Is this pdoc right?

First off, I'm in my early 20's and diagnosed by my pdoc with schizoaffective bipolar type, but I'm going to an IOP where I'm diagnosed bipolar 1 with psychotic features. Either way I'm struggling with mood swings and psychosis.
So the IOP pdoc says bipolar is worse in the early 20's and thinks I won't have an issue with my disorder in just a few years. Now I've been on enough forums and in enough hospitals to know that mood disorders and psychotic disorders aren't just a young person thing. I'm not sure if he actually thinks that or if he thinks he's giving me hope or what.
I want to know if he's right that late teens/early 20's are the worst. I've also heard of kindling theory where it gets worse as time goes on so... idk.

Hi Spikes,

I didn't have my first manic episode until my mid 40s and then it got worse. I have been free of mania and psychosis for almost 2 years now and am hoping to never have that experience again.

sometimes. i knew a dude who was only in treatment till he hit 25 or 26...a lot of it was froma chaotic lifestyle, he matured, tapered off the rx treatments, he's OK now. I think there's a lot of different outcomes within each diagnosis.

I mean it was definitely chaotic in my 20s. First because I wasn't diagnosed properly. But once I did have a diagnosis I was either not med compliant, or my cocktail wasn't right and I still had crazy swings. Once I got into my 30s, things even out a bit because I was more knowledgeable about bipolar disorder and what to look for before things got out of hand and/or I knew when to seek help. Who knows what my 40s will hold.

I was diagnosed at 43yrs of age, I’m now 47yrs and considerably worse.

It may be because the longer you have this the more meds and psychotherapy you've tried. I (age 43) was no better than I was in my 20s until we made the carefully considered decision to go on first Emsam which is an MAOI and then several years later clozapine and while I'm not stable (and currently having my worst time in 10 months) I am much closer than ever before. I've been out of the hospital for over 3 years.
The last time I was in was to get started on clozapine. But it took many years and may meds to get here and it is totally med dependent; take away the clozapine or Emsam and I'll be out of control again regardless of being older.

Hello Spikes. Sorry you are struggling. I live with unipolar depression rather than bipolar but want to offer my support and a couple of thoughts. It can be problematic to ask/compare yourself to other people's mental health trajectories. I have met plenty of folks with unipolar who said nothing worked for them and it remained severe throughout their lifetime. However, my very worst period was when I was age ~14 to 18. I am now in my late 30s and doing much better. I still have problems and I'm planning to do more therapy but I never feel as bad as I did back then. And I don't take meds because they never worked for me whereas other people find relief from them. Every brain is unique therefore every trajectory varies.

I think the most important piece is to find a provider you trust and follow their guidance as best you can. Also continue to develop friendships and activities for yourself....as a person and not a "patient." Use the medical model for what you need but try not to let it define you....consider ways of honoring body, mind, and spirit...whatever feels meaningful to you. A holistic approach to my health (mental and physical) has helped a great deal.

I completely understand why you would want to make predictions but I think that can be dangerous. If you read about self-fulfilling prophecy, it really can happen. The research also suggests that optimism can have major and positive effects on health. I'm not at all suggesting that you can simply think your psychosis away (of course not) but in addition to your treatment, telling yourself that you will continue to improve and gain balance could be really helpful for your future health. On the other hand, telling yourself that you will probably feel worse as you age could in fact increase the likelihood of feeling worse later, if you see what I mean.

These are just my thoughts from a place of care and regard. You don't have to agree. I wish you peace, hope, and a bright future

I have done better when i keep on living my life, rather than becoming a professional patient with constant introspection. We really need the distraction of participating in real life. I agree w SilverTrees in that regard.

We’ve become more stable living wise. We don’t work, or go to school but live off disability. When my husband can he volunteers. We have to keep our life very, very simple. I’ve never been well enough to even volunteer. My husband volunteers 4 hr a week. I spend my days on PC and FB helping people. We also raised(ing) our son. We chose to homeschool him k-12. It’s not as much read aloud and math puzzles but taxiing now. We use to have appointments 1x a week but now it’s anywhere between 0-3x a week. We’ve let our health deteriorate this past year and we’re trying to get back on track. Our lives are less chaotic then they were when we were trying to juggle everything and getting improper mental health care.

I think in some ways I have become a professional patient. I don't have a lot going on in my life, living alone and on disability with only a few friends and no one I really consider close except for my son, but he has to live his own life too.

I think we just have to stay vigilant in the moment, but take it as it comes. My diagnosis keeps changing and the doctors really aren't sure what to make of me. I'm 38 and all of this is new to me. I'm trying to roll with it and not read too much into my expereinces compared to 'normal'.

I'm not sure I agree with your doctor saying what he did. It sets expectations and your experience could be wildly different. I do hope he is right though!

I am in my early 60's and I avoid all the triggers I can ... the calmness that comes with age ,,, good meds ,,, a good pdoc ,,, and maybe a little wisdom earned over a life time keep me very grounded ,,, depression and anxiety are my only issues now ... my anger is almost completely suspressed .... yes for me it has gotten better with age ... little boring but better ... Tigger ..

I personally think it is foolish for any doctor to be making predictions about how a patient will turn out. There is so much variability and a big factor is how a person responds to medication and how compliant they are with taking them, in addition to doing all the other things that make for mental wellness.

I believe I have had a loss of cognitive functioning as a result of each manic episode. Or maybe I just have chemo brain. But this cognitive fog has not impacted my mental health bipolar-wise. I just make more mistakes doing simple things and cannot do anything complicated.

I don't think though that my bipolar is going to get any worse than it has been in the past. I hit 'rock bottom' in my last episode and have avoided getting psychotic symptoms since then by taking an AP and by making sure to get enough sleep. I have a fitbit to help me keep track of that. If I am not getting at least 7 hours then I take an extra olanzapine until my sleep is ok again. Maybe this is the 'special sauce' that will keep me sane.

I m a senior now. I started symptoms that I m aware of around age 13. I have basically struggled most of my life. Been through many hospitilizations. Lots of therapy. Different med cocktails. It has only been the last couple of years that the meds are mostly working n I have actually experienced stability.

So in my case, at least, that proc statement is wrong.

You don't know the future. But you do the best with what is available to you.

And even now I can never say that I won't end up back in the hospital again.

Mostly I m just trying to live day by day.

I have been told by multiple pdocs that it gets worse with age. YMMV

I’ll be 36 in a couple weeks. My worst episodes occurred between 14-18 and 28-32. I’ve had severe episodes since the ones in my early 30s but they’ve been shorter and more isolated.

My pdoc has told me that every manic episode scars my brain.

I believe this. My brain felt like it was on fire. I had a pdoc tell me that extreme mania looks exactly like a seizure on a brain scan. Prolonged seizure activity cannot be good for the brain.