My mom has been struggling with manic depression and psychotic episodes for months.

[doinnothin]

TL;DR my mom (59) has been struggling with severe anxiety and insomnia that evolved into psychotic episodes and manic depression that has lasted about 4 months. She’s lost a lot of weight/hair and refuses medication or any medical help. Unsure of what to do or how to help her.

This all started in October of 2018 when my mom (59) lost her father. The two were extremely close and his passing really affected her. But she was able to distract herself with all of the arraignments, fixing up the house to sell, etc. This also created a massive rift between herself and two of her three brothers. They no longer speak and there’s a good chance they will never reconnect. Through all of this she was experiencing anxiety, but was able to combat it with keeping herself busy.

December of 2019: my mom went back and forth on whether or not she should sell the house. Ultimately she realized it was too much work to keep up and when the house sold everything changed. The death of her father finally hit her and the anxiety started to turn into a form of manic depression. At first it manifested in her sleeping patterns. She typically slept around 6 hours a night, but she began only sleeping around 3 hours every night.

In January of 2020: I decided to move out of the house to move in with my girlfriend. This was another massive change for her to swallow as she and I are very close. She suddenly began to obsessively panic trying to figure out what she was going to do with her life. We spoke daily about this crisis and I tried to get her to see a therapist or life coach. She eventually went to our family physician who suggested therapy and prescribed Xanax to take whenever she felt a serious bout of anxiety coming on.

February 2020 - now: over the last few months her state of mind has dissolved. Her insomnia has gotten to the point where she’s only sleeping a couple hours a night. Her focus and ability to follow conversations began to severely decline. She couldn’t watch TV as it frustrated her too much. We took her to the same family physician who prescribed Zoloft. Despite our efforts, she wouldn’t take it. Over the next few weeks she became increasingly paranoid and manic. After a pretty severe meltdown we got her in to see a psychologist who also recommended Zoloft. She still wouldn’t take it.

My dad then took her to another family physician who prescribed Remeron. She agreed to try it as it would also help her sleep, but would only take half of the suggested dosage as she became paranoid of becoming dependent on medication. This paranoia grew to the point where she would stare at the side-effects for hours on end. She only took the half-dosage of Remeron for a couple weeks and then refused to continue.

We returned to the doctor and he prescribed yet another anti-depressant that she refused to take. It became very clear that this approach wasn’t going anywhere. Her mental state continued to decline as well as her physical appearance. She’s typically thin and athletic. She’s lost a lot of weight and all the muscle definition in her arms and legs is completely gone. She’s basically skin and bone despite eating somewhat normally. On top of that almost half of her hair has fallen out.

The physical side of this has compounded a lot of the problems she was already facing. She now stares at herself in the mirror for hours and won’t leave the house. She can’t even get the mail or go sit in the backyard. This makes any doctor’s appointment or potential therapy sessions impossible. Luckily, with the COVID quarantine she’s been able to keep a low profile with her friends and hasn’t been pressured to see anyone outside the house.

My father has been with her 24/7 through all of this and has managed it the best he can. It’s great that she’s not alone, but at times he wonders if he’s enabling her behavior. It’s a daily occurrence where she will just stand and stare at him for long periods of time until he tries to walk away. She’ll grab his arm and try to get him to stay. She’s become increasingly paranoid that he’s going to abandon her.

He’s hit a breaking point twice. Once he asked me to come to the house where we tried to bargain with her to go to the hospital to get help. My mom was a complete manic wreck and I stood in the yard for 10 hours trying to calm her down and get her in the car to no avail. She was a nurse and was convinced that if we take her to the hospital that she’d be put in a straight jacket. I know she knows this isn’t true.

The second time was a couple weeks ago when my dad called the NAMI crisis line. They sent a mental health professional to the house to assess the situation along with two police officers. My dad had no idea about the police showing up and my mom had another meltdown. She became so worried that the neighbors would see all the cop cars at the house and told them to leave. They somehow talked her down and the mental health professional was able to speak with her. Because she’s not a risk to herself or anyone we cannot legally force her to go to the hospital.

Ultimately they suggested a phone-therapy routine that consists of talking to a therapist, a life coach and a sponsor (somebody who has also experienced similar psychotic episodes / manic depression). And now we are caught in a catch-22 where she doesn’t believe the people on the phone will help because they can’t see her physical state and she won’t go see a therapist because she’s self-conscious of her appearance.

Now she’s just stuck. She hasn’t had any meltdowns recently, but she’s still suffering from crippling anxiety, can barely sleep and has behavioral ticks that won’t go away. She’ll stand at the kitchen table for hours at a time, repeat sentences and basic activities (like texting or watching tv) seem insurmountable. I call her about 2-3 times a week and try to keep the conversation small talk (I do all the talking) because if we start talking about her condition we will go around in circles for hours. I try my best not to get frustrated with her but have slipped a few times.

The timing of all this with the quarantine has been a blessing and a curse. It’s given her time and privacy to try and get through this, but it’s also made everything feel more strange for her. Now as things start to re-open I don’t know what to expect.

Thank you for reading. Any help or suggestions would be very much appreciated.

 

[Nukelavee]

Do you and/or your father have access to some form of therapy or counselling for yourselves?

It might seem backwards, but you must take care of yourselves, too. This much stress will begin to burn you out.

Not a doctor, can't really offer much, but - lack of sleep is making her worse. Sleep deprivation destroys our mental states. I've gone through a couple brief periods like your mom is having, a week or so at a time, and lack of sleep made everything even worse.

I think that, somehow, you need to figure out a way to get her some more sleep. That will help her begin to think a bit more clearly.

I also think a big part of the issue was delayed grief/dpression from loss of her dad. So long as she was busy and had a goal, she was "fine". People with depression are good at focusing on tasks as a distraction, but when the distraction is done, it all crashes down.

You're right - she has no goal set right now, and she's too upset to set them herself. If you can aim her at a task, or convince her self care is a valid goal, she might begin to come back to herself.

 

[Blooming]

This seem to be a terrible and some sort of hopeless situation. She cannot be forced into a hospital as long as she is not a danger to herself or others. She needs treatment, but will not allow it.

I second Nukelavee's understanding about that you and your father need help so you don't get too much caught up in this. Personal help can be given by a Therapist or Counsellor to each one of you. Other types of help (self-help) will be to make room and time for yourself (yourselves). A walk in a park, a visit to a library to sit and relax and read a paper in peace. (I do not know how much is locked down due to corona at your place). It is also important that you and your father get enough sleep, nutrition and physical exercises. You have to learn to put your main focus on other "things" then this mother of your's.

Your mother seem to be very sick. Through her sickness she controls you (even if she is not aware of it). If this continues, it has to be a question about if you will allow this. You have probably talked this over before, but you can do it again. You have to find your own way, but what I had in mind was your father tells her that he is tiered of all this and want her to go to a hospital voluntary or he will leave (for vacation for a couple of weeks). You can visit her now and then to point out that her husband had to go and will not come back until she agrees on treatment. I know this sounds harsh, but you can discuss and plan the whole "thing" with your family doctor. (I am not a specialist, am only trying to think logic).

I would not have thought about grief as something she has to go through to become better. I would rather have thought that a loss put this on, but other "things" makes it continue. Those "things" can have been there hidden deep inside her for many, many years. She is seriously sick and needs help.

Are you sure she is manic? What behavior has made the doctors conclude that she is manic? Why have they not put her on anti-psychotics or medication for bipolar? Xanax is for anxiety. Zoloft and Remeron are for depression only, that is UNI-polar, not bipolar (google them).

You need to "man up" and take a serious talk with your family doctor.

 

[Blooming]

By the way, has she had a proper physical examination?

 

[doinnothin]

Do you and/or your father have access to some form of therapy or counselling for yourselves?

It might seem backwards, but you must take care of yourselves, too. This much stress will begin to burn you out.

Not a doctor, can't really offer much, but - lack of sleep is making her worse. Sleep deprivation destroys our mental states. I've gone through a couple brief periods like your mom is having, a week or so at a time, and lack of sleep made everything even worse.

I think that, somehow, you need to figure out a way to get her some more sleep. That will help her begin to think a bit more clearly.

I also think a big part of the issue was delayed grief/dpression from loss of her dad. So long as she was busy and had a goal, she was "fine". People with depression are good at focusing on tasks as a distraction, but when the distraction is done, it all crashes down.

You're right - she has no goal set right now, and she's too upset to set them herself. If you can aim her at a task, or convince her self care is a valid goal, she might begin to come back to herself.

I'm going to look into local therapists I can see that are covered by my insurance. I'll definitely need to start that process soon. I think there's a lot to unpack for myself personally and hopefully I'll be able to get some advice for how to manage this situation with my mom.

I've reiterated that she needs to take all that energy she typically puts towards others and turn it inward and build herself back up. It's hard to tell if she takes any of my suggestions to heart.

Yesterday I asked if she wanted me to come over to the house and she adamantly asked me not to visit as she doesn't want me to see her in her current state.

Kind of at a loss at the moment. Running out of ideas for how to get her the help that she needs.

 

[doinnothin]

This seem to be a terrible and some sort of hopeless situation. She cannot be forced into a hospital as long as she is not a danger to herself or others. She needs treatment, but will not allow it.

I second Nukelavee's understanding about that you and your father need help so you don't get too much caught up in this. Personal help can be given by a Therapist or Counsellor to each one of you. Other types of help (self-help) will be to make room and time for yourself (yourselves). A walk in a park, a visit to a library to sit and relax and read a paper in peace. (I do not know how much is locked down due to corona at your place). It is also important that you and your father get enough sleep, nutrition and physical exercises. You have to learn to put your main focus on other "things" then this mother of your's.

Your mother seem to be very sick. Through her sickness she controls you (even if she is not aware of it). If this continues, it has to be a question about if you will allow this. You have probably talked this over before, but you can do it again. You have to find your own way, but what I had in mind was your father tells her that he is tiered of all this and want her to go to a hospital voluntary or he will leave (for vacation for a couple of weeks). You can visit her now and then to point out that her husband had to go and will not come back until she agrees on treatment. I know this sounds harsh, but you can discuss and plan the whole "thing" with your family doctor. (I am not a specialist, am only trying to think logic).

I would not have thought about grief as something she has to go through to become better. I would rather have thought that a loss put this on, but other "things" makes it continue. Those "things" can have been there hidden deep inside her for many, many years. She is seriously sick and needs help.

Are you sure she is manic? What behavior has made the doctors conclude that she is manic? Why have they not put her on anti-psychotics or medication for bipolar? Xanax is for anxiety. Zoloft and Remeron are for depression only, that is UNI-polar, not bipolar (google them).

You need to "man up" and take a serious talk with your family doctor.

I appreciate you taking the time to read and reply.

We've never been given a proper diagnosis outside of "depression" from the psychologist we visited a few months back. I've personally labeled it "manic" because the description I've read online matches a lot of her current behavior. Where she's constantly on her feet all day. Either staring at herself in the mirror or staring at a piece of paper on the counter. As well as the severe sleep depravation and lack of motivation.

I'm unsure of what you mean with "proper physical examination." She's seen two family physicians and a psychologist. We have an appointment with a neurologist for July 3rd but we doubt we'll be able to get her out of the house.

The plan you laid out seems like it would work in theory, but it's pretty scary to think what she could do to herself if left all alone. Especially if she somehow finds the courage to get in her car and drive. I like the idea of some kind of ultimatum but worried that the risk of complete isolation could be too high. We will be calling our family doctor to figure out a plan of action soon.

 

[Nukelavee]

Yesterday I asked if she wanted me to come over to the house and she adamantly asked me not to visit as she doesn't want me to see her in her current state.

I went through a period like this when I had a breakdown 15 years ago. I hid from everybody for months - I knew people would know I'd lost it if they saw me or my home.

When my Mom finally came to see me, it was like a dam breaking. I saw the look on her face, she knew how messed up I was. Not feeling like I had to keep it a secret was literally a life saver for me.

I'm not saying your mom will react like I did, letting people help me - but I can promise she's aware of how messed up she is.

I'll point out my mom came over with my permission.

 

[Blooming]

I'm unsure of what you mean with "proper physical examination." (...)

The plan you laid out seems like it would work in theory, but it's pretty scary to think what she could do to herself if left all alone. (...)

We will be calling our family doctor to figure out a plan of action soon.

With "proper physical examination" I meant that sometimes what seems to be a mental illness can be rooted in a physical disorder like a brain tumor or other. It seems slike she is taken care of by the description you gives.

Yes, I see that leaving her for some time can have unwanted effects. That's why I suggested that you made the plan with your family doctor.

If I were you I would have used time upon "helping the doctor" to see the whole picture around your mother. Be careful, some doctors don't like that medical ideas come from others then themselves. You can, as an example, try to tell that you are worried about all her activity in spite of almost no sleep and perhaps ask if she can have another disorder in addition to her depression, and then ask if there are other types of medication ...

Depression is about not being able to do anythig (worst case scenario) or at least need a lot of rest. You tell about the opposit. As far as I have understood by reading here and there, medication for uni-depression is not to be given to bipolar persons because it can make the bipolar illness worse. (Some people with bipolar disorder can use an SSRI in addition to medication for bipolar).

Whatever diagnose she will end up with (it could even be something else than bipolar) I hope that she soon will be given proper medicaion and accept that so it is. She needs medication for her plagues, while the diabetics need another medication for their plagues. It is not a shame to use meds.

I wish you and your father the best of luck to be able to live with this until right medication and treatment can be given to her.

 

[Dice]

Agreed. Antidepressants for Bipolar (Manic depression), if it is that, will be pouring fuel on the fire, I speak from first-hand experience of that one unfortunately.
Who goes with her to the doctors appointments for changes in medication? (actually, I suppose that's done over the phone at the minute, right?) Either way, it sounds like outside input is needed from either yourself or your dad to really ram the message home that she's a mess as she is. You could start with requesting a reassessment of her diagnosis, which could then lead to different medications that actually do something. Personally, I would say it sounds like a case for the hospital but it's tricky. Maybe you could record her behaviour and show it her because she will think, due to delusional thinking, that these things aren't happening. Maybe if she sees it, it may register. Be sure to reassure her that you want to look after her and help her though, as she may see that as you plotting against her. I feel for your family though, it sounds like a terrible situation. I guess it's times like this where being sectioned involuntarily, as we have it here, is evidence of why we have it. When you're that out of touch with reality you do need it. Best of luck to you.

 

[nyarb]

I don't know the situation with medical emergencies in the UK, but here, she is a danger to herself, because she isn't eating, sleeping, and her hair is falling out. Her behavior is erratic. That is a danger to her well being. I would do an intervention, it is extreme. Also cudo's to those who know bipolar, anti depressants are the wrong, wrong meds for bipolar. She needs an anti psychotic to get the sleep she needs, she needs a forced entry into a hospital for evaluation, sleep, food, and a controlled environment. Since it is dangerous to do hospital with covid, she needs to be tricked into getting some meds for manic-depression or ptsd. I am not a doctor, but her behavior sounds a lot like those mentioned. Anti depressants ARE NOT right. They promote bipolar mania. She needs sleep first, then nutrition. Threatening to leave her is not a start, but find a "good' moment to discuss this, or run the risk of losing her to poor health, or hospitalization during Covid, that could kill her, since her body is already compromised. Sorry for this, wow, I am so sorry. I hope you can get her help, she needs it now, this has gone on too long and she is very sick. Call the help lines in your area, reach out wherever you can. Read up on her symptoms. But it doesn't sound like depression, it's closer to mania, possibly ptsd, or worse schizophrenia. Take all necessary measures to get her some help.