Thanks again ladies.
I had an interesting chat this morning with my fathers community elderly psychiatric nurse (he has alzheimers) and although she obviously could not giver me specific advice for my sister, she did give me a couple of contact help numbers in the area where my sister is. I also called one of my sisters friends on Saturday morning and she has not seen my sister since Christmas, sporadic text contact etc. She has tried to go round a couple of times but sister will not come to the the door. We had a good long chat and Alison (the friend) has told me she will try harder to make contact and will keep an eye on things. She also wrote a lovely note for my nephew telling him she was just around the corner and available for a coffee/hug/shoulder/ whenever he needed.
My sister had a terribly hard time coming to terms with her husbands illness, and the impact on their lives. He was diagnosed very young and has been severely disabled for years. It all began really when I noticed she was very detached from her son when he was born, I thought she had post natal depression. She withdrew quite a lot when her son was young, then as a family, we began to notice a distinct cycle of mania and depression about six years ago. She just never seems to have any 'normal' periods. Two cycles, in her case it definitely is 'bi polar'. She is either on top of the world, (completely hyper, super motivated..she is booking holidays, buying cars, never off the phone, talking non stop, hysterical laughter etc) or she is the complete opposite, where she retreats, withdraws and does not answer the door or phone. She will not talk about it when she is manic, as she brushes it off and refuses to admit a problem exists. I once got her to talk to me when she was in her low cycle, and she told me she just feels completely dead, empty, joyless. My nephew says she spends hours lying on her side in bed, staring into space, no music on, no TV etc. She functions, in that she eats and drinks but she hardly speaks to anyone and does not put on make up, or shower or go out. She has not been to work for two weeks this time.
I know she has been on anti depressants, but as far as I know has never been diagnosed with manic depression. Whenever I gently tried to bring the subject up she flatly refused to consider it, saying she never wanted to be diagnosed bi polar as lithium is the treatment drug and she did not want that. She has never gone to the GP during a manic epsiode, so they cannot see the other side of the 'low'. We as a family have seen it and it does not take a genius to work out what is wrong with her. I just don't know when is the time to say enough is enough - you need help whether you admit it, or want it or not. Perhaps she should be hospitalised....I just don't know.