Supporting someone with bipolar disorder

Bipolar disorder causes big swings in mood and energy. A person may go through times of feeling very "up," wired or irritable (mania), and times of feeling very low and hopeless (depression).¹ These swings affect the whole family, not just the person who has the condition.

You cannot control someone else's illness, but you can help a lot. This page explains how to spot warning signs, stay calm, keep people safe and plan ahead.

First, learn the illness

The more you know, the less you will take things personally. Read our pages on signs of mania, hypomania and depression and types of bipolar disorder.

Each person has their own early warning signs. For one person it might be sleeping only a few hours and feeling fine. For another it might be fast talk, new big plans, or pulling away from friends. Watching for big mood changes and knowing what tends to set them off are among the most useful things a family can do.¹ Sleeping much less without feeling tired is a common sign of mania.¹

Hypomania is a milder form of mania. The person may feel good and very productive and not see a problem. But family and friends may notice the change.¹

Some people with severe episodes have psychosis. That means they believe things that are not true (delusions) or see or hear things others do not (hallucinations).¹ This is part of the illness, and it needs prompt care.

How to help during mania

A person in a manic episode may feel wonderful, powerful or very irritable. They often do not believe anything is wrong.^2,3 Some people cannot see that they are ill because of how the illness affects the brain. This is called anosognosia, and it is not simple denial.²

1. Stay calm and gentle. Use a low voice. Do not argue about their ideas or try to prove them wrong.²
2. Listen and reflect back. You might say, "It sounds like you feel you can do anything right now. Is that right?" You do not have to agree that unreal ideas are true.²
3. Name what you see, without blame. Calmly describe the specific changes you noticed, such as not sleeping or spending a lot. Ask kindly whether any medicine doses were missed.³
4. Lower the stimulation. Steer away from crowds, loud noise and bright lights. Suggest a quiet walk together.²
5. Give space. Do not stand too close or block the way out of a room.²
6. Delay big decisions. Encourage waiting on major purchases, quitting a job, sudden trips, big new projects and other life changes.^2,3
7. Steer away from risky situations. Gently discourage long-distance driving, going out alone at night and meeting people known only from the internet.³
8. Do not take it personally. Irritability and harsh words are common in mania.²

Avoid threats or ultimatums unless you are ready to follow through.³ If you need help, bring in other trusted family members, friends or the person's doctor.³

How to help during depression

Bipolar depression can be deep. The person may feel slowed down, hopeless or worthless. They may have trouble doing even simple tasks.¹

• Offer steady support and hope. Remind them that treatment helps and that getting better is possible, even if it is slow.^1,3
• Do not say "snap out of it." Depression is a medical illness, not a character flaw.³
• See negative thoughts as symptoms. Statements like "I ruin everything" come from the illness, not from the facts.³
• Help in practical ways. Offer help with errands, housework, rides to appointments or picking up prescriptions.^1,3
• Keep them included. Invite them to easy, enjoyable activities. If they do not want to go out or talk, quiet time together at home also helps.^1,3

Ask about suicide

People with bipolar disorder have a much higher risk of suicide than the general public. Studies suggest the suicide rate is 10 to 30 times higher.⁴ Risk is highest during depression and during mixed episodes (when signs of mania and depression happen at the same time). It is also high in the period right after a hospital stay.⁴

This is serious, but it is not hopeless. Treatment lowers risk. Lithium, a common mood stabilizer, has been linked to lower suicide risk.^1,4 Never change a medicine on your own; talk with the doctor first.

NIMH suggests five steps when you are worried about someone:⁵

1. Ask directly: "Are you thinking about suicide?" Research shows asking does not raise the risk.
2. Be there. Listen without judging.
3. Help keep them safe. Ask if they have a plan. Put distance between the person and dangerous items, such as guns or large supplies of medicine. Ask a trusted person to store them for now.
4. Help them connect to the 988 Lifeline (call or text 988), their doctor or a trusted person.
5. Follow up. Stay in touch, especially after a crisis or hospital stay.

Our safety plan tool can help you and your loved one write down warning signs, coping steps and contacts. Warning signs include talking about wanting to die or being a burden, giving away things, or saying goodbye.⁶ If someone is in immediate danger, call 911.

Make a crisis plan together

The best time to plan for a crisis is when the person is well. A written plan, shared with trusted people, means everyone knows what to do.³ It can include:³

• Early warning signs of mania, depression or suicidal thoughts
• Stresses that tend to trigger symptoms
• What the person wants family to do when signs appear
• Phone numbers for doctors, therapist, trusted family and crisis lines
• The person's agreement to reach out for help when things get bad
• Short reminders, such as "No big decisions when my thoughts are racing"

Add current medicines and what has helped before. Our page on living well with bipolar disorder explains how a person can learn their own warning signs.

Protecting money

Heavy spending, risky deals and big loans can happen during mania.^2,3 A plan made in a calm time can protect the person and the family. The person should lead these choices when well. Ideas to talk about:

• A waiting rule. For example, agree that any large purchase waits a few days, or needs a talk with a trusted person first.
• Spending limits. Ask the bank about alerts, lower card limits, or a separate account for daily spending.
• Saved payment details. Remove saved cards from shopping sites and apps.
• A trusted helper. Some people agree to let a family member see account alerts or co-sign big decisions.

Durable power of attorney. A person can sign a document naming an agent to handle money if they cannot. An agent must act in the person's best interest, manage money carefully, keep it separate from their own, and keep good records.⁹ In Virginia, the document takes effect right away unless it says otherwise.⁹ See our page on durable power of attorney. Talk with a lawyer about the right choices.

Social Security benefits. If someone cannot manage their Social Security or SSI payments, Social Security can name a representative payee to manage that money. People can also name, in advance, up to three people they would want as payee.¹⁰ Call Social Security at 1-800-772-1213 to talk about concerns.¹⁰

Advance directives for mental health care

A psychiatric advance directive (also called a mental health advance directive) is a legal paper written while a person is well. It says what treatment they want if a crisis leaves them unable to decide.⁷ It can name:⁷

• Preferred doctors and hospitals
• What helps most during a crisis
• Medicines that have worked, and ones that should not be given
• A trusted person (agent) to make decisions

People who have one are more likely to work well with their care team and may face fewer forced or coercive steps during a crisis.⁷ If a person has both a regular and a mental health directive, naming the same agent in both avoids confusion.⁷

In Virginia. Virginia's advance directive law covers mental health treatment.⁸ The state's suggested form lets a person allow their agent to approve a hospital stay for mental health care of up to 10 days. A doctor at the facility must first certify in writing that the person has a mental illness, cannot make an informed decision about admission, and needs treatment there.⁸ The form also has an option that lets the agent approve this even if the person objects at the time. That option asks for a statement from a doctor or licensed clinical psychologist that the person was able to make the decision when signing.⁸ Rules differ by state. See our page on advance directives.

Give copies to the agent, family, doctors and the hospital the person prefers.

Working with the care team

Adults have privacy rights, and doctors cannot always share details with family. But the privacy law called HIPAA allows more than many people think:¹¹

• You can always share information with the doctor. HIPAA does not stop a doctor from listening to your concerns.
• If the person agrees, or does not object, the doctor may talk with family who help with care.
• If the person is unable to decide, the doctor may share what family needs to know when it is in the person's best interest.
• If there is a serious and immediate threat to safety, the doctor may share what is needed to prevent harm.

Ask your loved one, while they are well, to sign a release so the care team can talk with you. Offer to come to appointments if they want you there.³ See supporting someone in treatment.

Family therapy helps. A large review of 39 trials found that therapy added to medicine lowered the chance of new episodes. Education about the illness given to families or groups worked better than education given to one person alone.¹² Moderate evidence Ask about family-focused therapy. Learn more on therapy for bipolar disorder.

If your loved one is older

Bipolar disorder does not go away with age. In later life, kidney function often declines, and that can make lithium harder to manage safely.¹³ Some common medicines can also raise lithium levels. These include certain water pills (diuretics), some blood pressure medicines, and pain relievers called NSAIDs, such as ibuprofen and naproxen.¹³ Help keep an up-to-date medicine list, and make sure every doctor and pharmacist sees it. See medicines for bipolar disorder.

A first manic episode at about age 50 or older needs a careful medical check. In older people, mania can be caused by a stroke, a head injury, other brain problems or side effects of medicines.¹³ Read bipolar disorder in later life.

Take care of yourself too

Supporting someone through mood episodes is hard. Your own health matters, both for you and for the person you love.^1,3

• Get support from friends, family, a counselor or a support group.³
• Set limits you can keep. See setting boundaries as a caregiver.
• Watch for signs of caregiver burnout.
• The NAMI HelpLine offers free support for families at 800-950-6264, or text 62640, weekdays 10 a.m. to 10 p.m. Eastern time.²
• If English is not your first language, ask the clinic or hospital for a free interpreter.

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.