I'm so sorry to hear your sister has declined so, and I applaud you for wanting to help. A lot of us here have families who are clueless, mean or both.

Since you live so far away, it might be best to see if you can find help where your sister lives. Maybe check online for social services in her county or city? If the house is that bad, social services WILL do something since kids are in it. I'm a reporter who covers courts and I just did a story on a young couple (I was amazed to find out just how young, as they each looked a solid 10-15 years older) who had their kids taken away till they cleaned up their house. Theirs was much as you describe your sister's.

Do you know how long she has been off the meds? It's more problematic going straight to somebody's doctor, because of privacy laws, etc, so I'm not sure what you can do besides strongly suggest she start up again.

FWIW, I often sleep with a teddy bear and my house is a pit. And yes, that can be the depressive part. Housekeeping is generally the first thing to go for me when I'm heading into the abyss. The wild spending on unnecessary items definitely can be a symptom of mania. Mine tends to be less on expensive stuff (as I have no money, and no credit left, but that's a story for another time) and more just the happily blowing off bills to buy clothes, music, etc type thing.

I'd be happy to help you look for resources if you like. Feel free to PM.

Candy