Bipolar

First - *hugs* Have you tried looking for a NAMI group in your area? They might be able to furnish some advice, support groups etc.

I've almost been there and done that - the story is not quite the same.

Shortly after I started nursing school my son began acting in a very similar way. He broke down and nobody could get in the way of what he wanted to do. He would almost demand money with menaces - we would give in, because we were too scared about what he would do to himself if we said no. I believe we did the right thing at that time.

He was on a benefit, and as soon as his benefit money arrived he would buy vodka and cigarettes. To see someone who could offer effective help - we had to wait three months. Too long.

Hang out for the month - maybe get some kind of stabilising medication from a local doctor to tide your sister over. All I can suggest is that you do your best to plough on through this until you can get some help.

There are good medications now days.

My son was in a depression, he eventually received a diagnosis of aspergers - with the diagnosis came understanding. Having an understanding of why there is struggle can help people to turn their lives around.

There is struggle within your family at the moment - but things will get better. Let your instincts guide you to do what is best for your sister.

oh - my thoughts. If she is unwell at present - don't apply an extra stress.

Don't put pressure on her. Try to compromise with her in some way in order to get your sister to take her medications.

One other thing, prozac made my son wild, it feed the hypomania.

just a quick encouragement, as I'm off to work. I know from family experience that bipolar runs a broad spectrum, it is difficult for some people to get leveled out on meds (but it can happen) and when one is only 18, their body is still maturing physically and emotionally. Sadly, your sister may have to become sick and tired of the mood swings before she takes her self-care seriously.

I am so sorry that this is causing you undue stress. As a wife and mom who has just graduated from nursing school and started a new job, I can relate to the super-stressed aspect.

Hang in there!

Tam

Hi-

I actually have Bipolar II, that's the form of the disorder that is accompanied by less dramatic "hypomanias" rather than the all out manias. Still, this has wreaked havoc on my life- I took time off from college, and I've been to the hospital before. Now I've managed to pull it all together and have a psychiatrist and am on a stable regimen. I'm actually more than half way through medical school right now (I was lucky- I never did anything that ended up on my permanent record).

I'm nearly 30, so sometimes it takes a while to really get it together when you have an illness like this. And it's the earlier years that are the most difficult. Your daughter will most likely not be like this forever!

Also, a psychiatrist that you can go to regularly is key!! Not everyone is so lucky, in many cases they don't take insurance, nobody's taking new patients, insurance doesn't cover it... My main psychiatrist does not take insurance but has lowered her fee for me given my financial situation.

A must read-

The Unquiet Mind by Kay Jamison- this is the author's own memoir about struggling with her diagnosis, whether or not to take meds.

My ex husband was dx with Bipolar a year after our second child was born. It was a really hard road with him. I tried and tried to get him the help he needed, unfortunately his parents didn't believe his dx and blamed me and marriage problems for his problems. And his dad is a retired psychologist. I went back to school so I could leave him when I realized things were not going to get better. He was very emotionally and mentally abusive towards me. He became manic and left me half way during my prereqs. Luckily, a judge saw he was sick and gave me primary custody, allowed me to move out of state with my two sons to go live with my mom so I could go back to school. I graduated in May, and started orientation this week.

I am so so so sorry you will have to travel down this terrible road and I hope your outcome is much better than what I experienced with my husband. I think a major problem in getting him well was he never had consequences to his behavior. I felt if I left him, his emotional abuse would turn towards my kids who were small at the time if I was not a buffer, plus I had no means to support them and he would make a divorce really hard and expensive (which he did when he left). His parents always bailed him out of any trouble he got himself into...usually financial probs like spending rent or car payment on stupid things. Giving him money when he blew yet another job. I think your best bet and this is my personal advice is to set boundaries. If she continues to not take meds or go to the psychiatrist then she shouldn't be able to live in your home. You can support her getting well but not getting worse. Because if you don't assert your boundaries she will just continue to rule the roost making your life really difficult. This is so much harder done then said but I lived with bipolar for years in my home and just being permissive to disruptive behavior will not help. I almost feel like having a person with bipolar is similiar to having an alcoholic in the home and sometimes it takes them hitting rock bottom to get the help they need. If everyone makes things easier for them, takes the bad behaviors and have no consequences they think, "Hey my life is going ok, don't know what my family is talking about, I don't need meds etc." I would wager a bet that since bipolar has genetic links your father actually has it and self medicates with alcohol. If you have any questions, or need to talk this out feel free to send me a message. I am sorry I do not have easier advice...this disease is so sucky for everyone.

There is a very good Psych Nurses Forum under the specialty tab. The people there are great and you may want to post there also to get more feedback.

I can only sympathise and tell you how sorry I am that you are having these problems, and say good for you and your Mom for working together to make sure your family has a better future.

Bipolar disorder aka Manic Depression is a difficult illness for many who have it. It is even more difficult on the family. Family is often the ones who have to pick up the pieces...sort of like damage control after a raging tornado set loose in the house.

Bipolar Type I appears to be what your sister suffers from (as described by the picture you paint)...with the high manias alternating with the low depressions. She also may be suffering from what is called "rapid cycling" which occurs about 5-15% of folks with the illness (4 or more mood episodes during the past 12 months)....which has a poorer prognosis.

Approximately 10-15% of adolescents with recurrent major depression will go on to develop Bipolar I. Bipolar I is a recurrent disorder with 60-70% of all Manias developing right before or after a Major Depressive episode. 60-70% of folks with Bipolar return to a fully functional level between episodes...which is good news. 20-30% do not and continue to suffer impairment even when out of the throes of it. Many folks, especially when they are young, are totally non-compliant to treatment because of denial or stigma. Think of the adolescent or young adult who is newly diagnosed with diabetes...and refuses to take medication and eats all the chocolate and sweets any way. Many folks unfortunately have to hit their rock bottom before reality really sinks in and that they cannot do this any more. Despite their dislike for meds and the illness, they finally come to realize that Mania is not what it is cracked up to be. Many become noncompliant because it "slows" them down. Yes....that is the intent. In mania, they lack brakes. Medication gives that person a pair of brakes...actually, this empowering, not disempowering.

Not all folks with Bipolar I, like any illness, have the exact symptomatic picture...there is some variation. Some folks who are Manic are happy go lucky and are very likable as they ride their manic high, some become very irritable (even mean). But typically, the more the mania, the more the excess energy, the more the impairment. In mania, the person tends to run where the impulse carries him/her...therefore, more impulsivity. This is where individuality of the illness becomes apparent. Some folks become impulse spenders, some folks become impulse travelors, and some become impulsively promiscuous. Many begin multiple projects out of inflated self worth that later become left unattended to later on when the manic high runs out of steam. Many come to enjoy their manias because it feeds more energy into their creative/artistic endeavors. Where the impulse takes them, they tend to go....without much thought regarding consequences...and many may often become irritable when prevented from carrying out their impulses. Self medicating via substance abuse is very common...another impulse...because it feels good or it is a poor attempt to self regulate their illness in their own way. However, many folks in the throes of mania, despite the havoc it causes, tend to also look upon their manias quite fondly....reluctant to let them go...because they have all this energy...doing and experiencing things very unlike their depressions (which leave them little energy). Due to impaired insight, they often fail to see that the very mania that they come to love and enjoy actually causes more stress for them, which just feeds into their stress load....like a squirrel in a wheel...unable or unwilling to jump out of it. Like any illness to any extreme, the higher the mania places them at great risk for psychotic episodes as well, much in the form of delusions. Delusions are fixed, false beliefs...and some of them can become quite grandiose and even bizarre. Paranoia is not uncommon. When a person is highly manic, delusional, irritable and paranoid...it is not the time to confront them...but to call in the authorities to bring him/her in for involuntary treatment....especially if family believes that the person is at risk to harm self or another. The family member may need probated by the courts against his/her will then. As you can tell, the higher the mania, the more the impairment in insight and judgement in order to make rational decisions, especially when things are done at the impulse. The illness is hell for the person who has it, but also doubly so for the family who have to undo the damage and pick up the pieces...because the person is unable or unwilling to do so. Burning out the family is not uncommon either.

Family really needs to get all the support they need in order to understand the illness for what it is, how it impacts that family member and them, how to stay on top of it, and learning what they can (and cannot) do when mania raises its ugly head. NAMI (a family support group) is a nation wide support system devoted to families who have a loved one with a significant mental/emotional disorder (like Bipolar and Schizophrenia). It is there to support, educate, and help offer suggestions for family. Most families who use the NAMI groups find them extremely helpful...other folks who have been there and understand. The NAMI website is http://www.nami.org/ From there, you can locate a local chapter to assist you.

There are many books out there on Bipolar disorder. Do a web search or visit any library or bookstore. For family, knowledge is power. Coming to understand the illness makes it less scarey for you and empowers you as family members as well. One book just to start you off is:

Which can be found here: http://about.pricegrabber.com/search_getprod.php?isbn=9781572305250&nrd=1&found=1&search=Miklowitz&mode=about_bipolar&

Bipolar disorder is hard disorder for those who suffer from it. Many who have it, despite the manias, really do hate the disruption it causes in their lives. Many folks who have it do, however, lead better productive lives when it is managed well...which means medication. Medication is key to success. Without medication, failure. There really is no compromise. It is a medical illness that requires medication. Since there is a significant genetic loading for this illness, I would tend to agree that your father most probably suffers from Bipolar disorder, or maybe another mood disorder. This also places you at some risk too...so the more information you come to know about the illness for your sister, it may also become helpful for you too...if you should develop a pattern of depression, placing you at risk for mania since it is present in the family already. Knowledge is power and is empowering to you.

In knowing about stress and stressors, it is correct that the more the stress, the higher the risk in developing depression. So, learning how to manage daily stress is key. Learning better coping skills, balancing work and play, having friends and supports, giving oneself little time outs to decompress, and improving one's diet and sleep. All key to reducing one's life stress. School can be very stressful, so this is doubly important here.

I hope this has been a little helpful to you. I encourage you to learn more about the illness, to take care of yourself, to get support (like NAMI), and to continue on with your life despite the mania/bipolar in the family.

You have my very best,

Wolfie

Thanks, Tunderwolf! That's some great information. I printed it out, and will share it with my mom. You're right-- it is taking a toll on my family (the caregivers left picking up the pieces). It is difficult knowing how much of what we are doing is supporting, and how much is enabling my sister. I guess we will figure that all out with time.

Thanks to everyone for the support!

What I am going to post may not be......very acceptable. I believe that bi-polar is very OVER-DIAGNOSED. I think there are many people (women especially) that suffer from PTSD, major depression, and other behavioral disorders that get misdiagnosed with bi-polar.

And the reason this is such a problem is many. Some of the meds and treatment modalities are the same or similar but not all(for example a mood stabilizer can help a person with depression or bipolar). Being diagnosed with a "Severe and Persistent Mental Illness" is a big deal. If an 18 year old with lots of stuff going on in her life (like it sounds that your family has experienced) is "labeled" bi-polar and she really isn't, it may be with her forever. For example, in the state of Montana if you are diagnosed with a mental illness you can never have a hunting license, perhaps not a big deal to some but a very big deal to others. One of the psychiatrists I worked with as a psych nurse was "diagnosed" with depression in medical school and she could not get a life insurance policy as they said she had a mental illness and was too much of a risk.

And also at the risk of being flamed (however I am not sure how I feel about it) there are many in the psych community, especially psychologists, that do not believe that bi-polar II is really a true diagnosis.

As an FNP student I was working with a clinic based FNP and a young college student came in and her complaints were that she couldn't sleep, had problems with money, had some "unsafe" sexual experiences and used some alcohol and drugs. The FNP used a "tear-off" sheet given to her from EliLilly (makers of Zyprexa) and because the girl answered "yes" to 5 out of 7 questions the FNP "gave" her the diagnosis of bi-polar, (and gave her a few of whatever psych med she had in the sample closet) which will be with her forever now. And if you look at the "symptoms" many of these are common behaviors of our youth.

A responsible health care provider (even a psychologist or psychiatrist) will see a person several times prior to giving a diagnosis. In fact one of my psych-nurse practitioner friends always used the diagnosis of "Adjustment Disorder" until it is very clear what a person maybe suffering from.

Another part of the problem is when a person "has" bi-polar many feel "they can't help it" and it takes the ownership of behavior away from them. This "helps" a person with a behavioral problem to continue as they have no responsibility.

I just encourage you to really have her seen by someone in the psych field (not a primary care provider) and don't be sure of the diagnosis and ask them to please try a few things (including therapy which will be such a big piece of the puzzle) prior to setting on what she "has".

Hope I did not step on any one's toes.

ruralnurs, I, for one, thank you. I agree that the label is given rather frequently just as I believe ADHD is. I became even more disheartened by it when I saw the number of women who were diagnosed when I did my psych nursing rotation. When I read their histories, I couldn't help but wonder if their life circumstances and perhaps even normal hormone issues were not responsible for many of their problems. In addition, I was very upset to see that the drug reps sponsored Tuesday morning breakfasts for the psych hospital staff where samples and other literature was given for many of the represented meds. Unethical, if you ask me.

That is not to say that I believe BP and ADHD are not real because I am sure that they are..just that it has become too convenient in our society to diagnose these things, perscribe meds and consider it done.

The labels do affect people with regard to military service, licensure in various fields (including nursing), etc..

Lastly, as I stated before, this illness does run a broad spectrum, so even if someone does truly have it, they still may be capable of living a productive life.

Thanks for sharing this perspective.