How to help your loved ones with bipolar disorder: drug treatment and advice for family

With such a diagnosis, opposite phases alternate, or rather, interspersed with periods of normal mood: mania and depression.

The symptoms of mania from the outside may seem like a gift of fate: this is a wonderful mood, regardless of external circumstances, surging energy and energetic activity. But they are dangerous, because they can lead to a complete loss of connection with reality, and after a few weeks or months they inevitably end in depression. If the mood, on the contrary, is low, there is no strength, any activity is difficult and this continues for more than two weeks in a row, we can talk about depression.

Short information about bipolar disorder

Bipolarity can be expressed in varying degrees, from relatively mild fluctuations, which are more like a seasonal blues with periods of intense activity, to extreme swings from euphoric mania to suicidal depression.

Bipolar disorder is characterized by the fact that a person's intelligence and adequacy are almost not affected, they are able to be aware and control their behavior in most cases.

You can check whether your mood swings meet the criteria for bipolar disorder using mania and depression questionnaires. For example, Young's Mania Scale, Beck's Depression Scale.

If a loved one has such a diagnosis, or you have reason to suspect it, this is not a reason for panic. This disease can be controlled; with adequate treatment (usually, the use of antipsychotics such as Ziprasidone and antidepressants such as Clomipramine) and lifestyle bipolar people little differ from the people around them, except for a changeable mood. But this is not an easy task, and therefore the sick person will really need your support.

What to do?

- Trust them. The first help you can offer to someone important to you is just to trust them. Listen and not to question that it is very bad and difficult for them and that they are not to blame for this.When there is a loved one nearby who understands what is happening and does not judge for it, coping with the disease is much easier. Most bipolar sufferers have to spend a lot of energy maintaining a "decent" appearance in the midst of depression and convincing family that symptoms are not their whim.
Of course, a diagnosis is not a presumption of innocence, and you don't have to forgive any ugly behavior. Talk about what you think is inappropriate. If a person regularly behaves defiantly, does not try to correct oneself and does not take steps towards recovery - obviously, the problem is in the personality, and not in the disease.
- Suggest a treatment. In severe bipolar disorder, the only way to stop mania and depression is with medication. So a visit to a psychiatrist is inevitable. You will be very helpful to your loved one if you do not speak critically and devaluingly about it. In this case, the option "You are normal, you do not need a psychiatrists" is no better than "The mental hospital is waiting for you."
You can find a good private specialist and arrange an anonymous appointment. Modern clinics look as pretty as psychological centers, so there is nothing to be afraid of. For most bipolar patients it is quite possible to choose a treatment regimen at home without going to the hospital.

But this is just the beginning. Even if the drugs work well, loved ones will have to make sure that the patient takes them regularly. For most, a course of several months will suffice, but some will have to take them for years as a preventive measure. And then resistance to treatment comes on.

In the head of a bipolar person there is a constant bargaining with the disease: “Maybe everything has already passed? Or were the doctors wrong, I'm not sick at all? " Try to support this fragile motivation for treatment. Remind them politely of how the previous breakdowns ended, talk about the benefits of controlling the disease. But do not ignore complaints about side effects: perhaps the drug is really not suitable and needs to be changed.

Psychotherapy for bipolar disorder helps, but as an adjunct to medication, not a substitute. The most effective is cognitive-behavioral therapy, based on the training of practical skills. For example, how to recognize and control emotions.

Keep your balance

Although the disease is biological in nature, the frequency and severity of attacks is highly dependent on the patient's lifestyle. Behavior can provoke acute phases, or, on the contrary, smooth them out.

"Friends" of a bipolar person are a stable daily routine, restful sleep for eight to nine hours and moderate physical activity. That is, it is a daily routine, which the restless spirit resists with all its might, because it is used to doing everything "according to the mood." Establishing a stable daily routine for such a person is a huge work, and it is easy to break off, especially if friends invite you to a party/drink /have a trip tomorrow.

So if you often spend time together, at least don't provoke these breakdowns. Dancing the night away, flights every week, late shift work, constant stress and risk are what shatters an already unstable psyche.

As a maximum, maintain useful activity: regular jogging, a book before bed instead of gadgets (they stimulate the brain, preventing it from calming down), healthy eating.

Strong alcohol and drugs can provoke a real psychosis in a person predisposed to it. Not to mention, when combined with medications, they cause unpredictable side effects.

There are also personal triggers - something that worsens the condition of an individual. Even strong coffee is bad for some. Your loved one's triggers are worth knowing and keeping in mind.

Avoid extremes

A person with bipolar disorder is fully functional and adequate for most of their life. But in the midst of the phases, which someone has every spring, and someone - once every 10 years, it drifts. That is, patients lose criticality to their behavior and do not feel when it is too much.

It is worth discussing such a risk in advance, when everything is calm, and agreeing on an action plan. Noticing signs of mania in a loved one, you should protect them from rash actions, for example, spontaneous large spending (hide bank cards), in addition, you should warn your family not to get involved in any business with him, and even more so in conflicts. Call your doctor and make an appointment.

Depression is no less dangerous: if it reaches the stage when your loved one is no longer happy, everything around them seems hopeless and meaningless, the risk of suicide is quite real. At the same time, a person does not always lie exhausted and cry. Many, especially men, endure to the last and even try to laugh it off. If your friend's humor suddenly turns dark, that is also a wake-up call.

Do not push them

The golden rule is do not argue with the maniacal person and do not demand accomplishments from the depressed person. It is important to distinguish seizures from normal activity and “just a bad mood” so as not to twitch a loved one with constant nagging.
Even in mild hypomania, the most annoying thing is when they try to restrict and control you. And in the midst of mania, obsessive control can provoke paranoia.

It is much more constructive to channel irrepressible manic energy into a useful channel. Has your partner decided to emigrate to Argentina tomorrow? Or invest all the family's savings in a risky startup? Ask them to develop a project first and show you in numbers and graphs how cool it is, and they will direct the efforts to gathering information. Writing a book, drawing pictures, putting together a collection may seem silly to you, but at least it's safe.

This technique is only suitable for the state in which the person is still able to hear you. If the situation is completely out of control, all that remains is to call the doctor, and in case of dangerous behavior for him or others, call an ambulance.

In depression, on the contrary, you should not demand much from your loved one. If they cope with taking care of themselves and sometimes go out into the fresh air, this is already a reason to give them a thumbs up.

Post by: Christopher Ames, MD, pshychiatrist, Medibank, Sydney, New South Wales, Australia