Where do I begin? You can do many, many things to help. It’s best if your sister-in-law wants help. If she doesn’t, she’s just likely to get upset with you and become even more stressed out if you try too hard to intercede.

If you are afraid of her safety (suicidal) or the safety of those around her, and she will not agree to hospitalization, you will have to try to work with the system to get her the help she needs. That may include calling social services or even law enforcement. (Most counties, I believe, have mental health services; check the county services listing in your phone book.) Be careful, though. Not all law enforcement officers are accustomed to dealing with people experiencing a full blown manic episode. They could end up harming your sister-in-law or causing more problems for her. I’d try working through social services or a local branch of a mental health advocacy group like NAMI.

If your sister-in-law is not posing a danger and does not want your help, you may want to back off. This is really a tough call to make and is entirely your decision. I can’t give you advice either way on this.

If your sister-in-law does want help, you can help in numerous ways:

• Take some of the daily burden off of her - watch the kids, cook, pay the bills… whatever she finds most stressful, try to remove the stressors from her life.
• Attend doctor visits with her (requires her permission). Take copious notes and do what you can to help her follow the doctor’s orders, such as taking her meds.
• Attend therapy sessions with her. A good therapist can suggest all sorts of practical strategies for making life more manageable and reducing stress.
• Offer mood feedback without being a nag about it. My wife often can’t see when she is cycling. I have to point it out.
• Offer to do something fun with her. When life is all about bipolar disorder, it gets pretty annoying. Sometimes, you need to forget abou the disorder.

Part V of our book Bipolar Disorder For Dummies is called “Assisting a Friend or Relative with Bipolar Disorder” and has three chapters on what you can do to help. Another popular book that many people seem to find helpful is Loving Someone with Bipolar Disorder by Julie A. Fast and John D. Preston. I have a copy but haven’t gotten around to reading it, so I can’t exactly recommend it, but Julie writes a column for bp Hope magazine and has a solid reputation in the bipolar community, so I expect it is good.

We wish you and your sis-in-law the best.

It is uncommon for the mood stabilizing agents Lithium and Depakote to cause panic or anxiety. In fact, Depakote is sometimes used as an adjunctive treatment for anxiety.

The atypical antipsychotics - Risperdal, Zyprexa, Abilify, Geodon, and Seroquel are also unlikely to have the side effect of anxiety or panic - they tend to “cool down” the brain responses rather than rev them up. But I have seen some paradoxical anxiety reactions with some of these medications including Seroquel and Geodon.

Lamictal, another mood stabilizer that has anxiety listed as a potential side effect, but I have not seen Lamictal increase anxiety very often in my patients.

The antidepressants all carry some risk of exacerbating anxiety in certain individuals, in addition to the risk of triggering mania.

If you are concerned that anxiety has started or increased after beginning any new medication or increasing the dose of a medication, be sure to go over this with your prescriber. As I said, even if it isn’t a common side effect, your body and brain are different from anyone else’s and so could have a unique response.