I have been fighting bipolar disorder for a long time now. I take my medications on time. I also had a series of shock treatments. But I am exhausted trying to function on a daily basis. I walk through work in a daze, clearly not doing well. The least little task is so overwhelming, I go to bed instead of completing it. Life is emotionally painful. I have a dog and cat, and they are the reasons I have not ended mine. They need me. I am 49 and have minimal retirement. Can you tell me if there are some people who, even with chemical treatment, never get better with bipolar? I cannot continue the way I am going. Are medical retirements feasible for manic-depressive people?

L.

It may be possible for you to qualify for psychiatric disability if you are not able to function well enough to work. Check with the personnel or human resources department (if there is one) of your employer to find out whether they have a mechanism for medical or psychiatric leave, or a disability determination process. You can also contact your local Social Security office to find out more about qualifying for Social Security disability payments, should you become completely unable to work.

In order to consider whether you are psychiatrically disabled, the Social Security Disability Administration and/or your employer or private disability insurance company will need to examine your mental health treatment records. They will probably also request that you be evaluated by a psychologist or psychiatrist independent of your current clinicians.

There are disadvantages to receiving psychiatric disability status, however, which I recommend that you consider carefully and discuss with your therapist or psychiatrist. For instance, living on disability payments alone can be financially stressful unless one has private disability insurance or some other means of income providing something close to one's previous salary. After two or three years on Social Security Disability, people become eligible for Medicare, which then becomes their primary insurance company. A change in your insurance might require a change in clinicians, as some do not take Medicare.

Also, some people who stop working and go on psychiatric disability seem to deteriorate further, becoming even more depressed or dysfunctional. I suspect the structure of regularly going to work may have helped hold them together, so to speak, and provided them with opportunities for positive experiences -- which they lost once they started staying home must of the time.

I encourage you to discuss your condition -- and your despair -- with your psychiatrist and your therapist. Your psychiatrist needs to know that you are still having difficulty functioning, so he or she can consider whether changes in your current treatment regimen are warranted.

If you don't have a therapist, please make an appointment with a psychologist or other therapist ASAP. Psychotherapy can be very helpful in alleviating stresses that can trigger manic or depressive episodes, as well as helping individuals deal with the traumatic nature of the illness itself and its effect on their lives. If you've never worked with a psychologist or other therapist (that is, if your treatment has been primarily medical or biological), you might consider trying that before pursuing disability or retirement options. Good luck.