Has anyone come across any anecdotal evidence or research supported information which correlates the length of time someone is in a progressively worsening manic phase and the stubbornness in treatment of rebound depression?
Anecdotally one of my friends (Emily) in the online support community had semi treatment resistant Bipolar Disorder. Over the years she was part of the forum I think we all definitely noticed a pattern where the severity of her manic phase correlated to how long she would end up spending in hospital, and just how equally severe, and non treatment responsive her depression would be once she'd crashed.
Sometimes she'd have what I, as a lay person, would think of as 'mini episodes', where she'd be in a type of manic phase (not sleeping, umpteen dozen different arts projects on at once, posting on the forum almost non stop with these lengthy soliloquys, etc), and then she'd finally crash and become very despondent, not showering, not getting out of bed, refusing to eat, and so on (one of her close friends who also knew Emily's family would always keep us up to date with what was happening).
And then sometimes she'd have the sorts of episodes that I think most people would think of if you said the word 'Bipolar' to them. It would start off much the same way as her other, more minor type episodes, there'd be the boundless energy, her insistence that she didn't need to sleep, her idea that she could do everything at once, the lengthy soliloquys she'd be posting several times a day, but then things would tip over to the point where she increasingly stopped making any sense. Her forum posts would often run together with no space between words, jump from one completely unrelated topic to the other, contain talk of invincibility and specially granted powers, and so on. During one such episode she went missing from her home, only to be found having walked some 20 *** to a neighbouring township, in the middle of winter, barefoot, and dressed only in her underwear and a windcheater, where she was arrested and taken to hospital after numerous complaints of a disturbance of the peace (she'd be walking around the neighbourhood shouting nonsensically at whatever imaginary figures were accompanying her.
So she'd end up back in hospital yet again, more of than not under a detention order, and they seemed to be able to get her mania under control, or rather they could keep her sedated until she'd come down, but as soon as she swung the other way into a depressive state that's when we'd all get really worried. She was meant to be on 1:1 obs at all times, but some of the hospitals she was in weren't that well resourced, or a Nurse would make the mistake of taking her eyes of Emily for just a moment, and with the severity of her mania correlating to the severity of her depression, that would be all it took for Emily to make a mad dash up the nearest stairwell and break bones throwing herself down it, or to find some secluded spot where she could attempt to hang herself, or if she wasn't on a locked ward by that stage, make a break for it out the hospital doors and attempt to run into oncoming traffic. And the depression always seemed to be the hardest thing for them to treat. Obviously they were trying to treat her Bipolar Disorder overall, by my understanding at least I figured they thought if they could get the whole package under control then she wouldn't be going into these severe and treatment resistant episodes of depression, but unfortunately apart from Lithium (which she was forced to stop taking due to severe renal toxicity) there was no other drug, or combination of drugs that worked (and for the last year of her life she was pretty much a walking lab experiment - name anything in Britain circa 2003-2004 that was purported to treat Bipolar Disorder and she was on it at some stage).
She committed suicide in late 2004, at the age of 22. I miss her.
