Bipolar Disorder
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Depression: Major Depression & Unipolar Varieties
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How Family And Friends Can Help Those with Bipolar Disorder

Rashmi Nemade, Ph.D. & Mark Dombeck, Ph.D.

Help with Bipolar Disorder

The family and friends of bipolar patients may become frightened and aggravated by the impulsive and self-destructive behaviors associated with bipolar disorder they see played out again and again, but they also generally want to help. This is a good thing, because having access to the help and support of family and friends can make or break bipolar patients' chances for keeping themselves maximally stabilized and healthy. Family and friends provide social support and encouragement, which tend to provide a moderating influence on mood (e.g., helping mood to keep from sinking too low or too high). This moderating influence takes on several different forms.

First, support takes the form of monitoring. Family and friends are in a perfect position to help bipolar patients to monitor their moods. Often, family and friends will know that moods are shifting before patients will themselves, and can help make the patient aware that they are again entering into a dangerous period. Family and friends can monitor patients' medication-taking behavior, and can help patients either get back on bipolar medication when they stop taking it, or help marshal resources to help cope with the mood episodes that are likely to occur when patients are not medicated.

Second, family and friends can persistently encourage patients to comply with bipolar treatment and professional recommendations (taking bipolar medications as prescribed, attending bipolar therapy groups, etc.). Treatment compliance is important at all times (as treatment during periods of limited mood symptoms can help prevent future mood swings from occurring). However, helping patients to comply with bipolar treatment recommendations is especially important when mood symptoms are waxing, as professional treatment offers the best opportunity to limit symptom severity. Patients frequently complain that they don't like the way that medication makes them feel, and become motivated to stop taking it. Stopping medication also stops any prophylactic (preventative) effect that the bipolar medications provide, setting patients up for new mood cycles, sometimes with tragic results. Family and friends can help defuse this sort of situation by reinforcing professionals' treatment recommendations, including the importance of taking medicine as prescribed.

Third, family and friends can help support bipolar patients by helping them to "reality-test"; to raise their awareness concerning times when patients' own judgments are faulty, or when they are acting in odd, bizarre ways, and help patients to make more sound judgments. Often individuals suffering from bipolar disorders make excuses for their behavior, blaming other people or situations for their bipolar symptoms. Family members and friends can help point out this tendency towards externalization to patients when and if it occurs, so as to give the patient some objective perspective on their behavior.

Fourth, family and friends can initiate an intervention when necessary. This is to say, they can make psychiatrist appointment, or an appointment for bipolar therapy, and even accompany patients to see the doctor or therapist when this becomes necessary. This helps the patient get connected to treatment and with the presence of a known person, may alleviate the anxiety of seeing a professional. Family and friends can also help make arrangements for hospitalization when hospitalization becomes necessary.

Interventions are not just useful during times of crisis. During normal mood phases of bipolar disorder, family and friends can help bipolar patients to plan for what they can do to minimize their future mood cycle intensities, and help them implement the various components of that plan. For instance, if the mood stabilizing plan calls for regular exercise, family and friends can offer to be an exercise partner, and thus increase the chances that exercise will actually take place (because it is generally more pleasant to exercise when you have a partner with you). Ongoing encouragement and bipolar support are crucial to patients' stability.