Hi Dr. Gorman,

In May, my brother, 23, was diagnosed with Bipolar Affective Disorder after a manic episode and involuntary admittance to the hospital.

He did well in school and even graduated with honors from college. His first job out of school caused him stress, and he left. After 3/4 months of unemployment, a relative helped him get a job in the computer field. The stress from this job, along with other factors, resulted in a manic episode.

Unfortunatley, he was fired yesterday. While we knew it was pending because he did not have enough experience/certifications, it hit him hard. Today, he overslept and goes through bouts of "I am not good at anything", "what am I going to do?", and overly worries about financial situations. His attention drifts off, and he mentioned being "better off dead" today. My sister spoke to him about that, and we are on high alert. The family hasbeen very supportive and suggested taking some computer courses. As much as we talk with him and listen to him, I feel heis going to experiece manic depression or another episode. How do we go about getting him help before this or anything else happens?

N.D.

My advice is fairly simple for this tragic situation. Your brother probably needs to be hospitalized for his depression. Bipolar depression responds to medication, but the suicide risk is high. A period of time in hospital is a start to recovery. In Canada it can be difficult to access outpatient care for patients out of the loop, and even patients with psychiatrists can need inpatient carefor serious depressions. If your brother is anxious and hopeless, his risk of suicide is higher. There is nothing more serious than depression in a bipolar patient, and hospital care is as important for them as patients with heart disease. Good luck.