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Q:  Hi David - I'm hoping you can redirect my husband and I.  Here's the story.  Chris went away to his Junior year in college this September.  Pledged a fraternity (bad judgment) and suffered enormous amounts of sleep deprivation.  He drank a lot and experimented with drugs, cocaine as well - he told me he did cocaine 3x per week approx. (we had no knowledge of any of the above with the exception of the fraternity) He came home for Christmas break.  He seemed sullen, but trying hard to make me believe he was okay.  He wore a short sleeved tee shirt.  On his left arm there were three sizeable squares of burned/peeled skin that appeared to be healing.  I asked him what happened.  He said he did it.  He didn't know why. Shortly thereafter I found out about the drugs and figured it must be the reason behind the self injury.  Sent him to rehab 4 nites per week for 6 weeks and he graduated just three weeks ago.  We also at the same time sent him to a psychiatrist.  She diagnosed him as bipolar.  He is on 100 mgs of zoloft and .5 mg of  risperdal. He did not return to college away, he attended and continues to attend here at home.  He seemed improved.  However one week ago, he attended an overnite, his old college campus.  He assured me in the most believable way that he would not choose those behaviors again.  Within hours he was high on cocaine and in touch with his sister who called us imediately.  He came home.  He told his psychotherapist what happened and she said she will not see him again.  She does not treat drug addicts.  She knows about the bipolar diagnosis which was her purpose in seeing  him.  He had already been attending a drug treatment center.  So now he has no one to talk to, which he desperately needs. 

He meets monthly with his psychiatrist to evaluate condition and he is afraid to let her know what he has done because she may not see him again and he knows he needs HELP! and the medication.  However, my husband and I took Chris with us this weekend when we went away overnite.  He burned himself with a cigarette (he doesn't smoke).  I noted it this morning - it was not there before. He denied it and then ten minutes later admitted he did it.  Again, he doesn't know why.  I am so concerned that the psych. too will say she doesn't want to see him. Chris is the oldest child of four in our family and so smart and fun, but in the summer he seemed so depressed (runs on my side) my daughter's neurologist checked him over and put him on 50 mg. of zoloft.  I have read that bipolar treated with antidepressants alone can cause quite an episode.  Chris took these medications 3 weeks before college and then left, that's when all of the above occurred.

Unfortunately that is not the end of the story.  During the above time, he had a three week relationship with a girl and because he had such extremely poor judgment, he did not ask if she used bc - which she did not.  He did and apparently it was ineffective and she is having his baby in August.  He  has so MUCH to deal with.  I don't  know how to help. Thanks for any help you can give me.

Dear D,

     With all due respect to your son's psychiatrist, psychotherapist, and your daughter's neurologist, TREAT THE BIPOLAR DISORDER FIRST.  This means that because of the seriousness of the illness and any accompanying behaviors such as drug abuse and self injury, your son must make it his top priority to focus on bipolar disorder first and its appropriate medical treatment, so that his life can achieve stability.  In order to end the control that the disorder has on your son's relationships requires that you use all the tools you can find to prevent bipolar disorder symptoms.

     Most individuals are first diagnosed with depression because their depressive symptoms are unpleasant and they are more likel to seek relief for them.  But when in their manic phase, they often feel ecstatic, make unwise decisions, engage in dangerous activities and have an unrealistic view if what's possible.  They don't see themselves as ill or view their reckless behavior as problematic.  However, medications for treating depression are NOT good for treating mania, so MORE problems can ensue with an incorrect diagnosis or treatment.  Please discuss this with your psychiatrist.  Your son would likely benefit from the addition of a mood  stabilizer.

     ALL aspects of your son must be treated if he is to get well.  Communicate openly about ALL of his behaviors and symptoms and select a psychiatrist and psychotherapist who is persistent in getting as much accurate information from your son as possible and is willing to treat the WHOLE person.  If not, keep searching.

     With regard to your son's drug abuse, he may have a primary addiction problem or he may be trying to self medicate the secondary effects of his bipolar disorder.  It is possible that once he is properly medicated for bipolar disorder, your son may become less reliant on the use of illicit drugs to regulate his mood.  Be relentless in getting knowledgeable about your son's primary and secondary diagnoses, all of which impact on his psychiatric care.  The professionals with whom he spends time should not pick and chose but be familiar with all aspects of your son's clinical picture.

     Encourage your son to stay on his treatment.  It requires patience and persistence to get the correct medications and dosages.  Once he feels improvement, he needs to continue his medication for the rest of his life.  Stopping his medication just because your son feels better can throw him into a relapse which can impact his ability to return to his earlier level of funtioning.  Bipolar Disorder is a chronic disease like diabetes and requires constant treatment and re-evaluation.

     Encourage your son to adopt a healthy lifestyle.  Get sufficient rest, regular exercise, eat a balances diet, work at managing his stress level, and avoid alcohol or other drugs.  Research has shown that individuals with bipolar disorder who are able to maintain a daily and regullar routine are better able to avoid relapses in their disorder.

     Learn to identify symptoms that can trigger relapses.  Have an action plan in mind (such as who to call, which medications to add, or which proactive behaviors to engage in) when you notice signs of a possible relapse.

Get as much information as you can on this disorder.  I have listed several helpful resources below:

     Depression and Bipolar Support Alliance, (800) 826-3632;
     National Mental Health Association, (800) 969-6642; www.nmha.org
     "Loving Someone With Bipolar Disorder: Understanding & Helping Your
     Partner", Julie A. Fast, 2004.

David Schafer, M.Ed.
Staff Psychologist

Published April, 2006

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