Support for the Patient. Recommendations for supporting the patient include:

• Create a treatment contract as a first step. In this contract, the patient and family agree to specific steps for maintaining emotional stability, including compliance with treatment. If such measures fail, all parties agree on further actions to be taken during an acute episode, including hospitalization.
• Be supportive. Unlike relatives of patients with alcoholism who may be encouraged to get tough, relatives of patients with bipolar disorder must be strongly supportive because of the high risk for suicide with this disorder. Simply listening attentively and being empathic can help. Bipolar disorder results from an imbalance of chemicals in the brain and not from anyone's fault.
• Get the patient to comply with treatment, even if it means threatening a hospitalization if the patient fails to comply.
• For emergencies, have ready a hotline number or the telephone number of the patient’s psychiatrist.

Support for the Family. Bipolar disorder can take a serious toll on family members. Loved ones must also learn to care for themselves and reduce the stress that accompanies the illness. Support groups and Internet message boards can be very helpful for caregivers.

Interpersonal and Social Rhythm Therapy

Interpersonal problems (such as family disputes) and disruptions in daily routines or social rhythms (such as loss of sleep or changes in meal times) may make people with bipolar disorder more susceptible to new episodes of their illness. A form of psychosocial treatment called interpersonal and social rhythm therapy (IPSRT) focuses on maintaining a regular schedule of daily activities to reduce these potential triggers and improve emotional stability. Patients also learn how to avoid problems with personal relationships. Preliminary evidence suggests that IPSRT combined with drug therapy may help prevent new manic episodes.

Lifestyle Factors

Exercise. Exercise can help manage weight gain and increase feelings of well-being.

Sleep Management. Good sleep hygiene is particularly important for patients. Techniques used to enforce healthy sleep may help reduce mood cycling.

Diet. A healthy diet low in saturated foods and rich in whole grains, fresh fruits, and vegetables is important for anyone. People with bipolar disorder should be sure to maintain a regular healthy diet. They may need to restrict calories if they are on medications that increase weight.

Some research indicates that consumption of omega-3 polyunsaturated fatty acids found in oily fish (such as mackerel, sardines, salmon, and bluefish) may help reduce the symptoms of a variety of mental illnesses, including bipolar disorder. Researchers are investigating the mental health effects of eicosapentaneoic acid (EPA) and docosahexaenoic acid (DHA) omega-3 fatty acid supplements.

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Review Date: 01/28/2011
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)