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Q:  David, I have a very bright 20 yr. old daughter with bp disorder who is currently out of college while we try to find the correct med dosage for her.  She was diagnosed a year and a half ago and had to quit college because of instability.

She is currently at home doing very little.  She has become a recluse and has no friends.  I hate to see her at home alone this way.  I wonder if I should encourage her to get a part time job?  Should I give her chores to do at home?  There are times she is so unstable that I hesitate to ask her to do anything.  Should I demand she help around the house when I see that she is feeling ok?  Her moods are still all over the place and so I have grown fearful of upsetting her.  When she is depressed, she stays in her PJ's all day and stays in her bedroom.  I have encouraged her to go to a support group but she refuses because she feels too vulnerable and uncomfortable in that environment.

What do you recommend?  When she is feeling "normal," she is a disciplined, kind young lady.  She desperately wants to go back to college and becomes depressed about her "falling behind" her classmates. By the way, my daughter excelled in high school (before her diagnosis).

I would appreciate any suggestions you may have.  She is currently under the care of a good psychiatrist who is working hard to stabilize her.

Thank you!

Dear S,

When your daughter is ill and unstable, her beliefs about herself and her world will be distorted.  If you try to talk to her about your about her relationships, school, work, or life in general, chances are you'll be talking to the bipolar disorder instead of the person you love.

Treat the bipolar disorder first.  Major depressions can dramatically interfere with functioning such as work, school and relationships.  The duration of a major depressive episode can vary substantially from person to person and often persists for a number of weeks or months.  A depressed person often slows down to the point that nothing can get done.  Getting out of bed can be a monumental task to the depressed brain.  For now encourage your daughter to remain relentless in assisting in her own recovery by staying on her treatment, keeping her appointments, and communicating openly about all of her behaviors and symptoms with her psychiatrist on a regular and frequent basis.

It requires great patience and persistence to get the correct medications and dosages and once your daughter feels improvement, encourage her to continue taking her medication for the rest of her life.  Stopping her meds because she feels better can throw her into a relapse which can impact her ability to return to her earlier level of functioning.  Bipolar disorder is a chronic disease, like diabetes and requires constant treatment and re- valuation.
As difficult as it may be to watch your daughter in her withdrawn state right now, I would trust your instincts about pushing her during this time of instability.  Discuss with her psychiatrist the appropriate timing and gradual re-integration of your daughter back into her social and school life according to what is manageable and important to her.  In my subjective opinion, individual therapy can be just as, if not more beneficial than group support if your daughter is willing.  Again, I would not push this during times of extreme depression or general instability.  This is another topic for discussion with your psychiatrist.

These suggestions may seem insignificant but they are really quite important now and across the lifespan for problem prevention.  Encourage your daughter as she is able to adopt a healthy lifestyle.  Get sufficient rest, regular exercise, eat a balanced diet, work at managing stress levels, and avoid alcohol or other drugs.  Research has shown that individuals with bipolar disorder who are able to maintain a daily and regular routine are better able to avoid relapses in their disorder.

Learn to identify symptoms that can trigger relapses.  Have an action plan in mind such as who to call, which medications to add, or which proactive behaviors to engage in, when you notice signs of a possible  relapse.

Recommended Reading: 
Loving Someone With Bipolar Disorder, Fast, Julie, A, 2004.
The Bipolar Disorder Survival Guide, Miklowitz, David J., 2002.

David Schafer, M.Ed.
Staff Psychologist

Published May, 2006

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