Bipolar Disorder and Depression: Navigating Treatment Options

Depressive disorder with irritability?

My current girlfriend has a history of depression and bipolar disorder, for which she was hospitalized for treatment.
After being discharged, she has been on long-term medication for control.
To my knowledge, she can only sleep peacefully after taking her medication, and there have been no relapses during her medication period.
Recently, she has experienced emotional instability and has relapsed twice, including one incident where she ingested a large amount of her medication and had to be rushed to the hospital for gastric lavage.
She is a divorced woman but still lives under the same roof with her ex-husband, sleeping in separate rooms.
Due to her recent relapse, her ex-husband insists on admitting her to National Taiwan University Hospital, while also having her take medication prescribed by an outside clinic.
She mentioned that after taking the medication, she sleeps all day, and even when she wakes up, she feels groggy and is not allowed to go out.
She is extremely fearful of being admitted to the hospital again and is left to take the medication all day, living in a daze.
Otherwise, she resorts to using marijuana and drinking alcohol to numb herself.
I suggested that she first return to the outpatient clinic to see what the doctor says, and she expressed a desire to go back to the outpatient clinic.
However, her ex-husband is adamant about admitting her to the hospital, making her afraid even to visit the outpatient clinic, fearing that she will be forcibly admitted if she goes.
Is it possible for outsiders to forcibly admit her to the hospital? Is my suggestion inappropriate? I only know that the prospect of hospitalization causes her significant stress.
Is it necessary for her symptoms to be treated only through hospitalization? Note: She has had this condition for 8 years, has been hospitalized for over a month, and has been on the same medication throughout the rest of the time.

kevin, 30~39 year old female. Ask Date: 2004/05/15

Dr. Zhou Sunyuan reply Psychiatry

In response to your question, I will address it from two aspects: First, the legal basis for involuntary hospitalization is established in the Mental Health Act.
It stipulates that for individuals with severe mental illness who exhibit self-harming or violent behaviors, or are at risk of such behaviors, or are unable to care for themselves, involuntary hospitalization can only occur following the diagnosis of two psychiatric specialists (Mental Health Act, Article 5, Paragraph 2; Article 21, Paragraph 2; and Article 23).
Therefore, it is not permissible to involuntarily hospitalize someone arbitrarily.

Second, regarding your girlfriend's issues, in addition to her pre-existing bipolar disorder, she is also struggling with alcohol abuse and potential marijuana misuse or dependence, which complicates the situation further.
The state of lethargy she is experiencing may not necessarily be caused by medication.
It is important to clarify whether her current condition is in a manic phase, depressive phase, or remission.
I recommend that she first address her alcohol and marijuana use, and then encourage her to visit an outpatient clinic, where she can be informed that involuntary hospitalization cannot be done arbitrarily.
Only under a physician's supervision can her medication be appropriately adjusted to address her lethargy.

Reply Date: 2004/05/15

More Info

Bipolar disorder, commonly known as manic-depressive illness, is a mental health condition characterized by extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). Understanding this disorder, especially in the context of your girlfriend's situation, is crucial for navigating treatment options effectively.

From what you've described, your girlfriend has a history of bipolar disorder and depression, which has led to hospitalization and ongoing medication management. It's important to recognize that bipolar disorder is a chronic condition that often requires long-term treatment strategies, including medication, therapy, and lifestyle changes. The fact that she has experienced multiple episodes, including severe depressive episodes and suicidal behavior, indicates that her condition is serious and needs careful management.

The medications prescribed for bipolar disorder can sometimes lead to side effects, such as sedation or cognitive dulling, which may explain why she feels "drowsy" or "foggy" after taking her medication. It’s essential for her to communicate these side effects to her healthcare provider, as they may need to adjust her medication regimen. The goal of treatment is to stabilize mood without causing intolerable side effects.

Regarding her fear of hospitalization, it’s understandable that she feels anxious about being forced into a situation where she might lose control over her treatment. In many cases, hospitalization is considered when a patient poses a risk to themselves or others, or when outpatient treatment is not effective. However, it is not always necessary, and many individuals with bipolar disorder manage their symptoms effectively with outpatient care, including regular visits to a psychiatrist or therapist.

Your suggestion for her to return to outpatient care is valid and could be a less intimidating first step. It’s crucial for her to feel safe and supported in her treatment journey. If she is concerned about being hospitalized against her will, it may help to discuss this fear openly with her healthcare provider. They can provide reassurance and outline what to expect during outpatient treatment, as well as the criteria for hospitalization.

In terms of her current living situation, sharing a home with her ex-husband while experiencing these challenges can add to her stress. It may be beneficial for her to seek a supportive environment that promotes her mental well-being. Encouraging her to engage in healthy coping mechanisms, such as therapy, support groups, or mindfulness practices, can also be helpful.

Substance use, such as marijuana and alcohol, can complicate bipolar disorder and may exacerbate symptoms. It’s important for her to understand the potential risks associated with using substances as a way to cope with her feelings. Encouraging her to discuss these behaviors with her healthcare provider can lead to more effective strategies for managing her symptoms.

In summary, navigating bipolar disorder and depression requires a comprehensive approach that includes medication management, therapy, and support from loved ones. Your role as a supportive partner is invaluable, and encouraging her to seek professional help while addressing her fears about treatment can lead to a more positive outcome. It’s essential for her to have a treatment plan that she feels comfortable with, and open communication with her healthcare provider is key to achieving that.

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