Question: My brother suffers from Type 1 bipolar. He lives with me since he cannot work due to the multiple cycles he has every day, and he seems to be getting worse. It is affecting all our lives to such an extent that I now suffer from severe depression. I have tried to help him, but nothing I say or do has helped.

Dr. Hibberd's Answer:

Type 1 bipolar victims are very difficult to live with unless their condition has been modified with effective medications that need to be taken every day. By definition, their view of reality is impaired during a manic spell, and they are regarded as incompetent to make decisions of any kind. Suicide, spending sprees, and self-destructive behavior are common.

Usually a mixture of mood controllers (such as lithium), an anticonvulsant (such as Tegretol or Depakote), and mood modifiers (such as an antipsychotic as in Risperdal, Haldol or Stelazine) is needed for effective control. The use of conventional antidepressants will trigger a manic episode unless used in conjunction with a mood controller, and is often seen as the equivalent of a stress test for bipolar disorder Type 1.

Daily cycling and recurrent flares are associated with adverse outcomes, and I recommend you seek the assistance of a mental health facility without delay. Most psychiatric hospitals have intake areas to assess for urgent situations, and I encourage you to call or visit one soon so help can be arranged for you.

A violent flare at home often comes to the attention of law enforcement via a 911 call for help from family, friends, or observers. They are empowered to involuntarily detain and arrange for immediate emergency medical attention for victims felt to be at risk to themselves or others. This care will be in a facility under a 72-hour hold when risk is evident and certified by a physician.