Struggling with Bipolar Disorder is an on-going and exhausting battle for the affected individual. Watching someone you love struggle with Bipolar Disorder can be equally challenging and exhausting. Seeing your loved one experience hopelessness, frequent crying spells, social and career frustrations, and feelings of worthlessness can be heartbreaking. Conversely, being the target of anger and anxiety and witnessing successive poor life choices can be frustrating. Never knowing how your loved one will feel on any given day makes you feel equally helpless and makes you feel as if you are perpetually dancing on egg-shells.
The first step in supporting someone with Bipolar Disorder is gaining a deeper understanding of it (see Understanding Bipolar Disorder). Bipolar Disorder is not a mild fluctuation between sad and happy moods, but rather is an extreme vacillation between manic and depressed states over which the individual has little control. Attending family counseling sessions with your loved one can be very beneficial in helping to understanding how these emotional extremes affect your loved one and how you can offer effective support.
It is far easier to help your loved one remain in a euthymic state (stable mood state) than to help him or her recover from a manic or depressive episode. If your loved one has been diagnosed with Bipolar Disorder, accepts the diagnosis, and is motivated to seek treatment, individual psychotherapy in conjunction with medication management offer the best treatment outcomes. Encouraging your loved one to remain compliant with medication is highly recommended, since stopping medications is one of the biggest triggers for relapse.
Ask your loved one how you can offer support if their mood becomes unstable. Although there are general techniques that can be helpful, supports that are individually tailored are the most effective. This will involve the loved one working in counseling to identify what interventions have been helpful in the past and what interventions they think could be helpful in the future. Compiling a list of what to do if your loved one is depressed or manic can be helpful. A sample list might include:
When I’m feeling depressed . . .
- 1. Give me a hug and tell me you love me
- 2. Sit down and watch a comedy with me
- 3. Encourage me to leave the house and go out with friends
- 1. Try to problem solve for me
- 2. Tell me I have no reason to be depressed
When I’m feeling manic . . . .
- 1. Point out that my mood seems too high
- 2. Ask me to reach out to my psychiatrist and therapist
- 3. Remind me to prioritize sleep
- 1. Tell me that I’m acting crazy
- 2. Encourage me to make big decisions
It is also helpful if your loved one can provide you with information about when their thought process is in a depressed, neutral, or manic state. Frequently, an individual experiencing a severe mood swing does not recognize that their thoughts are not “logical.” It can be beneficial if you assist your loved one in recognizing that their mood is affecting their thoughts. “The Bipolar Workbook” by Dr. Monica Ramirez offers tangible CBT (cognitive behavioral therapy) interventions that assist individuals in identifying these type of thought patterns. For example:
1. When I feel depressed . . . I feel like everyone hates me
When I feel manic . . . . . . I feel like everyone loves me and wants to be around me
When I feel “ok” . . . . . . . I know I have some close friends and acquaintances
2. When I feel depressed . . . I sleep 12 hours a day and am still feel exhausted
When I feel manic . . . . . . I barely sleep, but still have lots of energy
When I feel “ok” . . . . . . . I sleep 6-8 hours and feel a little tired when I get up
Helping the loved one recognize that their thoughts and behaviors have changed and reminding them with their own words that they may be experiencing a mood swing can help convince them that an intervention is needed.
How to help a loved one who is actively depressed or manic
An individual diagnosed with Bipolar Disorder who has been doing everything right and whose mood has been stable can nonetheless still experience break-through symptoms. The return of symptoms can occur because of a change in medication, an increased level of stress, or for no apparent reason.
Family members who are trying to learn to support someone with Bipolar Disorder often find that although they offer logical feedback or solutions, their suggestions are either dismissed or even appear to aggravate the situation because the distressed family member feels misunderstood and, consequently, frustrated in attempts to communicate. The reason logical solutions do not work is because a person in a depressive or manic state is not thinking logically. The emotion the person is experiencing can be so overwhelming that it skews the way they look at themselves and the world in general. There are no satisfying solutions, and consequently, the focus in these situations should not be problem-solving, but should instead concentrate on alleviating the current emotional state so that the person becomes more willing to accept logical suggestions.
If your loved one is exhibiting self-destructive or psychotic symptoms, the only alternative is to go to the hospital. There are no other options. An extreme mood that places the person’s health or well-being at risk can be addressed only through a supervised environment and medication. If the mood is not this extreme, reminding your loved one to take any prescribed PRN (as needed) medication can be a relatively quick way to decrease the emotional severity. The ultimate goal is to get the individual to stop ruminating on the troubling or obsessive thoughts causing the distress. If the loved has compiled a list of coping skills, encourage them to try each skill until something is helpful. Any significant change in mood should be reported to the loved one’s therapist and psychiatrist as soon as possible. The more people working together to support the loved one, the more likely the situation can be resolved quickly.