Need advice about a friend...

So, down to business, I suppose. I posted this in the Intro forum too because I wasn't sure where it would be most helpful...

I actually decided to try this website because my best friend is bipolar and two things are happening:
1) I'm running out of ideas on "how to help" or what to say to him
2) I'm starting to get irritated with him about it.
I know that sounds like it makes me a horrible friend, but bear with me.

We've been best friends since we met in college several years ago, although it doesn't seem long, we pretty much know EVERYTHING about each other. It's embarrassing sometimes how personal the conversations can get.

Anyway, he ended up have a major depressive episode, dropped out of school for a year, went back finished and for the last year and a half has more or less been in another depressive episode.

Occasionally, he seems to hit a hypomania stage for a few weeks, especially when he revamped his religious beliefs (it was almost two months of him being happy!), but overall, he's very irritable, anxiety-ridden, has constant suicidal ideations and feels the entire world is a horrible, evil place that is conspiring to bring him nothing but pain and misery. Just today, he told me that he feels like evolution itself designed him to make him extinct.

He refuses to take medication, claiming it caused a suicide attempt at least once, followed by hospitalization. He refuses to see a psychiatrist again because he feels that they do nothing but judge him and aren't empathetic enough. He really refuses to leave his apartment at all unless its to run to the store at 3am when no people are around to stock up on food.

I know that on top of his bipolar disorder, he's had some very traumatic events happen in his life, including watching several people die very violent deaths and other occurrences. He really has no support from his family and only one other good friend.

So I do understand some of his perspectives and why his depressive episodes might occur so frequently for such extended periods of time, but he lives 700 miles away from me now so all I can do is try to talk to him everyday, but I don't have anyone to talk to it about afterward and I'm really just kind of winging it with no idea about what I'm doing.

Today, for instance, he was describing how to world was such a horrible place and wanted to know why I was just listening and not offering my opinion, so I told him that I've just experienced otherwise, gave him examples because he didn't believe me and when we got off the phone I was left feeling like I'd just made things worse for him.

I almost never take his moods personally, that much I do understand, but I can't help but also feel like he's setting himself up for these depressive episodes. For example, he constantly talks about how he's lonely and isolated, but he refuses to leave his apartment and he admits that he will deliberately act "crazy" to new people in his life to "test" them. I've tried to explain that's not a healthy way to interact, but he's convinced it's the only way someone worthy could stay his friend.

All I'm really asking is, HELP. I don't know how to help him...

Any advice would be WONDERFUL.

I'm sorry that this is causing you so much stress, it sounds very challenging. Unfortunately it's hard for you to help someone who refuses to help themselves. It's good you don't take his moods personally but it does seem to be causing you stress. Is there anyway you could go visit him? It might be easier to convince him to get help in person?
Good luck and I hope that he will get help !

Diagnosed: Generalized Anxiety Disorder & Obsessive Compulsive Disoder. Previous: Borderline Personality Disorder.

I've been working passionately as a therapist since December 2016

I don't know if you want to set limits. You might let him know that there are certain behaviors of his that you cannot tolerate anymore, define them, and that you will not spend time with him, unless he gets some help.
You could let him know you are going to leave, or ask him to leave, when you are not willing to be around him.
Otherwise, perhaps not giving him feedback except that he clearly needs professional help, the broken record routine. Only talk when it is about something positive, a common interest, or an activity. Stop trying to help. Let him know you can't.

It sucks, but there is not much you can do to help someone who does not want to be helped. It's possible that by talking to him every day, you are actually helping him postpone seeking professional help. It's probably not healthy for your own sanity.

I have struggled with this issue. It is very hard to watch someone engage in self destructive behaviors without being able to convince them to stop. At a certain point, I find myself stepping away. It feels really horrible to do that, but what else can you do?

In many cases, my friends have eventually sought treatment and we have been able to reconnect. I hope things work out with your friend.