Bipolar Treatment: When Nothing Seems to Work

My sister has been diagnosed with Bipolar Disorder. She is 55 years old and has suffered with this since her teens although it had not manifested itself severely until her husband left about 20 years ago. Since then she has suffered horribly through severe mania with legal problems to severe depression. She has had rapid cycling. She had been living in Hawaii but now is living in Florida with our mom. She has always gone to regular counseling along with psychiatric visits. They have tried every drug under the sun and nothing seems to prevent her from these mood swings. She came here from Hawaii after being depressed for over 8 months. She had 3 "good" months since coming to Florida and is now in a deep depression. They are playing with her meds again. She has talked about not being able to take it any more and said other things, which to me, sound suicidal. I think if she didn't have a son who she adores, she would have killed herself. She's had so many car accidents while manic, I wonder if those were really attempts. She refuses to even talk about the word hospital and even if I could Baker Act her, it's only a 72 hour hold. I've been on all the sites, read about ECT, or perhaps she's really got BPD. We are not a family of means who could take her to a fancy treatment center. She's on medicaid. What can I do? Thanks for your time.

Ben's Answer:

This is a very difficult situation. There are those with Bipolar Disorder who are very difficult to treat for a number of reasons. Your question of whether she may actually have Borderline Personality Disorder is a common one, since many symptoms look similar between that and BP. It is very possible she has both. Borderline Personality is viewed by some experts to actually be like a chronic state of trauma - similar to Post Traumatic Stress Disorder. Many people with Bipolar Disorder, also have some degree of unresolved trauma in their lives (either directly related to catastrophic mood episodes, suicide attempts, manic periods, losses, hospitalizations, etc) - or sometimes very separate life events that were traumatic. For the person with Bipolar Disorder, any unresolved emotional trauma is an ongoing trigger. For some, the mere thought of a past emotional trauma or loss can trigger strong emotions, which in turn trigger mania or depression (or both - a "mixed" episode). This can be very confusing and overwhelming for everyone involved.

There may be little you can do. These sort of issues often respond poorly to medication. I see a strong need for psychotherapy that includes a focus on trauma work. EFT could be useful as a component of therapy. A good, long term, trusting relationship with a therapist would be another important aspect of treatment.

Dialectical Behavioral Therapy (DBT) has a good reputation for helping these issues (particularly for Borderline Personality), and is great in general. It combines CBT (Cognitive Behavioral Therapy), with Mindfulness skills, learning to tolerate your own strong negative emotions, and to maintain self-awareness. It's a good, practical approach. Many treatment centers use DBT, and sometimes you can find therapists who use it privately as well.

It's sometimes worth the effort to contact a local out-patient/intensive treatment center and ask if they have any grants or scholarships for their program.

The picture is further complicated when you consider other possible factors, such as nutritional issues - a frequently overlooked and under-diagnosed aspect of mental illness. A good Naturopath (ND), Ayurvedic Practitioner, or Doctor of Chinese Medicine/Acupuncturist is often a good avenue to explore for those issues. Sometimes you can find low fee clinics where such doctors offer services.

Best Wishes,
Ben Schwarcz