Q: Husband Hasn't Worked
or Functioned in a Year
My husband has been in a bi-polar depression since last October, when he finally
agreed to go back to a psychiatrist (instead of his GP, who was prescribing for him), because he had been in mania for about three years.
The psychiatrist took him off his antidepressant and put him on mood stabilizers.
He crashed. Now he is on lithium, abilify, paxil and he is getting worse. I am
beside myself. He can't complete sentences and hasn't worked or functioned in
almost a year.
Where can I go to get him the right treatment? The psychiatrist says that no
medicine will help him...he needs extensive psychotherapy (which he is in).
Dear Ms. Jí --
Not sure what is going on here. It would be extremely unusual for an episode of
mania to last three years running. The fact that the psychiatrist recommended
psychotherapy in the fashion you describe opens the possibility that she/he does
not think your husband has bipolar disorder. At minimum, you could begin by
suggesting to your husband that he ask for a specific diagnostic statement, so
that you can research treatment options accordingly.
For example, it could be that
the psychiatrist thinks your husband has some sort of a "personality disorder"
(a terrible term, in my opinion, but that is the current naming system). The
good news there is that even the most difficult of these diagnoses, "borderline
personality disorder", has recently been shown to respond to several different
psychotherapy approaches, with quite good outcomes in many cases.
Alternatively, it could be
your husband does indeed have bipolar disorder and that the psychiatrist is
missing or overlooking that. In that case, a "second opinion", if only for a
diagnostic impression, could be useful. Even if you have to travel hundreds of
miles for it, you could seek out a mood disorders specialty clinic for that kind
of assessment (even if it might take months to finally get in there).
Turning to the issue of your
husband's response to treatment (or lack thereof): there are people with bipolar
disorder for home the search for an effective medication approach seems to go on
and on. Fortunately this is not common, but it does occur. I have accumulated
several such patients in my practice over time. However, it is extremely
unusual to reach a point at which I am basically saying I have no further
options to try.
Two further thoughts on that
issue: first, if the antidepressant was stopped relatively quickly (within a few
weeks) that could easily have contributed to a sudden worsening. Mind you, this
is standard procedure. Surprisingly, I have only heard one mood expert, Dr.
Gary Sachs from Harvard, recommend going more slowly than this. After hearing
him recommend taking four months to taper off an antidepressant, I began trying
that approach and have been stunned to see how much more often I can
successfully get the antidepressant out of there without things getting worse.
You know we do not have very good research on this, I am now quite convinced
that "25% per month", quoting Dr. Sachs, is a very good guideline.
Secondly, in the treatment of
bipolar disorder, particularly complex cases that do not seem to respond to
routine treatments (such as lithium and aripiprazole [Abilify]), many mood
experts think that antidepressants can prevent an otherwise effective treatment
from working properly.
Therefore, it may be that
treatment approaches your husband has received did not work because of the
presence of an antidepressant -- including Paxil is currently taking, for
example. [May I emphasize that this is merely a general statement, not a
specific statement regarding your husband's care. I offer it to raise the
possibility of an approach to be investigated, not as a recommendation. In
particular, you should not recommend to your husband that he stop the Paxil.
Rather, you could recommend that he talk about doing so with his psychiatrist,
by raising this issue of whether antidepressants could be interfering with the
Good luck with all that --
Published October, 2008