Caring for Someone with Bipolar Disorder

Soon after Missy had her daughter, she stopped sleeping, going from eight hours a night down to only two or three. Her thoughts were racing, and she was going a million miles an hour. After a few nights, Missy’s husband Bill finally took her to the hospital. He couldn’t believe that one minute his wonderful wife seemed just fine and now she had become a patient in a psych unit.

From the time Ally was nine months old, her parents Bill and Nancy knew that something was wrong. Ally couldn't sleep, had temper tantrums up to 20 times a day, and increasingly became more aggressive. Medical professionals told Bill and Nancy not to worry, that she’ll grown out of it, but they continued to seek help from doctor after doctor.

Nell’s sister, Maud, stopped taking her medication for bipolar disorder and fell into a depressive episode. Nell threw all her energies into visiting her sister at the hospital, comforting and supporting her while the doctors tried drug after drug before finding the right ones; explaining to Maud’s boss why she would be out of the office for weeks or more; and wondering how to cope with the new financial and emotional burdens in her life. 

Missy, Ally, and Maud all have bipolar disorder (also known as manic depression), in which moods gyrate between the highs of mania and the lows of depression. They have been hospitalized, have struggled to come to terms with their diagnosis, and have suffered deeply.  All three have family caregivers -- a spouse, parents, a sibling – who are dedicated to helping them recover, but who feel uninformed, isolated, overwhelmed, sad, and at times, angry and hopeless.

Caring for someone with any illness is difficult. Caring for someone with a psychiatric illness is especially hard for many reasons.  Health care coverage is far more limited than for other illnesses. Just getting someone who is in a state of mania -- even when psychotic -- hospitalized and accurately diagnosed is a major accomplishment. People living with bipolar disease, particularly when they are in an up (manic) rather than down (depressed) phase, often refuse to see a clinician and stop taking their medication. The medications are powerful and have unpleasant side effects.  

There is no cure for bipolar disorder and so the drugs must be taken for life, a daunting prospect, especially for younger sufferers.  Finding the right meds may take as long as several years, and over time they may stop working.   For family caregivers, coping with someone who is manic or depressed takes a heavy emotional toll and strains the relationship, often to the breaking point. An added burden is the stigma of mental illness, which leaves families feeling frightened and isolated, unaware that many other families share their experience.

Given all these challenges, caring for someone with bipolar disorder can be overwhelming and at times an impossible responsibility to maintain. But there are ways to cope effectively. Families for Depression Awareness, the nonprofit organization I founded (after losing my brother and helping my father get diagnosed with depression,) has interviewed many families that are doing well. True, it took a while to learn how best to help and support their bipolar family member, and time, too, to learn that caregivers also have needs that must be met.  Sometimes the stresses and strains were intense, and these families have had their ups and downs. But by educating themselves about bipolar disorder, improving treatment by finding the best possible medication and therapy solutions possible, and communicating as a tightly knit unit, these families have met the challenges, survived intact, and are emotionally healthy.

Here are ways that you can help someone with bipolar disorder:

• Become educated. The first step is to become educated about bipolar disorder, so you have realistic expectations and coping options. 
• Make this is a family matter. Acknowledge that one member’s depressive disorder affects the entire family. Everyone in your immediate family needs to learn about bipolar disorder, its symptoms and early warning signs, how it is treated, and what the side effects of medications may be. And to whatever degree possible, each member should participate in the caregiving process.  Being a caregiver is stressful, and it is important that family members discuss their feelings and opinions. Sometimes it helps if a skilled family therapist facilitates these discussions in group sessions.
• Be a partner in treatment. Find the right treatment for each individual bipolar sufferer usually means going through a process of trial and error with multiple different medications. Patients also need talk therapy to heal. Finding qualified clinicians (e.g., psychopharmacologist, psychiatrist, psychologist) is essential.  As a family caregiver, you can help by finding the best clinicians in your area, scheduling appointments, keeping track of medications and making sure they are taken as prescribed, and being an early warning systems by reporting changes to the clinicians.
• Meet with the patient’s clinician. Make sure to meet with the clinician treating your family member from time to time. Try to go with your family member and if needed, set up some appointments on your own. Although clinicians have to maintain patient confidentiality, they can listen to you and you can report issues you are having caring for your family member.
• Be understanding. Let your family member with bipolar disorder continually know that you care. People with bipolar disorder have negative thoughts and are hopeless in a depressive state. They need to be reminded that you and others are concerned about them and that you are working together to help them get well.
• Take care of yourself. Set healthy boundaries on how much you do so you don’t burn out. Take a vacation from caregiving from time to time. Many caregivers develop depression, so don’t be afraid to seek medical help for yourself. You also may need help processing and dealing with your emotions.
• Find social support. Dealing with bipolar disorder can be lonely and isolating. You’ve watched the healthy person you once knew deteriorate and suffer. Your friends don’t understand bipolar disorder, and it is difficult for you to go out. Make sure you find sources of support such as a bipolar support group in your area.
• Develop a crisis plan. Talk to your family member with bipolar disorder about what you will do if the person becomes manic or suicidal. For example, some people with bipolar disorder and their families decide that it is best for the person with bipolar disorder not to use credit cards. Also, determine what you will do if you need to hospitalize the person. Put your plan in writing.
• Have hope. Remember that in most cases, bipolar disorder is treatable and can be stabilized. The condition is usually cyclical, so be prepared for it to worsen and/or improve at times. Finding the right treatment can be a drawn out process, but in time, a solution will be found.

Symptoms of Bipolar Disorder

Bipolar disorder is depression alternating with mania (elated or irritable moods and increased energy).

Depression

• For at least two weeks, five or more of these symptoms:
• Feeling miserable and sad almost everyday
• Losing interest or pleasure in most activities
• Feeling anxious or irritable
• Having trouble concentrating or remembering
• Feeling tired
• Feeling guilty
• Sleeping too much or too little
• Eating too much or too little
• Have medically unexplained aches and pains
• Abusing alcohol or drugs
• Thinking of death or suicide

Mania

• At least three of these symptoms:
• Increased energy and decreased need for sleep.
• Excessive irritability, euphoria, or aggressive behavior.
• Increased talkativeness or pressured speech.
• Disconnected and racing thoughts.
• Impulsive behavior and poor judgment such as spending sprees, erratic driving, or sexual indiscretions.
• Inflated self-esteem
• Increased goal-directed activities
• Distractibility

Signs of Suicide

If someone has been preoccupied with thoughts of death or suicide, call his or her clinician today. If you think the person may be harmful to you or others, call 911 or take the person to your local emergency room.

• Other warning signs include:
• Talking about hopelessness and worthlessness
• Suddenly being happier and calmer during a depressive episode
• Making unusual visits or calling people one cares about
• Making arrangements or getting one’s affairs in order
• Giving things away

If Someone is Manic 

During mania, a person may become paranoid, believe ideas that aren’t based in reality, spend a lot of money, or engage in unsafe activities. Remember that these behaviors are part of a manic state and the person is not in a normal state of mind. Try to prevent the person from carrying out these actions by talking to them and calling the clinician. You also need to keep the person and your family safe. Sometimes people in a manic state must be hospitalized. Make sure you discuss the behavior and options with your clinician, if possible before a crisis occurs so you can take appropriate action.