As a friend of someone living with bipolar disorder, you can offer valuable support by staying alert to the signs of both depression and mania.
“Red flags” can alert you when your friend with bipolar disorder 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, also known as an early warning sign, suggests your friend is moving from relative stability towards crisis mode. It may include early symptoms of mania, depression, or suicidality, as well as things which, while not directly bipolar-related, suggest that 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 regimen, and ability to manage symptoms change.
RELATED: 5 Subtle Signs of a Bipolar Mood Shift
What you’re looking for is often a subtle shift in behavior 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 signs of mania may occur in your friend or loved one. If you see any, take it as a signal to talk to them about how they’re feeling. These signs may include:
- Talking rapidly, suddenly changing topics, or taking “leaps of logic,” something that doesn’t have a supported conclusion
- Having more energy than usual, especially if they need little sleep.
- Being intensely focused or finding it hard to focus.
- Sudden increase in goal-directed behavior, such as starting a new hobby, buying certain items, starting a new business, etc…
Red Flags for Depression
It’s essential to recognize the common signs of depression, as this can help you identify if your friend or loved one may be going through it. Some of these signs include:
- Having difficulty maintaining personal hygiene, such as taking showers or combing/brushing their hair
- Not doing their usual tasks or chores, like washing dishes, doing laundry, or paying bills
- Withdrawing from people, online or in-person
- Poor sleeping habits (which can also be a red flag for mania) or sleeping more than usual
- Using specific language or phrases indicative of a pending or current mood episode. For example, “It’s not working” is 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 also don’t ignore it. Acting promptly and appropriately can help your friend gain control of their mood shift.
First, calmly — and non-judgmentally — share what you’ve noticed and see if your friend agrees. They may have a different take on things. Remember, you’re not trying to diagnose them; only a healthcare professional or psychiatrist can do that.
On the other hand, your friend is the expert on how bipolar disorder affects them, 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 that suggests she’s at risk for a mood episode.
Every situation differs, but you and your friend have three basic options. (Note that “hoping it will go away” isn’t on the list!)
- Decide everything is okay and nothing needs to be done.
- Decide something may be happening and agree to keep an eye on things until you’re sure.
- Decide something is definitely going on and discuss what to do about it. For instance, you can encourage them to seek professional help if needed.
Have a Wellness Plan in Place, Just in Case
The idea with red flags is to take preventative action before things get out of hand. But situations can change rapidly when someone has bipolar, and it might be a little late for prevention by the time you spot the impending signs.
RELATED: Recognize Cognitive Changes to Monitor Your Moods
So, it helps to have a wellness plan in place, something to refer to, rather than trying to recall what’s working 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 in mania, 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, your friend’s doctor, psychiatrist, or therapist. In an emergency, it might include online or telephone crisis lines.
Unless you’re 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. 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 of Mood Shift Symptoms
Keep in mind that none of this is an exact science. On occasion, I felt something was going on with Fran, which turned out to be a temporary mood shift.
Living with bipolar doesn’t mean you can’t have “up days” or “down days” like everyone else. Yet, on the other hand, Fran sometimes mentions 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 view vigilance in a spirit of curiosity. Every red flag is an opportunity to learn a little more about how bipolar manifests for Fran, to explore how 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? 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