Thanks everyone for your responses on this subject. I feel like I have a much better picture in mind based upon your input. I really appreciate it.

Right. I didn't say clearly what I meant which is actually what you said since it is an actual AP med used short-term. His opinion so far is that tbi is secondary until I am more stabilized and he won't add other meds until we have things sorted out better. Makes sense because my self-destructive impulses are a lifelong issue and if they win the day, we won't have the opportunity to try anything. And, he does not want me in hospital. So, we're waiting on the lithium.

I'd have to see the link between unmedicated bipolar and early onset dementia and senility. That's a new one for me but since it obviously comes from a clinical source would like to read it. As for untreated bipolar or depression of course it catches up to a person. When I said schizophrenia stabilizes over time I meant on medication. Anyway, as a person with schizoaffective disorder like most, although I started medication voluntarily, it would have happenned to me anyway. Unlike bipolar unless a person is homeless or mistreated people with schizophrenia or schizoaffective cannot hide what is going on and ends up on medication regardless. Fortunately, the course of recovery is much brighter than when I started treatment and there were just the old line antipsychotics such as Haldol. Of course the number of identified mood stabilizers increases all the time as well. With the increasing number of options I believe the recovery rate will increase as well as mental health awareness more people will start medication earlier which will help as well. They had no idea I had schizoaffective when I was a teenager and now mental health awareness is part of the health education classes so things do improve.

No that another issue entirely. A psychiatrist will prescribe an antipsychotic to take someone out of an extreme manic swing that has psychotic aspects and then as that settles down and the mood stabilizer kicks in may take them off it. Obviously for myself as a person with schizoaffective I need an antipsychotic for life. And an antipsychotic by itself may not do the job as a mood stabilizer because I need a mood stabilizer as well. But if someone is hospitalized or psychotic or rapid cycling as mood stabilizers take a while to build up to a proper dose an antipsychotic is what they are given first.

In some ways, my BP symtoms are not as bad as they used to be.  But I think that's because I have learned to manage them.

It's almost as if BP is an entity in and of itself, fighting for control over the intellectual part of my brain.  It's also metastatic, like cancer, reaching out it's long fingers of death to settle into all the parts of my brain that control who I am and how I am, and I must fight in order to keep it at bay.  It increases in severity and depth every day; and the neurons follow this worn path, wearing it down further as time goes on.

This was once a slower process, but it seems that the more I learn, the more BP seems to take over.  This leaves me to wonder if it`s really due to age, or to my subconcious just giving up and giving in to what ``should`` be BP symptoms.  You know, like the hypochondriac I was always accused of being as a child.

Studies have shown that Bipolar like all mental illnesses does get worse with age which stands to reason.  This is where unmedicated bipolars suffer more as well because linkages have been shown between undiagnosed and unmedicated bipolars and early onset dementia and senility.

I managed 15 years med free and controlled my hypomania I thought, keeping my diagnosis hidden from everyone even my wife and family, I thought I had it under control and fooled myself, of course when diagnosed everyone went "we knew something was wrong" and i was only fooling myself really and when I looked back the whole process was there, the high and low and mood swings, the anger, the depression and now I can even recall the suicidal feelings I like to claim I never had.

Ultimately its a matter of not if but when for bipolars - you can run unmedicated and even hypomanic a long time but eventually the right combination of stressors and events builds up and you get blindsided - the rate of suicide from people who upon investigation were not diagnosed with a mental illness but had one is very high and there are many many bipolars whose diagnosis came in a hospital ward or worse a suicide watch room like my first one did.

Hey ILAD - When I most recently saw my psych - who is also a neuro - I was hypomanic and out of control. He gave me Zyprexa. I took it for four days. That is not how many/most psychiatrists would handle it, from what ya'll have written here. Regardless, that's what he likes to do to bring patients down. After four days on Zyprexa, I was still a little hypo, but not like that day. I thought I was sliding into depression, but then I popped up again.

The day I saw him was the day I had the urges to run into people with the car, when I couldn't keep my eyes still and when I was so aggressive that he laughed and said I was being a b-word. And, I had been in that state and worse since Friday. I saw him on Tuesday... So, no we didn't get into any kind of discussion in detail because I was in no state to conduct such a conversation. Let's see - that would have been around December 16th, maybe? It was an emergency consult - for obvious reasons.

My next regularly scheduled visit with him we will be addressing several things, not the least of which is the head injury. However, he is aware of it already.

  I'd have to find out if bipolar increases with age. Schizophrenia does lessen over time from what my psychopharmocologist said. And I have schizoaffective disorder which may be a more extreme variant of bipolar with psychotic features (in schizoaffective disorder you are psychotic all the time, in bipolar with psychotic features its only during moodswings) from what I learned during testimony I conducted. People with bipolar usually have some mood episodes before the full onset. Its complex. I know for myself I first started having auditory hallucinations ("hearing voices") at the age of 13 (at the direct onset of puberty) and had a full onset of psychosis at the age of 18 (when I left for college) and that's fairly common. That's when I started Lithium with an antipsychotic and I've been on medication ever since. Lamictal is generally good but if someone has tried the standard 3 (Lithium, Depakoate, Lamictal) then there are other options. I've presented this link enough:
http://www.psycheducation.org/depression/meds/moodstabilizers.htm
  As for antipsychotics I've never heard of them given PRN in recent times but then again treatment for a tbi is different. For bipolar with psychotic features in general they must be taken daily to work. Horselover65 if you haven't had a full consult with a neurologist for treatment for a tbi that would be essential. Medication dosages vary for people with tbi as well as treatment and a tbi can cause psychosis and personality changes of its own. I've mentioned the experimental antipsychotic I am on in enough posts already but the recovery you are not experiencing you might very well when this class of antipsychotics (glutamate antagonists) is approved. I don't know of many medications used off label as antipsychotics except for Zofran which I am on which is used as an off label experimental antipsychotic but has too many side effects for me to personally reccomend but I'd be interested to know which one you are on. In general I'd say that if people think that in the future their symptoms will be worse I'd strongly say that's untrue because even if that's the natural course of the disability (I'll find out more about that) in each generation new treatments become available that are more targeted and more helpful.

My experience is that it has definitely gotten worse, lasts longer and is a lot more unpleasant. Depression started in childhood and as I got older, there were a few mildly psychotic episodes and some hypomania, but it was also relatively mild. As a teen, I could go from deep depression to hysterical laughter, rapid speech, etc., but I went right back to depression within hours. Depression has been my natural state, I guess. When I was in school, the hypomania came in handy when I needed to study, but if I was depressed, boy things were rough.

I am now 43. I've had one good, normal year in my whole life. The past several years, things have seemed to decline. The past year was a more noticeable decline. The past 6 months or so, things have declined so quickly and drastically that I have contemplated on an almost-daily basis whether there is any hope at all, whether I should leave my husband or seek in-patient care, and just what is going to become of me.

My psychiatrist did tell me about a female patient who'd originally seen him at about age 38. At that time, she was managing fairly well without medication and discontinued treatment after only a few sessions. By the time she was 41 or 42, she was having psychotic episodes and delusions to the point that she couldn't cope any more. So, I think even a few years can make a big difference.

I was also told that the more we go on and off medication, the more issues we'll have. Don't know if it's true... I thought I was on a mood stabilizer as a teen, but I looked up the drug a few weeks ago and found out it was an anti-psychotic. Other than 2 attempts with Lamictal, both within the past 5 or 6 years, I had not been treated with a MS. I had been on lots of different anti-depressants and the occasional sedative, but no other MS. I'm on lithium now with an anti-psychotic that is PRN (which is an off-label use, apparently) and Xanax which I take occasionally.

Okay, the boring stuff: The psych thinks that along with bipolar 2 I have anxiety and agoraphobia, but he also suspects PTSD (an old diagnosis, so probably true), obsessive personality or OCD (I don't think it's OCD and the obsessive could be part of bipolar - who doesn't count, for pete's sake?), ADD, hyper-something or other and panic attacks. I also had a severe head injury about five years ago that was untreated. (Knocked out several times, had a seizure - thanks to a new weanling who is now a big boy and kicked the trainer a couple of months ago). I thought the escalating rage might be associated with that, but we haven't investigated yet. I am wondering if an MRI would show anything after all this time. It happened 5 years ago. I am starting to wonder if things would wait 4 1/2 years to get bad. I doubt it. I think it's the bipolar symptoms getting more severe. The psych did think a few weeks ago I was in full mania, but then he back-pedaled and decided it was more likely hypomania along with everything else that's happening. It does make things complicated because some of this stuff should resolve at least partially when the bipolar is under control and he doesn't want to toss a bunch of drugs at me. The idea is to do it systematically, but that is also the slow way to go. God, how boring...

I will add that on a positive note, I seemed to have more clear incidences of psychoses, more hallucinations, etc. when I was younger. For decades, I had none of those that I recall. It is only now that it is creeping back a little and I usually know that something isn't real. I still hear it or, very rarely, see it, but I know that it isn't actually there. The agoraphobia-related stuff is still there, though, and it's trickier. I thought some of it was paranoia. So sometimes, yeah, I am still convinced someone/something is lurking around the house. We'll get to it. As long as I don't hallucinate monsters outside, I am okay. Right? Ha ha ha.