How to Help Someone with Bipolar Manic Depression: A Guide for Supportive Friends and Family

Bipolar Disorder is a serious mental health condition, and according to WHO, it is the sixth leading cause of disability. Around 2.4% of the population worldwide lives with bipolar disorder. In India, bipolar disorder affects between 0.5 and 21 per 1000 people.

Bipolar disorder can be a difficult condition to live with due to its unpredictable mood swings. It is common among working-age as well as young people.

However, a huge number of people with bipolar disorder are either misdiagnosed or untreated, largely due to the societal stigma and discrimination they face.

Additionally, low- and middle-income countries lack access to healthcare services and interventions. It is important to offer support to people suffering from bipolar disorder, as it can significantly affect their relationships, academics, jobs, and daily life activities. They are also at a higher risk of suicide and developing other mental health issues.

To help someone with bipolar disorder, it is crucial to get a basic understanding of it.

What is Bipolar Disorder?

Imagine a bar magnet and its two poles—north and south—although they are the exact opposites of each other, they co-exist in the same magnet, right? This is exactly how a person with bipolar disorder feels.

Bipolar disorder, previously known as manic depression and bipolar disease, is a mental health condition characterized by episodic emotional states of intense highs (mania or hypomania - less extreme than mania) and intense lows (depression). An episode may last for several days to weeks or even longer.

Mania and hypomania both have the same symptoms but differ in severity. 

1. Extremely elevated mood: very upbeat and jumpy 
2. Increased energy levels
3. Inflated self-esteem
4. Unusually irritable
5. Uncontrollable fleet of thoughts 
6. Highly distractible 
7. Impulsivity, hence poor decision-making, tends to get involved in risky sexual behaviours and mindless shopping 

Mania can interfere with one's daily life activities. Hypomania isn't as severe as mania, but it still differs from one's usual state. During a manic episode, the person may experience a blurring of reality (psychosis) and may need hospitalization.

Depression (major depressive episode):

The depressive symptoms seen in bipolar disorder are similar to those in major depressive disorder. 

1. Low mood and energy 
2. Persistent feelings of sadness, hopelessness
3. Worthlessness and guilt
4. Fatigue/ tiredness
5. Irritability 
6. Decreased capacity to think and concentrate 
7. Disturbed sleeping and eating habits
8. Suicidal thoughts and attempts 

The different types of bipolar disorders include:

• Bipolar I Disorder 
• Bipolar II Disorder 
• Cyclothymic Disorder
• Rapid Cycling Bipolar Disorder 

#3 Challenges of Bipolar Disorder in 2024

Due to extreme mood fluctuations, living with bipolar disorder can be challenging. Individuals may find it difficult to navigate social as well as personal life :

1. Relationships: intense mood episodes can make it difficult to think before you act and may end up unknowingly hurting your loved ones. Supporting someone with bipolar disorder can also be confusing as well as difficult, and not many will be prepared to do so. This may lead to strained relationships. 
2. Work: for someone with bipolar disorder, getting work done consistently can be difficult. One day you might be super enthusiastic to do it all, whereas the next day you might feel totally unmotivated and withdrawn. This can affect work productivity and may lead to workplace conflicts. 
3. Personal well-being: last but not least, being diagnosed with bipolar disorder can take a toll on your own health. It could feel like you're on an emotional rollercoaster. A person might experience psychotic symptoms such as delusions and hallucinations during manic episodes. All these can leave one feeling overwhelmed.

How Can I Help Someone with Bipolar Disorder?

Juggling the intense emotions of bipolar disorder is not easy. However, we must remember that caring for and coping with a loved one diagnosed with bipolar disease is also not easy.

Here are 10 practical tips you can follow to help someone with bipolar disorder:

1. Educate Yourself

This is the first and foremost step in helping someone with bipolar disorder. Learn as much as you can about the cause, triggers, behavioural patterns, warning signs, and symptoms of the condition. This will help you be better equipped to understand and support your loved one the next time they have a severe mood fluctuation.

2. Listen

People with bipolar disorder are often reluctant to open up about their thoughts out of fear of being judged or becoming a burden to everyone around them. 

Hence, it's important to make them understand that you love and genuinely care about their well-being. 

This will help them feel more at ease and communicate their feelings. Take care to listen to them with an open and empathetic mind. Do not be dismissive or insulting when they share their struggles.

3. Be Active in Their Treatment

People suffering from bipolar disorder tend to avoid or refuse treatment. You can help them out by searching for a qualified and experienced doctor or therapist. 

If they do agree to seek treatment, be supportive. Joining them for their appointments, with their consent of course, can be helpful. 

Try to stay positive and encouraging. Let them know that there's nothing to be ashamed of about getting help, and, in fact, it’s a sign of great strength and bravery.

4. Make a Plan

Due to the unpredictable nature of bipolar disorder, you should be prepared in advance to face tough situations and emergencies.

This plan of action must include what to do if the person’s behaviour is erratic during a manic episode or they have suicidal tendencies and thoughts during a depressive episode.

1. Remove sharp objects or anything that is a potential tool for self-harm.
2. Use code words, signs, or emojis in case of a mood episode. You can come to a mutual decision with your loved one on what kind of words to use for each feeling. This helps you understand what exactly they're struggling with during an episode without getting them to explain in detail.
3. Write down things in your diary or phone describing what has and hasn't worked for them in the past.
4. Keep a list of emergency contacts, such as helpline numbers or emergency services, in case things go out of control

5. Offer Support, Don't Push

While your support is essential for a loved one with bipolar disorder, you should also take care not to be pushy or overly assertive. Keep the communication open and simple.

Share your concerns in a loving manner, and even if you don't agree entirely with what they say, make a genuine effort to listen to them. 

6. Don’t Neglect Yourself

Taking care of your loved one is important, but so is taking care of yourself. Neglecting your own needs carries the risk of caregiver burnout. Remember that this not only affects your physical and mental health but also deprives you of the energy to support your loved one.

1. Find time to engage in your hobbies, hang out with your friends, or do other activities that cheer you up.
2. Share your feelings with someone you trust. Looking after a person who has bipolar disorder can feel stressful and cause worry. So, it's important that you seek emotional support by talking to a trustworthy friend or family member or by joining a support group. You may even consider seeing a therapist. 
3. Manage stress by eating on time, getting enough sleep, and working out. Practice mindfulness and meditation to keep your stress under control.

7. Know When It’s Too Much

Living with someone who has bipolar disorder can be overwhelming, as you are constantly concerned about them. But if you feel like it's becoming too much for you to handle, seek help from a professional.

Know your limits on how much support you can offer. Agreeing on more than what you are able to do can make you lose sight of your own priorities. 

Boundaries can act as a blanket of protection for you as well as everyone else in your life. Set healthy boundaries, explaining what you can and cannot tolerate, as it helps both you and your loved one in the long run.

Other 3 Ways to Help Someone with Bipolar Disorder in 2024 

Some additional tips to help a loved one with bipolar disorder include:

8. Do things together

During a depressive episode, your loved one may lose interest and withdraw from doing anything. In such times, encourage them to do things they usually enjoy, or you can give them a gentle nudge to join you for dinner or a simple walk. If they refuse, don't force them to do so. Let it go, and ask again after a few days.

9. Avoid assuming things

Since you're constantly taking care of them, it's natural for you to think that a mood episode is about to start when you notice the slightest change in their emotions. This is totally understandable, but remember that it may not be helpful for them.

In such situations, if you're unsure, instead of assuming, just talk to them to check what's really going on. Remember that it's still possible for them to show a wide range of emotions despite feeling well.

10. Express your concerns

Your loved ones' behaviour can impact you a lot, and know that it's totally okay to discuss it with them. 

Instead of blaming them for their actions, let them know how it makes you feel. Since it's understood that this is a tough conversation to have, take the help of a therapist to talk about it and to make it comfortable for you as well as your loved one.

The Importance of Support in Bipolar Disorder Recovery

Support from family members and friends helps people with bipolar disorder do better in general. They tend to have fewer manic and depressive episodes, and even if they do, the symptoms might be milder in nature.

Some people with bipolar disorder may find it more comfortable opening up in front of support groups. Many organisations have self-help groups that enable people with bipolar disorder to talk about their feelings and also receive helpful ideas. 

Bipolar Disorder and the Family

Family members may struggle with a multitude of emotions, such as fear, worry, anger, guilt, and helplessness, due to their loved ones' behaviour during manic or depressive episodes. This may lead to strained relationships. 

It can be difficult for the family to carry out routine activities since they're on a continuous lookout. Families may also face financial distress due to excessive spending or unstable income. 

The first thing that a family can do is accept that bipolar disorder is an illness and that it isn't anyone's fault. 

It is also important to keep expectations realistic, i.e., bipolar disorder doesn't go away and the person most likely will have to take medications for the rest of their life. 

So instead of expecting them to just snap out of it one day, accept that things may never go back to “normal” again.

#4 Tips for Coping with Bipolar Disorder in the Family in 2024

1. Accept the illness and its limits

Understand that it's not in your loved ones' power to control the emotional highs and lows they experience. If they could, they would've done that way earlier. 

So, stop blaming or expecting your loved one to overcome their illness through “self-control” or "willpower.”

2. Accept your limits

Remember, as much as you want to save your loved one from the clutches of bipolar disorder, you too have your own limits. Nobody's a superhuman. You can continue to offer support and care, but ultimately, the outcomes are not in your hands.

3. Open communication 

Keeping communication open and honest is essential. Ask your loved one how they're feeling, share your concerns, and make genuine efforts to listen to what they want to say, as this makes it easier for the family as well as the person with bipolar disorder to cope.

4. Reduce stress levels 

Increased stress can make things worse for your loved one. Ask them how you can be of help or if there's something they need your assistance with. 

Sticking to a routine—going to bed and waking up at the same time every day, setting regular meal times—and encouraging them to follow it can reduce stress for both the person with bipolar disorder and their family.

Speak to a Therapist

The most efficacious treatment for bipolar is a combination of medication and psychotherapy. 

Approaches like Cognitive Behavioural Therapy (CBT), interpersonal therapy, and family therapy can help a person with bipolar disorder and their family learn healthy coping strategies.

Supporting a Person with Bipolar Disorder

Try and say reassuring things like:

1. “You're not alone in this. I'm here for you.”
2. “You matter to me. Your well-being is important to me.”
3. “I understand that it's your illness that makes you feel or behave this way.” Remind them that they're more than their illness.
4. “I may not understand exactly what you're feeling, but I want to help and support you because I care about you.”

How to Convince a Person with Bipolar Disorder to See a Doctor

People with bipolar disorder may not realise that they have this condition. So, they might not accept the idea of visiting a doctor. 

In such situations, don't argue with them, as the idea of having a mental health illness might sound scary to them. Instead, adopt a neutral stance and educate them about the importance of taking care of one’s mental health, no matter what one’s struggles may be. 

If they are not open to seeing a psychiatrist, you may want to try to convince them to see a psychotherapist to simply talk about what they’re feeling or going through. 

Try to tell them that everyone needs a safe and non-judgmental space to explore their inner life, and therapy is just that.  

Supporting a Loved One During Bipolar Disorder Treatment

Getting someone with bipolar disorder to agree to treatment is not easy. Once they agree, try and be an active part of:

1. Learning about their medicines
2. Monitoring their mood 
3. Keeping track of their treatment progress
4. Looking out for signs of relapse

Sharing your concerns and insights with the doctor, with the consent of your loved one Inform the doctor in case of any problems or if you feel like things are going overboard.

Encourage Your Loved One to Take Bipolar Disorder Medication

Medications are a fundamental part of treatment for bipolar disorder. The common reasons why someone with bipolar disorder may not regularly take or totally stop taking the medications include being scared about the side effects, feeling that it won't work out, forgetting to take them, or simply because they don't realize there's a need to take them.

You can help your loved one with bipolar disorder stick to the medicines as prescribed. Let them know that medications are going to help them feel better. Educate them about the importance of medications and how abrupt stoppages can be dangerous. 

You can also try to normalize the need for medication by telling them that all of us need medical help for something or the other - aches and pains, stomach bug, headaches. Taking medication for bipolar is no different. 

Additionally, encourage them to speak to the doctor about any bothersome side effects; it can be an unpleasant experience. A change in dose or medication might solve the issue. Periodically remind them that you'll be there for them along this journey.

Watch for Warning Signs of Bipolar Disorder Relapse

Despite sticking to the plan of treatment, sometimes there might be a worsening of symptoms. Around 75% of people with bipolar disorder are known to have relapses as part of the disease.

Identifying the emerging or warning signs and taking immediate action may help you prevent the escalation of a manic or depressive episode.

9 Mania Warning Signs and Symptoms

Here are the common warning signals of mania or hypomania:

1. Less sleep (most common); feels fully rested even with inadequate sleep
2. Elevated mood and high energy levels 
3. Rapid thoughts - comes up with many plans, ideas and schemes 
4. High sexual desire and flirtatious behaviour 
5. Irritable and agitated ( intense emotions)
6. Restlessness; unable to concentrate 
7. Arguments with friends and family 
8. Poor decision making
9. Indulging in risky behaviour - spending a lot more money than usual, binge drinking 

12 Depression Warning Signs and Symptoms

1. Altered sleeping pattern: excessive sleep or insomnia
2. Lethargic, fatigued ( even after getting the required amount of sleep)
3. Excess worry and sadness
4. Change in appetite
5. Lack of motivation 
6. Loss of interest in activities 
7. Reduced sexual desire
8. Socially withdrawn: avoiding social contacts, not attending phone calls
9. Difficulty in concentrating
10. Neglecting self-care and personal hygiene 
11. Body aches  of an  unexplained cause

What to Do When Someone with Bipolar Pushes You Away

There can be several reasons why someone with bipolar disorder might be pushing you away, despite sharing a close relationship with you. A few include:

→ feeling that they're a burden to others 

→ overwhelming feelings such as guilt, and shame. 

→ distrust in others; thinks that they'll leave them when their behaviour becomes  a handful 

→ worried about hurting others physically and emotionally when they lose control over their thoughts and actions.

Being pushed away by your loved one can be a bitter experience. Do not take it personally, as it is an indicator of their condition and not a reflection of your relationship with them. 

Try to follow some of the tips given below the next time a loved one with bipolar disorder pushes you away:

1. Respect their boundaries: It is important to give them their space and let them communicate the extent of interaction they're comfortable with. Remember that it probably wasn't an easy thing for them to do, so respecting their decision would be the best thing you can do.

2. Be patient: Due to the heavily fluctuating nature of bipolar disorder, pushing away might be a temporary response. Give them some time to reach out to you when they feel better.

3. Remind them that you're there to support them: Simply remind them you're there when they want to talk or need help doing a chore. Leave in daily texts such as “just checking on you” or offer to help them in daily activities such as cooking or cleaning the house. Simple acts of love, such as picking their favourite meal for dinner, can remind them that they haven't lost you because of their condition.

4. Listen more, advice less: Offering advice to a person with bipolar disorder can frustrate them. While opening up to you, they're not looking for solutions; rather, they want a listening ear. Try your best to actively listen when they speak to you about their concerns.

Extra tip: Stay as calm as possible when deciding what to do in critical situations.

In a crisis situation, call a doctor or inform the healthcare team, as they may need to be taken to the hospital. 

Frequently Asked Questions of Bipolar Disorder

What Should You Not Say to Someone with Bipolar?

There are certain things that you should avoid saying to a person with bipolar disorder:

• “You're just overreacting again.”
• “Everyone's a little bipolar sometimes.”
• “ Stop acting crazy” or “You're a psycho.”
• “You seem so normal.”
• “I wish I was manic so I could get things done.”
• “Anything that doesn't kill you makes you stronger.”

Apart from these, throwing in negative and insensitive words like nuts, crazy, and bonkers can be harmful.

Instead here's what you can say to someone who has bipolar manic depression:

• “It's okay if you don't feel okay. I'm here for you.”
• “You're not crazy. This is a medical condition.”
• “ I am proud of how well you are doing.”
• “If it's okay for you to share, what about bipolar disorder do you identify with? I’d like to learn more  so I can know what to look for and how to support you.”

How Do You Make a Bipolar Person Feel Loved?

1. Let them know that you care for their well-being.
2. Do not minimize their experience when they share their concerns and feelings.
3. Listen actively, and avoid giving unsolicited advice.
4. Respectfully ask them what you would like to know about their condition.
5. Avoid being overly critical of the things they say during a mood episode.

How Do You Calm an Angry Bipolar Person?

1. Accept that their anger is not under their control. They might struggle to find a balance between the raging emotions.

2. Practice ways to calm down by understanding more about their triggers and emotions. Take action before things progress into complete mood episodes 

3. Ensure they're taking the medications as prescribed.

Conclusion

Bipolar disorder is a challenging mental health condition consisting of highly fluctuating mood episodes of mania and depression. It can impact every aspect of one's life.  

Fortunately, there are treatment methods such as medications and different kinds of therapies that have been proven effective for many with bipolar disorder. 

Living with a loved one who has bipolar disorder isn't easy, but implementing the practical tips mentioned above can help them lead a near-normal life.

If you have seen the movie Silver Linings Playbook, where one of the protagonists suffers from bipolar disorder, you'll understand that your illness doesn't define you and that you too deserve to live a happy and healthy life just like any other human out there.

Do give it a try if you haven't watched it yet!

References 

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