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Identifying triggers of mania or depression can help prevent a destructive mood swing. Here’s what patients and caregivers need to know.

Living with bipolar disorder can feel like a rollercoaster ride. The extreme ups and downs of the disease can disrupt the lives of the patient and those around them. To make the disease more manageable, it’s important for the patient and caregivers to know what may trigger episodes of mania and depression.

When one family member has bipolar disorder, it’s as if the whole family has the illness. Primary caregivers may need to help with medications, talk to doctors, and keep a predictable, low-stress household routine. It’s also essential for caregivers to pick up on the sometimes subtle signs that their loved one is slipping into mania or depression.

Bipolar Disorder: Mania and Depression

Bipolar disorder, also known as manic depression, is a serious mental illness that causes marked shifts in mood, energy and activity levels, according to the National Institute of Mental Health. The extreme “high” is called mania. People in a manic phase are usually full of energy, overly excited, and even irritable or jumpy. During an episode of mania, the patient may feel invincible, take risks, engage in impulsive sex, go on huge spending sprees, or even have hallucinations. What’s worse, the bipolar person may not recognize they are manic because they feel so good.

At the other end of the spectrum is depression, which can spiral into talk of, or even attempts at, suicide. Always take talk of suicide seriously. If your loved one threatens to kill himself, call a health care professional or 911 immediately.

Although bipolar disorder is a lifelong illness, it is controllable. Usually patients are treated with a combination of medication, psychotherapy, and lifestyle management. Many people go months or even years between mood episodes and report that they feel good in the meantime.

Bipolar Disorder: Tracking Triggers

Life events, anxiety, and even physical changes can cause a mood swing. What triggers an episode of mania or depression varies from person to person. Here are some typical physical triggers, according to the National Alliance on Mental Illness (NAMI).

• Not getting enough sleep
• Using alcohol or drugs
• Stopping your medicine
• Beginning antidepressant medication (this can cause a switch to mania)
• Hypothyroidism (low thyroid function, a possible side effect of lithium medication, often used to treat bipolar illness)

Emotional stress and big or small life changes can also cause mania or depression. The Depression and Bipolar Support Alliance gives these examples:

• Major life change like moving or starting a new job
• Arguing with a friend or loved one
• Financial problems

Louisa Sylvia, PhD, a psychologist at the Bipolar Clinic and Research Program at Massachusetts General Hospital in Boston says, “Changes in daily routines, such as staying up late studying or flying to another time zone, can cause a mood swing.”

Sylvia explains that bipolar disorder interferes with the body’s circadian rhythm, the 24-hour rhythms, such as the sleep-wake cycle. As a result, bipolar patients are likely to have unregulated daily routines, such as meal and bed times. For instance, they may wake up in the middle of the night or sleep late. They may not eat anything until the afternoon. So, Sylvia says, it’s imperative for the bipolar person, and the rest of the family, to maintain a regular routine to avoid mania or depression.

Since regular sleep is vital to keeping bipolar episodes in check, keep an eye on sleep patterns. Changes and disruptions in sleep are often the first indicator of illness, according to NAMI. Sleep is usually disturbed very early in an episode of mania or depression. If the mood swing is caught early, there’s a better chance it can be stabilized, possibly by adjusting medications.

Bipolar Disorder: Charting Your Moods

Mood charts provide a visual snapshot of changes in mood over the course of a month. Every day, the patient jots down medication, mood level, and significant life events. The patient, family, and doctors may be able to see emerging patterns and pinpoint triggers more accurately. Sylvia says mood charts are an “excellent resource for patients to monitor and be more aware of moods.”

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Self-injury is fairly common among younger women with bipolar disorder, especially during particular phases of the illness.

Many people with bipolar disorder deliberately injure themselves. Self-injury is often referred to as “cutting,” but other tactics such as burning, punching, and pulling out hair are also used.

Women are much more likely than men to cut themselves, but people of all races and all backgrounds engage in the behavior. Usually cutting begins in adolescenceor early adulthood, but once started it is more likely to recur even as the person gets older, especially during certain phases of bipolar disorder.

If you have a loved one with bipolar disorder who engages in self-injury, it’s important to learn why she does it, what mood episodes may contribute to the behavior, and what you can do to help her.

Bipolar Disorder and Cutting: Why?

You may be surprised to learn why people living with bipolar disorder cut themselves. Self-injury is actually not suicidal behavior. It usually has a different motivation entirely. “With cutting, it’s a [tension] release phenomenon,” says Suresh Sureddi, MD, assistant professor of psychiatry at the University of Texas Southwestern Medical Center in Dallas and director of Lifepath Systems, a community mental health clinic in Plano, Texas. Tension has built up within the patient and cutting helps get it out. “They’ll tell you, ‘I never wanted to hurt myself. I felt depressed, but I was so tense I just cut myself — [and now] I don’t feel bad anymore.’ ”

Dr. Sureddi says that in people living with bipolar disorder, cutting is more common during what is known as a “mixed phase,” during which the patient is experiencing manic and depressive symptoms at the same time. However, Sureddi notes he does see it during severe depressive phases of the illness as well. During mixed phases, patients often feel very depressed and sad, but also can’t sleep, are agitated, and have impulsive behaviors, so they tend to be in distress — and this phase tends to be the most destructive one of bipolar disorder.

Sureddi adds that any phase of bipolar disorder can lead to use of alcohol and drugs: “When you mix drugs and when you already have depression or any of the major mood episodes, you are also much more prone to cause self-injury.”

Bipolar Disorder and Cutting: How Can Parents and Caregivers Help?

Cutting is such a serious, dangerous, and frightening behavior that you may feel helpless. You may fear that there isn’t anything you can do to help your loved one. But there are some very positive steps you can take to help her control her bipolar disorder, which in turn may help control her cutting behaviors as well:

• Be calm and supportive. Although living with a loved one with bipolar disorder can be very frustrating, it is very important not to show that frustration to her or to be critical. She is also likely to be frustrated by her illness and needs your support. Sureddi says that in order for your loved one with bipolar disorder to do well, family members “have to remain calm, stay supportive, and educate the patient to stay on the medication, encourage the patient to finish either school or maintain jobs, [and] maintain a healthy lifestyle.” He emphasizes that regular sleep patterns are very important in terms of controlling moods and staying well. You may also be able to help your child find alternative ways of relieving stress, which is a common trigger of mood episodes.
• Help identify mood changes. Another important role you can take is to go to doctor’s appointments with your loved one and learn how to recognize signals that she is starting a mood episode. Sureddi says he discusses with his patients the importance of letting family members help them identify when their moods are changing and they are beginning a bipolar phase. He says the phases can come on so suddenly that the person living with bipolar disorder may not even realize it, but family members will notice the signals — such as being cranky or irritable, or not sleeping — sooner. “You can catch it very early and adjust medication or start another medication that actually prevents hospitalization or any other negative outcomes,” Sureddi says.

If you see any of the signs that a loved one with bipolar disorder is cutting or otherwise injuring herself — such as scars, wearing long sleeves in warm weather, or giving excuses for how injuries occurred that just don’t make sense to you — tell her doctor immediately. Together you can figure out the best way to help.

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Bipolar children can have anger and rage episodes lasting several hours. What can be done to control these episodes?

All kids get angry and upset from time to time, but bipolar children can have severe episodes of anger, irritability, and hostile behavior. Unlike other children, bipolar children aren’t usually able to manage their anger with timeouts and other disciplinary measures. “Fortunately, treatments and therapies are available to help bipolar children deal with their anger,” says David Fassler, MD, clinical professor of psychiatry at the University of Vermont College of Medicine in Burlington, Vt., and author of Help Me, I’m Sad: Recognizing, Treating and Preventing Childhood Depression.

Bipolar Disorder: Why Do Bipolar Children Struggle with Anger?

Anger is more common in people with bipolar disorder than in those suffering from general depression, and bipolar children tend to feel anger more intensely than adults with bipolar disorder. “When bipolar children have manic episodes, they’re more likely to feel anger and rage than the elation or euphoria that is common in adults,” says Dr. Fassler. What’s more, bipolar children don’t yet have the skills and emotional maturity to handle their anger outbursts.

While the cause of bipolar disorder is not well understood, it’s thought that chemistry imbalances in the brain play a major role in the condition. Anger in bipolar children is often triggered by stress, but it’s unknown exactly why so many bipolar children have anger issues. “It’s known that bipolar children and teens have more rapid mood changes than adults with bipolar disorder,” says Fassler. These mood changes often manifest themselves as anger episodes.

Bipolar Disorder: What Anger in Bipolar Children Looks Like

Anger in bipolar children can appear as extreme temper tantrums involving verbal and physical aggression. Children with bipolar disorder may physically attack playmates or family members, destroy their favorite toys or siblings’ toys, kick, spit, cry, and scream. It’s common for bipolar children to become extremely upset when they are disciplined or told “no.” These temper tantrums can turn into rages lasting for hours. Bipolar children are often intentionally “dare-devilish” and tend to be risk-takers, which may bring injury to themselves or others. In addition to severe anger episodes, irritability is common in bipolar children, especially when first waking up in the morning.

Bipolar Disorder: Anger in Bipolar Children vs. ADHD Children

Bipolar disorder is sometimes misdiagnosed as attention deficit hyperactivity disorder (ADHD) because the illnesses have some similar behavior characteristics, including irritability and hyperactivity. But anger in bipolar children tends to be much more severe. “ADHD kids calm down in 20 to 30 minutes,” says Fassler. Anger in bipolar children typically goes on much longer.

While ADHD kids may break toys and destroy things carelessly due to their hyperactive behavior, bipolar children do so in anger. Bipolar children also react much more violently and aggressively to parental limit-setting and may conflict with authority figures. And while an ADHD child may stumble into a fight, bipolar children are more likely to enjoy danger, seek it out, and look for a fight.

Bipolar Disorder: Treating Anger in Bipolar Children

Children exhibiting extreme anger outbursts should be evaluated by a child psychiatrist or behavioral pediatrician experienced in working with bipolar children. “It’s important to get an accurate diagnosis before initiating a treatment plan,” says Fassler.

Medication may be the first intervention recommended. Medicines can help restore the chemicals in the brain to a more normal level. This means that the bipolar child is less likely to be flooded with brain chemicals that cause anger outbursts. Family-focused therapy and individual psychotherapy tailored for children can also help bipolar children control anger outbursts. “These therapies help bipolar children tolerate frustration and express angry thoughts and feelings in ways are less disruptive and destructive,” says Fassler. Additionally, family therapy sessions teach parents how to implement techniques at home that can reinforce positive behavior and reduce the frequency of angry outbursts in bipolar children.

There is currently no cure for bipolar disorder, but a combination of medicine and psychotherapy can help reduce the frequency of anger episodes and help bipolar children learn to better manage their anger and disruptive behavior.

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Not taking medications properly is a common problem among bipolar children. Find out what steps parents can take to help them stay on track.

With proper treatment, most bipolar children are able to control their mood swings and related symptoms of bipolar disorder. Most bipolar experts believe that medication can be an effective treatment for bipolar children as long as the medicines are closely monitored. But medicines are only helpful if bipolar children take them as prescribed, which may not always happen. Fortunately, there are a number of ways that parents can help bipolar children stay on their medications.

Why Bipolar Children Struggle with Staying on Meds

It’s common for children, and especially teens, to stop taking their medication at some point during treatment. Bipolar children may stop taking their medicine in an effort to fit in. “Bipolar children and teens don’t like feeling different from their peers who may not need to take medicine for bipolar disorder,” points out David Fassler, MD, clinical professor of psychiatry at the University of Vermont College of Medicine in Burlington, Vt.

In some cases, bipolar children may stop taking their medicine when they start feeling better or because side effects are bothersome. Also, bipolar children may be resistant to feeling dependent on their parents. While independence is a normal part of growing up, children shouldn’t be allowed to handle treatment compliance on their own.

Problems Caused by Medicine Non-Compliance in Children

Bipolar disorder is best controlled when treatment is continuous rather than off-and-on. “Not taking medication or ignoring other aspects of treatment can lead to difficulties, including worsening or recurrence of symptoms and problems at home, in school, or with friends,” says Dr. Fassler. Plus, the longer bipolar children go without taking their medicine, the more resistant to treatment the bipolar disorder may become. Bipolar children should never stop taking medicine or change the dosage prescribed without consultation with a doctor.

6 Ways to Help Bipolar Children Stay on Their Meds

If your bipolar child fails to stick with treatment or resists taking bipolar medications, try the following strategies:

1. Inform and involve. Explain what the medicine is and how it will help your child feel better. “Involving bipolar children in discussions and decisions about medications can also make kids less resistant to taking medicines,” says Fassler. Don’t talk over your child at doctor appointments. Direct some comments to your child about the medicines being prescribed and encourage your child to ask questions.
2. Be honest. Answer your child’s questions as honestly as possible based on what is age appropriate. For young bipolar children, you might say: “Just like some medicine makes you better when you are sick, these pills help sad or angry feelings go away.” For older bipolar children, you might say: “Just like some of your friends take medicine for asthma or diabetes, people with bipolar disorder take medicine to make them feel better.”
3. Use positive reinforcement. For young children, Fassler recommends using praise and rewards, like stickers, when your child stays on the bipolar medicine and takes it without complaint. For teens, you might emphasize how proud you are of your son or daughter for staying on the prescribed treatment plan and never missing doses of bipolar medicine.
4. Try a pill dispenser. These devices can help bipolar children and teens remember to take their medicine in the correct amount and help you keep track of how much medicine for the bipolar disorder has been taken. Pill dispensers are available at most pharmacies for just a few dollars.
5. Monitor side effects. No two bipolar children respond to medicine in exactly the same way. Some children may experience side effects. “Most side effects are temporary,” says Fassler. Explain to your child that these unpleasant symptoms should be going away soon, and that you’ll work as a team to fix things if they don’t. (Let your child’s doctor know about side effects; there are sometimes ways to reduce or eliminate them, or your child may need to put on a different medicine.)
6. Find a role model. “It can be extremely helpful to find a peer with bipolar disorder to talk to your child and encourage him or her to stick with treatment,” notes Fassler. Support groups for bipolar children and teens are perfect for this. By hearing about other kids’ experiences, bipolar children will often feel less alone and understand why it’s important to take their medicine. The doctor who is treating your child’s bipolar disorder may be able to help you connect with a support group.

Bipolar disorder usually lasts for one’s entire life. By getting into the habit of taking medicine as prescribed and sticking with their treatment plan, most bipolar children can lead normal lives now and for years to come.

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You don’t have to be a caregiver to offer love and support to a friend battling bipolar disorder.

If you’ve just found out that a friend has been diagnosed with bipolar disorder, you probably don’t know quite what to do or what to say. But no matter how your friend acts, and even if she brushes it off as no big deal, she will need your help. So instead of saying “please let me know if there’s anything I can do,” take some initiative and figure out what you can do to best help your friend with bipolar disorder.

Bipolar Disorder: How Your Friendship May Change

Coming to grips with a diagnosis of bipolar disorder and undergoing treatment — usually a combination of therapy and medication — will be difficult for your friend. But what you should understand is that bipolar disorder affects you too. It can be tough for you to watch your friend deal with this illness, and it can put a big strain on your relationship.

“When you’re caring for someone with [bipolar disorder], it’s really a collaborative approach,” says Adele C. Viguera, MD, a psychiatrist and associate director of the perinatal and reproductive psychiatry program at the Cleveland Clinic in Ohio. She stresses that doctors and patients can’t do it alone, and that friends and family members play a huge role in treatment, support, and preventing future bipolar disorder episodes.

The stress on your friend can cause changes in her behavior toward you, which can be tough to swallow when all you’re trying to do is help. What’s important is to keep in mind that bipolar disorder not only affects mood, but energy and activity levels, as well as the ability to do daily tasks.

“Remember that it’s the illness speaking; it’s not her,” says Dr. Viguera. “It can be damaging over time — there’s a lot of resentment that builds up.”

Understand that your friend, you, and your relationship have a long road ahead, but that there are many things that you can do to make it easier on everyone.

Bipolar Disorder: How You Can Help

The caregiver isn’t the only one who can help your friend through this time — you can be a huge help when it comes to your friend’s treatment, because you can offer a great outside perspective to her doctor. Viguera says friends and family play a big part in encouraging healthy behaviors that help with treatment and spotting signs of the early stages of another bipolar episode.

Here are some ways that you can help your friend in her battle with bipolar disorder:

• Learn about bipolar disorder. The more you know about the illness, the better equipped you are to understand what she’s going through, and how to help. Read everything you can find.
• Know the early warning signs of an episode. Everyone’s warning signs are different, according to Viguera. If you know that your friend is about to slip into a manic or depressive episode when she stops eating or sleeping for a couple of days, or shopping excessively, you can warn her — and her doctor.
• Encourage healthy habits. If your friend suggests heading out to a bar for the night, redirect her to a healthier choice. You can suggest a movie, a fun night in, cooking dinner, or hitting a restaurant. Encouraging exercise, plenty of sleep, and healthy eating is always a big help — and these things are much easier to do when you’ve got a buddy helping you stay on track.
• Be involved with treatment. Offer to go to doctor’s appointments with your friend, and tell the doctor that you’re available if he needs to contact you. Viguera says that you can be a powerful influence, both on your friend and for the information you can provide to the doctor. “You really need somebody on the outside observing, whom they trust, saying ‘you really haven’t been doing that well in the last few months,'” says Viguera.

There are many times in life when we don’t quite know how to help a friend. But when a friend has bipolar disorder, there are many things that you can do to not just support, but truly help. Be there, stay involved, and know that this illness can be an ongoing struggle.