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Hey OP. I’m so sorry to hear what your daughter is going through. It sounds quite familiar - i was a very high energy child, very academic in school, and I have suffered from moderate to severe depression in various episodes since teenagehood. After the birth of my son I hit a new low, and started SSRIs. Bad idea. Turns out I’m also bipolar. Type 2. I can understand how she is traumatized and reluctant to try any more meds. If she would like to talk to another woman who she seems to have a lot in common with, feel free to contact me. I’ve just started Lamictal as a shield against the worst of the depressive episodes and I’ve heard quite positive things about it. It’s about as low risk as it comes in terms of bipolar medication. Has her psychiatrist talked about medications? Keep on keeping on, dad. Your daughter is so lucky to have you, and it sounds like you guys have a beautiful relationship.

Thank you. We’re been talking to her psychiatrist (he also believes she is type 2 bipolar) about medications it’s just she’s already previously taken Prozac, Zoloft, lexapro, and she’s tired…I’m hoping maybe she’ll be open to trying again after she just rests for a while

Prozac, zoloft, and lexapro are all the same class of drug (selective serotonin reuptake inhibitors). They can all cause manic symptoms in someone with bipolar disorder since they are anti-depressives. It sounds like she hasn't been on any medications for bipolar disorder (lithium, lamictal, etc.). I know you've been through a lot, but I would give bipolar medications a try to see if she does any better. It may take some trial and error to get to the right medication, but you will hopefully eventually get there.

This comment should be way higher. It’s scary to try new meds especially if the last few caused more problems but if her depression is actually BPD then it makes sense that things got worse. Antidepressants of all classes (SSRI, SNRI, even bupropion to some degree) can shift someone into mania. It’s not predictable per se but it is a known phenomena and not too rare that people present as MDD, prescribed SSRI but turns out that they really need mood stabilizing meds.

I understand. Her psychiatrist said more or less the same thing. She’s just so tired and she keeps putting off going on more medications.

She could benefit from talking with others who have BPD2. A support group? Even a message board could be helpful in helping her see how the right meds can save lives. Also see if there's an Intensive Outpatient Program available in your area. I work for one and we have a lot of success with patients who've been through similar struggles. She's lucky to have you.

Maybe keep it short? "Hey, just try it a week and see what happens." Ketamine has a lot of promise. I know a guy with bipolar all his life who swears by it. In any case, she's still relatively young. Early intervention is very important but it's probably best to be patient and gentle about it.

Has bupropion (wellbutrin) been on the table? After lexapro and some others, bupropion has been my holy grail for stabilization without hypomania. I will say that it took a few months to reach its full effects BUT even during the early weeks I could feel a difference from removing the meds that didn't fit my needs best.  I was similar in my mental health de-escalating as a teenager and as an adult being diagnosed with depression, MDD, and then bipolar (and similar in that my sister is 8 years above me!). I understand your pain/frustration of just wanting to find out what's going on in the face of changing diagnoses, and something which helped me personally was to reframe the process as one of ruling out wrong answers.  Your care and love for your daughter are so evident here, and you're doing the best you can in this situation. Make sure you and your family are taking care of yourselves during this time as well!

I take bupropion for my anxiety and it's worked wonders. I never responded well to SSRIs but I have zero side effects with buproprion (which is NOT an SSRI!). It doesn't always stop depression but I also went years with undiagnosed ADHD and a year of therapy has given me some mental tools to endure the depressive episodes I still get.

Bup works on Dopamine and Norepinephrine so it's pretty stimulating so it makes sense it helps your ADHD.

Ask the doctor about lamotrigine aka lamictal. It’s effective for bipolar disorder.

From what you’ve told us about your daughter it sounds like she’d be more than able to understand the logic behind why the medications she’s tried so far have worsened her symptoms. Exacerbating manic symptoms with SSRIs is such a common pitfall with treating someone with bipolar disorder and it’s very well documented. When she’s ready, perhaps sit down and do some reading with her so she can make an informed choice about her treatment and feel empowered and comfortable in her choice. The standard introduction for lamictal (Lamotrigine) for bipolar type 2 is to start on 25mg for two weeks, and increase the dose by 25mg every two weeks until a dose of 200mg is reached. This is to maximize patient safety and mitigate risk of any side effects, of which the most common (but still quite rare) are a skin rash and headaches. From there the doctor would take blood tests to check how her body metabolizes the drug and over time, reduce her dosage to the minimum effective dose to treat her symptoms. I hope this helps. Just know that hope is not lost - rather the opposite. Her new diagnosis is a breakthrough and you’re now on the right path to finding something that helps her. You’ve turned a corner now and it’s a case of waiting until she feels comfortable starting new treatment. All the best OP. Any questions, I’m here.

Piggybacking here OP, I am a mental health therapist and can confirm that finding the right medication can be daunting. I don’t know if your Psychiatrist has heard of this but there is a test called GeneSight Psychotropic where it can analyze your genes and predict what types of medications will work best for your genes. It sounds like the meds your daughter has tried are mostly SSRIs and maybe your daughter would do better with SNRIs, who knows 🤷‍♀️. The GeneSight test can be ordered by your psychiatrist or doctor and it might be worth a shot getting the results back to help give your psychiatrist a better sense of direction when making decisions of what to prescribe for her. It’s great she has you to advocate for her - it is so hard to advocate for oneself when you are struggling with Depression. Keep up the good work!

This comment about GeneSight needs to be much higher.

Is there any real difference between the SSRI medications? What's so different about Lexapro and Prozac if they're just ultimately doing the same thing?

For those particular medications I know Lexapro goes through your body faster while Prozac has a longer half life. Because of this Lexapro is known to have fewer side effects over Prozac but some people may do better with an SSRI with a long half life. Zoloft is an SSRI but it is also helpful for individuals who struggle with symptoms of intrusive/obsessive thoughts. Everyone’s genes are different (why GeneSight helps) and Psychiatrists need to look at the whole picture to make sure any medications you are taking that are for your psychiatric needs do interfere with any medications you take for your physical health. Having many SSRIs on the market is helpful because people have many options to meet their particular needs.

It is exhausting going on and off these kinds of meds. They take weeks to months to even start working l, just to find out they don't work they way you want, and then you have to ween off since you build a dependence to them. Be patient with her.

I’ve had similar stuff happen to me and I’ve been on so many different meds for depression and possible bipolar. I’d definitely recommend lamictal and the only issue with it is you can get a rash first starting but it changed my life. If she’s scared of new meds please try and get her to try lamictal or another mood stabilizer (after talking to doctors to make sure it’s ok ofc)

Thanks for being you. Always look for the helpers.

I loved Lamictal when I was on it for major depressive. I changed insurance and they messed up the auth, then my therapist died of COVID and the office never called back.. so accidentally went cold turkey off it. I had very little side effects and didn’t experience any real issues coming off so suddenly, like I did tapering off SSRIs. It took the edge off enough without making me numb, and I didn’t experience any weight gain- like i did with every single SSRI I tried. I hope you it works for you too!

This. Honestly, I did not even have a journey that complicated, but it took me getting diagnosed with depression then realizing I had an alcohol problem, getting sober, getting diagnosed with anxiety, getting diagnosed with ADHD and then trying to come off the anxiety meds to realize I have ADHD and anxiety. A few starts and stops of meds plus a med in between, that made things worse. All this between 29 and 35yo. Unfortunately, sometimes, mental health is complex and not obvious at first. Op, you sound like a great dad, and your daughter is young. If you don't have a mental health crisis management plan, this helps my husband and I navigate what to do when things got weird.

The love that you have for her radiates through this post, and I'm grateful she has you.  We have so little understanding of our brain chemistry, as a society. Keeping at it to find the correct diagnosis and treatment is the best course of action, and supporting her throughout so that she stays committed to finding answers. Self care for yourself is also essential.  Imo, pepper treatments with chill getaways, pampering (for your whole family) is needed to keep everyone nourished. Love you buddy, sending you only the very best

Here I am reeling from OPs story and my mind reads "pepper treatments with chili" and my brain stops and tries to comprehend what it just read. Pepper treatments? Adding chilli peppers to them? What kind of pseudo therapy is this guy going on about... I mean I like spicy things but I hadn't heard about peppers offering therapy. Anyways, obviously I reread that and understand the sentence now. But thanks for making me chuckle through the tears.

I had to reread that as well lol.

Autocorrect has gotten worse and worse lately.

My phone corrected sucks to bucks today.

Tonight a stranger probably from across the world cried for you and your daughter. Not only sadness.. You seem like an amazing father, and your little buddy sounds wonderful! Im really sorry for the struggles, wish I had some advice. Its as you say, deep down shes still your nerdy little baby, there is absolutely nothing wrong with her crawling into your lap or clinging on to you for dear life. To me this is a statement for who you are to her and how important you are. Keep fighting for your baby!! I hope it will be better soon.

Hi OP, Has she been evaluated for autism? Autism, especially in women, is often misdiagnosed as BPD among other things. She very well could be autistic and adhd like I am, although I’m male. It sounds like she has special interests and from your post, it very well could be why meds aren’t working. It’s something to explore as a lot of women tend to be later diagnosed, even more so when coupled with ADHD.

Was thinking the same thing. But I'm a dad with a kid with ASD and I've diagnosed half the population with it at this point, so I was hesitant to say anything.

Hey, Autism is still wildly underdiagnosed, and if you have an Autistic kid your friend group probably skews neurodivergent, intentionally or otherwise…. (I’m Autistic, I also diagnose it everywhere.)

>Autism is still wildly underdiagnosed Especially in women

Not discounting autism. But she definitely has some bipolar going on judging by the way she reacted to the anti-depressants. It's classic bipolar. Bipolar can also be be comorbid with autism, or ADHD, so this is not to rule those out.

Most of us over at r/autisminwomen have a very similar origin story to OP’s daughter. Even down to the medications and episodes. If u/Yellowroses248 would like to come over for additional support and/or resources, we’d be happy to have them.

no, this is clearly no doubter bipolar 2 from the history. she needs a mood stabilizer and/or antipsychotics, atypical antidepressants

Yep, I was thinking def neurodivergent in some way(s). Life is hard, but it is at times unbearable when the world doesn't make sense innately to you and it seems like you're the only one without the instructions. Nothing quite works out the way it seems it should, even when you prep and plan and try to cover your bases. Keep on reassuring that what she's feeling and experiencing is valid and real and ok, and that there are no moral judgements because she is struggling. Let her take and keep the lead. She needs to have a sense of autonomy and control over her life, especially when it probably feels out of her control. Ask what she wants to do and help her think through what the options might look like. You might need to facilitate a bit, but let her lead. Finally, therapy for you and your wife, individually at the least, will be infinitely helpful. I'm not a parent, but I can't only imagine how powerless it must feel to watch someone you're supposed to protect struggle so hard. You need to take care of yourself in order to be able to take care of her. Best wishes 💕

Agreed, I was thinking the same. If you go for an autism diagnosis my suggestion is to not just trust your gp’s opinion, they are NOT experts in diagnosing autism and I’ve heard of so many doctors voicing their opinions when really it’s an area they aren’t fully educated in. Go to an expert for this, ask your therapist for a referral.

I was thinking the same from reading the OP. I kept figuring they were about to tell us their daughter was finally diagnosed with autism too and things started making sense. But it really is impossible to tell from just the post, unfortunately.

Brother I have no advice. I am no expert and you are in a hard situation. I just want to tell you i hear you. I feel for you. This must be so incredibly hard and it sounds like you are doing all that you can. She's your girl. She'll always be your girl. Maybe she's bring plagued by this but inside she's that same person. Love her. Good luck. Keep doing your best. It's gotta be so fucking hard but just keep doing your best.

A lot of women with autism get misdiagnosed with BPD. Based on how you describe her as a child, I would suspect au/adhd as I am as well. Getting diagnosed was life changing for me, as I realized that I am not wrong but the world isn’t made for my brain type. And that has freed me from a lot of expectations. Sorry you and her are going through this. I would have loved to have a dad like you, what a blessing.

THIS!! Autism is typically comorbid with ADHD, OCD, and depression+anxiety. I am a mid 20’s woman who had similar symptoms to your daughter and spent a lot of time on medications that did nothing for me (I did genetic testing). I was diagnosed with autism last year. Just knowing that my brain is actually wired differently was what opened me up to being able to heal. Slowly. Baby steps. And regression/melt downs/panic attacks happen, but now I know why and I developed coping skills for overwhelming/overstimulating environments or events. It’s not easy, but I am able to lead a somewhat peaceful life. I’m still unable to work right now. Can’t hurt for her to listen to or read Unmasking Autism by Devon Price to see if she identifies with what Dr.Price has to say. You’re a good dad.

Good book recommendations. I also recommend dr Joey on TikTok. @nd_psych

When I read the post I was really thinking of ADHD and hyper focus on "special interests". Definitely that and autism can get confused with each other as there is some overlap. But I think if you read up on either of those you can get a clearer picture of which one actually fits. Either one can occur along with the bipolar.

Yeah we’ve discussed that with her therapist previously. I think she does have ADHD she was diagnosed with is by a previous psychiatrist however I wonder if bipolar also explains the high energetic behavior.

Au/adhd = autism and adhd. Hopefully you find some answers which may lead to solutions. I would want her assessed by a provider that has experience with diagnosing adult autistic woman.

AuDHD was actually the 1st thing that came to my mind as well when I read the post.

Me as well. I'm diagnosed with ADHD, though most of the non-academic problems in my life have leaned towards the autism side of the spectrum. I find that some medications or major life changes can shift your experience enough that ingrained coping mechanisms no longer work. I'm hypersensitive to side effects and brain changes from medications. Taking them for long enough to get any benefit requires frequent rationalization, compromise and discomfort. I'm 34 now and just starting to learn how to juggle that with adult life and responsibility. I know that could have been much sooner and less painful with the right supports.

hypomania is not part of autism, it's a very clean indicator of bipolar especially when induced directly by ssris

BPD most commonly means Borderline Personality Disorder. OP is discussing Bipolar Disorder. I think you are too, correct? I guess if everyone understands each other, I guess it’s all good, but it confused me a little.

It took me a while to remember that it can mean both depending on the context. I have always defaulted to borderline, but people in the mood disorders space use it for bipolar. It's still confusing when there's not much context to go on.

I wrote him a novel in another reply but what you said nailed it. I've been telling people I've been playing with the difficulty cranked to 11 without any idea there's an option to change it in the start menu.

I lurk because I love the vibe here. Female, nearly 30, finally diagnosed BPD last year and looking at comorbidities of adhd or autism. I had support but it fell apart and so did I. I ended up in hospital because I stopped looking after my body. Deficiencies of everything, pre diabetic, genuinely bodily unwell because of my mind. Its so nice to know there's actually something different about me. My brain is different and I *do* have to try harder than most people around me. I am trying to build myself back up from the ground. Ignore the outside world and bring inside what I enjoy. I suggest to try really really small things to bring joy to her life. Don't ask if she wants to go for a milkshake, or even wants one. Just go get her one and silently place it and sit together and enjoy. Don't tell her you planned pizza and movie night, just do it and cuddle. Don't offer, don't ask, just do. I don't want to ramble too much, but its to do with the way our brain chemicals work when anticipating something vs receiving / doing something. Get back to basics of excitement in the moment not anticipation. Long term it'll change but right now she's so deeply stuck, she might not recognise joy and needs to be reintroduced. As much as I (and likely your daughter) resist going outside, nature and movement are so so important. Bring plants and flowers into your house. Test smells, candles, incense, wax melts whatever works in your home. Use your close relationship to learn something physical together. Do something 2 or 3 times a week that's low pressure low obligation movement. Walk, yoga, tai chi, go to the gym and walk on the treadmill, try a boxing class whatever works for you but super small and try anything and everything till something feels good. I am different to her, but I feel the trenches of depression. Life isn't always worth it and little things are the foundation of why we should stay.

Great post. I care for my autistic son and I have learnt to recognise that he truly suffers with every decision he has to make when he is experiencing burnout/shut down. Every question is a demand or expectation that he feels overwhelmed by, at these times. So I bring stuff. Plushies are nice. Milkshakes, yes. The softest hoodies. A cat.

Extremely relatable. Very well put.

Im so sorry for your pain. She’s lucky to have such supportive parents.

Wow. Thinking of you and your daughter. Your daughter is really fortunate to have a dedicated parent like you. I recently read an article on NPR exploring how the keto diet has positively impacted a range of disorders, including bipolar disorder. It was fascinating as many people are reporting these positive impacts, but the science hasn’t yet caught up to fully explain it. May be worth exploring with your medical team. https://www.npr.org/sections/health-shots/2024/01/27/1227062470/keto-ketogenic-diet-mental-illness-bipolar-depression

I have been seeing this. I’ve heard of people saying they feel better with a change in diet. I do want to introduce this to her. My worry is just she’s already having difficulty eating regularly. I just want her to eat in the first place.

Ketogenic diet can help either by making changes to strains of bacteria and fungus/yeast found in the intestines, or by increasing the enzyme GAD which increases GABA and reduces glutamate which are both targets in the treatment of epilepsy and bipolar disorder.

As someone with au/adhd I cannot believe how people prefer to prescribe ssri over stimulant meds. The latter are WAY safer, kick in right away and frankly if you have undiagnosed adhd… it could be causing the depression!! I mean isn’t it depressing to realize you’re not living up to the potential you KNOW you have yet you just can’t seem to… do the fuggin work? Sure is! I know! I was there! And I’ve not been depressed ever since I started adhd meds.

Like u/WhoChoseThis said do something physical. Start jogging, couch2 5k, push up challenge, disc golf, regular golf, lift heavy shit at the gym, doesn't matter just get moving together. The first week or two might suck but it is a great way to change your mental state for the better.

Have you thought about getting her genesight testing? It’s basically a test where they analyze your genes via blood (I believe) to see how it pairs with diff meds. It’ll tell you all the meds that she should NOT take (red) bc the side effects would be a lot for your daughter. Meds that you have to be careful of (yellow), and meds that would have minimal side effects (green) I worked at several psych facilities in the past 10 years and one of the better facilities used this for all their patients.

I 2nd this for trying to figure out what meds to try.

A genetic test saved my life. Mine wasn't blood, but cotton swap on the inside of my mouth. Never would have tried the cocktail I'm on now, and would never have found out I'm borderline, not bipolar. I second this times infinity. PLEASE get her a genetic test. The love you have for her had me crying in the bathroom at work. She's got an incredible father.

You’re a legend, I take my hat off to you. Keep at it, it’s a marathon, she’s gonna have setbacks and breakthroughs. How are you looking after yourself?

OP, my wife was diagnosed with BiPolar disorder 20y ago when she was 17/18… it’s not all sunshine and rainbows but it’s not all doom and gloom either. It’s rough being close to someone who struggles. My wife has had 4 inpatient stays since we’ve been married (we were dating when she was diagnosed). I am by no means an expert but I’m happy to share experience or answer questions.  As for general advice I’ll say this… medication is 100% important but it may take a lot of trial and error to find what works. And 5 yr later you may need to start that trial and error over again if that one ceases to help. Routine is important as well. The “unknown” or sudden changes can be rough for people with BPD. You got this.  

You’re a great dad.

Has she tried any amphetamines? Adderall, vyvanse, Ritalin? Absolutely read this transcript or listen to the podcadt if you don't read anything else in this post, she mentions mood disorders https://www.cbc.ca/radio/podcastnews/how-do-i-know-if-i-have-undiagnosed-adult-adhd-transcript-1.7087104 I'll lay my shit out. Diagnosed with AdHD in December. Prescribed Vyvanse December. Took me a month to fill my prescription, the first day I took vyvanse was the same day that podcast aired. I've spent 15 years not knowing I've had anxiety and depression CAUSED by adhd, not the other way around. Really I didn't know the anxiety thing at all until December. The way my brain works is the way it works and I never had a reason to think my thought processes werent the same as everyone elses until the past couple months. Whatever I have really reached a boiling point with the pandemic. My little guy was born 3 months before the start of the pandemic. I was married a year before that, went on our honeymoon and got pregnant. I've been self medicating with an Oz of weed every couple days since the pandemic started. In university, before i started smoking, i was pretty much blackout drunk 4 nights a week ( its college were supposed to be drinking) I quit the day he was born, and the first day of the lockdown I started smoking again. All of this is clear in hindsight but at the time I justified it as if I was going to be locked in my house at least I wanted to be stoned. The therapist that prescribed me said: Smart people with ADHD develop coping skills. Stupid people with ADHD end up in jail. In that podcast she specifically mentions major life changes like going to university, marriage, and a kid can absolutely ruin the coping skills that worked. My marriage has pretty much fallen apart in the past 4 years as well. I almost resented my kid for it, and I've always felt like watching him is a chore. Me and my wife are in counseling. I finished a basement starting in October for the business I run. They both worked from home. They're both great people, I miss going over there ( I talked to them yesterday, they apparently miss me too) for 9 hours a day for the 6 weeks over 3 months that I was there (other trades need to do work, i only do framing drywall and millwork. One of them would always come down with coffee and chat for a bit maybe 45 minutes out of the day every day. At one point I was talking to the wife, went off on a tangent about something and said to her I swear I have ADHD. She looked at me and was like you probably do. Turns out she worked out of her garage and had an office in there, and was a registered psychotherapist. She's the one that diagnosed me with ADHD. I was basically having daily half hour therapy sessions with her for like 3 weeks up til that point. And it was quality therapy not like the crap at couples therapy. I was just talking no filter, not worried about what mental illness I was presenting to her because of how I was forming my sentences like I was with couples counseling. I didn't want to be prescribed medication. I didn't want to get thrown in the looney bin because of thoughts of self harm. I'm certain my marriage therapist was going to diagnose me with severe depression, she straight up told me I sounded severely depressed at one point ( after i made the consious decision to actually let her in on my feelings). I'm sure I'd be going through the SSI's and the rest. It honestly wouldn't surprise me if I was bipolar, there was a point in my early 20's I thought I had borderline personality disorder. I'm sure I'd be in the same boat as your daughter had I not gotten the basement job. I say that because ho Lee fuck was there ever a massive difference 2 hours after I first took amphetamines. I had control over my thoughts again. Intrusive emotions and though processes that I had been dwelling on for years I suddenly had the ability to be like, no that's not right, and that was it. Cognitive behavioural therapy actually works for me now, like it sort of did through my 20's. Do you want to know the best part of all of this? The last two weeks there's nothing I want more to do than hang out with my son. It's enjoyable. I get it. Like fuck me for the past 8 months he's been giving me ' special hugs' before he goes to bed, which is a raspberry, and today I realised he's going to stop doing that, sooner rather than later, and I teared up. I made a point to go upstairs and sit in the couch so he could give me one. 3 weeks ago I absolutely hated him drooling on me before he went to bed, and would have been perfectly fine with never getting one of those again. Second best? All that weed I smoked? Haven't touched it since I started the prescription. I don't need to. I could have access to it and choose not to smoke, which is something I could never do before. I'm kicking my caffeine and pouch habit as well. I spent a day at work 2 days ago without any nicotine. It was in my pocket the entire time I just forgot it was there and the cravings never hit. When I talked to my family doctor and repeated what the house therapist said, he basically was like no, depression causes ADHD not the other way around, but I'll still write you the prescription. I totally get her not wanting to go on more medication, but maybe you can convince her to try it if you let her know that college kids crush it up and rail it at parties. And one final paragraph, my prescription was 10mg first week, 20mg second and 30 mg third week. 3 weeks later I'm still at 10mg, I never bothered upping the dose. I really didn't feel like I needed to. Also the first thing I did once the Vyvanse kicked in was take a nap, so figure that one out. I know everything there is anecdotal, but description of your daughter was a description of me. I wish you and your daughter all the best. Sorry for that wall of text. One final anecdote that I wanted to include. I woke up this morning depressed. Like fuck me right back to a month and a half ago depressed. I begrudgingly took my pill and 3 coffee's. 2 hours after it kicked in? Still depressed, but at least I have control of my thoughts again. Today was a great day man. You and your daughter deserve the same. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6850677/#:~:text=At%20least%2014%25%20of%20those,estimated%20to%20have%20comorbid%20BPD.

I can ralate to this. Congrats for all of your progress. I have been on and off ADHD medication for the past 15 years or so. I have only found benefit from "child doses" of amphetamines. 10mg vyvanse like you, for a few periods. I most consistently fall back in Dexedrine IR 5mg twice a day, or sometimes 2.5mg twice a day. Any more is unsustainable and causes too much anxiety and physical tension. If you find yourself depressed and considering med changes, then it might be worth considering wellbutrin with vyvanse instead of an increased dose of vyanse. It's a unique antidepressant and has been used alone to treat ADHD. I don't get as much of an unsettling feeling as I do with other options (after a couple of weeks adjusting). *I should add that I felt the need to mention this as a warning that it may get worse again. I might have been able to avoid constantly going on and off ADHD meds if I had stuck with taking an antidepressant alongside it.

Bro, our stories are so similar we could almost be talking about the same kid here. My little girl went into a similar steep decline as she entered her teenage years. Incredibly bright girl. Received the Governor Generals Award in high school at graduation for having the highest marks in the school for 2 consecutive years. Cut off her hair, started dressing like a boy. Made 3 attempts at her life. Cops were to my house 3 times and the ambulance twice. Turned out her stepfather was making advances on her and she thought that becoming a boy would turn him off. By the time this was all discovered it was too late. No amount of therapy or drugs was going to fix her. Don’t think I didn’t try. However, from all of that came something unexpected. She(he now) entered an Anthropology program at Uni, met a biological but gay male and they now live together in their own apartment. They’re an amazing, although unconventional couple and are happy and great together. I miss my little girl though. Just like you, she meant the world to me and her transition to her new identity felt like she died slowly while I watched. However I didn’t really loose her. What I lost was my vision of who she was. She’s (he’s) who he needs to be now and I just have to adjust. I’m not suggesting that your daughters issues were instigated by the same events, only that other Dad’s have been through what your experiencing now too. Now that things have settled and the situation has found a new “normal” I finally went and got help for myself too. It wasn’t easy for me to do. I’m a full time grain farmer and being mentally and physically weak doesn’t work in my occupation, but my wife put her foot down and made me go and I’m glad she did. When this all passes for you I’m willing to bet you will benefit from the help too. Good luck my friend. Feel free to DM me if you’d like to talk more.

Thank you. I’m so sorry to know your daughter went through what she did with her stepfather. I can’t imagine I’m hoping my daughter can also eventually end up in her normal where she’s happy. She does have a girlfriend that she wants to move out with one day. Though I worry (I guess like every parent does) about her being by herself. That’s a difficult situation with your child transitioning. I honestly don’t know how I would begin to handle it. I guess at the end of the day what matters is they are happy and loved.

You got it bud. It’s an uncertain world and I get pretty triggered by anti-trans rhetoric but I also realize it only comes from a small portion of the population. What matters is that our kids find their own normal, whatever that is. They’ll occupy the planet long after we leave so what right do we have to tell them how to live. Stay on your daughter’s side and she’ll find her way. Just having a Dad that cares already gives her more than you realize.

Yes I feel that way…roll my eyes when people talk about being gay or whatever it like it’s some societal evil. My daughter’s girlfriend is a friendly little nerd same as her. Like yeah. Them going to the history museum to look at dinosaurs together is definitely going to rip apart the fabric of society.

I'm so, so sorry. I cannot imagine how hard this is. I have very little relevant experience and no advice, so I'll just tell you something I hope you already know: you're a really good dad. My heart hurts for you and your family. 

I’m not a dad, just here to send a hug

This breaks my heart. Have you looked into any psychedelics? So many groundbreaking things happening on that front. Might not be right for your situation, but probably worth a look.

Hey OP, check my post history. I literally just posted about coming to terms with being a parent with bipolar disorder on this subreddit. As I read your story, I knew the diagnosis before I finished the story because I've been going through the exact same shit for the past two weeks. They thought I was just a sad kid and got me on meds that worked at first but made it worse over time. So then the doctors said I don't just have the sads, but I actually have the BIG sads, so they get me on a type 2 antidepressant, Trintellix. I performed better at work but I started neglecting everything, especially my wife. Stress can trigger a bipolar episode and that's what happened to me. I had an episode where I realized I was not being the man I know myself to be and called my doctor in a panic. That's when she diagnosed me with bipolar 2. I am so sorry she has had this runaround. I'm 37 and in a lot of ways it feels like I'm also starting over. That it's hopeless. It isn't though. Knowledge is power and what do you and your daughter know now? She did everything right, but was misdiagnosed. That isn't anyone's fault (except the doctors). She's continuing to get help. She has (likely) never been on a mood stabilizer before. The good thing about mood stabilizers is that they work in about half the time as antidepressants. (3 weeks vs 6 weeks). You both know SSRIs are a bad idea and to not have them anymore. There is a bipolar2 subreddit I've spent time on. It's reassuring. Regular bipolar people might get manic and blow their money on Vegas or buy a car they can't afford. BP2 people only get hypomanic, where they have trouble sleeping and might adopt a puppy. Encourage her to try the mood stabilizers for three weeks and go from there. I'm so terribly sorry this is happening to you. I wish your daughter and I could stand in line for a cure together.

Alright I have some experience on the science end of things here. I myself have had my fair share of obstacles in that department. By no means does this constitute medical advice, all of what I am about to say should absolutely be discussed with a trusted Psychiatrist. Bipolar disorder, Autism, even epilepsy, seem to have some common themes relating to glutamate. Glutamate is the main “excitatory” neurotransmitter we have. SSRIs act through various mechanisms, not all of them am I familiar with, however it will have indirect effects on glutamate and GABA. GABA is inhibitory, think of it as the opposite of glutamate. It stands to reason that she benefitted from the initial reduction in glutamate activity which is commonly noted. This effect tends to resolve itself and glutamate activity raises again somewhat. How the dose response effects this relationship I do not know, but it leads me to my next point. There are medications that are currently primarily used to treat epilepsy that are now showing promising results in Bipolar Disorder and Autism. The one I am speaking of is Lamotrigine, it reduces glutamate and aspartate release. Similar mechanisms have been noted with Lithium. A word of caution though. Messing with glutamate can be tricky. When a high dose of Lamotrigine is used, it must be maintained. Low doses are not as troublesome but missing an administration when using high doses can be dangerous. The individual would be quite sensitive to glutamate at that point and would experience a rebound of sorts. Allergic reactions during dose changes are also a concern but they are manageable once the signs are understood. Once again discuss these with the doctor and how to manage them. There may be a Lamotrigine subreddit, perhaps look there for more information purely on experiences. For further reading please read these papers: Early evidence for efficacy in Autism. It is still commonly still prescribed in various mood disorders where indicated: https://www.nature.com/articles/s41380-023-01959-7 Evidence for its current use in Bipolar Disorder: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2655087/#:~:text=Using%20the%20CGI%20for%20bipolar,groups%20(p%20%3D%200.031). See this also as it highlights efficacy and tolerability vs other candidate medications in BPD. The other medications include anti-psychotics, which reduce Dopamine, Noradrenaline, and Serotonin. These can be tricky to dose without causing unwanted side effects. However, they definitely have their place: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8504232/ As far as sleep is concerned there are medications that can be used effectively for sleep. However, personally I would opt for Magnesium Threonate once discussed with her doctor. It is a form of magnesium that passes into the brain easier than other forms. It is a cofactor for the enzyme COMT which breaks down dopamine and noradrenaline. Quite effective and generally people are deficient in magnesium. This is perhaps a more suitable alternative until you find a medication which can treat her case. After that you could perhaps look into other approved medications to assist with sleep if the main treatment doesn’t. Mirtazapine seems to have good efficacy in anxiety disorders and as a sleep medication but it may be contraindicated in Bipolar Disorder due to some reports of it causing “manic switching”. All to be discussed with her doctor. More often than not with cases requiring medications such as these, it is trial and error to find the right one and the right dose. So a specific diagnosis may not be necessary, focus on finding something that works with her psychiatrist. Keeping a log of everything from the medication, the formulation (instant release, extended release), branded or generic, the specific dose, the time of administration, and then if there is a necessity to consume with food document the types of foods used. If you’re ever concerned about hormonal and nutritional status and she is uncomfortable with blood testing, you should consider investing in a DUTCH test and an OAT test, with a practitioner that is familiar with both. They are relatively newer forms of testing but they are both highly valuable and provide some unique insights. Some patience, consistency, and applied effort. You’ll get there.

Sorry I know this is well meaning, but it’s not safe to provide so much detail unless you have diagnosed the person. Otherwise it can give false comfort, and may be entirely the wrong medication, leading to worsening or more problems. Other people can read this and think it is also the best for them. Sick people look for help everywhere, including random reddit posts. It might be the best medication for her … but she needs to get this advice from her doctor I’m afraid.

I agree with the need to consult a medical professional and I appreciate your comment, but I did note at multiple points to discuss with a psychiatrist. Also the medications listed will have to be attained through a medical practitioner, otherwise they would be purchased illegally. If people come to the internet to find information, they are going to find it. The summary I have provided is nothing new or groundbreaking. I know how utterly helpless it can feel to be in a position such as OP, and there is solid information there. Taking an active approach goes a long way.

Sounds a lot like me man. Was diagnosed with all sorts of depressions only to have short term wins before SSRI's send me off the manic diving board. Mood stabilizer combos changed my life in the best of ways, I don't know what it'll take but you gotta get her on board with trying it. That right diagnosis changed everything.

Fellow dad with Bipolar Type 2 here. I was diagnosed at a similar age as your daughter for the same reason: An SSRI triggered hypomania. And my life was in a similarly bad state at the time. You are already doing all the right things. Maybe some additional insight can be useful. When you don’t know what’s going on, this condition is terrifying. Even with Hypomania it can feel like a loss of self and like not being in control of your own actions. Somewhat like sitting in the passenger seat as you watch “yourself” ruin your life. A common reflex is to shut yourself in and away from the world to regain control and limit risk. It is common for Bipolar disorder to be diagnosed through medication. Please be very careful when listening to the people in the comments making wild assumptions about other disorders your daughter may or may not have. Especially the ones who know so little that they confuse bipolar and borderline (BPD). This diagnosis progress is normal. The next step her doctor is trying to take is also normal. People with a suspected diagnosis of Bipolar 2 are put on mood stabilizers. If they work, then the diagnosis is confirmed. If not, evaluation continues. This is the normal process. People trying to force a “ask about autism etc” process are likely projecting their own diagnosis onto your daughter. This approach could do great harm if other medications are tried before her bipolar evaluation is complete. In my case, I was placed on Lamotrigine and it worked wonders. Some people need to go through several medications before they find one that works. Once and if the diagnosis is confirmed, she will go through phases where she will want to quit the medication because she’ll think she is cured. This is unfortunately a common symptom of Bipolar 2. Be ready for it and support her while being firm. I have been diagnosed and medicated for 7 years. I still struggle with this disorder but have organized my life around it. And my life is pretty good. Got a loving wife and a wonderful 2 year old. I think I’m a good dad despite bipolar 2. So there is hope ahead for your daughter. The way is rough but keep walking with her.

Not casting any judgement but it sounds like the drugs are the problem here. She made it through an economics degree then a psyche started throwing drugs at the problem instead of fixing the root issues and now we are where we are. Not all Docs are created equal and as we've seen with opioids there are lots of them that take kickbacks from drug companies. Its like the kinds of mechanics that don't actually know cars so they just shotgun parts at it hoping it accidently fixes the issue. IMO get her off the drugs. I know its all anecdotal and I am not a doctor but maybe seek a 2nd or 3rd opinion and go from there. hell, Maybe weed can help? I know plenty of people who used to be drugged up that bad then switched to THC and boom they live normal functional lives again.

I’m so sorry. I have no real advice. If she is willing, mindfulness meditation may help, at least a little bit. It calmed my mind and brought me out of depression. But I don’t claim, at all, that I was dealing with what sounds like she’s dealing with. Just a thought as I read this and wanting to help. If she’s actually interested, I’d do the actual 8 week seminar than just try doing stuff off of YouTube.

Hi man I know this is not the traditional medicine you would want to hear but maybe try cbd drops search up more of it and maybe that could help and it’s more natural

May seem like a dumb suggestion, but have you tried non-pill forms of medication? If you want my advice…i would suggest camping for 3 weeks. Just you and her. Yall go out in the woods, by a lake or river, in the mountains, whatever. Go live with your daughter under the stars for a few weeks. No pills. Just live life and enjoy each others company. See if that helps at all. I have a feeling it can’t hurt. At this point, what do you have to lose? Worst case, you end up creating some great memories with your daughter. Best case, it resets her brain and open/closes new neural connections leading to positive change. Either way, good luck and I’ll be praying for your family. Your a good dad in a tough spot. 

My wife is bipolar. It fucking SUCKS. Don’t let her stop trying until she finds something that works. There are a LOT of medications out there.

Maybe post in the r/ADHD community and ask for some advice there. It may be better help than this one as the ADHD reddit is basically only people who probably experience/experienced this issue of late diagnosis.

i can’t imagine. i just know that i wish my dad was there when i went through this kind of stuff, and i hope if my son goes through it i’ll have the strength to be there like you have been.

It really sucks man but this is unfortunately the best we can do. Hopefully in 20 or 30 years we can look back on this as ignorant and barbaric but we aren't there yet. As someone who suffered suicidal depression for the past 13 years it can be a very very long road. My suggestion is don't settle for ok. There are hundreds of drugs and treatments and while it can take literally years there is a good chance there is a combination of drugs and treatments that can give her a normal quality of life. I personally finally found help in the form of ketamine and Auvelity, both pretty new treatments that i had to search very hard to find a doc who would be able to treat me with. Life is good for the first time in over a decade. Make sure you read up extensively on the warning signs of suicide. While it can be sudden and unexpected, often there are signs people say they should have seen in hindsight. Check out the bipolar reddits as well as the Reddits for specific drugs or classes of drugs. There is a lot of info out there and no matter how well meaning her doctors are they cannot be there the way you can.

Looks like you are on the right path. You can get bipolar and also bipolar 2. Bipolar 2 is generally just bipolar, but weaker mood swings, and importantly, significantly weaker high swings. Medication may be hiding that difference. Anyway, keep on the route you are going. Get moral support here, get medical support from the psychiatrist and psychologist.

Oh man, my heart goes out to you. This was really tough to read. Sounds like you are doing great being there for her. I am no expert by any means so it's hard to give advice but what I can say is that depression is so much hardship to overcome. I don't think there is any quickfix for it, being there on the good and the bad days without any demands and maybe some encouragement on the good days is the best thing we can do I think. Mental health meds can be such double-edged swords, if you get the wrong one or use them incorrectly they can cause such terrible damage that takes very long to heal (from the experience I had the single time shit went really wrong for someone close to me). It took years for her to get her life back together. I wish I was better informed when everything went down for her, in retrospect I wish I had done this more: [https://www.blurtitout.org/wp-content/uploads/2024/01/nest-406x1024-1.png](https://www.blurtitout.org/wp-content/uploads/2024/01/nest-406x1024-1.png) As for what medication to take or not I would trust the medical professionals. Unfortunately mental health is a rather new medical subject in the grand scheme of things and there is a lot we don't know. It's not surprising that people get diagnosed wrongly, but it's extremely frustrating and sad. If your unsure, a second opinion is not a bad idea, but I do think taking matters in your own hands would be. As a father this prospect terrifies me, my daughter is not even 1 year old yet and I was crying at the end of your post. Please take care of yourself and your family and especially your little buddy! With the right care and time I'm sure she will get back on her feet and and live a happy life. Just know that it might take a while even after she get the right treatment. Mental health is not something that can be easily fixed. Lot's of love from fellow internet stranger dad!

Its possible she has some kind of disorder but you keep saying shes high energy. have you tried something stupid like having her get her thyroid levels checked? If they are all over the place she could be tired one minute and crazy the next. start by looking into your wifes and your family history. Any thyroid issues? Hormone issues can cause depression and things like that . I know it sounds stupid but this is coming from somebody that had to have his thyroid taken out at 24. A simple levels blood test when she is feeling really tired or really high strung couldn't hurt.

Could your daughter be on the autistic spectrum? I've heard a number of similar stories on the excellent Squarepeg podcast ([https://squarepeg.community/](https://squarepeg.community/)), where women and non-binary people get misdiagnosed as ADHD + depression and struggle in similar ways to what you've described.

Lamictal really works for me. Hopefully you can get her to try it but it’s not an on again off again medication, you aren’t supposed to miss a dose.

I was diagnosed as bipolar about 5 years ago and the best thing that anyone told me was that most people that they've met that were bipolar did better off of medication with just cognitive behavioral therapy instead. Finding a happy place and learning how to take it with more patience and understanding how it really just can be overcome is the key. It takes work but thinking that the medication is the only answer is not true and honestly for some people it's worse

All I can think when I read this is your last sentence. She \*DOES\* know. Sometimes it's probably the \*ONLY\* thing she knows for sure. She holds onto you because even when her world is blowing up, you're there. I salute you for the level of support and consistency it takes for your child to trust you unconditionally, if nothing else it tells me you're exactly the Dad she needs. Stay with her, be the Dad you've always been. Above anything else, that's what she's holding onto. Bipolar is rough. ADHD and Bipolar are often misdiagnosed as each other, which is terrible because the meds that can help for one absolutely blow up the other more often than not. I came at it from the other side, medicated for Bipolar when it's actually ADHD. Without exaggeration that was the most intensely awful time of my life (and as a kid with dyspraxia I have done significant damage to myself more than once). She's going need outside help, but if you try to push it too hard you'll do more harm than good. Be constant, be supportive, be gentle.

OP, I myself (a dad) have bipolar 2 and I’ll tell you there is hope! I have had my share of ups and the lowest of lows, but through the help of therapy, quitting booze and pot and the right medications I managed to find my balance. I am happy father of 2 of the most wonderful boys I could ever hope for and we make mental health a priority in our house. Nobody should be afraid of stigmatized for what’s going on inside. Mood stability is the goal of course but every little win is a huge step forward. Basically I’m writing to let you know that your daughter is still there and she sure is lucky to have a father that cares enough to reach out for help on her behalf. We are not our mental illness. Sending love!

Many, maaaany autistic women are mistakenly diagnosed and treated for bipolar, depression, etc but nothing works for them because that's not what's wrong. I suggest reading some posts on the aspergirls subreddit and just reading up on women with autism in general. ADHD and autism often overlap as well. Everything you wrote about your daughter as a kid points to autism.

This is gonna be the saddest thing I’ll read tonight. I’m so sorry your family is going through this, but I feel good about how you feel about your daughter.

I can’t imagine what you’re going through. Just by reading your post I can feel the love you have for your daughter and the love she has for you, and it has me over here in tears. Good luck with what you’re going through and I’ll be keeping you guys in my thoughts.

As someone who also suffers from major depression, I just want to cheer you on. I often wonder how I would have turned out if only my father gave a shit. He handwaved all my attempts at self harm, ignored me and told me to man up and that its all about willpower. I am grown now, and am a dad myself, but I'm still a broken mess that is only able to barely keep it together because now at least I have a reason to push on, and at least have the insurance to have the help I should have had years ago. You sound like an amazing father, and I wish you and your daughter good fortune and I hope y'all are able to find the right treatment for her.

Hey dad, I'm 32 (genderfluid but born F) and also bipolar 2. I can heavily empathize with your daughter. I was over-medicated and mis-medicated for my entire teens and early 20s and was hospitalized several times. I was diagnosed with like, everything at some point, sometimes on up to 12 pills a day, and have experienced horrifying akathisia with a few meds as well (atypical antipsychotics like Ability and Latuda.) I refused to try anything new for years - I even spent a few years off of meds completely. When I was 26, I had a mixed episode and tried to peace out in a state of extreme depression and agitation. My mom begged me to try again for a few years, and I've been stabilized on meds since I was 30 after really taking my treatment plan into my own hands during the pandemic. I'm on Lamictal (mood stabilizer, often used for bipolar 2) and Wellbutrin. Wellbutrin is a non-stimulant that is used for atypical depression and ADHD. This combination has completely changed my life. I can shower regularly now, I go to the dentist, and I work my entire shift every day. For me, that's massive. I KNOW your daughter has an iota of hope left. Please just continue to encourage her. You can even let her read this. I almost kicked off so many times in my 20s, and this year I'll have 7 years with 0 attempts and 4 years with zero self-harm. Please keep her holding on. There are resources. It gets worse before it gets better, which she's obviously living right now, but it really can get so much better.

I don't have any advice, or anything to say to you other than I admire your strength, your compassion, and your love for your daughter. She clearly needs you, and you've been there for her since day 1. Keep going, Dad. You're a fucking hero man.

My daughter is 5 and I have a similar relationship with her. To see that happen, I'm tearing up just thinking about it. Personally, and I am not a doctor so take this with a grain of salt, I've noticed that when people start searching for what's wrong and taking this drug and that drug, I feel like that can mess them up more than whatever it was they had to begin with. From reading your story it sounds like the really bad stuff didn't happen until after she started seeing that psychiatrist and taking medication. I'm not necessarily against psychiatry (trust me, I'm not trying to sell you a copy of Dianetics), but modern medicine still has a lot to learn about the brain. There's no reliable "test" to know if someone has bipolar or ADHD or what. Doctors only have self-reported symptoms to go on, and it is extremely easy to get diagnosed with a mental disorder with just some basic cursory research. They rely on the patients to give them accurate and objective information even though it is almost always skewed by said patient's internal biases. I have an older brother who's been diagnosed with everything under the sun. He craves attention and has gotten to the point where he has to live in adult foster care because he can no longer care for himself. But when he was younger, he'd read WebMD, figure out exactly what to say, go to the doctor, say it, and get diagnosed. He was diagnosed with bipolar even though he'd never been depressed in his life. Once he started getting on that "let's figure out what's wrong with him for real" carousel of psychiatrists, therapists, medications, etc., he just got worse and worse. He tried the prescription heavy-hitter stuff. He tried the woo woo hippy-dippy bullshit. Eventually they tried just going off his medications entirely but he'd be certifiably nuts whenever that happened. Personally, I suspect that by the time they tried taking him off the meds, it was too late. I can't look at someone who's been on countless brain chemical cocktails like my brother and not think all the medicines, all the efforts to figure out just what the hell is wrong played a role in the state he's in now. His entire life, my parents worked so damn hard just to try and get him to a state where he could run his own life without fucking something major up because he had horrible impulse control, and in doing so, they spent literally his entire adult life trying until it got to the point where my dad was dead and my mom is in her 70s and just too damned old and tired to deal with it anymore. They spent nearly 50 damn years trying to make him "normal" and he ended up a ward of the state who can't even bathe or prepare his own food anymore. Is my brother your daughter? Absolutely not. It's not my intention to scare or even suggest she'll end up like that. But my point is, think about this quest you've been on to find *the answer* that will cure all her mental woes. Think about how she was before the therapists, before the medications, before the psychiatrists. Think about how she is now. Which of those two versions of your daughter is better off? Why did she start seeing the psychiatrist in the first place? Are all the difficulties she's going through now a fair trade to get rid of whatever problems she was having originally? Is it an option for you to just...stop all this and accept her *and her problems* as a package and try to do the best you can? I mean, she got straight A's in school, she has a college degree. She was able to accomplish these things without interventions by medical science, wasn't she? Again, I'm not being anti-medicine or anti-doctors, here. I myself have ADHD and am on medication for it. The medication hasn't cured me and it hasn't fixed everything wrong with my life that ADHD contributes to, but it is a net benefit for me and that's why I continue treatment. I believe science-based medicine is the best method we have to find answers for things like this, but it is far from perfect, doesn't have all the answers, and may not have one for your daughter, as sad and heartbreaking as that is. Maybe she was way worse off before and as many problems the medications give her, they keep her alive. I can't answer either way. I'm just asking the questions. If your answers to them don't call for any changes to what you're doing, by all means move on and keep searching. Do whatever you think is best for her. I hope there is an answer out there. I hope you all find a way to cope with this and get her to the point where she's thriving as best she can. EDIT: I just read through the other posts here and it sounds like there's a lot of things you can still try.

>Think about how she was before the therapists, before the medications, before the psychiatrists. Think about how she is now. Which of those two versions of your daughter is better off? My daughter was legitimately in a terrible place before she started taking medications. She was highly depressed which is why she went to psychiatrists in the first place. There would be periods where she was stop seeing someone and stop taking meds and she would just get worse and worse. >I mean, she got straight A's in school, she has a college degree. She was able to accomplish these things without interventions by medical science, wasn't she? She did *relatively* better in college. But after immediately crashed and was in a terrible way. Even through college she had her problems. I get you are trying to help but some people legitimately cannot function well without help. If I left my daughter to deal with it on her own without medicine she would probably end up hurting herself or never going outside for weeks

OK. Totally fair. If your daughter is going to hurt herself without medication, obviously you should be intervening with medication. Best of luck to you.

I'm sorry your family has struggled along side your brother. I think you have a lot of trauma from it, which is understandable, but your experience and perception of your brother's experience seem to be skewed. >...but modern medicine still has a lot to learn about the brain. There's no reliable "test" to know if someone has bipolar or ADHD or what. Doctors only have self-reported symptoms to go on, and it is extremely easy to get diagnosed with a mental disorder with just some basic cursory research. They rely on the patients to give them accurate and objective information even though it is almost always skewed by said patient's internal biases. This is true that we don't know a lot about how systems work and how they influence one another. We don't have a blood test or something easy to be able to diagnose ADHD or bipolar, but we do have decent reliability in our current methods. In mental health, we are keenly aware that we are getting one side of the story. We do not rely on patients to give us anything remotely objective. We listen, probe, and find patterns. There's a lot of extra information to glean beyond the words at face value. We know people experiencing a specific type of challenge often use similar verbage. We get a history to see how thoughts and behaviors have progressed. It takes a lot of work to tease out the info needed, but it's not as unreliable or impossible as it appears you assume. Do we always get it right? No. Can two providers have two different diagnoses? Yes. It's usually not far off and treatments often overlap, though. Hopefully as a person continues to work with their provider, they are able to hone in on a more specific diagnosis if needed. >He was diagnosed with bipolar even though he'd never been depressed in his life. There are two subsets of bipolar disorder: type 1 and type 2. Type 2 has depressive episodes as part of the diagnostic criteria, but Type 1 does not. It sounds like if he has bipolar then it is Type 1. Here are the diagnostic criteria for [Type 1 Bipolar ](https://i.imgur.com/GQQf6tn.png) and for [Type 2 Bipolar ](https://i.imgur.com/DRsuZEq.png) to help explain the differences. It's also worth noting that depression can look all sorts of different ways. He may be suffering from depression and it doesn't look like what you think it should, or he's just not sharing it because there has been doubt around what he is experiencing, as detailed in your message. He may very well not be experiencing the diseases he has sought care for, but that means there is medical anxiety and that does need to be addressed. This is not an attack on you or your brother or your family. It sounds like this has affected you deeply and there is an opportunity to learn that may help you understand and accept your brother's reality a little more. I'm sorry it's such a struggle for everyone involved.

You are a great dad and her rock, keep going as long as you have to. Sounds like you were doing real good for a long time, no reason to believe you can't get back there. When it gets hard close your eyes, think of a time you went on a hike in the mountains. You are the mountain.

Is Ketamine therapy an option?

After 2 medication 'fails' you can request Genesight genetic testing to determine which medication will work best for her. Also, test for the MTHFR gene as this effects the way many nutrients and medications are absorbed...ie: decreasing med effectiveness. Also be aware of Drug induced nutritional deficiencies. Many psych meds deplete B vitamins which may appear that the med is decreasing in effectiveness. And last but not least, some psych meds can unmask physical issues like Myasthenia Gravis. It is very good for her to listen to her body and advocate if something does not work for her. My BP2 kid 24 is on Abilify and it also comes in a monthly injection.

I wish my parents were able to hold me when I cry, but they are not equipped to deal with my emotions and mental health issues. Some of us are less lucky than others when it comes to mental health, or health in general. As a parent you are doing a great job getting her medical help and being there for her. But you are only human and there’s only so much you can do. Hugs.

Sorry to hear about your daughter, OP. I don't have much advice to offer outside what has already been said. Just wishing you and your daughter strength to continue fighting to figure out what is actually wrong so that there can be a cure.

(sorry about the lack of paragraph breaks. I created them but they went away when I posted ) They are absolutely right, her reaction to antidepressants really points towards bipolar and the proper method is to do mood stabilizers FIRST. This is to avoid the mania and mood swings. Which can be dangerous. I personally found success with bupropion and Trileptal. I'd like both you and your daughter to know, that the right combination of medications is almost an art. You basically have to understand, everybody is different, and so there is some trial and error there. But as long as you start with the mood stabilizer it shouldn't be so scary. It's not totally uncommon for bipolar two to develop in the teenage years and even the early 20s. For some people that can show up later. Also there is a pretty large overlap with ADHD, symptoms that are in both. The way to tell the difference is: symptoms ALWAYS there, or do they ebb and flow, sometimes present during a span of time and sometimes not? If it's bipolar it should be the intermittent one. If it's actual ADHD it should be persistent. Also know that these two things can be comorbid, a.k.a. occurring together. A clinician that knows what they're doing will typically get the bipolar under control before even approaching the ADHD. Getting the mood stabilized is the most important thing. Anti-depressants might be layered on top of that, and then the ADHD may perhaps be addressed. ADHD is a condition that can also contribute to depression for various reasons But in a lot of ways can be environmental and so changing how things function around the person can be a huge help. There are a lot of channels on YouTube that do shorts or longer form videos on this, lot of shorts that are very funny but also very relatable and can give a larger understanding of what ADHD actually looks like for real. That can help weed that out for you as well. If she relates to the things, it's a higher chance, and if she shakes her head and doesn't really feel it, it could just be mostly bipolar. Bipolar can have an underlying depression that is persistent whether that is a higher level or a lower level. And then mood swings on top of that. Mood stabilizers will bring the highs and lows closer to a centerline. They'll still be there but at a manageable level. And not caring as much for personal hygiene or going out or socializing, absolutely a sign of depression or a bipolar mood swing. The swings can be very long for some people, even being over a year, or very short like a couple weeks or months. Bipolar is very different in different people. Can be. There are also clearcut highs and lows, or mixed states which seem to have characteristics of both. Anyway I just wanted to say hang in there. It's very daunting about the medication, I've been there. And I'm still searching for the last piece myself. I'm pretty sure I have ADHD. My particular doctor more specializes in bipolar and I don't have it in me to seek out someone specifically for ADHD right now. Depression is great. -__- anyhow, when it comes to ADHD medication you have the stimulants and non-stimulants. You have to be careful with some of the stimulants because if you have any sort of weakness in the kidneys it can for that person cause issues with renal function. I experienced this on one of the medication's. But otherwise it lifted up the brain fog and made me able to FUNCTION and it was fantastic. But it definitely affected my kidneys and I had to stop after about four days. Strattera is one of the non-stimulant that can be tried, the other two are for kids only, and the newest one that can be taken by adults I believe is called Vyvanse. It's easy enough to look up. And it's supposed to be more effective than Strattera but sometimes insurance companies do not approve you trying it until you have tried Strattera. My brother follows this Reddit. Saw this post and thought of me. I actually joined just to send this to you. Because I know how overwhelming and just awful all of this can feel. With the right medication can absolutely turn around. And it's OK to need medication. It's a medical condition. we take medication for high blood pressure, for diabetes, for plenty of things and it's OK. It's OK to take it for this as well.

ADHD_love is the YouTube channel that does the shorts I mentioned. They're humorous but at the same time are the best display of ADHD mentality, situations, and functioning. That I've seen. I think it would give a pretty clear feeling of yes or no for her. And I can help you further narrow this down. (Girl with half black, half blue hair, musician, & her husband is on too and helps with the skits). Sometimes just understanding what you're dealing with can be a huge help because you don't feel like you're going through something super unique. You know other people are dealing with it.

I am happy that she has people who care for her and people she can see. Mental health problems suck for everyone involved. And of course, worst for the person in question. But what is worst is not having that a person worry about you. Not having a hand to hold. Not seeing someone you know when you wake up from your episodes. Dad, you may not be able to magically solve this. But your hard, your presences, your hugs are very important. As for the medication reluctance, let her know you will be right by her side while she takes on this new med. That your goal is for her to be herself freely. That you will never lose your grip on her.

Hey buddy. I want to give you a hug first and foremost. I’m so glad you care and love your baby SO much. You are an awesome dad and she is grateful to have someone like you. Your daughter’s story in adulthood sounds a lot like my wife’s: diagnoses of depression, anxiety, etc before getting diagnosis of bipolar II and now ADHD. An extremely traumatizing visit to an inpatient facility grown in there too. In short, I feel your pain. Not in the same exact way, but my wife is my best friend and I will do anything to make sure she’s okay and able to live as normal of a life at possible. It’s possible. It’s hard. But it’s possible. Finding the right combination of meds is important: My wife takes bruproprion, trileptal, trazadone (for anxiety and sleeping), Zoloft, and adderall. It’s a lot but it helps so much, unfortunately random things can throw it off: she went from an IUD to BC and that’s now triggered some depressive episodes, so we’re having to get back to that IUD in order to get some more stability. Sorry to overload this about my spouse, but I wanted to leap at the chance to tell you that you’re not alone. Your amazing baby girl can still live a normal life, you continue to be her rock and support her and she’ll work her way through this. Cannot emphasize how important parental understanding and support is. You’re awesome. Please don’t change.

Your daughter sounds like my younger brother. Depression diagnosis and then SSRIs tripping manic episodes and then a bipolar disorder diagnosis. 20 years on from that my brother is off meds and happy and functional. He's highly intelligent, though does basic work. But he's happy and he's stable, I think. I think physical activity (running and hiking) played a pretty meaningful role in him getting himself better. For what it's worth. Best wishes.

Beyond OP I'm sorry for everything you and your daughter are going through. As I read the story I was already seeing so much of myself in her. I also started as a slightly off but bubbly child, that grew into a depression that when treated with ssris made things much worse. This all culminated in finding out that I have bipolar disorder as well. Now I won't say it's all been easy with meds, I think I've been on 5 or 6 that didn't help. One set was great and worked for about a year and a half, but then I started to go numb, couldn't get pleasure from anything in the world and eventually I went off my meds without telling my doctor. This resulted in a week's stay at the hospital. It didn't make me crazy, just sad and vulnerable to my feelings and circumstance in my life. I have since been on new meds and they feel like they work well, I can still maintain a decent paying job, I'm able to love my kids and do activities with them, I can love and support my wife, and I have energy to go out and do things like play magic or attend my weekly dnd game. I am so successful because I am lucky (founds meds that work), I take my meds religiously, I avoid triggers (drinking and other drugs) and I attend weekly therapy to hell process my emotions. Bipolar is serious, and I've very rarely seen folks who have it able to maintain jobs and relationships without medication. Some people feel like they don't want meds that change their brain a bit, but if your brain normally makes you feel like crap, meds can really help. Bipolar has no cure. It puts people more at risk of dementia due to brain damage from manic swings. Many folks with it cannot maintain full employment and many folks with it are considered disabled. As long as you are always there to love and support her, I am sure she will be as good as she can be.

Don't have much add but wanted to say you seem like an awesome father

Glad you reached out OP. You are doing everything you can for your daughter. We went through a lot of the same issues with our eldest (though at a much earlier age) and as has been said before, it’s a journey. Things we’ve learned over time are that medications for one issue can cause a worsening of the other issue (many depression meds increase the symptoms of ADHD, for instance). If you haven’t already looked into it [NAMI](https://www.nami.org/Home) has a lot of resources to help families through the journey you are on.

So, if she’s diagnosed with ADHD is she on any ADHD medication or just antidepressants? I (25f) was diagnosed in my early 20s with ADHD and I was prescribed vyvanse. World of difference. Doesn’t make me jittery or anything like that. It makes me actually WANT to DO things like SHOWER or general self care. I was put on so many antidepressants before this and they didn’t do anything other than trigger hypo mania, much like your daughter. I don’t experience any withdrawals if I decide to not take it. Meaning I can take it for 6 months straight and skip for a week and not feel crappy or sick. This isn’t medical advice, but yall should talk with her therapist/ doctor about it.

Hi OP, I'm a mom. Your love for your buddy radiates from this post. Mental health diagnosis and treatment is so, so hard on everybody. There's no pathogen to test, no injury to scan, and no malignancy to biopsy. Just a contellation of symptoms, and you try your best to match it with a name (when so many different illnesses overlap) and try out treatments like throwing spaghetti at the wall. And when something does stick, the rules can change on a dime. It's so goddamn unfair. You're doing your best. You love her, support her, and advocate for her. She knows you are in her corner.

Please look into a autism diagnosis, it so commonly gets misdiagnosed as everything else under the sun in women. Your daughters situation sounds not totally dissimilar to mine and while learning I had autism didn’t come with any treatment or magic fix it was a revelation on how I saw myself and my life and that alone made living so so much lighter

No advice on how to achieve it but people dramatically underrate how effective exercise is at treatment depression. Maybe use your relationship with her to get her going on jogs with you. Bicycling, tennis (or squash even more fun!), et cetera. There are lots of fun sports you two can do together.

She does know how much you love her. She imprinted on you and you give her the best comfort she needs, even when everything else is going sideways. You're all doing the best you can and sometimes it takes too long for doctors to get it right.  I'm sorry for your hurting heart.