Friend with bipolar diagnosis

[Chippingnortonset123]

I am afraid that she is going down again, based on what she has told me. She has been well for six weeks. It was awful last time and I am dreading a return to that. She is under the recovery team once a fortnight but they only stay ten minutes and do nothing.

And paranoid about mental heath services is pretty standard. I started getting proper psychiatric treatment only recently and still brick it when I go to appointments. I know it's not rational, but....

That's OK teaches me to type on my phone when in a rush! There's enough misunderstanding out there without me adding more to the mix :)

Paranoid about health services is very common. Do you think her daughter will call? Your friend doesn't sound good sounds very depressed.

Remember to look after yourself first and foremost though, you will be no help to anyone if you start feeling drowned in stress. I used to work for a boss who was bi-polar and I found her up/down moods extremely difficult to cope with. Remember you need to be getting something out of the friendship as well :).

I am going to be more realistic this time; I ran myself ragged last year, against advice, but I hoped it was a one off. I am going to make sure the dogs are looked after. I am not going to call the ct myself but I certainly won't discourage the daughter doing so.

Visited today with food that was unacceptable . Bought Greek yogurt. Refused to walk the dogs. She was mainly in bed but this time I am ignoring the summons.

Ah I'm sorry to hear that. There's really only so much you can do. She's not going to respond to anything you say or do. But you were a good friend for going. Did the daughter call her doctor?

You are right, there is little that I can do beyond dropping off food. I was there from 11.30 to 2.30 and she was mainly refusing to get out of bed. We did a fly lady on the kitchen.
Daughter drops in every evening but she has not texted me yet since this latest downturn.
Thanks for your support. I am not family but I am doing what I can.

The odd thing is that she has been fine for six weeks; hosting lunches, going out, getting organised, etc. This has been very, very sudden.

Fingers crossed her dd has called the doctor. Is her visit from the community team due soon as well? They may take any choice away from her and put her into care.

The change can be sudden particularly if she is not regular with her medication. I get so resistant to taking it when I am in a bad way and dh has to really threaten me. If she's go no one on her case about it then this is what can happen :(

it isn't entirely paranoia necessarily with mental health services - there are pretty horrendous psychiatrists out there - i had one who literally said to me, 'oh well it's a good job you've lost the baby really given you have mental health problems' then when i tried to articulate my feelings about what he had said it spiralled to, 'well you clearly have personality issues' and i felt like he was going to diagnose me with some awful personality disorder for daring to stick up for myself.

they are not all like that but some are unfortunately and i've seen and heard some horror stories.

rapid cycling stuff is very hard to get managed and some psychs don't seem nearly well informed enough about it or think the patient is exaggerating. nhs pyschiatrists can also be very stuck in their ways (nice guidelines and cheapest approach doesn't help) over medication forcing patients to keep on a medication regime that doesn't work for them, sticking to a first we try this for an eon, then we only move onto next treatment option when that is exhausted etc.

if you are not an intelligent person with a lot of inbuilt rationality outside of the illness and ability to research and take control of your own treatment and options and assert your wishes in a convincing way it must be really tough. even having all of those attributes i found the mental health services a degrading and paternalistic experience and don't engage with them anymore.

the other thing is that some are fixed in their 'can't give bipolar antidepressants ever' state when in fact some people who have a lot of lows that don't respond at all to mood stabilisers (which solo just sink them into horrible depression) need ads AND something like an antipsychotic together which both deals with the mania side of things and has a catalyst effect on the ad which finally nails the depression.

sorry long waffle. do you know what meds she is on?

i was diagnosed as bipolar type 2 with rapid cycling and did indeed have a bloody awful through the mill couple of years (whereas prior to that i'd just had periodic awful depressions that eventually cleared). thankfully i've been fine for ages despite not taking mood stabilisers - i only take antidepressants and occasionally something prn for anxiety or sleep issues. it actually gives me cause to wonder if i ever was/am bipolar. for me there were a lot of huge hormonal events around that period of my life and it was only with my GP that we managed to untangle the interplay of my menstrual cycle with my mental health. is there anything else going on with your friend? could she be peri menopausal for example?

i'm not a good example really as i believe it's quite rare for it to just virtually go away. it's worth bearing in mind that for some it gets rapidly worse and i'm told can frequently at middle age hit much harder and spiral into psychotic type illness.

not saying she isn't bipolar btw!! just meant anything else going on that is interacting with it and making it intense and worse such as the interplay of hormone issues from menopause - a) hormones can in themselves effect bipolar and b) some bipolar meds interact with hormones re: some effect hormones and some are effected by hormones.

if you find out what meds she's on and can say how old she is, when things became worse etc it would give a clearer picture. unfortunately these illnesses require such strength and focus and determination to actively monitor, manage and learn from and about the symptoms and some people really struggle to find that. it sounds like your friend is struggling to find any self assertion and resilience and is playing helpless and expecting others to pick up all the pieces. understandable maybe but she will not get better or learn to manage this with that approach.

bless her silly lass - hope it's sorted now. my friends mother has recently had a thyroid issue that didn't get treated properly and as a result is having an awful mixed mania episode. wish docs would be better informed about the interplay between other conditions for people with bipolar.

Thank you for replies. I have avoided this thread for a bit but have now read carefully. Thanks especially to Numpty.
She is 63. She is on lamotragine (sp?) and something else. She HAS had her thyroid removed.
The Recovery Team are due tomorrow. She is going to try to put them off.
I haven't been in contact with her daughter this time but I was last time. I suspect that D May ring for help but I don't know and am reluctant to get over involved this time, as I did last time.
I am going round on Friday and taking lunch/shopping. It is halftime here.

She is no longer taking diazepam. She has a tendency to take all the pills at once.
I would say that she is very intelligent when well.
She is terrified of inpatient Graeme t and gets extremely worried about her dogs.
(She even complained about the Greek Yoghurt, which was meant to feed her up. It is very hard to please her).

Just to remind myself, when she is well, she is
Intelligent
Witty
Very kind, albeit in a bossy way
Adores animals
Well dressed and good hair
Can talk to anyone
Wants to do the best for her children and grandchildren
Great cook
Great at interior design
Interesting experiences at international living and travel
(Probably more but they would be individual stories of kindness)

hmmm. surprised by that actually. if she's rapid cycling she could maybe do with something heavier - lamotragine can be a bit activating but is becoming more commonly used with people who suffer a lot of depressive times due to it's reported AD effect. lamotragine is one with whacky effects on and from hormones but at her age presumably she's well past menopause. when was her thyroid removed? bear in mind that the thyroid meds levels will be as key as the meds for the bipolar so i do hope her specialists work together to address interactions and how changes to one can impact on the other.

i think, fwiw, that taking lunch and shopping round is a good idea and maybe best given you are reluctant to get involved with it all to just keep it very much at that practical level of support and at fixed intervals. she knows you're there for her practically but you're not getting involved with the more demanding side of things that way maybe? set your boundaries and stick by them i guess.

I would simply invite her to stay with us but there is no way that we could accommodate her dogs.
I am thinking of suggesting the following:
D moves into her house and feeds and walks the dogs
Friend stays with me for a week and eats a bit and gets about a it/interacts/criticises my housekeeping?

i wouldn't if i was you chipping. do you really want her to get in the habit of coming to stay with you as a solution? or knowing if she neglects herself enough you'll swoop in and put her and pamper her?

i don't mean to sound harsh but you need to think it through as this appears to be a cycle that she and her hcps aren't cracking so you will be likely be setting yourself up for repeat expectations.

I think that I over extended myself last time, which was from mid Oct to New Year. I would do more if I thought that it would be helpful.
She seems to think that I can drop everything and turn up, which I can't in half term.
In my experience they will refer her to the ct who will deliver the meds so that she doesn't take them in one go. Then she will see a psychiatrist, who appear to be locus so she can't build a relationship.

yep crappy locum service, everything treated as one offs when in fact it's a clear pattern that the condition is not under control and the medication isn't working. it isn't really 'last time' is it? it's only february now, a few good weeks isn't enough to say someone was better.

if you had it in you the best thing you could do for her would be to go with her to the pscyhiatrist and be her advocate and stress that her treatment isn't working and that her meds need changing and she needs to be seen regularly by a prescribing pscyhiatrist until she is stable. that's the only real solution imo. mental health services are a wasteland in some areas for those who aren't assertive and good at self management and directing their treatment.

locums are often foreign trained, not a problem in itself if they are well trained and well adjusted to the culture but a massive problem if they bring with them attitudes about mental patients, the elderly and/or women that they haven't been trained to subdue. cheap quick turn around of foreign pscyhiatrists from misogynistic cultures which see docs as gods (even more than our own) with minimal supervision or accountability can create a seriously horrible situation for vulnerable female patients.

does she have a good GP? a genuinely good GP can act as an intermediary in situations like that (shitty mental health service) and be their patients advocate and shield IF they are aware of and accept the state of affairs with the cmht and genuinely want the best for their patient. they have power to prescribe, change meds and all sorts if they're the type to use that power rather than just go oh well i wrote a referral so it's not my problem you know?

Is it all about the correct medication?

a lot is about medication if she is genuinely bipolar chipping.

a lot is about self management BUT that includes being aware of and assertive about your medication and treatment.

bit of a vicious cycle really if you're not managing well or good at asserting yourself and you don't have an advocate.

her gp could perhaps also pull strings to see if she can be allocated to a permanent pscyhiatrist rather than an endless roll of locums.