Expert: Ivan Goldberg, M.D. - 2/3/2008

Question
Hi Dr Goldberg,

I was diagnosed with Bipolar II over 14 years ago after a bout of 3 hospitalizations and treatment for self injury.  I have actually been in denial for the past 14 years as I had NO hospitalizations, no self injury and have held 2 incredibly successful jobs long term (10 years and 5 years)
This past July I was hospitalized for severe depression and suicidal ideation after a bout with mania that included several nights without sleep and high stress on my job after a surgery that resulted in a staph infection a month off of work and feeling the need to catch up just to meet my performance objectives.  Since this hospitalization in July, I have had 3 additional hospitalizations (at Mayo Clinic which was fantastic in terms of giving me the tools and education I need to work on recovery) and have attended a partial program for the past 3 months. I also see my therapist 2x weekly. Each time I was admitted I worked very hard at learning coping skills like CBT, DBT, distraction, mindfulness and many other things.  In fact I probably worked too hard at trying to overcome this that it just became a battle within my head to beat the illness when really the illness was taking more and more control over me.  I've had 4 major med overhauls since July having gone through abilify, Trileptal, lithium and now Lamictal along with Wellbutrin which does seem to be starting to work. Through this I have lost my partner of 5 years, my job, almost all of my savings, many friends and nearly myself.  My job was the most recent blow as it was actually my dream job and I was so proud of it and really enjoyed it.  I know that stressors are not good for bipolar and that plays a huge part in why my recovery is taking so long but there has to be an end in sight....How long can one expect a major episode to last?  This has gone on for nearly a year since I was struggling with depression since Feb of 07.  As you can imagine, I'm totally frustrated and suffering from severe battle fatigue...I just want to get better and be my old self again...a funny, creative, intelligent and humorous individual with a huge love for life and all of that great stuff.  Seriously I know that I shouldn't be asking how long I can expect this to go on but is it out of the ordinary for an episode to last this long?  I've heard that some can go on for up to 2 years.  Any suggestions?  
Thanks for your help

Kathy

Answer
Hi Kathy . . .

Usually with intensive treatment an episode of bipolar depression can be controlled in a few months but as the underlying bipolar disorder is a chronic illness, long-term medication is necessary to prevent additional episodes.

It is not unusually for someone with bipolar depression to require a "cocktail" of medications that in most instances should include both lithium and Lamictal. CBT, DBT, mindfulness, etc are great but one therapy that your did not mention that is super-important is Social Rhythm Therapy. See:
http://www.wpic.pitt.edu/stanley/2ndbipconf/ppt/W404_37/sld001.htm
and
http://www.wpic.pitt.edu/stanley/2ndbipconf/ppt/W404_37/sld001.htm

If your progress seems too slow, you may want to get a second opinion from one of the experts listed at:
http://www.psycom.net/depression.central.psychiatrists.html

Best regards . . .
Ivan