Many people with bipolar disorder have long periods of time when they are happy and well. Sometimes, people can forget that their medication is helping to prevent future episodes. Other people who have recovered from a serious episode want to stop taking their medication because of unwanted side effects, or because their medication reminds them of times when they were very unwell. Talk with the person you care for about your concerns. You can ask questions such as: Are there any side effects which they dislike? Can the person talk to their psychiatrist or doctor about these side effects? Are there other medications which may have fewer side effects? How long ago was the person’s last serious episode of mania or depression? It can take up to twelve months for the brain to stabilise after a serious episode of bipolar. Are there any triggers which may happen in the near future? It might be a good idea for the person to keep taking their medication during a period of stress. People who have had a serious episode of bipolar are vulnerable to having another episode if they are feeling stressed. Can you both agree that the person will keep taking medication for the time being until the person discusses the situation with their psychiatrist or doctor? Can you talk with the person and their doctor to ask what to do if there are symptoms of a relapse? Are there any risks if the person stops taking their medication without talking to their doctor? Some medications can be dangerous to stop taking unless the person is supervised by a psychiatrist or other doctor. Can you agree with the person and their doctor on a plan to reduce their medication? It can take up to three months for some medications to be reduced safely.

People with bipolar disorder are often very sensitive to stress, and stress is a major cause of bipolar episodes. Most people who have had episodes of mania and depression say that they were very stressed just before they became unwell. If a person has episodes caused by stresses that most people face from time to time, such as problems at work, relationship issues, or financial difficulties, it is very likely that they do have bipolar disorder. If a person has experienced a single episode after a major trauma in their life, such as a miscarriage, surgery, cancer treatment, or a car accident, it is possible that they may not have bipolar. However, they should still stay in contact with their psychiatrist or doctor so that they can be monitored for any signs of a relapse. Talk with the person you care for about your concerns. You can ask questions such as: Do they remember doing things or feeling things in the past that seemed normal at the time but might actually have been signs of mania or depression? Can you both talk about your loved one’s concerns with their psychiatrist, doctor, psychologist, or counsellor? Can you both agree that the person will keep taking their medication for the time being and get a second opinion from another psychiatrist or doctor?

Although we think that bipolar disorder is in the genes, it is hard to predict who will develop the condition in a family. Some members of your family will probably have depression or bipolar, and many others will never be affected by a mood disorder at all. The most important thing to be careful about is stress, because people who are very sensitive to stress are more likely to develop bipolar. Some things you can watch for which might indicate that your child is at risk of developing bipolar include: Depression or anxiety Trouble with alcohol or drugs Difficulty sleeping, such as staying up all night when stressed Problems at school, university, or college Family conflict Don’t panic if you see any of these signs! They do not mean that your child will definitely develop bipolar. However, it is a good idea to organise some help for your child as soon as you see these sorts of problems. For example, you can ask your family doctor to write a Mental Health Care Plan so that your child can see a psychologist or counsellor. You may also wish to start practicing the open communication skills described on page 29 of the Coming Home with Bipolar booklet. This can help your child to feel more comfortable if they need to tell you that something is wrong.

A serious episode of mania can be life threatening. When a person is in hospital, they are usually given antipsychotic medication to reduce the symptoms of manic illness and psychosis. These medications have lots of side effects, but these are mostly just annoying and almost never harmful. When the person you care for is out of danger, their psychiatrist or other doctor usually gives them a mood stabiliser to replace their antipsychotic. It is common to have a period of depression after a manic episode. This can cause the person to sleep a lot and have difficulty doing ordinary things like housework and grooming. It is very important that your loved one sees their psychiatrist or other doctor regularly after coming home from hospital. It may also be a good idea for them to see a psychologist or counsellor, especially once they start to recover from their episode. Talk with the person you care for about your concerns. You can ask questions such as: Is the person keeping track of their feelings using a mood chart or smartphone app? What simple things can you do to help your loved one feel a bit better? For example, you could go for a walk with the person every afternoon. Is the person experiencing suicidal thinking or suicidal thoughts? (You can read more about these thoughts on page 19 of the Coming Home with Bipolar booklet.) Can you talk with the person and their psychiatrist or doctor to find out whether their symptoms are being caused by their antipsychotic medication? What would the person like to happen if they become very depressed? (You can read about Advance Care Directives on page 31 of the Coming Home with Bipolar booklet.)