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As a friend of someone living with bipolar disorder, you can offer valuable support by staying alert to the signs of a mood shift.
When you know a friend well, you often notice small changes in their mood or behavior before anyone else does. In bipolar disorder, these changes — sometimes called red flags or early warning signs — may suggest that your friend is moving toward depression, mania, or another period of mood instability. These red flags won’t look the same for everyone and may change over time, so the key is to know your friend’s usual patterns and notice when something feels different.
What Are Bipolar Red Flags, and How Do You Spot Them?
A red flag is an individualized, pattern-based change from how your friend usually thinks, feels, or behaves when they are relatively stable. It might involve early signs of mania or depression, suicidal thoughts, or other changes that suggest something may not be right.
Red flags aren’t universal symptoms, and a single change doesn’t necessarily mean a mood episode is developing. Staying up late, feeling extra energetic, or skipping a shower can sometimes have an ordinary explanation. Warning signs become more meaningful when they reflect a familiar pattern for your friend, occur together, and continue over time.
Early Warning Signs vs. a Mood Episode
Early warning signs are changes that may suggest your friend’s mood is beginning to shift. They may be subtle, such as sleeping less, withdrawing, or behaving differently than usual, and they don’t necessarily mean that a full mood episode is underway.
A depressive or manic episode generally involves a more sustained cluster of symptoms that affects daily life. As a friend, you don’t need to decide which one is happening. Your role is to notice changes, check in, and support your friend in deciding whether additional help may be needed.
RELATED: 5 Subtle Signs of a Bipolar Mood Shift
What you’re looking for is often a subtle shift from your friend’s usual behavior, routines, or symptoms, which is why staying in regular contact with them is important. If you only check in with each other every few weeks, it’ll be hard to recognize if something out of character is happening.
Based on my experience supporting my best friend, Fran, here are some potential red flags to watch for:
Red Flags for Mania
Certain changes may be early warning signs of mania, especially when they’re new, occur together, or differ from your friend’s usual behavior. If you notice them, consider it a reason to check in, rather than taking it as proof that mania has begun. These signs may include:
- Talking rapidly, suddenly changing topics, or taking “leaps in logic” that are difficult to follow
- Having more energy than usual, especially if they need less sleep
- Being intensely focused on one activity or having difficulty focusing
- Showing a sudden increase in goal-directed activity, such as taking up several new hobbies, making unusual purchases, or starting an ambitious project or business
Red Flags for Depression
Changes associated with depression can also be subtle at first. Look for patterns that are unusual for your friend, rather than treating any single behavior as proof that they’re becoming depressed. Possible signs include:
- Having difficulty maintaining personal hygiene, such as not taking showers or combing or brushing their hair
- Not doing their usual tasks or chores, such as washing dishes, doing laundry, or paying bills
- Withdrawing from people, online or in person
- Sleeping more than usual (changes in sleep can also be an early warning sign of mania)
- Using specific language or phrases that your friend has previously associated with a mood shift, such as “It’s not working,” one of Fran’s red flags for depression
What to Do if You Notice a Red Flag
If you pick up on something, don’t assume the worst, but don’t ignore it either. First, consider whether you’ve noticed one isolated change or a broader pattern. Then, calmly and nonjudgmentally share what you’ve observed and ask how your friend is feeling.
Remember, you’re not trying to diagnose them; only a qualified healthcare professional can do that. Your friend is the expert on how bipolar affects them, but as a caring friend, you also have a role to play. Fran relies on me and other trusted friends to speak up if we notice changes that may signal a mood episode.
Every situation is different, but you and your friend have three basic options:
- Decide that everything is okay and nothing needs to be done.
- Decide that something may be happening and agree to keep an eye on things until you’re sure.
- Decide that something is definitely going on and discuss the next steps, such as encouraging them to seek professional help if needed.
The response should match the situation. A subtle or uncertain change may call only for another check-in, while more serious symptoms or concerns about safety may require professional or emergency support.
Have a Wellness Plan in Place, Just in Case
The idea behind watching for red flags is to respond before symptoms become more difficult to manage. But mood changes can sometimes intensify quickly, so it helps to have a wellness plan in place before you need it.
A plan gives you and your friend something to refer to, rather than having to try to remember what helped previously or come up with ideas on the spot.
Wellness plans include steps your friend can take to prevent things from worsening. 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 them to write down what they will decide to try, or offer to write it down for them.
Most wellness plans include a crisis strategy, covering what to do and who to involve if your friend is manic, depressed, suicidal, or otherwise struggling.
RELATED: What Is a Crisis Plan, and Why Do You Need One?
This might involve contacting other friends and family, as well as your friend’s doctor, psychiatrist, or therapist. In an emergency, it might include contacting a crisis line or emergency services.
Unless you’re immediately concerned about your friend’s safety, support them in taking the next steps, rather than going against their wishes or contacting people behind their back. Also, be prepared to act if your friend is unwilling — or unable — to help keep themselves safe.
Then, update the wellness plan after the mood episode and when your friend feels stable, to see how things went. That way, you have something to refer to in the future.
Staying Vigilant for Signs of a Mood Shift
Keep in mind that none of this is an exact science. On occasion, I felt something was going on with Fran that turned out to only be a temporary mood shift.
Living with bipolar doesn’t mean you can’t have “up days” or “down days” like everyone else. At the same time, Fran sometimes mentions that she, or someone else, has noticed a change that I’d missed. So remember: Vigilance is a team sport.
In our experience, the best approach is to remain vigilant while approaching changes with curiosity. Every red flag is an opportunity to learn more about how mood shifts tend to show up for Fran, explore ways to support her stability, and deepen our friendship.
Do you help a friend or loved one keep an eye out for red flags? Or, if you live with bipolar disorder, does it help to have a vigilance ally? Or do you feel that it’s unnecessary or intrusive? I’d love to hear more about it in the comment section below.
UPDATED: Originally posted May 29, 2018