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Help with a loved one with Bipolar 1

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Agapemou

Member
Joined
Jan 13, 2022
Messages
7
Location
USA
Hi Everyone, I'm new to this forum and wanted to reach out to ask for any advice to help a loved one who has Bipolar Type 1 in getting help. My loved one is my brother who is in his mid 40s and was diagnosed with his condition a few years ago when he just turned 40. The situation that I'm in is that after my brother had been on medication for nearly 3 years he slowly drifted off medication in June of last year and has been off medication since that time. I and our parents encouraged him to get back on medication but sadly he did not wish to. He finally left our parent's home where he was staying in early September and has been living in hotels in a nearby city since then. Today he has come back home. Although my parents and I are excited to see him we are trying to figure out how to approach the next steps in the conversation without triggering him. We think when he had made the decision to leave abruptly it's because we triggered him by trying to get him back on medication so taking that into mind we clearly don't think it's a good idea to bring the medication up but we know that he needs to get some sort of treatment and medicine. When he was on medication he was totally fine and it was working well. Through several appointments with his doctor he slowly decreased the dosage to the point it wasn't helping him no longer and he finally made the decision to go off of it. Any help and advice is greatly appreciated! Thank you so much and God Bless you!
 
A

Agapemou

Member
Joined
Jan 13, 2022
Messages
7
Location
USA
Hi, is there anyone that can help with this situation?

Thank you.
 
K

keith74

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Sep 14, 2020
Messages
735
Location
Canada
@Agapemou Welcome to the forum. I hope you find the answers/support you seek!

It sounds like he either is in a bit of denial over his diagnosis or the medication side effects are strong for him to the point where he rather not take them. Do you have an idea on which it may be? Have you discussed why he doesn't want to be on it?

Regardless of the above, it is important that his family (you and your parents) are firm in regards to him needing proper treatment. That would include medication and lifestyle changes. If he lives with your parents, they also need to be firm in terms of what behavior they will tolerate and what crosses the line. It can be tough to stick to those boundaries but it is the best path forward.
 
A

Agapemou

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Joined
Jan 13, 2022
Messages
7
Location
USA
Thank you @keith74 for the warm welcome to this forum. I am excited to find the support and answers to help my brother navigate through this.

You are absolutely right he is definitely in denial of his diagnosis. When he was on his medication, Olanzapine, my brother did very well. He was on his medication for nearly three years, and he was definitely afraid of going to a lower dose early last year but by April he had had gone down to 2.5 mg and was feeling like he was doing well and decided that he no longer needed to be on his medication. That was the point of no return. At that point from my perspective it was as if those a fog had started to set over him and slowly darken his surroundings to the point where he thought that his psychosis, when it did occur a few times, was not real and that he did not need to be on his medication. At his last visit in late August with his doctor, he kept denying everything that had occurred, voices that he heard, microphones that he thought were planted in his car, and despite the doctor strongly recommending he starts taking his medication he insisted that he was "alright" and that if he would start feeling something he would start taking it. That was the last day I saw my brother. After that he left our parents house and started leaving in his car until two weeks later it broke down and left it on the street and moved into a hotel. He then came back twice to my parent's house with a rental car and took whatever little belongings he had (a couple shoes and some savings) and told our mother that he has "moved out".

Well fast forward to today, he has maxed out his credit cards, lost whatever belongings he had and returned to our parent's shop. My parents think he walked the distance from the major nearby city that he was staying at 30 miles to the shop because he was shivering when he came to the shop, completely cashless, and the soles of his shoes were completely worn to the point that the metal framing was protruding out and his legs were swollen to twice the size; he came to the shop yesterday morning. After that my dad and my brother drove home and after eating dinner and taking a shower my brother went to sleep around 7pm and did not wake up until 5:30 pm today. He ate diner and went to sleep again. This all tells us he is extremely tired. I know the sleep is good especially if one has been going through mania so my parents are letting him sleep and rest up.

How do we broach the subject of him needing treatment and when? My parents and I were talking today and we were thinking that especially since he is closest to our father that our father slowly brings up the damages left behind from his actions; thousands of dollars of debt, his broken down car, the fact that he lost everything that he had taken with him and encourage him to go back on his medication and see his doctor. I know this can't happen abruptly and of course it cannot be didactic as that will trigger him; he hates not being in control or told what he "should/needs" to do. Is this a good approach? Are there any examples of ways we can help encourage him that by taking his medication he will be so much better off?

Thank you so much and God bless for all the help and advice!
 
K

keith74

Well-known member
Joined
Sep 14, 2020
Messages
735
Location
Canada
@Agapemou Olanzapine is a common antipsychotic that is good for mania and psychosis. 5mg is considered the minimum therapeutic dose. Did he go on 2.5mg on his own or under the guidance of a psychiatrist? In any case it sounds like the 2.5 is too low and he slipped back into an acute mania+psychosis.

Since he can sleep, it indicates that he is likely coming down from his mania. And yes, sleep is HUGE to recover from mania. The sleep is a good sign. He may not be fully recovered yet but he is getting there.

You mentioned he got diagnosed at 40. Was he simply undiagnosed earlier? Or did it manifest recently? I ask because bipolar episodes usually start earlier in life. If it manifests late, it could be due to abuse of substances like alcohol or especially weed.

It is always super tricky to try to encourage someone to get help when they are in denial. The first rule is wait until they are back to baseline (or close to it). If they are still in a mood swing, then it is much harder to have a fruitful conversation.

Check out the below article for more tips:
 
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Agapemou

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Jan 13, 2022
Messages
7
Location
USA
Thank you @keith74 for the reply! He went to 2.5mg under the guidance of his doctor, a licensed MD and psychiatrist. When he was first diagnosed at 40 years, he was going through a huge manic episode and was 4 months into the episode; he had not returned to baseline on his own but rather through happenstance my father was able to intervene and urge him to go to the local ER to check a nasty bruise on the head that was caused by a police officer that had detained him two days prior. At the hospital my parents, and close family friends and loved ones talked to the psychiatric doctor that was managing the ER and explained everything that was going on and she sent him for a psychiatric evaluation after she heard all the things we were sharing with her; also at the ER, at that time, they ruled out any other medical causes for his behavior (i.e. tumor, brain trauma, etc) through running lab tests and performing catscans. He was sent to a behavorial center and there he was diagnosed with Bipolar 1. He was at the behavorial center for nearly a month and was released after he had started taking the Olanzapine that was prescribed. He was prescribed 15mg. Two months later after he was released his outpatient Psychiatrist at that time agreed to bring it down to 12mg. A year later he came down to 10mg under his 2nd Psychiatrist, the first one unfortunately had left the hospital to go to back to teaching, and he was on 10mg for an entire year. During that 2nd year my brother had asked for the possibility of going down to 5mg and his Psychiatrist said they can try that and see if it it's working for him but my brother himself didn't want to go down to the 5mg; he told his Psychiatrist it's ok I'll stay on 10mg for a few months more. It wasn't until late 2020 that my brother re-broached the topic with his Psychiatrist and was prescribed and started taking 5mg. A few months later at the beginning of 2021 my brother asked to go to 2.5mg and was on that for a few months until he really started to push that he didn't need to be on it.

My brother was never diagnosed before he turned 40 years nor did he ever go through an manic episodes, at least to the extent that psychosis kicked in that year (i.e. delusions of hearing and seeing people that did not exist). Even his Psychiatrists, the second one who is also the one that he has seen the most, said it was very rare for someone to experience full blown mania at that age but urged that in some small cases it can happen and when it does it needs to be managed through therapy, lifestyle changes, (i.e. sleep and reduction of anxiety triggers) and through medication.

Fortunately, my brother has never abused any substances. He never could physically take any medicine (swallow pills) larger than a baby Tylenol (he would gag terribly), never took weed, although he did smoke hookah recreationally in the past in a social setting on occasion.

I agree with you that being diagnosed that late in life could be from a substance abuse but that was ruled out. I do believe however that perhaps he was hypomanic for years before he turned 40 because now in hindsight he was always a bit of a "hot head" and had trouble managing relationships with people; he just never full blown went into psychosis or mania until that year; I think there were a lot of triggers and stress that year that advanced his illness into full blown mania: the fact that he had turned 40 years old I believe was a tipping point in his mind because he had told me I'm 40 and I haven't done anything "look at you you are already married, have a house" (and I'm younger by 7 years) and he was looking too at our youngest sibling who had also just recently got engaged to get married.

I also agree and too believe that 2.5mg was just to small of a dose, I'm hoping my brother can get back on this medication because when he was on it at a higher dose around 5mg or even 10mg it was working great with him and he himself said that he had no side effects from it and he really didn't. His blood pressure was under control as was his weight, and equally important he didn't have any side effects that he noted like it making him too drowsy where he couldn't function.

Thank you for your comment, I agree with you that it appears he is close to baseline, at least my parents and I are certainly praying for that! And thank you for sharing the article! I had read this article a long while back but I just re-read it and yes, I am guilty in the past of jumping too soon and pointing out his illness during a time when he was in mania and not so close to baseline; I did that in August at the doctor session and afterwards he did not want to talk to me, btw my brother has still not reached out to me but appears to be reaching out to our dad. I'm going to share the article with my parents today and I honestly believe my dad is the one that my brother may potentially open up to.

I just hope that my brother realizes the consequences of his actions and the huge impact they have had on his life right now as a wake up call so to speak for him. I had read in other articles that when someone finally opens up the key is to actively listen. After actively listening what are some techniques to potentially use to help my brother take steps forward towards taking medication to manage his illness without triggering him even more? I know it's easy for me to just want to say hey look at everything that just happened, start taking your medicine but I know that will only make things worst at the same time.

Thank you very much for the guidance and advice so far and God Bless!
 
K

keith74

Well-known member
Joined
Sep 14, 2020
Messages
735
Location
Canada
Was olanzapine the *only* medication he was on? If he was reduced to 2.5mg while not on anything else... that is pretty risky. Sounds like he tolerated it pretty well given his lack of side effects. The side effects are the main reason why many people want to taper off it but sounds like that is not an issue for him. Admittedly, olanzapine is more commonly used in acute manic settings. When a person is stable, a mood stabilizer (like valporate) is usually more preferred for maintenance.

Agreed that for people who are diagnosed late, in several cases that person showed hypomanic symptoms that was dismissed as a personality trait. Since untreated bipolar gets worse over time, eventually that hypomania erupts to full-blown mania. Sounds like that could have been the case with your brother.

Anyway I'm glad to hear that substance abuse is not an issue. That is usually a major source of contention since many people do not want to give these up - especially weed.

Good luck with helping your brother. He is fortunate to have a supportive family! I've always read that it is hard to make someone get treatment and take their meds. The best approach is for your family to express how they/you feel regarding is illness. Discuss how hard it was for you and your parents to deal with... the impact it had on everyone. And finally discuss that you and your parents need him to get proper treatment if he wants to continue to have a good relationship. Boundaries are important and if you are firm with them, they can be effective it convincing the person in denial to get help. Again, all of this will work best when the person is at baseline or close to it.
 
Backwoods Beast

Backwoods Beast

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Nov 10, 2021
Messages
169
Location
US
Just read this whole conversation. Lots of good input @keith74.

You sound like a really great sibling @Agapemou. Your brother is very lucky to have you and the rest of your family in his life.

I just thought that I'd add from personal experience... My "intervention" and acceptance of help came when the closest people to me made it super clear that my situation was painful for them to witness. As someone who cares very deeply about those people, I accepted help because of them, even while in denial. I was in a full blown psychotic state though, and had this strange hero complex where I wanted to help people (literally anyone) at all costs. I think it depends on the person. Common emotions and personality traits tend to be more extreme when people with Bipolar are cycling. It is probably best to wait until your brother is at baseline, but reading the situation and his personality is very important. If, for example, he's afraid of letting your father down or something, in his current state that fear might be amplified, and in that case it may be something that you could capitalize on. In any case, it sounds like it's definitely the right choice to have your father be the one to approach the subject if they share the closest relationship.

Best of luck to you all. Make sure you take care of yourself too.
-Beast
 

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