It can be VERY had to get the right combination/dose of medications. A neighbor of ours was bi-polar--when she & her husband lived in a northern community she was very happy and was fairly even on her behavior. She had good friends and a "coffee group" of ladies that she spent time with daily. Then they moved here and it was a totally different situation. We're out in the country here and most of the neighborhood women work, so there was no local coffee group for this lady to join. She was home alone too much of the time, and it was stressful for her.
The stress made her condition worse, and the meds that had been effective for her for so long stopped working. The doctors tried her on various combinations and levels to try and get her back on an even keel, and it just wasn't working. She and her husband separated and divorced, and then she was living and working part time in town--she was on social assistance I believe, and still not doing well last I heard of her. She'd have some good days, and then she'd have some very bad days.
Her family treated her like a small child--which really bothered her and just added to her stress level. Her husband's family, when they were still together, treated her like she was stupid--which also wasn't fair to her, and not good for her overall health. I've wondered what has become of her in recent years, if she ever got on a treatment that worked for her, or if she is still having a really bad time of things.