Mental health counselor here.

The outcomes of treatment for bipolar disorder are unfortunately very variable. It depends on how severe your son’s symptoms are, how well he responds to the medications cocktail he’s being given, what that medication cocktail is, and how well he adheres to it.

The important thing is that your son controls what he can control, which is largely whether or not he takes his meds and how much he engages in therapy. Therapeutic skills involve insight/mindfulness work (i.e. how well your son can recognize his symptoms as they’re happening) and resource use (i.e. does he inform his therapist and/or psychiatrist when he notices he’s be king symptomatic). Mania often feels amazing to people experiencing it, so they’re often motivated against treating it when it occurs, and this is major barrier to treatment.

A big component is whether or not symptoms of psychosis are involved in either the mania or depression. Psychotic symptoms are: 1.) hallucinations (false sensory perceptions, like hearing voices, seeing things, smelling things, etc), 2.) delusions (false beliefs that don’t conform to “normal” societal beliefs, like “I am Jesus” or “God has a mission for me”), and 3.) paranoia (i.e. feeling people around you are hostile to you or are spying on you, etc). These can be experienced in either mood state, but are most often seen in manic states.

I would suggest getting in touch with an organization called NAMI (National Alliance for the Mentally Ill) as they have tons of resources for people struggling with mental illness and family members of mentally ill people.

Type two here, with depression starting when I was 13. Was diagnosed at 21. Mostly struggled with depression and hypomania, and the rapid change between the two. Being diagnosed was maybe the best thing that happened to me. Everything fell into place. It took about 7 years to get the treatment just right, but the medication was mostly working after a year or two.

I've been to a lot of meetings, and I know a lot of bipolar people. The thing with bipolar is that when you get the medication right and you do the work, the disease is really manageable. But one of the most frustrating part of the disease is that many suffering from it are not taking their meds or not doing the work. And you can't force them to either. You can lead a horse to the water, etc. I have been really focused on getting better, but I see the appeal to just don't do it. One tends to see the disease through rose-tinted glasses. And it is work to just be "normal". So just saying fuck it and ride the nice initial waves of hypomania/mania can be really tempting. But there is nothing good coming out of that.

I highly recommend reading An Unquiet Mind by Kay Redfield Jamison (and her other books for that matter), she is an expert in bipolar. Both as a psychologist and as a bipolar person herself. Wishful Drinking by Carrie Fisher was also good. I think it is good to try to understand why bipolar people think and do as they do. I do recommend support groups too. Where I'm at there are group meetings 1-2 times a week. Relatives are welcome too. Sometimes there are meetups for relatives only too.

I wish you all the best, and just know that it is possible to live a full and great life as bipolar. There are medication and life-style changes that does wonders, the hard part is sticking with it.

Stepbrother has it and ultimately his mother died from it.

He's fine on his meds, but finding one's that worked was apparently bad. But once they did he's fine. Glad he managed to find them, hope he stays on them.

Diagnosed BIpolar 1, mostly depressive, but sometimes manic.

I am deathly afraid of the manic episodes that I've got some fear of "being too happy". I'd rather deal with the lows (even the lowest of the low) because at least with those, I can trust myself to lack the energy to be destructive. I am fairly confident that in my lowest, I won't even have the energy to commit suicide even if I want to.

Mania is a very different beast altogether. It might manifest on a spectrum from "just too wired up for sleep" to, in a couple of really badly unmanaged episodes, going off to an entirely different part of the country on a whim just because "who cares, I'm dying anyways?" Only through sheer luck did I manage to get home safe both times.

That said, honest self-awareness, honesty to the mental health professionals, and sticking to the treatment plan could make it manageable. It's no guarantee, but it helps.

It also helps to manage expectations: the treatment won't be on target especially on the first states, while the doctors adjust the medication and the dosage, deal with the side effects, etc. Some kind of faith in the process is necessary, I think--not blind trust, but trust that if you inform the doctors honestly any effects (side effects or not) to the best of your abilities, then the doctors can manage the condition better than if you think "I feel fine, the meds aren't needed anymore!"

The treatment--the management of the condition is likely to last until the very end, and that's fine.

About being in a relationship? It's really up to the person and their partner: I wouldn't trust myself to go on in a relationship without at least informing my partner about it--and keeping them up to date with "my mood weather report". However it probably takes experience, a few cycles to get used to it.

I was diagnosed with Bipolar type 1.

I also worked in mental health.

The early stages can be tough because the person diagnosed has not yet learned how to recognize and cope with the issues bipolar brings.

It's not hopeless. I finished university, started a stable career, bought a home, maintained some stable social relationships for decades, have a long term romantic partner. There were challenges along the way, but you generally get better at managing them as you go through more of them.

In addition to whatever recommendations the doctor makes , there are some things that every bipolar person can do to make things easier. If my illness is flaring up, I have a simple checklist.

If you notice a manic/depressive flare up, have you ... Slept well? Eaten a remotely healthy meal? Done anything physical? Done anything social? Done anything productive?

Yes, these things will help pretty much anyone if you do them regularly, but they're especially important for bipolar. They're also listed in order of importance.

Hi, Bipolar NOS (“not otherwise specified”) here, more down than up. It’s absolutely possible to do great. Like your son, early 20s onset, spent some time inpatient to get sorted out, and have been in consistent outpatient therapy and psychiatry treatment ever since. Completed a PhD program, got married, job market sucks but I’m still optimistic all things considered. I think consistency in treatment, lots of patience, and a good psychiatrist who you can trust are key.

My spiel on the medication part, and some bipolar stigma: some people want to chase the mania, or get a little hypomania and think they’re doing better and don’t need the meds, or think the medication “stifles creativity,” and they give us a bad name. Think Kanye. For every up, there is a down. Not every up is good. The down is far worse. For me, it’s important to remember how bad things can get, because I don’t want that. Whatever side effects and months/years of tinkering with medications are worth it, to me, over losing my spouse, friends, family, or even my life.

Yes, the process of trying medications sucks, but it’s entirely necessary. Also have a good plan for if things get suddenly worse, because they absolutely can — a dud batch of mood stabilizers from when your pharmacy switches manufacturers, for example.

I could literally go on forever, but the tl;dr is that you can do great, just be prepared to put some time and effort into it. And never stop taking medications because you think/feel you’re doing better.

There are multiple types of bipolar disorder with various features, so take any advice from strangers with a grain of salt, as they probably don't know the specifics. I have a couple of personal experiences with bipolar disorder in general.

First, a close friend of mine - his manic episodes would usually involve him staying awake for days at a time, and his depressive episodes were pretty bad. Before being diagnosed with bipolar disorder he had some pretty bad experiences with therapy from a "therapist" that clearly didn't know anything about depression or bipolar disorder, since being diagnosed and settling on a medication he has been much, much more stable. I used to lie awake unable to sleep from the stress of worrying about him, I don't anymore. He still has depressive and manic periods but they are much, much less severe.

Secondly, an aunt. She had one of the more severe types, but we didn't know it. She always had bad depressive episodes (and there was apparently an early bad episode of mania that was written off as a one-off mental episode from stress or something) but it wasn't until she suddenly left my uncle and their children to run off with a married man she barely knew that it became more apparent something else was wrong. I suggested - stressing that I am not an expert in the matter - that it kind of sounded a lot like some of the self-destructive manic episodes I had heard about, not from my friend but from Stephen Fry. I had heard him talk about his bipolar disorder at one of his shows in Sydney, and his past involved a lot more trouble than you'd expect. He has a couple of documentaries about it, but I can't speak on how helpful they would be. Anyway, I turned out to be right, and so far she seems to be doing better, but it's still early days.

The main takeaway is there is hope. One thing I took away from Stephen Fry's talks in particular was that it is vital to keep taking the medication and not to decide, after a period of stability, that you don't need it anymore, that's a recipe for disaster.

An important question; type 1 or 2? They're both difficult but type 1 tends to really wreck lives in a dramatic way.