Medication for the treatment of unipolar depression is often more successful than medication for bipolar depression because researchers know more about the depressed brain than the bipolar brain. Antidepressants that are clearly established as effective treatments for depression, often do not successfully treat bipolar depression, and in many instances can make it worse. The biggest concern is that antidepressants can cause mania, hypomania or induce rapid cycling.

Categories of Meds for Bipolar Depression

There are four main medication categories used to treat bipolar depression. Bipolar depression almost always requires more medication than unipolar depression in order to keep all of the symptoms under control without igniting mania.

Mood Stabilizers Like Lithium for Bipolar Depression

There are many mood stabilizers used in the treatment of bipolar depression. Some of the common mood stabilizers include:

• Lithium
• Valproate (Depakote)
• Carbamazepine (Tegretol)
• Lamotrigine (Lamictal)
• Oxcarbazepine (Trileptal)

In reality, only Lithium is a true mood stabilizer. The other medications are anticonvulsants that were created for epilepsy and were found to work on mood disorders. Valproate (Depakote), carbamazepine (Tegretol), and oxcarbazepine (Trileptal) work for mania, but only lamotrigine (Lamictal) and lithium has been shown to manage depression.¹

Learn more about Mood Stabilizers for Bipolar Disorder.

Antipsychotic Medication for Bipolar Depression

Antipsychotics were initially developed to handle the psychotic symptoms that accompany schizophrenia, but now have been found to work for a number of conditions. Taking an antipsychotic does not indicate the person is suffering from psychosis, but antipsychotic medications can be used to manage the psychosis that can come with depression, mania and mixed episodes.

Older generation antipsychotics like chlorpromazine (Thorazine) and haloperidol (Haldol) have fallen out of use in favor of the newer atypical antipsychotics. Atypical antipsychotics are thought to have fewer movement disorder side effects but may have additional risks in other areas. Atypical antipsychotics used in treatment include:

• Lurasidone HCI (Latuda)
• Olanzapine (Zyprexa)
• Quetiapine (Seroquel)
• Risperidone (Risperdal)
• Aripiprazole (Abilify)
• Ziprasidone (Geodon)
• Olanzapine-fluoxetine combination (Symbax)

Of these drugs, olanzapine, quetiapine, aripiprazole and olanzapine-fluoxetine have been found to be particularly useful in treating bipolar depression.

Learn more about Antipsychotic Medications for Bipolar Disorder.

Antidepressants for Bipolar Depression

The most familiar class of depression medications is antidepressants. While antidepressants are sometimes used as medications for bipolar depression, there is always the risk that an antidepressant will trigger mania / hypomania or create rapid cycling between bipolar highs and lows. Some doctors believe antidepressants may worsen long-term outcomes of bipolar disorder as well ² ("Are Antidepressants Safe and Effective in Bipolar Depression Treatment?").

If antidepressants are used to treat bipolar depression, they are combined with the use of a mood stabilizer or atypical antipsychotic medication to prevent the appearance of bipolar mania.

Tranquilizers

These are used to manage the anxiety that is very common with bipolar depression. They are also used as a sleep aid. Typical benzodiazepines and non-benzodiazepines used as medications for bipolar depression include:

• Lorazepam (Ativan)
• Alprazolam (Xanax)
• Clonazepam (Klonopin)
• Eszopiclone (Lunesta)
• Zolpidem (Ambien)

The last two medications are typically used as sleep medications. There is a risk of dependence with these drugs, but many use these drugs for anxiety and sleep without issue.

Bipolar Depression Medication Cocktails

Most people with bipolar depression who are successfully treated, often take several drugs simultaneously, sometimes called a medication cocktail. Results from a recent research project called the STEP-BD Project found 89% of those successfully treated for bipolar disorder required, on average, three medications from the above categories.

Bipolar Depression Approved Medications

All four of the above medication categories used to treat mood disorders are either approved by the Food and Drug Administration (FDA) for mood disorder treatment, or they are used in what's called an off-label use. Off-label use is an ethical and legal use of medications that have not specifically been sanctioned for use of a specific condition by the FDA.

FDA Approved Bipolar Depression Medications: At this time, there are three specifically approved medications for bipolar depression treatment:

• Lurasidone HCI (Latuda) - (Approved in 2013)
• Olanzapine-fluoxetine combination (Symbax) – Approved in 2004
• Quetiapine (Seroquel) – Approved in 2007

There are four medications approved for maintenance of bipolar disorder symptoms:

• Lithium – Approved 1974
• Lamotrigine (Lamictal) – Approved 2003
• Aripiprazole (Abilify) – Approved 2005
• Olanzapine (Zyprexa) – Approved 2004

Maintenance medications for bipolar maintain stability in bipolar disorder.

See also: "How Drinking Alcohol Affects Bipolar Depression Medications"

article references

Is living with a bipolar spouse causing you extreme stress or wrecking havoc in your home? Bipolar spouse support is extremely important and it's not unusual for spouses and family members to seek counseling to develop strategies for dealing and coping with the bipolar spouse. The National Alliance for the Mentally Ill (NAMI), the Depression Bipolar Support Alliance (DBSA) and Mental Health America all offer bipolar spouse support groups in local communities. You can locate these groups on their websites.

Strategies for Dealing with Bipolar Spouse

If you are living with a bipolar spouse, here are some things to consider when dealing with a bipolar spouse.

1. The mental illness your spouse suffers with is something that is happening to your entire family. All are affected and it is nobody's fault. It is not your fault, your spouse's or your children's fault. It is an unfortunate illness.

2. You cannot fix your spouse. There is nothing you can do to make him or her well, so don't feel compelled to try. What you can do is be supportive, loving and handling the everyday details and practical issues of life that he or she cannot cope with.

3. All members of the family have a responsibility to cope with the mental illness. Escape is not a helpful way of dealing with crisis. You all need each other.

4. The ill spouse must recognize and accept the illness, be willing to receive treatment, and if possible, learn to manage the illness. If the mentally ill spouse is not willing to do these things, it may become impossible for the family to continue to support him or her. The family is not required to throw away their own lives for someone who refuses to cooperate. There are limits and they must be enforced without feelings of guilt.

5. Educate yourself concerning every aspect of the illness. Education brings compassion. Ignorance just encourages anger and fear.

6. Grieve your loss. It is a great loss. You need to allow yourself the time and energy to experience the entire process of grieving.

7. Get help for yourself to cope with this incredible challenge, either from your own counselor or a NAMI support group. You can't do it alone. Don't refuse to recognize your own need for help, just because the ill spouse is getting most of the attention.

8. Help your children understand the mental illness as much as their age allows. NO FAMILY SECRETS. Don't deny them the opportunity to learn about the illness, the unfair stigma attached to it, and developing their own skills in coping. It can be an incredible learning opportunity for them. If they need proof and help to understand it and their own feelings, get it for them.

9. Try to create a safe environment for the spouse to express himself/herself without feeling threatened, constrained or condemned. He or she desperately needs a nurturing, safe place to express the incredible frustration he or she is feeling about coping with mental illness.

10. You and your children need to share your feelings, honestly and openly. It's okay to feel angry and cheated. At times you may feel embarrassed by the ill spouse's behavior, avoid trying to protect your spouse by not discussing the problem with family or friends. Don't require your children to conspire with you in a code of "family secrecy." Family secrets will only isolate you from others. Remember that small children, by their very nature, assume that they are responsible for anything in their environment that goes wrong.

11. Never put yourself or your children in physical danger. If you sense your spouse is becoming dangerous, you should leave and call for professional help. You should never tolerate abuse of you or your children. Trust your instincts and intuitions on this one. Say, "no way" and mean it.

12. Become your spouse's advocate with the medical professionals, assertively involved in his treatment and medications. If the medical professional or psychiatrist won't cooperate with you, demand a different one! Treatment should involve the entire family, so find a professional who will work with the whole family. You know more about your spouse's illness than anyone else. Trust your instincts.

13. Coldly assess what your spouse can and cannot handle, then compensate assertively. Some people with mental illness cannot handle money, some household chores, time commitments and too much stress. You must not do things for your spouse that he or she can do for themselves. Don't rob him or her of their dignity.

14. Maintain your own identity; resist becoming consumed with your spouse's mental illness. Life goes on. You have an obligation to yourself and your children to take care of yourself and meet your own needs. You all must continue to develop your own interests and talents. You are a valuable human being, so don't play the martyr role and sacrifice yourself. That's just self pity. "Get a life."

15. Always hope for healing. The psychiatric medications do work and new ones are being developed. You may get your spouse back whole some day. If nothing else, the experience will broaden and deepen you in ways you never imagined. Or, you can choose to let it destroy you, your family and your marriage. It is your choice.

16. Keep in mind that bad things happen to good people and you're no exception. You have not been singled out for a special persecution. Trying to make good choices in life won't protect you from misfortune. You haven't been "dumb" to "get yourself in this situation." It is not your fault. Life is not easy, we have to take what we get and make the best of it.

Can a child have bipolar disorder?

According to studies, approximately 2.1% of adults have bipolar disorder type I or bipolar disorder type II at some point in their lifetime, but is a child with bipolar possible? The intuitive answer for many is “no.” Mental illnesses are often thought to be “adult problems” and thus bipolar children can’t exist. Unfortunately, this isn’t true. Studies show that a child with bipolar disorder is quite possible.

How Common Is Childhood Bipolar Disorder?

Bipolar children are said to have pediatric bipolar disorder or early-onset bipolar disorder. It was once thought that bipolar disorder in children was extremely rare, but studies now show that it is much more common than once thought.

Bipolar disorder in youth (under the age of 20) has been shown to range between 1-1.8% in one meta-analysis. In another study, it was found that between 0.2-0.4% children have bipolar disorder type I and about 1% of adolescents have bipolar disorder type I.

Overall, about 20-30% of adults with bipolar disorder type I had symptoms before the age of 20.

The numbers above do not reflect the prevalence of bipolar disorder type II as there is a lack of study in this area.

Adult vs. Childhood Bipolar Disorder

The Diagnostic and Statistical Manual of Mental Illness, Fifth Edition (DSM-5) does not differentiate between adult and childhood bipolar disorder. This means that a child with bipolar disorder must meet the same criteria for experiencing both a manic and depressive episode for a diagnosis of bipolar type I or must experience both a hypomanic and depressive episode for a diagnosis of bipolar disorder type II.

This is in spite of the fact that some say a child with bipolar disorder may have different symptoms than an adult. And while clinical experience seems to bear this out, right now there is not enough research on the subject to pinpoint what specific symptoms children with bipolar might experience.

The Good News About a Child with Bipolar Disorder

While it’s very difficult for both the parents and the child with bipolar disorder, the good news is that the sooner bipolar disorder in a child can be detected, the sooner it can be treated. This means that the impact that this illness could have on a child’s family, schooling and relationships can be minimized. The earlier a mental illness is treated, typically, the better the outcome as well.

While relatively few bipolar medications have been tested in youth, some are used and are found to be effective. It can take time to find the right one and the right dose for any individual child with bipolar disorder. Additionally, family-focused therapy can decrease the chance of suicide in bipolar youth.

In other words, while it can be a major adjustment when a child has bipolar disorder, there is hope in treatment. Bipolar disorder in childhood is not the end of a child’s life.

Bipolar psychosis moves along a continuum. Explanation, examples of how psychosis progresses in bipolar disorder.

The following section explains how bipolar disorder with psychosis progresses. There are three terms you need to know:

Euphoric Mania: This mania includes expansive, grandiose, upbeat and on top of the world feelings.

Dysphoric Mania: In this episode, the person is agitated and depressed as well as manic. This is also called a mixed episode.

Up to 70% of people with severe euphoric or dysphoric mania have psychosis. Psychosis is more common in euphoric mania.

Psychotic Depression: It's so easy to confuse the negative, hopeless and often suicidal thoughts of depression with psychotic thoughts- but depression is not psychotic unless there are specific hallucinations and delusions associated with the depression. Up to 50% of people with bipolar depression have some form of psychosis.

The Bipolar Psychosis Continuum

It's helpful to think of bipolar psychosis as lying on a continuum of severity from left to right. On the left side, where there is no psychosis, symptoms can range from mild to severe mania and depression. Those on the left side of the continuum may be very ill, but they have not lost touch with reality and there are no hallucinations or delusions. When pressed, the person can at least admit there may be an illness involved and that their thinking is different from the norm. I

n the middle of this line is a gray area where over 50% of bipolar symptoms move into psychosis. When a person hits this gray area, they start to become unrealistic and eventually bizarre in their thinking. Many of us go in and out of the gray area and don't know it simply because we were never taught the signs of psychosis and we never cross into full-blown psychosis. And as I mention often in this article, up to 70% of those with bipolar I mania cross over the gray area into full-blown psychosis that often needs hospitalization (take psychosis test).

Here is an example of a psychosis continuum experience:

Left side of the line bipolar symptoms without psychosis: I feel helpless and hopeless. I don't think I'll ever have friends. It all seems so pointless. Why should I even get out of bed? I can't sleep. My body is so restless. I feel like I'm going to jump out of my skin sometimes. I'm so lonely. I'm so lonely! Where are my friends? Will I always be like this? (Realistic self-talk: Ok, I can see this is depression. I need to work on the depression. I have no proof that the friends I have are upset with me. In fact, I do have a lot of friends. What is wrong with me? It's like my brain is lying! It is lying- my meds aren't working. The reality check is intact. )

In the gray area: Milder psychosis: I think that people are upset with me. When I call them on the phone there is a silence I didn't hear before. They are not emailing me and I think they are talking about me behind my back. Yesterday, when I walked down the street, I had the feeling that someone was following me. I'm not sleeping well. I try but my mind is too busy. I just can't get the idea out of my head that all of my friends are conspiring against me. I think I saw a face in my TV last night but the TV was off. (Realistic self-talk: But I just don't have proof- what is wrong with me! It just feels so real. I need to call my doctor. This is a moderate reality check. )

Out of the gray area: Moderate psychosis: Last night, I heard the people next door talking about me. I could hear their voices like they were in the room. I think the manager was there. Is he out to get me? I can hear people all around my apartment. I haven't slept for over four days. I'm wound up. I just have too much to do. They will not stop talking!!!!!! If I could just turn up my music loud enough. Wait., wait. Is this real? It has to be real. This can't be real. I can't hear people through a wall. But I do hear them! (A little bit of reality is left, but self-talk is almost gone. The lack of sleep and stress have made a reality check almost impossible. )

Far right side of the line: Full-blown psychosis: My friends got together with my neighbors and created a plot to get me in the hospital. I showed them what I thought about that! I snuck out. I could hear them in there. Laughing and talking about me. I yelled, what do you want with me! I saw a few of them at the windows. They wanted me to drink their urine. I will drink my own urine and die! I will drink it and cure myself. I .. .DO... NOT ... WANT... TO ... BE ... STOLEN....! Someone is coming to take parts of my body. I cut out the pictures from the magazines and put them on my walls to show people what was happening to me! (Full-blown dysphoric manic psychosis. Zero reality testing.)

The above describes a psychotic dysphoric manic episode with hallucinations and paranoid delusions. That is quite a mouthful, but if you break down the description, it's easy to see what happened. The person started with agitated mania that involved depression (dysphoric mania). It then moved into the realm of mild paranoid ideas and eventually psychotic paranoia that crossed into delusions. The person thought they heard something and was able to reality check, but eventually, they experienced hallucinations they perceived as real. Finally, the psychotic mania became so severe the person was hospitalized. This is actually a very common pattern for people with Bipolar I, especially for a first episode. The above can happen in just a few days. Especially if a person is not on medications or goes off their medications!

Here is what Dr. John Preston says about the psychosis continuum:

"A depressed person can have very strong impulses, thoughts, feelings and a strong urge of wanting to be dead. They have intrusive thoughts such as I wish I were dead or I should be dead. They don't feel in control of their moods, but they don't hear a voice outside of their head or see images of their own death. The thoughts of wanting to be dead feel very odd and strong, but they have not crossed over into psychosis. If you ask the person if someone outside of their mind put the thoughts there, they would be able to say no. There is a sense of ownership to the thoughts as terrible as they are. Now, if a person thinks, feels and then says that the thoughts were put in their head by Satan, you have crossed over to delusional psychosis. They have moved from the gray area into psychosis."

Where do you, or the person you care about, exist on the psychosis continuum?

Here is the short recap of this more technical part of the article:

• Psychosis is a break with reality that has two symptoms: hallucinations and delusions. Hallucinations involve the senses and are experienced outside of the body- such as voices that are not your own or seemingly real visions that are not real. Delusions are feelings and false beliefs such as believing the government has installed cameras in your house to monitor your every move.
• Bipolar psychosis is different than schizophrenia psychosis as it is always combined with either depression, mania or both. The psychosis does not exist on its own.
• Bipolar psychosis is more common in Bipolar I with full-blown mania and severe depression though it often occurs in a milder form with Bipolar I and Bipolar II depression. It is very rare with Bipolar II hypomania. It's estimated that 70% of people with Bipolar I have mania with psychotic features and 50% of people with Bipolar I and Bipolar II have depression with psychotic features.
• Psychosis works on a continuum. There is a point where typical and even very strong and 'odd' bipolar symptoms such as seen in grandiose mania or suicidal depression move into the gray area between typical symptoms and these symptoms combined with psychosis.
• Psychotic symptoms are 'bizarre' and don't respond well to reality testing.

Discover the difference between depressed and manic thoughts and bipolar psychosis or psychotic thoughts.

Here is where things get complicated. There are many depressed and manic thoughts that are false. For example:

• I'm a failure and everyone knows it.
• I will be unhappy forever.
• I have enormous talent and the special ability to come up with more solutions to math problems than all of my teachers.
• I'm the most beautiful person in the room. I feel like I can do anything.
• I have the strength of a tiger!

The difference is that these thoughts are not quite bizarre enough to be delusions. There is a possibility you're very beautiful. Or you may have been very unhappy for a long time. And even though mania and depression can completely distort your thoughts and behaviors, they do not do so in a way that makes people look at you in surprise and think- this person is completely out of their mind! They may think you're too morose or energetic, but that's about it. Another important point is that mania and depression do not cause you to see or hear things that aren't there. When mania or bipolar depression become psychotic, there is a marked difference in thoughts, beliefs and behaviors that do cross over into the bizarre; where reality testing becomes very poor. For example:

I can go for weeks without eating or drinking and it will not bother me. This is very different from I'm a thin and gorgeous woman who could be a top model. There is a fine line between the expanded grandiosity of mania where there is still some critical thinking and the often dangerous delusions of psychosis.

Hallucinations and delusions are the primary symptoms of psychosis. Hallucinations and delusions in relation to bipolar disorder explained in detail.

As mentioned before, hallucinations and delusions are the hallmark symptoms of psychosis. Bipolar hallucinations involve the senses; bipolar delusions are about unshakable feelings and beliefs. The following section gives you in-depth descriptions of each psychotic symptom, as well as some real-life examples of each. If you're wondering "Am I psychotic?", take our psychosis test.

Bipolar Hallucinations: Symptom of Psychosis

When I started to get psychotic, I looked out my window and saw a man's face. I also saw a child's face in the trunk of a car. I then saw a tiger in a tree. I was in the hospital the next day. They just seemed so real! I saw them with my own eyes, so how could I know they were fake?

I hear my name called over the loudspeakers in stores. I hear it over-and-over again. It gets so bad I have to leave!

I see myself die a lot. If I'm standing on a street corner- I see myself get hit by a car- flipped in the air and then splat on the ground. I used to call them death images. Now I know what they really were! And I only got them when I was stressed!

I heard my mother screaming at me over and over again- but she lived in another state.

I heard a voice that told me I was the Messiah and that I could save the world with my magnetic stare. That's really weird! Someone talked to me. I heard the voice and it wasn't my own. I looked around but there was no one in the room.

Hallucinations are about the senses. They are not thoughts or dreams or wishes. If you experience something involving seeing, hearing, tasting, smelling or touching as though it truly happened and yet it's hard to tell fact from fiction, it's more likely a hallucination.

Bipolar Delusions: Another Psychotic Symptom

There is a fine line between intense or even odd feelings and delusions. Bipolar delusions are not intuition. Delusions are false beliefs. They truly do not have a basis in reality. Here are a few examples.

When I got sick the last time- I was literally and totally positive my wife was having an affair with her ex-husband. I kept asking her over and over again, "Have you been sleeping with him? When did you sneak out to see him?" The fact that they had been divorced for eight years and they had no contact simply didn't register in my brain. I lost all touch with reality and the feelings took over my life. I believed she was cheating with every cell in my body. It was that real even though there was zero proof. I am amazed we survived this.

I thought my blood was full of snakes. I could feel them writhing and slipping around in there.

I constantly felt like someone was following me. When I got with a group of people, I could see them whispering about me. I felt that every step I took was a message to the people who were following me. I wanted to go to the police, but I was too scared. I'm so glad I didn't!

For almost three months, I believed I was the smartest person on the west coast and I believed the president knew about it and wanted me taken out of the picture.

People can have really odd feelings when they are not psychotic - the difference is that they can have a reasonable discussion about the feelings, especially when someone asks them questions based in reality. For example, a depressed person may fear they have cancer, but a doctor can say, "Is there any proof you have cancer?" and they reply, "No, but I am so miserable and so worried that I think I may have cancer."

In contrast, bipolar delusions are unshakable and immune to reality testing. There is no challenging the person and often the delusion is very bizarre such as, " I have cancer from a government experiment that no one knows about, but I know! They put the cancer in my drinking water." As a person starts to move out of psychosis, they are more able to have perspective and eventually they can see their feelings and beliefs as non-realistic, but while they are happening, they feel as real as reality!

Not all people with bipolar disorder have delusions. I once had a very strong delusion. As I was driving over a bridge, I saw a billboard advertising a local brand of beer. I had the immediate thought, "Is that sign giving me a message? Did I do something wrong involving that beer last night?" I had enough insight to understand this was a delusion and was able to talk myself out of the belief. Plus, I would never drink that brand of beer!

I want to stress again that it's really so important to distinguish between the psychosis in bipolar disorder and that in schizophrenia. What it comes down to is that though the two illnesses have the same psychotic symptoms, but people with bipolar disorder are more able to function at a higher level even when they are having hallucinations and delusions. They may still believe that the delusion is real and their reality testing can be very poor, but they can still get dressed, make breakfast and go to work. Their train of thought around the basics of life is not always disorganized. This is one reason people with bipolar psychosis can go for years without anyone knowing they are psychotic- this is not possible for people with schizophrenia as all of their behavior can become disorganized when they are psychotic.

Of course, when someone gets severely manic and psychotic, they can be very disorganized, but it's episodic and not chronic. I once believed that all of the evaluations I received after a speech were fake. It was such an intense delusion, even though there was no proof and in fact, faking the evaluations was literally impossible. But even though the delusion persisted for days and I asked people if it were possibly true, I just kept on going as if things were okay.

Bipolar family support groups can help relieve the stress and give family members an opportunity to freely share with others the effects bipolar disorder has on the family. There are 3 major mental health organizations that provide bipolar support groups for families. Because these are national organizations, many have local chapters and hopefully there is one near you. These groups are designed not only to provide support to bipolar family members, but also to educate people about the details of the illness.

Bipolar Family Support Groups

Below, you find links to the bipolar family support groups that have local chapters that hold face-to-face support meetings. These organizations also offer support groups for your bipolar family member.

• The National Alliance for the Mentally Ill (NAMI)
• Depression Bipolar Support Alliance
• Mental Health America

If there is no local chapter, you might contact one of the above organizations to discuss starting one yourself. You can also contact your county mental health agency to see if there are other local support groups in your area. These organizations also offer online bipolar family support.

Family Support for Bipolar Disorder: Relieving Stress

There are positive actions that can be taken to make life more bearable when a family member has a mental illness:

1. Do as much as you can financially and physically to improve the situation, but don't feel guilty about all you won't be able to do. If it isn't possible to maintain a degree of peace, dignity, and well-being within the family while the person with mental illness lives at home, other arrangements should be made. If it is necessary, don't be embarrassed in seeking public support through available social services such as community clinics and state hospitals. You have every right to ask for information and help from the facilities of your state Department of Mental Health. Tax dollars are meant to support the truly disabled.

2. Strive for good physical health. Both the afflicted one and the other family members will benefit from a proper diet, regular exercise routines, and a clean, orderly living environment.

3. Watch your stress level. Don't let yourself burn out. Put on the brakes when you feel yourself sliding into an untenable situation when your nerves start to jump. A game of solitaire, an hour watching an interesting television program, a hot, luxurious bath, meditation, a walk around the block, digging and weeding in the garden - anything that stops or changes the direction of your thoughts can be helpful.

   Remember that no life is without stress. Learning how to cope with it is the key to making and keeping a life of your own. Look for what gives you peace of mind and enjoy it. A walk on the beach or in the woods, a movie, a play, a good book, a painting, a conversation with a dear friend, a prayer. The point is to let yourself go, to relax, to let your body and mind renew itself, thus recharging your energy.

4. An effort to maintain social contacts is imperative. If a family member becomes ill with a debilitating physical illness - heart disease or cancer, for instance - neighbors, friends and peripheral family members are often very supportive. If the illness is mental, the family involved usually feels stigmatized. The family unit often withdraws with their sick relative from the community at large. It is much better if they continue to circulate in as normal a way as possible. Such families are in a unique position to break down the walls of prejudice and fear that surround mental illness. If communication exists between afflicted families and their neighbors, there is often a great deal of compassion and understanding expressed.

5. Seek out and join a support group formed by families of people with mental illness. There is much comfort and knowledge shared in such groups. If a group hasn't been formed in your community, you might start one.

6. Continue pursuing your own interests. Burying one's hopes and desires in order to placate the demands of your relative with a mental illness will add to the problem, not diminish it.

   If you are an artist, continue to draw and paint. If you are a potter, continue to work with clay. If you enjoy woodworking, if you are an active club member, continue to do those things that give you pleasure and make your life fulfilling. You will be better able to cope with your problems because, at least to a degree, you will still be your own person. Don't let resentment build up in you because you have given up interests and dreams to meet the demands of your ill family member. It will do neither one of you any good. Be kind to yourself as well as to the patient.

7. Do something for someone else. Our own problems seem less defeating when we are involved in giving support to others.

Source: NAMI (National Alliance for the Mentally Ill)

Bipolar patients, their family and friends, share their definitions of "bipolar support."

Meaning of Bipolar Support

Offering bipolar support can be a tricky proposition. Parents, family members and friends want to be helpful, but many times are confused because they are rejected by the patient and told "you just don't understand." Before actually providing support for bipolar disorder, a  good rule of thumb is to ask the person point blank: "How can I help you? What is it you want from me?" To provide bipolar family members with further insight into the process of offering helpful support, we asked people with bipolar disorder and their supporters:

"What does bipolar support really mean?"

Below are responses from people living with bipolar disorder, and their friends and family members.

Bipolar Support: What I'm Looking For

"Support people of someone with bipolar disorder need to be patient, patient, patient! We are easily distracted, have difficulty with concentration and focus, forget what you told us 5 seconds ago, much less being able to remember to do something you asked us to do 5 hours from now. We lose things, misplace things, or just plain do not see things that are right in front of our eyes. While looking for that 'misplaced' item, we may misplace 10 more items. By this time, our mind is in a panic and total state of confusion. We used to be organized and on time, but now it can take hours to get organized and get together the things we need when preparing to get out the door to go somewhere. We lose our train of thought, what we meant to say comes out backward or the word we meant to say comes out a different word that starts with the same first letter. At times, we fly into a rage over seemingly nothing. Some of us get physical - most of us are not. To those bipolar support people and/or family and friends, understand that none of the above is personal. The irritation, frustration, and confusion that you feel about us at times, we feel triple that amount about ourselves plus add in a huge scoop of guilt and shame over our actions."

"With my husband, I adjusted to make doctor appointments, call for medication refills and other things for him. After the diagnosis of bipolar disorder, my continuing to do these things allowed him to deny that the bipolar disorder was HIS illness and he needed to deal with it. So I quit! I will do these things occasionally when needed, but I made him responsible for his doctor appointments. I do not count his pills. I do not ask him if he is taking his medications. I have made him responsible for doing these things and I trust him to do so."

"The most important way a significant other or family member can help me, or offer support for bipolar disorder, is by understanding me. I may act in ways that aren't 'normal.' Realize that this is due to bipolar disorder. You can best do this by reading up on this disease, learning the characteristics of this illness, the actions that it may cause me to do so that you are not surprised if one or two of them happen. Through understanding me, you can empathize with some of the difficulties I experience. I don't need nor want your pity, but empathy goes a long way. It allows you to see why I may do something that would puzzle you if you had not read about my illness."

"Trust me, yet know when to step in. Allow me to live my life independently and freely. Don't count my pills or tell me to take my medications. Let me make all my decisions as I would normally, yet recognize the warning signs of depression and mania and get medical help for me if I am unable to do so. Read up on the bipolar medications I am taking so that you know what possible side effects I may be experiencing. But most of all, believe in me and support me in my choices. Believe in me when I am going through a hard phase. Tell me that I will get better because you have faith in who I am and support me because you love me."

"Do not treat me as though I no longer have a brain. Do not hover. Trust me to make my own decisions, including those that affect my treatment and the course of my illness. Make me take responsibility for my illness and my actions, but love me regardless."

"Bipolar support? Understand that you will never really understand what is going on in my mind, because I rarely understand it myself. Know that when I say, 'There's nothing you can do to help,' that is probably the time when I need you the most."

"Accept when I say I can't, even if I could the day before."

"I will joke about my disorder. I will make wisecracks about being fruit loops or taking vacations at the mental hospital. Please don't do so yourself. This is my right, my defense mechanism, that I will allow you to share in time, but only you. Do not joke about it to your friends."

"Know that this isn't your fault. This isn't my fault either. I didn't ask for this and can't just will it away with happy thoughts. Be there anyway."

"I want to be treated the same as ever - whether you like me or not. I don't want anyone to be afraid of me because of my bipolar disorder. I don't want to be handled with kid gloves. I don't want to be any better or worse than anyone else."

"The most important thing that anyone can do, as a family member of someone with bipolar disorder is to inform themselves about it and ask questions. I don't mind at all if someone asks me about it, about my moods, my meds, anything, so long as they honestly want to know versus simply meddling in my business or searching for gossip. I think that the more someone knows, the less likely they are to do the things that offend me most. A lot of stress in my life could be eliminated if the curious would simply ask. I'm not ashamed, and I try to make myself as approachable as I can be."

"I did not ask to be born with this. Treat me the same way that you would treat someone with a chronic illness."

"Educate yourself about my illness. There but for the grace of God go I - should be a thought that you carry with you. If you don't know about the disease, ask me. I will tell you. Don't assume and don't believe every movie that you watch on television. I am no more prone to take you and your kids hostage as your minister would be. Treat me with respect and love me for who I am. I will probably be on medication for the rest of my life. Don't make fun of me. Just understand that at times I don't understand myself - so you need to understand and respect that."

Bipolar Disorder Support: How I Want to Be Treated

For those offering bipolar disorder support, it's sometimes easy to confuse the illness with the person. "Oh, he's bipolar." No, he's not bipolar. He's a person with bipolar disorder.

"Do not blame my bipolar for every argument that we have - spouses do have faults too and we're not always to blame, although our moods do contribute to our share."

"Please do not tell me how I feel. You aren't in my head and have no concept of the craziness that sometimes goes on. Own your feelings and I'll own mine."

"Please forgive me when I verbally attack you because the guilt that is felt afterward is absolutely horrible and we never really intend to hurt you in any way. The guilt is sometimes punishment itself."

"Be patient with us and know that most of us do what we can to take care of ourselves and take the responsibility of keeping the effects of our illness to a minimum. We need your love even when we act like we don't and we need you to care about us as individuals. Do not give up on us if we have not given up on ourselves.

"Please think of my bipolar illness the same as you would heart disease, cancer or high blood pressure. It is a real illness with complications just as any other. "Don't be offended if I am mean or act out of character when manic or clam up and avoid you when I'm depressed. If I'm active and able to accomplish things one day, don't assume I'm lazy and worthless if I can't function the next day. Treat me with respect and let me be as responsible as I can be. Encourage me but don't push me. Even though I have this illness I am still a person in my own right and I have self-esteem. Be there when I need you. Help me when I'm sick and please know that I love you."

"Spouses and loved ones need to take care of themselves to prevent depression from becoming 'contagious.' Not literally, of course, but it will bring others down."

"Be supportive and listen. Don't criticize or tell them what they should do. They'd probably rebel. They probably know what they should be doing, but depression makes you powerless to get control. It is frustrating for people who have depression because of that."

"Don't take anything personally. It is not because of you. People seem to take things out on the people they care most for. I don't think on purpose. They just feel more comfortable with the people who are close to them."

"Help them with the daily tasks that they find difficult to do."

"Being supportive would be taking the interest, care and time to educate oneself about the illness, helping the person in their various moods rather than blaming them, forgiving them for actions or words they may do when high and the little they may do when low, and taking an interest in their every day lives like any normal family member or carer."

"Don't ask me if I took my medications just because you don't like how I am acting."

"Treat me with the respect that I deserve. When I say something is bothering me, don't make light of it and tell me that it is petty and to move on. When I say that your joking around is not funny to me, even though I may have thought it was the day before, please do not continue - it only adds to my agitation. Take me for my word - there are days that I just do not feel like doing anything. Please do not try to force them upon me."

"Let me have the space I need so that I can come to grips with my life without feeling pressured to be/act 'normal' because it will make YOU feel better."

"Most importantly, love me for me. I cannot help it that I am the way I am. I am trying everything I possibly can to make myself feel better. Please do not think less of me because I may not act like the loving family member that I am supposed to be. I do love you dearly even though, at times, I may not be able to show you or make you understand that I truly do feel that way."

"Do not tell me that I'm okay when I'm not feeling that I am."

"Do not tell me that I can handle a situation when I don't feel that I can. These thoughts may help you believe I'm okay, but they can make me feel worse. Instead, listen to me, let me express my fears."

"Know that I may be trying to tell you that I'm not feeling like my 'normal' self and that I need someone to listen and be supportive."

"Don't tell me my chemistry is off. I may be in a state where I don't know what to do about that, so your statement may seem like a simple solution to you and feel like another burden for me."

"You can help me remember my meds by bringing them to me with a glass of water. I may be too depressed to remember or too hyper to realize the time for my med is long overdue. A pillbox for different times of the day can help us both know if it is time for the next pill(s)."

Bipolar disorder management can be challenging at times. Sometimes mental wellness seems to be easy to achieve while other times it seems almost impossible. However, if you remember these tips on how to manage bipolar disorder, you can put them into practice when things get tough (What Is Bipolar Disorder Self-Help and Is It Really Helpful?).

Bipolar Management Tip #1: Get Involved in Your Treatment

When treatment is started, most patients don’t know about bipolar disorder or bipolar disorder treatment, over time, though, many people develop their own ideas about the path treatment should follow. Part of effective bipolar disorder management is about sharing these ideas with your treatment team.

When you get involved in your own treatment, you begin to feel empowered and like you have a better handle on your illness.

Bipolar Management Tip #2: Recognize Your Signs and Symptoms of Bipolar Disorder

There are signs and symptoms of bipolar disorder found in a textbook and there are those experienced by any one individual. If you want to manage your bipolar disorder successfully, you have to recognize what you experience as part of the illness. Start by talking to your doctor about all the possible signs and symptoms as noted in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and work from there. And remember that not everything you experience may be captured in a textbook but it still may be normal for you.

Bipolar Management Tip #3: Create Structure in Your Life

Bipolar disorder can be thought of as a regulation disorder. It is particularly challenging to regulate your moods, of course, but others things like sleep can also be very difficult to regulate. Putting structure in your life is an important way to manage bipolar disorder. Structure around sleep is the most important. Going to bed at the same time every day and getting up at the same time every day will work wonders, but other structure such as when you eat, what you eat and exercise can help, too.

Bipolar Management Tip #4: Learn to Manage Stress

Stress is something that can negatively affect anyone and for a person with bipolar disorder, stress can make the illness flare up. Part of a bipolar management plan should always include learning to spot stress, watching for its effects on you and putting in place ways of dealing with it (take the Online Stress Test). And don’t forget, this includes managing bipolar disorder stress at work, too. It’s important to put these things into place before a major stressor hits, as when it does, symptoms can get out of control quickly.

Bipolar Management Tip #5: Be Careful What You Put into Your Body

A healthy diet can help anyone – including one with bipolar disorder. According to HelpGuide.org, when putting things in your body, watch for:

• Eating a healthy diet – If all you eat is junk food, your body (including your brain) has no quality fuel to run on and it can be impaired (Bipolar Natural Treatment Diet: Does Diet Affect Bipolar?).
• Getting your omega-3s – Omega-3 fatty acids can be helpful in mood disorders like bipolar disorder and, moreover, are good for brain health in general. Omega-3s are available as either over-the-counter supplements or by prescription. You can also increase your omega-3 intake by eating: cold-water fish such as salmon and halibut, soybeans, flaxseeds and nuts like walnuts.
• Avoiding alcohol and drugs – Alcohol and drugs, by definition, affect your mood. As a person with a mood disorder, you can’t afford to have any additional mood dysregulation. Additionally, drugs can interact with your prescription medications in extremely harmful ways.
• Being careful with other medications – Other prescription medications and even over-the-counter supplements such as St. John’s wort, can impact your mood and interact with your medication (Is There a Natural Cure for Bipolar Disorder?). Make sure to run anything you choose to take by your doctor.

You Can Manage Bipolar Disorder Symptoms

While none of the above bipolar management tips can cure bipolar, they can help you more successfully live with it on a day-to-day basis.

Being a new caregiver can be tough, but thankfully there is lots of Parkinson's help for caregivers. Parkinson's caregiver burnout, depression and stress are common in new caregivers, and many don't realize the enormity of the task they've taken on – particularly as Parkinson's disease progresses. For these reasons, it's important that you have a support system in place to help you meet the demands of your new role.  With this in mind, here's how – and why – you should find help for new Parkinson's caregivers.

Why Should I Seek Parkinson’s Help for Caregivers?

During the initial stages of Parkinson's disease, most patients are self-sufficient and don't have to make any changes to their lifestyle. However, Parkinson's is a progressive disease, meaning the symptoms worsen over time. Sadly, although there are plenty of treatment options to help patients manage the condition, there is no way to cure Parkinson's disease or prevent the symptoms from progressing.

Most people need full-time care when they reach the final stages of Parkinson's disease. Your role as a caregiver will likely include washing, clothing and feeding your loved one (or at least assisting with these tasks), helping your loved one in and out of a wheelchair, administering medication doses, keeping track of medications and appointments, communicating with healthcare professionals, reporting symptoms and organizing bill payments and legal documents.

The responsibilities of a Parkinson’s caregiver can feel overwhelming at times, and caregiver burnout is common in those who are new to the role. Your mental and physical health is a priority, too. Therefore, it’s important to seek help from the offset so that you have a support system in place.

What Kind of Help Is Available?

If you're new to the role, you might be wondering what kind of help for Parkinson's caregivers is available. Let's look at some of your options so you can figure out what kind of support you need.

• Emotional support

There is no shame in needing emotional support as a Parkinson’s caregiver. Whether you're in the role full-time or you're sharing the responsibility with others, life as a caregiver is emotionally as well as physically demanding. It may be distressing to see your loved one change and become less able. You may also struggle with the demands on your time and your loss of independence.

Emotional support can be sought from caregiver support groups, socializing with friends and other family members and attending one-to-one counseling sessions. Whether or not you're struggling emotionally, it's a good idea to talk to your care provider about caregiver help so that you are prepared for the future.

• Practical help

Many Parkinson's caregivers find the physical and practical demands of caregiving the most challenging part. Practical help for Parkinson's caregivers varies from additional support from nurses and outside caregivers to hiring cleaners, gardeners and accountants to assist your loved one with day-to-day living.

If you’re struggling to meet your practical responsibilities, be sure to ask for help before you burn out – don’t try to do everything yourself. Accept offers of help from friends and family or try to arrange support swaps with those in your caregivers' support group.

• Advice and information

It's important to educate yourself about Parkinson's disease so that you know how to care for your loved one and what to expect. Your care providers should give you plenty of information and resources, but you may wish to do research of your own. Be careful where you get your information, however. Always use trusted resources (like the ones referenced on this site) and refer to your support group for more information.

• Financial help

Caring for someone with Parkinson's disease can have financial implications for the whole family. On top of paying for Parkinson's treatments, you may also need to take time out of work to care for your loved one. The person with Parkinson's disease may have also faced a loss of income, particularly if they were diagnosed at a young age (5% of Parkinson's patients are diagnosed before the age of 60). If you live in the U.S., you may be able to apply for help with treatment and assistance costs via the PAN Foundation.

Where Can I Find Parkinson’s Caregiver Help?

There is plenty of Parkinson’s help for caregivers online. You may decide to join an online community, such as the Parkinson’s Disease Forum on the Caregiver Action Network or spend time on the Michael J. Fox Foundation website, where you can access information and support.

Many people seek help in-person as well as online. You can ask your doctor about support groups in your area or find your local meet-up through a Google search. You may find there are Facebook pages and WhatsApp groups to join that offer support and organize meetings in your local area.

If you’re struggling to find your local Parkinson’s caregivers support group, you can use the handy tool on the American Parkinson’s Disease Association website, which locates nearby groups using your zip code. The website also has plenty of resources for care partners.

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