help. Trust is also important once treatment for bipolar disorder starts. Through the eyes of a trustworthy friend or family member, a person with bipolar disorder can know when treatment is working -- when things are getting better, and when they're not. If your interest is sincere, you can be of great help to your friend or family member.

How to Help Someone Stay on Their Bipolar Medication

Just like someone with type 1 diabetes will always need insulin, a person with bipolar disorder will likely need to take medication for their whole life. Research shows that many of those who stop often find their symptoms return within a year.

As important as it is, people often don't stay the course with their medication. There are some common reasons why someone might skip doses or stop taking drugs. If you have a friend or family member with bipolar disorder, you can help them stick with it. And knowing the reason the person quits using the medicine can help.

Make sure you tell them that you care about them, that you believe medication is key to their being well, and that you'll be there to support and help them along the way.

The reason: The drugs don't seem to be working.

Encourage patience. Many medications can take up to 8 weeks to kick in. So it's not unusual to think they're not working at first. Sometimes, they and their doctor may need to experiment for months or even years before settling on the right drugs and doses. Reassure them that most people are eventually glad they stuck with the process because they end up feeling a lot better.

The reason: They just forget.

If your friend or loved one frequently misses doses because they're "too busy" or "just forgot," encourage them to find a way to make it part of their daily routine. Taking pills at the same time every day, such as before bed or with breakfast, can help. So may downloading a pill reminder app or using a pill box organizer. Ask if you can remind them with a phone call or text message. Offer to pick up their refills from the pharmacy.

The reason: They hate the side effects.

Encourage them to tell their doctor. Adjusting the dose or changing when they take it may help ease side effects. Their doctor might also have suggestions on how to deal with the side effects so they're less of an issue. If that doesn't work, their doctor may change their medication.

The reason: They just refuse.

There could be a number of reasons someone refuses to take a medicine. They might have a concern they're not willing to talk about. Or they may not want to accept that they have a mental illness or that they need medicine.

If your loved one is taking medication but talking about stopping, urge them to discuss it with their doctor. Warn them of the dangers of stopping abruptly. Their symptoms could become more severe, and they might have unpleasant side effects.

If your loved one isn't taking their medication, try to get a handle on their current state of mind. A person who seems relatively stable might be OK without medication for a while. But try to get them to agree to seek treatment if their condition gets worse. They might be willing to discuss the downsides of stopping medication and what's at stake.

Sometimes, a person who is manic or severely depressed may still refuse treatment. You may need to take matters into your own hands and contact their doctor. Your loved one might need to be hospitalized. While this can be a hard step to take, it may serve as a wake-up call that makes them understand how serious their condition is.

Bipolar Disorder Guide

Overview
Symptoms & Types
Treatment & Prevention
Living & Support

People with bipolar disorder tell how to properly support them

March 30 is celebrated as Bipolar Day around the world. With this disease, it is important to monitor mood changes, which can be difficult to do alone. The founder of the Bipolar Association, Masha Pushkina, has collected stories of people who are helped by treatment partners.

At the initiative of public organizations bringing together scientists, doctors and activists, every year on March 30, World Bipolar Day is celebrated. The date chosen was the birthday of Vincent van Gogh, an artist who, according to researchers, was the embodiment of a "bipolar genius."

With bipolar disorder, a person lives either in a state of high emotional uplift and excitement (mania), or in depression. According to world statistics, about 2% of people suffer from bipolar disorder in various forms. This means that in Russia there are at least three million bipolar people - this is about half of St. Petersburg.

In most cases, this condition responds well to medication. But, unfortunately, many do not seek help or do not know how to find it. Without treatment, the disease progresses and ultimately leads to sad consequences: loss of family, job, disability in general, and in almost every seventh case, suicide.

These consequences can be avoided. The peculiarity of bipolar disorder is that the onset of remission depends not only on the doctor and medications, but also on the behavior of the patient himself. Very often, bipolar people provoke seizures "with their own hands. " The mood of people with BAD (bipolar affective disorder. - Note ed. ) is very unstable, the balance is fragile, and mania or depression can be “started” in dozens of ways: the psyche is easily shaken by psychoactive substances, alcohol, lack of sleep, too intense work, travel and even love. So, a short time after the next course of treatment with powerful drugs, the person again ends up in the hospital. And each new attack reduces the chances of a long remission, affects social status, and even more painfully - self-esteem.

The experience of people with mental disorders around the world has proven that you are much more likely to cope with difficulties when you are supported by people who understand your problems and condition, but do not look at you as a patient. As practice shows, such a person can be not only a partner or close relative. An old friend, and even a person with whom you have never met in person, can help you get through the darkest times. Masha Pushkina, especially for Afisha Daily, spoke with several bipolar people about those in whom they found their support. The result is a story not about illness, but about friendship and trust, which can defeat even madness.

Yana, 31 years old

Housewife, collects books and is fond of confectionery

Purposefully, I didn't find out about the ways of support anywhere, everything turned out quite naturally. I have been sick for 15 years. The first person who looked after me was my best friend, and now it's my husband.

When my hypomania (a mild degree of mania, which is characterized by a constantly high mood. - Approx. ed. ) accelerated into a full-fledged mania (this state is also characterized by a one-sided attraction to some topic, sometimes accompanied by delirium. - Note ed. ), it became clear that I needed to be looked after. A friend began to pay attention to repetitive patterns of behavior in one phase or another, and we decided together to find out what helps in such cases. I think my friend was afraid to take responsibility for my condition, but she turned out to be generous and selfless. When I got married, a friend passed this knowledge on to her husband, and he already supplemented it, based on his own experience. The husband initially knew with whom he connects his life. He says it didn't scare him.

I have obsessions during my manic episodes. My husband does not argue with me at this time, but he also does not feed them, trying to redirect my stormy energy in a different direction. You can’t argue, because the result will be the opposite: I will finally get stuck on the idea, I will consider that I must prove it at all costs, even if the whole world is against me, and there are enemies and conspiracies around. If this does not help, the husband agrees to discuss all these things, but at the same time tries to slow down their implementation by offering to draw up a specific and detailed plan. Sometimes it takes me a long time.

For example, I always want to move somewhere. Right now, and why aren't we packing our things yet? My husband tries to make me write down what are the pros and cons of different cities, what attracts us to them. As a result, I sit for hours on different forums, make lists, think about how we will arrange our life, calculate the budget for different countries of the world. There is also a manic passion for travel, but after preparation, we usually implement these plans. And many years ago, in a fit of mania, I bought an apartment - with a mortgage, with hellish payments. Then it took a long time to resolve this situation, but, fortunately, everything worked out well.

My husband began to chart my mood. I also manage it, and we check the results so that they are objective. Quarrels due to the fact that the husband takes on the role of the elder often arise in the manic phase (never in depression). Then I become very suspicious, any attempts at control cause rage. But now the husband has learned from experience, so he does not react to attempts to unleash a conflict. With obvious attacks of rage and auto-aggression, he uses holding therapy (long strong hugs. - Note ed. ). We have seen this in autistic children, this is how their parents influence them.

When I'm depressed, he doesn't comfort me because it's pointless, but he tries to give reasonable arguments that this period has always ended and this time will also pass soon. We look at mood charts for the past months, discuss the duration of the attacks: two weeks have already passed and, judging by past experience, it should get better in a couple of weeks.

Such support from the husband helps in many ways. When I was being treated by two doctors, taking all the medicines, I didn’t have such support, everything was very bad. Over time, I stopped disappearing from home in a manic state and inflicting serious injuries on myself. All my super-ideas remain on paper in the form of graphs and tables, I don’t even have time to start putting them into practice, so that later I don’t have to deal with the consequences with the whole family.

Alisa, 27 years old

Biologist

To be honest, I don't always find understanding from my healthy environment, I often faced condemnation, devaluation of problems. But from a person who has a similar experience, you won’t hear “don’t invent”, “you can’t feel so bad”, “take a walk and it will pass”.

It just so happens that my best friend also suffers from bipolar disorder. I did not look for support in specialized communities where patients communicate, we met by chance. My friend is much older, he has much more life experience, and he was able to become a real mentor for me. Not once did his actions worsen my condition - I hope that he can say the same about me.

When I'm on the rise, I feel uncomfortable when he tries to slow me down and reduce my passions. But as soon as this state passes and I again take a sober look at the situation, each time I thank him for trying to stop the revelry and disgrace. My friend himself is currently not being treated, but he never imposed his position on me, and when I turn to doctors, he supports me in this.

I told the doctor about this source of support - he is all for it. Before meeting a friend, I had suicidal attempts, but during the entire time of our communication I never tried to say goodbye to life. When you know that there is a person who will understand everything and share warmth (while even my own family repels me), that there is a place where you can come in any condition and where they will accept me without unnecessary questions and teachings, this is a source of great strength. and hope.

When I was expecting my second child, I was depressed. My husband did not yet fully understand the features of the disease and did not want to admit obvious things - this added problems, and my emotional state became extremely difficult. It seems that only thanks to the participation of my friend, I did not do anything to myself and successfully endured the pregnancy. The child was named after him.

Sergey, 49 years old

Freelancer

At the height of the depression, I was looking for any available support and ended up in an online group of anonymous debtors (people who have taken on large loans). One of the participants drew attention to my condition and said that I urgently need medical help. Despite the fact that she lives in the USA, we began to communicate regularly via Skype. Olga literally brought me to the hospital and helped me prepare for the treatment.

Americans are a pragmatic people, many young and healthy people have folders with wills and instructions in case of their death. They also approach mental difficulties calmly and thoroughly. It is common practice for the patient to draw up detailed instructions in advance. In the United States, there is a practice of issuing Treatment Agreements for people with mental illness (Treatment Contract). This document is needed so that family, friends and doctors recognize the symptoms of deterioration in time and take into account your experience and wishes in the treatment. Typically, such a document contains: a list of trusted people; signs of a normal state; signs of an approaching episode; symptoms of mania and depression; actions that trusted people should take to help a person get better and keep him from destructive acts; plan of action in case of an emergency (for example, a suicide attempt). who and what will be done in case of his hospitalization, so that he can be treated without anxiety for household chores.

In a period of severe depression, there is a struggle inside a person between the craving for death and the desire to live - and many external things can outweigh in one direction or another. Every clue is important to help you get out. It is very difficult for one to cope with all this.

I madly didn’t want to go to the hospital and wouldn’t have made up my mind myself, until the last I hoped that somehow everything would go away on its own. But under the supervision of a friend, I drew up a preparation plan: warn the customer at work, arrange to look after my cats. Reported to her about every step. But then he could no longer simply “escape” [from hospitalization], because he felt obliged to both her and the doctor. During depression, one's own life has no value, but the people dear to me, the promises made to them, do.

At the most difficult moment, Olga became my “outer brain”, which told me what to do when I didn’t understand anything myself. After I was discharged from the hospital, I turned to four friends for support. Usually we call each other once a week, I tell what my condition is. It is important not only to chat online, but also to hear the voice, you can understand a lot from it. Friends immediately pay attention, if I suddenly disappear and stop calling, then something is wrong.

I think it is possible to find such a person if you set yourself such a goal. Take a closer look at people in support groups, religious or other communities - those who understand what compassion and mutual assistance are. This must be an internally mature person, ready to take responsibility for you in a difficult situation. If this person has similar problems, then he will better understand your experiences. For this reason, relatives are far from always suitable: they themselves can panic, seeing how bad you feel, choke you with their anxiety, overprotection.

It is necessary to establish the frequency of communication and observe it. And of course, in no case should you parasitize on someone else's kindness. The support system works when you yourself take responsibility for your life, and do not outweigh it completely on another.

Anna and Valeriya, 21 years old

Students

Anna: After a major depressive episode four years ago that almost ended in a suicide attempt, I started looking for information on [support]. I managed to find a guide in English for relatives and friends on how to behave with such a person. I have sent this list to all my friends so that they have an idea of what is happening to me. For the past few years, Lera has been monitoring my emotional state on a daily basis, and if, in her opinion, it goes beyond the norm, she tells me about it. Lera just asks every day how I'm doing, and if she sees that I'm reacting strangely, she wonders if something happened. At first, it was very difficult, because, in principle, I did not like to regularly share personal experiences. But by regularly receiving feedback, I can imagine the dynamics: do the pills help, how long do the side effects last, does the depressive phase go into a moderate and severe degree, do I lose my critical thinking during hypomania.

Valeria: We gradually established a very trusting relationship. Anya studied the topic of bipolar disorder up and down, and I read the articles that she sent me. The diagnosis did not change anything for me, because it remained the same. After that, we already discussed some formalities (for example, who to call in case of an emergency).

Anna: I asked Lera to watch for hypomanic manifestations in which I lose an adequate assessment of my actions: impulsive night walks, alcohol begin.

Valeria: My friend is a very responsible and conscious girl who takes care of herself, her health and her wallet. Before buying something expensive, she asks for my advice - and then we are already sorting out the situation. We can entrust accounts to each other and not worry. I also know where and to whom to run in cases of exacerbation.

Anna: I react badly to prohibitions and reminders of illness. Yes, I periodically have to turn to relatives for help, change treatment or take long breaks, but I expect mutual respect so that they don’t look at me through the prism of the disease.
When the mood is unstable, harsh phrases like “the disease speaks in you”, “these are not your real emotions” cause persistent rejection, even when they are true. The line between accepting a loved one's illness and identifying him with a diagnosis for healthy people is extremely thin. Therefore, those who were able to grope it deserve great respect.

Anna: In the last year, I go to see the doctor with my parents. When the doctor notices that I may not be able to do it alone, she duplicates the instructions and advice for them. I, in turn, am a friend. The doctor has repeatedly emphasized that the change of episodes is more noticeable from the outside.

Valeria: We don't have any kind of hierarchy in relationships, so there is no pressure when one makes decisions for another. This is not eating each other's emotional resources, but complementing and supporting.

Anna: The main danger in a relationship with a person with a serious illness is to fall into codependency. This format is equally bad for both the "controller" and the "subordinate". Unfortunately, I have been in such relationships before. It is worth maintaining mutual respect and treating each other as equals. Illness should not dominate a relationship. In difficult episodes, it temporarily comes to the fore, but you should always remember that you are not a disease.

Anna: I have memory problems: I don't remember some episodes. In such cases, I can ask Lera for help. If you remember the last weeks, then these are regular reminders to call the doctor. In mixed episodes, this becomes an acute problem, because I can suddenly change my mind or forget. Against the backdrop of a severe episode, I may develop psychosis, and this is the most dangerous thing in the disease. Thanks to our format, I manage to avoid such exacerbations almost always.

The advantages of observation from a loved one are an early response and the fact that he knows the patient's usual behavior very well and can notice even small changes. The main disadvantage is that normal friendly communication risks turning into constant monitoring of symptoms. Not every mentally healthy person is able to remain within the boundaries of reason.

It is important to agree in advance, before an attack, what is an undoubted sign of a worsening condition (for example, persistent insomnia), and what you do not need to pay special attention to (for example, loud indignation at something that you do not like). In a difficult situation, often a loved one begins to behave not as an equal, but as a “healthy” and “knowledgeable”. Not all relationships stand this test.

There is also a variant of "buddy" (when two people with mental disorders look after each other. - Note ed. ) - it is good precisely because it is the true request of the patient and more equal relations without mixing roles. But I don't know the buddy support system.

To choose a person you can rely on in a critical situation, take a closer look at your surroundings. Above all, a high level of trust is needed. Your assistant should be open to nonjudgmental and open dialogue and at the same time emotionally stable and resistant to stress.

Support is essential for every person - very often we as mental health professionals need it. And with bipolar disorder, this problem is especially acute. At the initial stages, those closest to you often ignore the presence of the disease, and friends advise you to either "pull yourself together" or, conversely, "relax", sometimes with the help of alcohol. When it becomes obvious to everyone that the “condition” will not go away on its own, urgent hospitalization is already required. The saved patient receives the "stigma".

Psychiatrists then make it the responsibility of the uninitiated next of kin (parent or spouse) to monitor any changes in the patient, and they really try to do so. At the level of "laughing out loud - hypomania has begun, upset - depression." As a result, psychiatrists begin to treat quite normal human emotions based on complaints from relatives... and the circle closes.

For this to change, mental health literacy must play a major role. Relatives, in order to be able to help, need to understand well what is happening with a loved one. In many, including state clinics, groups for training relatives either already exist or are being created.

The support of loved ones in case of emergency is especially important. In deep depression or mania, a person is not able to independently control his behavior, this decision is made by relatives, sometimes without his consent. In the case of bipolar disorder, this should be the last option when all others have been exhausted.

A loved one has bipolar disorder. What to do?

“Your mood is jumping. Looks like you're bipolar!" Bipolar affective disorder has recently become a very popular topic in the media and in everyday conversations between people. Noticing sudden mood swings, people “find” BAD from friends, partners, acquaintances, and even parents. In reality, bipolar disorder is a severe psychiatric illness that is sometimes difficult to diagnose even for the most qualified specialist, not like a friend or family member. In this disease, a person swings on a pendulum between the strongest mania and severe depression, however, it is extremely difficult to determine that this is bipolar disorder due to the similarity of symptoms with other disorders.

If your loved one does see a specialist and is diagnosed and treated for bipolar affective disorder, they are more likely to behave like a person without any disorders and their illness will not manifest itself in an acute form. However, this does not mean at all that you need to communicate with such a person as if there is no disease. It is, and it must be taken into account every minute.

How to understand that it is time for a loved one to see a specialist?

It is possible to assume that a person has bipolar disorder only if he is in the stage of the strongest mania. But for this you need to know what it is, and how the manic state differs from the usual enthusiasm to work, clean or move mountains. In a state of mania, a person feels omnipotent and his activity goes off scale. He does not get tired at all and can not sleep for several days. At the same time, the patient is not adequate in this state, he has a distorted perception of reality, so he can cause serious harm to himself and others, not realizing what he is doing. Usually, only those who have already experienced this can determine that a loved one has started mania. And then, for this you need to get clear instructions from a specialist. But what to do if you meet the strange behavior of a loved one for the first time? How can I convince him that something is wrong with him?

Therefore, the most convenient moments when you need to take a person to a specialist are hypomania and predepression - periods between acute conditions.

When a person has already crossed the border of psychosis and is in mania, it is impossible to explain to him that he is sick. Theoretically, this can only be done when he is depressed. However, even in this case, a person is not always ready to pick himself up piece by piece from the bed and go to the doctor. Therefore, the most convenient moments when you need to take a person to a specialist are hypomania and predepression - periods between acute conditions. At these moments, a person can really be convinced. It is important to explain to him how hard it is for his loved ones, and what suffering he brings with his behavior. If we are talking about a teenager, then you can try to bribe him - for example, promise to buy him something that he really wants after seeing a doctor.

See also

What is depression?

How to provide support in mania and depression?

In a state of mania, a patient with bipolar disorder primarily needs restrictions. He needs to be watched because manic psychosis is a dangerous, painful condition in which a person can harm himself and others. The most correct thing to do in a situation where a person is in a manic psychosis is to be hospitalized immediately.

A person suffering from bipolar disorder must be protected from extremes, and in every possible way to maintain his stable condition.

Depression is different. In addition to proper treatment, a person needs the support of loved ones and their care. He feels deep loneliness, it is very difficult for him to be with himself, and it is important for him that close people are nearby. In fact, you need to communicate with such a person in the same way as with a patient with ordinary depression: do not devalue his feelings and experiences and show all the time that you are with him. However, you should not relax - you need to correctly track the moment when the depressive state comes to an end. After all, depression is always followed by mania.

What is important to know when dealing with a person who is being treated for bipolar disorder?

If a person is on medication, they may remain stable for a very long time. However, he can come out of this state and plunge into psychosis. This transition can be seen in the same way as the transition from depression to mania and vice versa. You just need to understand the risk factors and watch for changes in behavior. When a patient is diagnosed by a psychiatrist and psychotherapist and depression is detected, specialists begin to work not only with him, but also with his relatives. Relatives receive general knowledge about the disease and clear instructions that help them communicate properly with the patient and respond to any changes in his condition.

See also

Why do we need a psychotherapist?

The therapist tells them about the risk factors to watch out for.

Learn more