I'm sorry to hear you are so frustrated. I am as well. I'm also almost 50 and still going thru the mood swings, tho mine are long episodes. I've been doing meds for 23 years and still yoyoing. I find therapy makes me feel worse. I get frustrated because i AM being resposible about my illness and taking the meds obediently and seeing a psychiatrist regularly -- but i still get manic.

I find my psychiatrist just lets me make whatever changes i want. I've come to resent it and realized a chilling thing: she let's me make whatever changes i want BECAUSE MY GUESS IS AS GOOD AS HER'S!!! She doesn't know any better than i what meds will work.

Well, that's a lot about me, but i just wanted you to know you're not alone in being frustrated with managing bipolar into middle-age. I guess it's more of an art than a science at this stage.