Expert: Ivan Goldberg, M.D. - 5/13/2005

Question
Dear Dr Goldberg,

Recently, one of my friends has gone into a period of deep isolation. He doesn't take phone calls, emails, "msging", and there's no chance in heck of seeing him in person. It has been almost a week and I am very afraid for him, as he has tried to kill himself 10 times before. He says he's not going to, and that he just needs some time completely alone. He's 41 and is not on any medication, although he has been diagnosed with a Bipolar disorder (I'm unsure as to what category).
We've become closer than friends, so it's not as if I'm just an aquaintance, and I've noticed a lot of rollercoaster episodes. The happier he gets, the harder he falls - and usually after any kind of really intensely pleasurable or happy events, he will change on a dime and become very irritable, despondant, angry, frustrated, and hopeless. Again, he REFUSES to ask the doctor for medication, as his trial of Lithium went rather badly apparently (he was much more aggressive), and Effexor apparently didn't do anything at all.
My questions:
1)Is his isolation healthy? (ie Should I just leave him alone?)
2)Is there any way I, as a friend, can help him to get better enough to want medical treatment; that is, any non-medical treatments etc?
3) Do you believe in forcing social situations, and phobic situations, in order to "knock" them back into a better state of mental health; or will this lead to worse symptoms?

Thank you very much for your time, it is VERY much appreciated.

Sincerely,
E.

Answer
Hi . . .

Not knowing your friend there is no way I can give you specific advice.


In general it is a good idea to stay in touch with someone who is severely depressed. You might take a look at:
http://home.blarg.net/~charlatn/depression/Best.things.html
for some things your might want to say to him.

As far as helping you friend get the help he needs, you might offer to go with him to see the doctor.

Best regards . . .

Ivan
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