I have always been high functioning -- able to work, go to school, parent, etc. -- right up until the moments I would crash and attempt suicide and end up in the hospital. My pdoc and T found that to be the very scary thing about me because they knew how quickly I could decompensate. Even if I was able to work, etc., I would also be reporting severe depression and suicidal thinking at that same time; we just had very little warning about when I'd go from thinking to action, and that was the big difficulty in treating me. Pdoc eventually just started being very cautious about my safety when a depressive/mixed episode would set in and admitting me proactively for my safety. Eventually we landed on a good med combination that kept things a bit better under control.

Now I am truly high functioning. I've been in remission for over two years, quite stable, and really very content. I'm not sure what got me to that point except that in therapy we worked really hard on skills to be more proactive myself so my episodes didn't get so severe without earlier intervention. I also think I had comorbid PTSD issues that probably were even a bigger problem than the bipolar disorder, and once I had worked through much of the PTSD-related issues, my mood was less frequently triggered and my episodes were less intense because my PTSD didn't get triggered at the same time as my bipolar symptoms.