Supporting the person’s bipolar treatment

Family and friends often find it hard to know how to support the person’s bipolar treatment. Medical treatment is the first line of treatment for bipolar disorder. Caregivers sometimes become concerned about the possibility of relapse when a person stops or reduces their medication. Psychological treatment may also be helpful when added to the person’s usual medical treatment. The sections below include ways to support bipolar treatment:

  • Supporting the person’s medical treatment
  • What if the person wants to stop or reduce their medication?
  • Could additional psychological treatment help?

Supporting the person’s medical treatment

The extent to which you are involved with the person’s bipolar treatment is a personal decision. This decision may be influenced to some extent by your other commitments, the person, their clinician, and the severity of the illness (see working together to deal with the illness).

Person making treatment decisions with their clinician

 

Supporting the person with their bipolar treatment does not have to mean managing their medications for them. This can make you exhausted and undermine the person’s confidence. However, if the person is severely ill and unable to manage their own treatment, you may need to help more. When the person is well, you can discuss plans for supporting their treatment when they are severely ill (see planning for times when the person is severely ill). If they are severely ill and at risk you can help them to get emergency treatment (see dealing with a bipolar crisis).

When possible encourage the person:

  • To find out about the range of treatments that has been shown to be effective.
  • To take an active role in making treatment decisions with their clinician (e.g. by getting information on their treatment, monitoring its effect and discussing options with their clinician).
  • To have regular appointments with their clinician to help monitor their progress.

If treatments are slow to work, or the person needs to try new treatments, encourage them to persevere and not give up hope. Some caregivers assist the person to monitor the effectiveness of the treatment or provide support if side effects occur. Telling the person if you see improvement in their bipolar disorder since starting treatment can be useful feedback for them.

What if the person wants to stop or reduce their medication?

Sometimes, people stop taking their medication, or do not take it regularly or at the required dose. Some of the many reasons why the person you care for may stop or reduce their medications include when the person:

  • Has decided together with their doctor to reduce or stop a particular medication due to side effects or because it is not helping.
  • Is currently experiencing an episode of illness and sees no reason for medication.
  • Seeks to experience elevated moods.
  • Is anxious about the long-term safety of the medication or a fear of possible side effects
  • Denies the severity of the illness, or that bipolar episodes are likely to re-occur.
  • Believes that the medication will control them or that taking it is a sign of weakness or dependence.
  • Has concerns about the stigma sometimes connected to taking medication for a ‘mental illness’.
  • Forgets to take the medication

People with bipolar disorder have a biological vulnerability to develop bipolar symptoms and taking ongoing bipolar medication helps to prevent relapse and negative consequences. Close family and friends often become concerned if the person decides to stop or reduce a medication (especially one that has minimal side effects and helps them to keep well) without discussing this with their doctor. If this is a concern of yours click on the following section: More on what to do if the person wants to stop or reduce their medication.

Could additional psychological treatment help?

Psychological treatments are not an alternative to medication. However, certain psychological treatment programs have shown additional benefits when used together with the person’s medication, particularly in helping to prevent relapse, reduce symptoms and improve daily functioning. Unfortunately, these well researched psychological treatment programs are not always available.

Some people with bipolar disorder report that they have found more informal psychological treatment or counseling helpful (e.g. when the person wants help with some of the losses or changes that have occurred, wants to learn ways to deal with stress or warning signs).  What is of primary importance when seeking psychological treatment is that the health practitioner (psychologist, counselor or psychiatrist) you or the person chooses is knowledgeable about bipolar disorder and how to treat it.

Psychological treatment may be most helpful when the person is relatively well and wants to find ways to prevent relapse and deal with the illness. There is currently no psychological treatment to help reduce symptoms when a person is acutely manic. However, psychological treatment can help to reduce symptoms and enhance functioning when a person is depressed. 1, 2

If you think psychological treatment may be helpful for the person, discuss this option with them. Encourage them to discuss this possibility with their doctor or mental health team.

References

  1. Miklowitz DJ, Otto MW, Frank E, et al. Psychosocial treatments for bipolar depression. Arch Gen Psychiatry, 2007; 64: 419-27.
  2. Miklowitz, DJ, Otto MW, Frank E, et al. Intensive psychosocial intervention enhances functioning in patients with bipolar disorder: Results from a 9 month randomized controlled trial. Am J Psychiatry 2007; 164, 1340-1347.

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