Bipolar Illness Is Often Unrecognized

An early sign of bipolar illness may be hypomania-- with high energy, moodiness, and impulsive or reckless behavior. Hypomania may feel good to the person who experiences it, so that he or she will deny that anything is wrong. In early stages, symptoms may appear as other problems: alcohol or drug abuse, or poor performance at work or school. Left untreated, bipolar disorder tends to worsen so that the person experiences more severe episodes of mania or depression.

More Facts...

Symptoms of bipolar disorder may prevent those affected from recognizing their illness. Family, friends, and physicians can provide encouragement and referrals for treatment. To ensure proper treatment and personal safety, commitment to a hospital may be necessary for a person in a severe episode.

Suicidal thoughts, remarks, or behaviors should always be given immediate attention by a qualified professional. It is not true that if a person talks about suicide, they will not kill themselves. With appropriate treatment, it is possible to overcome suicidal tendencies.

Bipolar disorder is a lifetime illness- to keep moods stable, ongoing treatment is needed, even when the person is feeling better. It may take time to discover the best treatment regimen for an individual-- it is important for both patient and family to work with the doctor to develop the treatment plan.

In addition to treatment, mutual support groups can benefit patients and their families. National Depressive and Manic Depressive Association (NDMDA) and National Alliance for the Mentally Ill (NAMI) sponsor such groups.


The possibility of suicide is the most serious complication of depressive illnesses. Feelings of worthlessness and guilt, combined with a special kind of psychic pain,may overwhelm the individual so that he or she feels unable to go on or unfit to live. Sometimes these feelings remain just thoughts, and at other times they lead to suicidal attempts.

Not all those suffering from depressive illnesses attempt suicide, nor are all those who attempt suicide suffering from a depressive illness. It is estimated that 15 percent of untreated or inadequately treated depressives may eventually commit suicide and, among suicide victims, more than half are suffering from a depressive illness. The person hospitalized for depression at some time in his or her life is about 30 times more likely to commit suicide than is the nondepressed person, with the greatest risk during or immediately following hospitalization. A family history of suicide is an additional risk factor.

The possibility of suicide increases with advancing age. In recent years, however, there have been alarming increases in suicide among young adults. Approximately twice as many women attempt suicide; however, men are more likely than women to actually kill themselves.

from: National Alliance for the Mentally Ill (NAMI)

What can families and friends do to help?

If you are a family member or friend of someone with bipolar disorder, become informed about the patient's illness, its causes, and its treatments. Talk to the patient's doctor if possible. Learn the particular warning signs for how that person acts when he or she is getting manic or depressed. Try to plan, while the person is well, for how you should respond when you see these symptoms. You will be thanked later!

Encourage the patient to stick with the treatment, see the doctor, and avoid alcohol and drugs. If the patient has been on a certain treatment for an extended period of time with little improvement in symptoms or has troubling side effects, encourage the person to ask the doctor about other treatments or getting a second opinion. Offer to come to the doctor with the person to share your observations.

If your loved one becomes ill with a mood episode and suddenly views your concern as interference, remember that this is not a rejection of you-it is the illness talking.

Learn the warning signs of suicide. Take any threats the person makes very seriously. If the person is "winding up" his or her affairs, talking about suicide, frequently discussing methods of follow-through, or exhibiting increased feelings of despair, step in and seek help from the patient's doctor or other family members or friends. Confidentiality is important but does not stack up against the risk of suicide. Call 911 or a hospital emergency room if the situation becomes desperate. Encourage the person to realize that suicidal thinking is a symptom of the illness. Always stress that the person's life is important to you and to others and that his or her suicide would be a tremendous burden and not a relief.

With someone prone to manic episodes, take advantage of periods of stable mood to arrange "advance directives"-plans and agreements you make with the person when he or she is stable to try to avoid problems during future episodes of illness. You should discuss and set rules that may involve safeguards such as withholding credit cards, banking privileges, and car keys. Just like suicidal depression, uncontrollable manic episodes can be dangerous to the patient. Hospitalization can be life-saving in both cases.

If you are helping care for someone at home, try, if possible, to take turns "checking in" on a patient's needs so that the patient doesn't overburden one family member or friend.

When patients are recovering from an episode, let them approach life at their own pace, and avoid the extremes of expecting too much or too little. Don't push too hard. Remember that stabilizing mood is the most important first step towards a full return to function. On the other hand, don't be overprotective. Try to do things with them, rather than for them, so that they are able to regain their sense of self-confidence.

Treat people normally once they have recovered, but be alert for telltale symptoms. If there is a recurrence of the illness, you may notice it before the person does. In a caring manner, indicate the early symptoms and suggest a discussion with the doctor.

Both you and the patient need to learn to tell the difference between a good day and hypomania, and between a bad day and depression. Patients taking medication for bipolar disorder, just like everyone else, do have good days and bad days that are not part of their illness.

Take advantage of the help available from support groups.

from: Frances A, Docherty JP, Kahn DA, eds. The Expert Consensus Guideline Series: Treatment of Bipolar Disorder. J Clin Psychiatry 1996;57 (suppl 12A).