Spouse newly diagnosed with Bipolar II

[goatgirl]

Hi,

My husband has just been diagnosed with Bipolar II Disorder and we are still trying to get a handle on what this means for him and our family.  This forum and the feedback from it has been very helpful to us.  We wanted to post some general questions here just to get feedback from anyone who may want to weigh in:

1) He started meds about 6 months ago (cymbalta, trazadone, lamical, ambien), but after a serious episode this week of a very extreme high - including memory loss - and then a serious crash (crumbled in a corner)...we are starting to think that his hypomania and depression episodes seem to me more often and more extreme.  Worse then before he even started his treatment.  Has anyone else had this experience?  Is it the meds? Could it be that we are just tracking more closely and notice the patterns?

2) Trying to figure out if maybe the Cymbalta isn't working, or if he needs to increase the Lamictal.  He is maxed out on dosage of Cymbalta, but still has a little room to increase the lamictal.  Had a really rough time in the beginning with the cymbalta and has resisted trying to go to something else.  Thoughts?  It seemed like the first month with Cymbalta helped with the depression (although awful side effects), but then started having a reverse effect.  Has this happened to anyone else?

3) Finally just a theoretical question.  People keep telling him that he can control his mind and that his mind doesn't control him.  Of course this is difficult for him to believe right now and he is doubtful this is true.  Anyone else felt like this and triumphed over their mind?

Thanks to everyone for their time and help!

[cowgirlnerd]

I was on Cymbalta - max dosage  - before being diagnosed BP1. Honestly, I had been on about every antidepressant known to man until properly diagnoses - the last being Cymbalta.   My pdoc told me that the Cymbalta was the worst thing for me and it resulted in a psychotic manic episode (along with ADD meds).  He doesn't recommend AD's for me.  At times, I still feel like I could use them - but he doesn't agree.

SO, my treatment is Lamictal 200mg.  It has been a life saver for me.  Literally.  Most that I have read on here have good results with Lamictal, but it's a person to person thing, I suppose.  If he has room to increase, he might be doing the gradually increase.  If you take the drug to quickly or too much, you can get SJS.  

You are in for a long hard battle, but with your support and the help of his pdoc and therapist and the proper meds, he will probably be fine.  Just make sure that you allow him the room to deal with his iillness and don't try to "fix it" for him.  Like Monkey said, we have to own our illness and not make excuses, and that also means not letting someone take complete control of everything for us.  He will need your help - you will also need an outlet to deal with your frustrations - don't sell yourself short in the process.

This forum is great to find resources to deal with the illness and have support in your day to day activities that you will go through.

[horselover65]

I agree that you need to speak to the doc about meds. I have been on Lamictal twice - with no results - and during that time my moods and behavior became much more erratic. I didn't attribute it to the medications. Figured it was a combination of things. I don't know what happens to other people, but I am always hopeful and optimistic when I try a new medication. That leads to a lot of up and down while we are trying to figure out dosages or if there is any improvement. Is it possible that there are elements of that contributing to your perceptions? I would be concerned about long-term Ambien use. If necessary, there are other, similar medications. I admit I'm not wild about trazadone either. I hope the doctor can help alleviate some of your concerns. If you know, what is the max dose of Lamictal the doc will prescribe? I think mine goes up to 600mg. Was just curious if that is becoming more common...

As for 3, I would be wary of the idea that he could be completely in control at this stage because you describe someone who is really struggling. Some of his judgment and behavior may be wilder and more unpredicatable. That's not to say that there is a complete absence of responsibility. However, having spent 30 years living with this, I can tell you that sometimes things happen that you wouldn't ever anticipate or desire.

I imagine you are a great comfort to him. I know how hard it is on my husband, especially when I go off the rails. It's wonderful that you are doing this together. I hope things improve soon. I hope you find someone to talk to if you need that. Sometimes friends cannot deal with run-of-the-mill hard times or get tired of hearing about it, so don't neglect yourself if you know or suspect this is (or may become) the case.

[jst4shanell]

P.S.
I hope things start getting better.  It won't happen overnight but it will get better.

[jst4shanell]

I was hospitalized and they put me on Trazadone along with a billion other medications.  My own psychiatrist who is also a pharmacologist immediately took me off.  He told me it was not a very effective antidepressent and not really good for people with Bipolar.  Antidepressants for me are a no no.  I become manic within a day or two.  That's just my experience. :)

[monkeyc]

Sorry this took me a bit longer than I would have liked, my own moods are not great right now.

OK on the control over your mind.  Learning to deal with bipolar is a continuing education process, none of us are perfect but we all have to do it if we want to move beyond the disease controlling us.

Basically first step is to understand that the disease does not define you - yes the disease makes you feel and behave in certain ways but that does not mean you have to define yourself only by those things - a big thing to do is accept the disease, learn about how your moods work and what triggers them and the learn to work with and around them.

Never use bipolar as an excuse or blame the illness for things - this is a bad trap to fall into as its handing over control - we are still human beings and capable of independant thought and from where I sit a huge part of coping with bipolar.

You notice I mention control a bit, this is not a suggestion you can control the disease its simply not letting the disease control you, its acceptance and learning about the illness and then using that knowledge to manag as much of your life as you can.

Education is key to living with Bipolar - You need to learn as much as you can about BP and treatments - there are some excellent books out there and Kay Redfield-Jamison's "The Unquiet Mind", I also found "The Bipolar Handbook: Real-Life Questions with Up-to-Date Answers" by Wes Burgess invaluable as its written by a psychiatrist and BP expert and an essential one for both of you is "Break the Bipolar Cycle: A Day-by-Day Guide to Living" with Bipolar Disorder by Elizabeth Brondolo and Xavier Amador.  This one has checklists and sample mood charts and sections for spouse's and family.

There are a few tricks to books and reading material on BP - avoid self help books not written by doctors or bipolars, avoid anything that has the word 'cure' in it, always look at content before buying.

With drugs there are 3 key things I tell people and I think its good advice.

1. Always understand the drugs you are taking, their side effects, interactions and how they work.
2. Ask questions of your doctors - always especially when taking something new
3. If you feel side effects or thing something is wrong ASK the doctor.

I also advise people to ensure they have a psychiatrist and a therapist - Family Doctors generally know nothing about Mental Health beyond the basics so you cannot normally rely on them - there are some that are different but we have to deal in majority.

Knowing your own mind takes time and stabilisation, the medication is what you need to focus on right now, I think you need to go back to your doctor and discuss all of this with him, once there is a stable medication profile and things stabilise your husband will find it easier to start knowing his mind and gaining some control - but be aware its not controlling your moods as much as it is understanding why they happen a bit better.

I like to jokingly call it "Dr Strangemind - or how i learned to stop worrying and love the bipolar me".. Id love to write a book titled that one day.

And last but not least there is one thing more.  Being a spouse of a BP is hard work sometimes, it takes an emotional toll on you and there are times when it can be really hard going.  I have watched my wife go through hell with me and I am eternally greatfull that she has stood by me.  Spouses and Partners need a support system as well, friends, family are good but there is no harm in seeing a therapist if you need one.  We are in this with our partners and we all have to look after ourselves.

[goatgirl]

Thank you for your response.  My husband is trying to get in to see both his counselor and psychiatrist this week to talk about a possible medication change.  Lately we have been leaning toward the medication as being the culprit to his extreme ups and downs, but it is so hard to determine sometimes.  He really wasn't this bad before he started treatment in late May.  Thank you again for your advice.

[monkeyc]

Im at work now but I will come back tonight when I get home and post some stuff for you, particularly on (3)

For 1 and 2 you need to be speaking to your doctors - (1) in particular is serious and may indicate a bad reaction - Trazadone can have bad side effects for some people - some listed here to start with : http://en.wikipedia.org/wiki/Trazadone

Extreme high and crash can be a mixed episode as well which can happen on any AD - any patient on an AD who goes hypomanic or manic should be withdrawn from the drug - these are known side effects.

MOre later.  Speak to your doc.  If you are not getting the answers see another one.