Bipolar identity
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| Mon, 09-11-2006 - 12:21pm |
Why does my bipolar friend spend more than $6,000 annually for meds/therapy and still has difficulty maintaining relationships with friends, family and significant others and cannot hold a job? He is truly miserable and worse off than when first diagnosed 20 yrs ago. He goes to the best therapists in this large metropolitan city and has access to the latest meds, takes them RELIGIOUSLY, adjusts them as needed under advice of doctors.
Sorry for my naivete I don't mean to offend anyone, but as a former anorectic I'm thinking the bipolar, as with anorexia, just becomes such a part of your identity that you in some senses choose not to let go of the behavior. It's easy just throw up your hands and blame your diagnosis for everything, and you get a lot of sympathy and attention for doing it. Also, he talks about bipolar/himself/his problems constantly and reads about it tirelessly; it's like he is obsessed with it but never takes action. I feel I've been there, in some capacity, and wonder if anyone has any insights.
Shouldn't the meds be alleviating his misery to some small extent? Ever?

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Hello. I'm glad you came searching for answers. I can't give you any, but I'm going to tell you what I think.
Having both been Bipolar and anorexic in the past, I can tell you that the two ARE NOTHING ALIKE!!!
In my case, (i will not speak for anyone else here) I do not choose these "behaviors". I wish with all my heart they would not be an issue. But, they are. We can't just "take our meds" and expect everything to be all hunky-dory. Oh how we wish that were TRUE!!! No, meds help control some of the mood swings. But, they do not give us tons of relief, unfortunately.
I also talk a lot about my BP, and I read everything I can on it too. Its not that we're obsessed or anything...just ill. Anyone with diabetes or cancer would do the same thing.
Some people don't fight as hard as others. That's true. But, your friend sounds like he is doing all he possibly can. You should allow him that time, to talk of his BP, his illness...sometimes we're feeling so chaotic in our heads that the only way to survive it is to talk about it. Incessantly.
It takes a strong person to be a true friend of a Bipolar. All my friends are now BP. Others just don't get it. I realize its hard to hear it all the time.
Anyway, just my opinion...
Hugs,
Keli
Hi Honey!
I don't know if I'm the best person for this but, I'll give it a try.
Love,
Thanks for your insightful replies. It seems there is a wide spectrum of response to the meds. In my friend's case, the apparent side effects of his meds (alopecia, sexual dysfunction, memory loss) are at the core of his current depression. I'm wondering if anyone has had any experience with cognative therapy combined with gradual tapering off the meds. I'm not sure they are right for everyone and the chronic effects seem to compound the problem. For instance the forgetfulness combined with him doing a lot of negative self-talk is really bad. He can't seem to remember anything good happening, ever. When I remind him of good things that have happened he has completely forgotten about them.
Also the sex dysfunction has manifested itself as a porn addiction of some sort, to the point that he has a very skewed idea of what relationships are all about...you can just imagine. We are living in a big city with lots of different types of people willing to engage in all sorts of short term arrangements. I think it's fine to experiment but at this point it's hard for me to imagine him ever having the type of fulfilling relationship that he ironically longs for. He no longer has any idea of how to get there from here.
He has already tried every combination of meds (he's on 4 for mood alone) and added on some meds for sex dysfunction, insomnia and fatigue. He is a walking medicine cabinet!!
Guess I'm not so much questioning that bipolar has a psychobiological basis but more that he might have been misdiagnosed, if what you are saying is true, that this is the best quality of life these meds can elicit.
Also, sounds a lot like hyperthyroidism, although I suppose he's been tested for that.
Edited 9/12/2006 5:58 pm ET by goddess_juju
Edited 9/12/2006 6:04 pm ET by goddess_juju
>>First,even though many people with bp have ed's, they have never found any correlations. They are totally different disease of the brain.
Not to belabor a point, but it's possible they are interrelated...nobody's disproved it either. It's not known if there is a neurological basis for eating disorders yet as far as I know.
I was really referring to more the effects on personal identity each of these disorders necessarily create, rather than the psychobiology though.
Hi Honey!
If you're suggesting he tapper of meds all together, that can be down right deadly.
Love,
Some people never learn to be adults because of the illness. There is just too much confusion and forgetfulness going on to feel like a normal person, if they even know what "normal" is. Some people were either so manic or so depressive that do not have the slightest idea what the in between is like. People who are manic would think the "in between" was a sluggish mood and people who are depressive might get panic attacks trying to deal with their new situation. I have had this illness for at least 20 years now and I was never able to stay in school or hold a job because my mind was processing everything around me wrong, causing me to panic and run away. It even caused me to act inappropriately and then get confused and angry at how people were treating me - all while on meds.
Lisa
every morning:
Depakote (valproate)
Wellbutrin (bupropion)
Lamictal (lamotrigine)
caffeine pills
Others:
Seroquel (quetiapine) - sometimes instead of Lamictal
Geodon (ziprasidone) - takes from time to time for sleep
Viagra - prn
Ambien - prn
I think he's also taken various SSRIs regularly in the past but has stopped them now. His doctor lets him dose himself at this point. I think he only sees one doctor.
He may have a whole stockpile of old drugs he takes from time to time so I don't know. It seems he's heard of/tried everything.
He's been suicidal for last 2 yrs but as far as I know hasn't actually acted on it ever. Doesn't smoke or do illicit drugs, drinks socially but really not very much at all except for the very occasional binge drinking.
>>Sure I have a horrible disease but, I don't have cancer.
I really wish he felt this way. It seems since his gf broke up w/ him 2 yrs ago he is unable to function in society.
Edited 9/13/2006 11:23 am ET by goddess_juju
Welcome to the board, Goddess_Juju! The other ladies have posted wonderful replies, so I'll keep mine short. Just a possibility that the new sexual addictions have more to do with his negative perceptions of himself as not being worthy or stable enough to sustain a relationship, so it's a "take the connection any way you can get it" type of situation. ?? Just a thought. Perhaps his medication should be adjusted to compensate for the depressive swing his current meds are giving him. Sometimes my meds for mania swing me into depression and then I need meds to balance out the depression. It's just a guessing game (and I'm no doctor), so please bear with your friend.
Something I found out fairly recently is that BP can actually go into "remission" and disappear for awhile. Often when it reappears after an extended absence, it's worse than before. It's also a progressive disease, in that it slowly gets worse when left untreated or not treated effectively. Many of the meds, including lithium, can cause memory problems (actually, especially lithium). You may be very right, though, about the negative self-talk feeding into his memory problems, but doubtful that that's the whole issue. Good luck and hang in there with your friend!
Hi again!
Like I said before...I'm not a doctor...This is only my opinion...It's great that he's working with only one doc.
Love,
I was just reading something about Depakote interfering with the metabolism of lamotrigine. It could explain why he is constantly adjusting his doses. Check this out from http://www.drugdigest.org:
"LAMOTRIGINE may interact with DIVALPROEX SODIUM (in Depakote)
Divalproex may block the breakdown of lamotrigine by the liver. If this happens, blood levels of lamotrigine could be increased and this could increase the risk of side effects including headache, upset stomach, and dizziness. On the other hand, lamotrigine may cause a loss of divalproex effectiveness by reducing the amount of drug in the body. If these drugs are used together, your doctor may want to monitor you closely when therapy with lamotrigine or divalproex is started, stopped, or when there is a dosage change. Discuss this potential interaction with your healthcare provider at your next appointment, or sooner if you think you are having problems.
This interaction is well-documented and is considered moderate in severity."
The Seroquel is apparently rather expensive and he is out of work often so I don't think he's substituted it recently. He seems to like it better and has a bipolar friend who prefers it as well. However he mentioned something about it having its own side effects.
Regarding therapy, I was bold enough to suggest he get some. He got very defensive and angry. According to him, he's already been there and done that. He retorted, "Why don't YOU go get therapy!!!" to which I simply replied that my problems are not affecting my day-to-day quality of life as they are his, and gave him some examples, to which he replied, "You may have a point there."
However, money is always an issue, so he never went. I tried to find some free therapy but had no luck. He does really need it, even if he can spout psychobabble I'm not convinced that he's gotten any meaningful therapy. So in the interim, I have been a poor substitute for a therapist, as far as talking. I would never make any suggestions regarding his meds. I was just curious and I might suggest that he discuss some of this stuff with his doctor (who does not believe in therapy, by the way).
He does have a great relationship with his Dad and stepmom which I think is the reason he is still with us.
Edited 9/13/2006 8:44 pm ET by goddess_juju
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