If you are a friend of someone living with bipolar disorder, you can play the important role of vigilantly helping them watch for symptoms of depression or mania.
Photo: Getty Images/ Milkos
By Martin Baker
In a recent article I mentioned “red flags” that can alert you when your friend may be slipping into depression or mania. What are these bipolar red flags, how do you spot them, and what do you do next?
A red flag is anything that suggests your friend is moving from relative stability towards illness or crisis. They include early symptoms of mania, depression, or suicidality, but also things which, while not directly illness-related, suggest all may not be well.
Everyone is different and red flags will vary from person to person. They may also vary over time as the person’s condition, treatment regime, and ability to manage things changes. What you are looking for is often a subtle shift in behavior or symptoms which is why it is important to stay in touch. If you only check in with each other every few weeks, it will be hard to spot if something is going on. Here are some potential red flags based on my experience supporting my best friend Fran.
Red Flags for Mania
Talking rapidly, sudden changes in topic, or “leaps of logic.”
Having more energy than usual, especially if needing little sleep.
Being intensely focused, or finding it hard to focus.
Involuntary facial movements, such as twitches or mouthing.
Red Flags for Depression
Having difficulty keeping up with personal hygiene (e.g. showers, brushing hair) or usual chores (washing dishes, laundry, paying bills).
Withdrawing from people, online and in person.
Poor sleeping (this can also be a flag for mania), or sleeping more than usual.
Specific language. (“It’s not working” is one of Fran’s red flags for depression.)
If you spot something, don’t assume the worst, but don’t ignore it. Acting promptly and appropriately can help your friend ease back from the edge of illness, or seek professional help if needed.
Share what you’ve noticed and see if your friend agrees. They may have a different take on things. Remember you are not trying to diagnose. Only a doctor or psychiatrist can do that.
On the other hand, your friend is the expert on how bipolar disorder affects him or her, and as a caring friend, you also have a role to play. Fran relies on me and other trusted friends to tell her if we notice anything which suggests she’s at risk.
Every situation is different, but you and your friend have three basic options (Note that hoping it will go away isn’t on the list!)
1. Decide everything is okay and nothing needs to be done.
2. Decide something may be happening and agree to keep an eye on things until you are sure one way or another.
3. Decide something is definitely going on and discuss what to do about it.
What if you decide something is going on? What do you do next?
It helps to have something to refer to rather than trying to recall what has worked previously or coming up with ideas from scratch.
Wellness plans include red flags (sometimes called early warning signs) with steps your friend can take to prevent things getting worse. If your friend has such a plan, suggest looking at it together to see if any of the strategies would be helpful.
If not, see what you can come up with together. Invite your friend to write down what you decide to try, or offer to write it down for them. Update it later when you can see how things went so you have something to refer to in the future. Fran and I have built quite a body of experience over the seven years we have been friends.
The idea with red flags is to take preventative action before things get out of hand, but situations can change rapidly and it might be a little late for prevention by the time you spot the signs.
Most wellness plans include a crisis strategy covering what to do and who to involve if your friend is in mania, depressed, suicidal, or otherwise struggling.
This might involve contacting other friends and family, your friend’s doctor, psychiatrist, or therapist. In an emergency, it might include online or telephone crisis lines or the emergency services.
Unless you are immediately concerned for your friend’s safety, support them in taking the next steps rather than going against their wishes or contacting people behind their back. On the other hand, be prepared to act if your friend is unwilling or unable to help keep themselves safe.
This is not an exact science. On occasion, I’ve felt something was up and it’s turned out to be nothing more than a temporary shift. Living with bipolar doesn’t mean you can’t have “up days” or “down days” like everyone else. On the other hand, Fran sometimes mentions she or someone else has noticed a change that I have missed up to that point. Vigilance is a team sport!
In our experience, the best approach is to approach vigilance in a spirit of curiosity. Every red flag is an opportunity to learn a little more about how bipolar disorder manifests for Fran, to explore how best to keep her as stable as possible, and to deepen our friendship.
Do you help a friend or loved one keep an eye out for red flags? If you live with bipolar disorder, does it help having a vigilance ally or do you feel that is unnecessary or intrusive?
Group Therapy + CBT—a Beneficial Combination for Bipolar Disorder September 1, 2020, VELDHOVEN, The Netherlands—Receiving cognitive behavioral therapy in a group setting has lasting benefits for people with bipolar I or II, according to Dutch researchers. Looking at a small cohort of people with bipolar I or bipolar II who participated in group cognitive behavioral...
Tailored treatments a priority for people with bipolar II June 15, 2021, MELBOURNE, Australia—A preliminary inquiry into how adults with bipolar II disorder manage their condition indicates they are hungry for tailored psychological treatments delivered by clinicians knowledgeable about this form of bipolar. Utilizing an online questionnaire with individuals having a confirmed bipolar II diagnosis,...
You aren’t alone in wondering about your loved one’s future. As an expert in bipolar management—with bipolar—I still face mood swings and symptoms. Here’s why. Bipolar Disorder, Expertise, & Mood Management I’ve been writing books about bipolar disorder management since 1998, and my web page started in 2002. How is it possible that I still...
I often think, “What do ‘normal’ people wonder about bipolar?” So, I asked my friends and family to send me any questions they had—boy, did they come through! What Do You Want to Know about Bipolar? Since I’m always looking at life through my own perspective and experience as a person with bipolar (or “PWB,”...