Oh, Doctor, doctor, can't you see I'm burning, burning
July 27, 2011 5:44 AM   Subscribe

Boyfriend is bipolar but won't take bipolar meds - help?

So boyfriend's psychiatrist thinks there may be validity in the idea that my boyfriend is bipolar. He's also an alcoholic and borderline substance abuser who self medicates, and as you can guess by me posting, is in a state. Over the weekend his family did a mini intervention because of his manic state; he has all the classic symptoms of both the mania and the depression, and has only ever been in antidepressants and anti anxiety medication which didn't address the bipolar mood disorder. He, his doctor and his family and I all sat down on Sunday and talked about his problems and what to do. He gets along well with his doctor, but the problem is that the boyfriend is excellent at talking his way out of problems - including bipolar medication, which he does not want to take. It's the next logical step after this dreadful weekend, but he's somehow convince the doctor that he'll exercise, see him every day and all will be fine.

He's someone who sees the negative in a situation, and has devoured all the information on CrazyMeds - and only sees the side effects of Depakote and Abilify, the two ones his doctor has recommended. He just thinks he's going to end up bald and fat, and can't see the benefit of getting his moods stabilized because when you're on a manic high, your family worrying about your temper, aggressiveness and mood swings is just 'bringing him down'. I've tried to explain the idea of risk/benefit ratio (i.e. side effects happen, but you have to look at the the statistical likelihood of getting them and balance that with the benefits). Sadly he thinks we're all trying to control him, and doesn't want to 'negotiate' about the meds, even though this to me is a breaking point in the relationship. At one point he mentioned he'd consider taking them, but that's changed - and whenever I bring it up in a non-threatening, calm supportive tone asking if we could talk about the issues, he yells and says it's not up for discussion. I've explained that yes, the drug ramp up period is frustrating, but if we don't find a drug that works or has bad side effects we'll try other ones, and that we'll get through this - the importance is to just try. But I'm starting to wonder if *I* can get through this.

Both his family and I are frustrated - his doctor can't force him to take the meds because it's his choice, and now that the crisis 'appears' to be over (i.e. weekend anxiety is over, he's seeing his doctor every day) it's back to status quo. This means us picking up the pieces until the next crisis, and I'm exhausted, and don't want to wait for the next mini intervention or for my boyfriend to hit rock bottom because he's not taking responsibility for getting well. I sympathize - nobody loves being on meds, but if it's helping him then it's worth it. He's not psychotic enough to be committed, but he's obviously gone through so many periods of mood instability that he doesn't remember the stable periods in his life. My question is if there's a way to look at the list of side effects and say 'yes, this one has this side effect, and this is how likely they are to happen'. I want to work on putting the best, most compelling case to him in the hopes that he'll be convinced to at least try them. I hope to have the positive case ('look how your live will become stable') but will consider using a negative case if that's what it takes, because I'm at the end of my rope. I also don't like using ultimatums, but increasingly feel like I have reached a point of no return with him and have to figure out if I should break up with him and move out - which of course is hard to contemplate with him in such a stressful state.

Does anyone have any ideas of what will work? There has to be a way to help someone who's self destructing in slow motion in front of me.
posted by anonymous to Health & Fitness (28 answers total) 4 users marked this as a favorite
 
Leave.

Is this is a deal breaker for you, and you have said so, then you need to enforce yor boundaries or you become complicit in your own situation.

Leave, explain why you are leaving, and do not negotiate.
posted by DWRoelands at 5:54 AM on July 27, 2011 [19 favorites]


Yea, you're stuck between a rock and hard place and if he doesn't want to commit to change, you should get out and get out fast and safe. This is not about him so much as it is about you and your safety. If he doesn't agree to anything within a week, time to pack
posted by wheelieman at 5:57 AM on July 27, 2011 [3 favorites]


There's no powerpoint presentation that can convince someone who is not thinking in his best interests to do so. He's clearly not thinking rationally (see his belief that you're all trying to control him), so rationality is not going win the day here.

The only thing you can control is how you react to his decisions. It's clear that, while you love him, you no longer want to be on the roller coaster.

I'm sorry. Good luck.
posted by inturnaround at 5:59 AM on July 27, 2011


Speaking as someone who has been with a bipolar person for close to 15 years, you have to set a boundary. Either they can behave and not do negative things or they can in a relationship with someone else. That's it. If he can reach that without meds, fine. If it takes meds, that's fine. But you continuing to be in a relationship as he proceeds with negative behaviors that effect you and the relationship is not fine.

The only positive is that they'll be able to function in a more steady state, without the ups and downs. But the problem is that the maniac phrase can be incredibly productive, which helps foster the delusion of "I'm ok, hell I'm better than ok, it's the rest of ya'll that are slow and stupid. Everyone should be like this" (My wife jokes that there's nothing like a good maniac to get all the errands and chores of the day done). Most bipolars have problems seeing "able to function in a more steady state" as plus. It usually takes a cycle of repeated ups and downs over years to see how destructive those mood swings can be. He doesn't sound like he's there yet and that people are enabling him. That's his choice, but it doesn't have to be your choice to to go along with it. You need to take care of yourself before you can take care of anyone else.
posted by Brandon Blatcher at 5:59 AM on July 27, 2011 [5 favorites]


Leave.

You can throw as many ropes to someone in a pit as you like. If they won't grab them and start to climb, it doesn't matter how hard you pull to help them out.
posted by stevis23 at 6:01 AM on July 27, 2011 [1 favorite]


I have to agree, it sounds like you've done all the leading-to-water that can be done here. You can't force him to take care of himself, you can only demonstrate to him that his decisions have consequences, and those consequences include losing you.

Wait until he's in a stable period, tell him that you're moving out and that he can call you if and when he has his disease under control.

I'm very sorry; I know this is hard.
posted by ook at 6:03 AM on July 27, 2011


You are within your rights to leave. You don't have a moral obligation to continue propping up someone who won't take steps to make their situation better. Your first priority should be taking care of yourself, and I know that is very difficult to hear and believe.

I'm married to an addict who has (thankfully) found recovery, but one of the things I was told early on by professionals is this: Things are likely to never get change. You cannot assume this situation will get better. It is out of your control. Are you willing to live like this forever? If yes, by all means stay, but you will have to learn to accept the situation for what it is. If not, well, there's no point in wasting another day of your life.
posted by something something at 6:21 AM on July 27, 2011 [1 favorite]


He doesn't want to get better. You can't convince him to want to get better. You can only make your situation better, which, in this case, seems like it's only going to happen if you leave.
posted by xingcat at 6:24 AM on July 27, 2011


1) You are not his doctor. You are not even a doctor. Also, the fact that he's seeing a doctor every day seems to suggest that he does, in fact, want to get better. It also suggests that the doctor has a pretty good idea of what's going on.

2) When his manic episode has passed, tell him that this is a dealbreaker. Because it is, and you have every right to leave (and, honestly, you don't really owe him any favors at this point). You can even give him an ultimatum with a date attached to it. But don't force him onto meds that you think he needs.

3) Although his doctor cannot discuss his medical conditions to you, you may be able to contact the doctor, and non-specifically talk about what your role can be in all of this. It's not as though he's never met a bipolar patient who wouldn't take meds....
posted by schmod at 6:35 AM on July 27, 2011 [2 favorites]


It worry's me that you, his family and his doctor are all talking to him at once. You've gotten a lot of good advice up thread but I think you also have to deal with the fact that it seems you're putting a lot of pressure on him.

If he already feels like he has a lack of control over his life and his mood I don't think it helps if you make him feel like a project. It probably makes him feel quite trapped and lacking in agency. Taking medication at this point probably feels like he is giving up even more of his control.

Perhaps he needs to get a second opinion as well it might help him to feel secure that this is a real thing.

I think you should set boundaries re his behavior. He isn't "a bipolar" he's a person with bipolar who is responsible for his actions and you need to set reasonable boundaries around how he acts towards you. That's your choice, his choice is whether or not the side effects of medication are worth it to him.

Get yourself some support to. There are support groups for the friends and family of addicts/the mentally ill.
posted by SpaceWarp13 at 6:52 AM on July 27, 2011 [2 favorites]


Manic-depressives often don't want to take medication because, like Brandon Blatcher pointed out above, the manic state can be highly productive and experienced as a "high." I can sympathize with his resistance to taking meds. I think you need to make a judgment call here. Are you able to see him through this? If this is destroying you from the inside out, then you might have to leave. But if you can/are willing to see him through this, then you should maybe change your strategy and not make him feel like you are siding with his family and against him. The more everyone makes him feel like they're trying to control him, the more he's going to resist.

Surely you can understand why he would not want to take meds. I think the entire psychiatric/psychotherapeutic profession is too medication-happy. I tend to think that medication should be a last resort. Unless your condition is such that you're completely unable to function (such as when someone is experiencing a severe psychotic episode or is so seriously depressed that they can't even get out of bed at all), you should consider alternative treatment options before resorting to meds.

From your description, it sounds like your boyfriend experiences short manic episodes and then returns to a somewhat normal state, and although he exhibits self-destructive behavior, it does not sound like he's completely non-functional. Maybe you should look into alternative treatment options. These may or may not work, and I realize that there's a lot of quakery out there. But it's worth a try.

By the way, there's a fascinating book about people with bipolar disorder. It's called "Touched with Fire: Manic-Depressive Illness and the Artistic Temperament" by Kay Jamison. The author's theory is that many of the great artists, writers, and musicians are manic-depressive. These people's careers are often characterized by bouts of productivity, followed by periods of downtime. It's very interesting.
posted by raynax at 7:03 AM on July 27, 2011 [1 favorite]


Aww, babe. I'm so sorry you're going through this. Watching someone you love self-destruct is so awful, so soul-crushing, so frustrating. Because of this, we often try to convince ourselves that there surely must be SOMETHING we can do to help, long after it's become apparent that the loved one in question has no interest in exiting their self-contained demolition derby.

I've been there myself - I've fantasized about kidnapping family members with drug issues, chaining them to the bed in a hotel room and forcing them to get clean. In the end, admitting that people don't always change - and when they DO, it has to be self-directed - can be as hard as watching the self-destruction itself. The feelings of helplessness and powerlessness really suck.

This is all a long-winded way of saying this: you cannot and will not change your boyfriend. You can only rely on him to change himself. He has repeatedly, emphatically indicated that he has no interest in changing. Unless he is able to express a genuine desire to get his shit together - and make a genuine effort to follow through on it - you need to get out ASAP.
posted by julthumbscrew at 7:09 AM on July 27, 2011


He is seeing a doctor every day right? Why don't you trust the doctor to know whats medically best? I doubt your boyfriend has "convinced" them that he doesn't need meds if he is speaking with him every day. The doctor probably actually believes that he will be OK without them, and you should try and feel some security in that, even if the last episode was traumatic (as I know they can be).

That said, there will almost definitely be more episodes in the future. So, if you can't deal with that (and you don't have to!) you should leave. This could very well be your whole life if you choose to stay with him.
posted by LZel at 7:12 AM on July 27, 2011 [1 favorite]


It sounds like you've done a great job of handling the situation. It can be very difficult to remain level-headed in the face of something so unstable. Your boyfriend is lucky to have a team of people thoughtfully considering what's best for him and trying to work with him to find a solution to his problem.

To answer your question directly: you could indeed do the research and compile a list of possible medications, their potential side effects, and rates of occurrence. But do you really think he'll listen? I don't think this is something you or his doctor can reason with him about.

What stands out to me in your post is that he's "excellent at talking his way out of problems - including bipolar medication, which he does not want to take". I grew up with an uncle who managed to negotiate his way out of mental health diagnoses and treatment, and was therefore never "well". This impacted the lives of everyone around him. I'm worried for you if you stick with this guy -- even if he's not a physical danger to you, someone able to convincingly argue his way out of treatment is not safe to be with in an emotional sense. I can go into more detail privately if you'd like -- feel free to MeMail me.

The bottom line: You need to take care of yourself, not just him. You need to decide for yourself what your limits are if he isn't open to potentially useful treatment options. It sounds like you're approaching that decision in a very rational and compassionate way.
posted by cranberry_nut at 7:23 AM on July 27, 2011


As you have already gotten some good input above from people who have dealt with relationships with bipolar people, I thought I'd chime in on this nugget:

He's also an alcoholic and borderline substance abuser who self medicates.

While the specifics of your situation is unknown to me, obviously, I do know well several people, my recovering roommate included, who showed severe symptoms of various mental and emotional illnesses due to excessive substances being imbibed or swallowed, bipolar included. One of my friends is on medication to control his moods still, but the dosage he needs to take (and therefore the side effects) have gone down considerably since he has stopped playing mad scientist with an already difficult brain chemistry.

Lastly, just something to look out for in someone who struggles with substance abuse. In my experience, substance abusers, addicts and alcoholics will often ascribe wild mood swings and such with a mental illness or other psychiatric issue because they are trying to draw attention away from how much or what is being taken to chemically alter moods.
posted by Debaser626 at 7:49 AM on July 27, 2011 [1 favorite]


Your boyfriend's desire to avoid unpleasant side effects is not in itself a bad thing. If he's already having mental issues, worrying about adding to the baggage he has to carry is a valid concern.

The good thing is, there are a lot of different meds and med combinations that work for bipolar disorder. Mental illness can manifest so differently in different people - even with the same diagnosis - that the drugs that are miracle cures for some people can be impossible burdens for others. If he has specific concerns about Depakote and Abilify, he can tell that to his doctor, and ask to be prescribed something different without even starting them first.

A patient can tell a doctor "I am not willing to experience ____ side effects" and they will try to work around that. Also, as you mentioned, not all patients get the whole list of side effects, and those who do generally report (IANAD) that the effects stop (and often reverse) soon after they stop taking the medication. So you can reinforce the idea of treating all medication as a trial process - one that he can change if the downsides outweigh the benefits.

One comparison that helped me: if he had a broken arm, he would see a doctor and do what the doctor suggested. He wouldn't self-medicate and pretend nothing was wrong. Or, if he did, he would know that walking around with a broken arm that won't heal right is his choice, and not to be surprised when he can't lift things and people notice. Right now, something is broken. Yes, it is his choice if he wants to follow medical advice or not. But that doesn't make him a doctor. If he trusts his doctor, he needs to try to find a way to work together to find a solution. If not, then the doctor isn't really helping him - and he might actually want to think about finding a new doctor who can.
posted by Mchelly at 7:49 AM on July 27, 2011


There has to be a way to help someone who's self destructing in slow motion in front of me.

Wouldn't it be wonderful if that were true! Alas, it isn't. If he's at the point where he's "yelling and saying it's not up for discussion," he has some deep, deep issues. I'm surprised no one has mentioned his being an alcoholic; he could really use some long-term rehab.
posted by Melismata at 7:53 AM on July 27, 2011


He IS willing to take medication (alcohol, drugs). He's just not willing to take the medication that the doctor prescribes. That's a bad combination. I understand that the side effects of the prescribed medication frequently suck, and that it's his choice to take them or not, but you can't live like this. His chosen treatment plan isn't working out for you, and you absolutely have the right to tell him that if he doesn't change how he manages his illness, you're out the door.

As for the specific side-effect list you're looking for, CrazyMeds is probably your best bet. You can also google "{name of med} side effects" and pick through the list until you find the full paper with the incidence of all the various side effects if you want.
posted by KathrynT at 8:15 AM on July 27, 2011


The problem with people who focus on the side effects of medication is that *they* have to realize that the benefits outweighs the negatives, and nothing you say will make them realize it. You said he's read CrazyMeds. I've been all over that site and they have caveats everywhere that the side effects "probably won't happen" but your boyfriend focuses on the negative side effects to rationalize his way out of taking the proper meds.

I was med-resistant for nearly 15 years (I also have bipolar - for about 25 years now back when it was called manic-depression) because I did not want to suffer from the side effects of the meds. It didn't matter how many people told me of the benefits of taking meds, or how the meds turned their lives around. No, I only knew that those meds were "poison" and I would be a "zombie" once I started taking them. There finally came a point in my life where I knew I couldn't handle this disorder with "diet and exercise."

He has to get to the point in his life where he will realize this as well -- and sometimes that means he has to hit rock bottom with nowhere else to go and no one to hold him up. I hope it's not true for you, but that's often the case. As someone above said, you can throw as many ropes into the pit as you want - he has to be the one to pull himself out. Neither you nor his doctor can pour the medication down your boyfriend's throat. It's all up to him.

I've also been on your side of the fence, facing a loved one (two actually a family member and a SO) who simply refused to seek the help they need to live a normal life. Both say they can take care of their health themselves, both are diagnosed with bipolar. Both have psychotic episodes that are disruptive to everyone's lives. The family member has been hospitalized three times for suicidal depression, and the SO got violent during a manic episode. I feel your pain. Dealing with a mentally ill loved one is draining to say the least. My advice to you is, if you feel he is dragging you into his hellish world, the best thing you can do is turn around and walk away. You have shown him the emergency exit, and he has refused to take it. Thus ends your obligation to him. You do not need to live in his hell for any length of time. It doesn't matter if his episodes last a month, a week, a day, or even an hour - they are not yours to share. Distance yourself from them for your own sake of mind.
posted by patheral at 8:29 AM on July 27, 2011 [1 favorite]


Taking medication is most probably going to suck and take a lot of adjustments as well, so boyfriend is going to need a reason to put up with it. If he's rational enough to listen, explain to him why he needs medication and that his manic episodes are too extreme for you to be asked to endure. If you decide you can't deal with him anymore, leave the door open so he can turn to you if he decides to try medication. Maybe talking to other people with bipolar disorder will help him realize how medication can help him achieve long term goals and live life. Avoiding depression might be enough of a motivation. See if there is a bipolar support group nearby, maybe he'd be willing to hear what other people have to say, but it doesn't sound like he's really open to listening to anybody right now. He could just be living moment to moment in a tide of emotion. Learning about the possibility of traumatic hospitalizations, paranoid delusions, disturbing hallucinations or just the realities of being extremely obnoxious during mania may inform him. You can try a lot of things but ultimately he has to make the choice himself. Be there if you can but protect yourself.
posted by provoliminal at 8:42 AM on July 27, 2011


If I were you, I think I would give the psychiatrist a chance; I suspect he's not as clueless as you think he is. I think he's probably trying to establish a trust relationship with your boyfriend--okay, you don't wants meds, let's try it your way for a while--and then when things go to hell, he's going to use that leverage to try again to get him on meds. As the young rope-rider said, the doctor's taking this very seriously if he's willing to meet with him every day, so I would give the process a little time to play out.

Does your boyfriend know how distressed you are by the situation and that you're thinking about leaving? I don't like ultimatums either, but he deserves to know that your relationship is in jeopardy and is dependent on his behavior. And whatever you do, establish your boundaries and maintain them.
posted by WorkingMyWayHome at 9:01 AM on July 27, 2011


I suppose this is just an anectodal aside, but I know someone who has been taking antidepressants and tons of Depakote for years, is now in his 50's and he's definitely not bald or fat.
posted by serena15221 at 9:59 AM on July 27, 2011


I grew up with a bipolar parent who was unmedicated through most of my childhood. The best thing I ever did was to attend a NAMI seminar for family members of the mentally ill. The most important thing that they taught me was that you cannot reason with an irrational person. It will drive YOU crazy. There is no putting a best case together and convincing him.

In your situation, I would leave. Nothing you say is going to work for any period of time. He knows how to manipulate people and he will tell you he's taking his medication when he's not, etc. It will drive you crazy. I am split on telling him you'll come back when he has his shit together, because that might be a rollercoaster. OTOH, the ultimatum might genuinely spur action.

Whatever you do, don't have kids with this man until he has his act firmly together for at least a year.
posted by desjardins at 10:04 AM on July 27, 2011


I have been taking medication for bipolar for several years now. I worry constantly about the effects they have on my liver and kidneys. I still take my medicine, every day, because I remember how horrible my life was--and how horrible I was--when I was using "natural" treatments of exercise and alcohol. And because I've seen relatives with Bipolar quit taking their meds (in one case at the urging of a romantic partner who didn't believe in psychiatric medication, or thought that they were stifling his creativity as an artist, or some such poisonous shit) and destroy their lives.

Now I'm in a long term relationship with someone I love, and I have a new reason to take my meds every day. I don't want to inflict the burden of my illness on anyone else, much less anyone I love.

Your boyfriend isn't there yet. He doesn't yet love at least one of you enough to take care of himself. Leave, and don't look back unless he's stable.
posted by Marty Marx at 10:33 AM on July 27, 2011 [1 favorite]


Do not focus on his condition or his meds. Focus on his behavior. If he is good to you, interesting, fun, shares your values, etc. then be with him. If he is badly behaved, for whatever reason, then do not accept that behavior. You can love him, and accept his rationale for bad behavior, but don't accept it. How he deals with his life, and his possible illness, is up to him. Your post is all about him, but all you can manage is you.
posted by theora55 at 3:45 PM on July 27, 2011 [1 favorite]


I've been down this road many times. It does not lead to the Emerald City.

Basically, there is nothing you can do unless he threatens to harm himself or another person. Or blatantly breaks the law. Even then, he could talk a judge out of an extended hospital stay.

What happens is you will go through tremendous amounts of stress, until it reaches a crisis. Maybe he'll get arrested or have a really bad down cycle that he'll agree to be hospitalized. You then have hope that he will receive proper care with the meds. Then you realize the meds are wrong and the doctors are full of shit. Because they release him before they've taken effect or even worse, they make him more manic or hallucinate. When you try to reason with the doctors, they will tell you "there, there, we know best," and send your boyfriend home for you to deal with.

Now, since you are not married to him, you have no rights. Only a family member does. So you're stuck between a rock and a hard place. Being his caretaker, but not being able to be privy to his medical plan or having the ability to go before a judge and get him committed if he's out of control either way. For me, with my Mom and my ex-husband, I could do that. I could also give the doctor permission for electroshock therapy and argue with them when my ex was catatonic or hallucinating.

Seriously. You have to consider whether or not you are willing to go through this sort of stress and caretaking for the next 40-50 years. My dad has stuck with it, 50 years and counting. But last time my mom got off her meds and struck me, I left. I just couldn't do it anymore. I was married to my ex for several years and never realized his manic behavior was abnormal until he went into a severe down cycle and confessed to me that he'd been diagnosed bipolar 20 years before and refused to take the meds. Well, six electroshock therapy sessions later, he was out of it and then I guess he did take the meds, but by then he was living with his well off brother, because I was done.

It's not that you don't care, it's that you care too much. And then you subsume yourself into this situation so much that you feel like, well, if only I did this or said this, they would see reason. There is no reason. Go look at your wall. Talk to it. Does it see reason or respond to you? No.

His family knows what he's like and they are there to deal with him. Are you willing to do this for 50 years? Because it does not get better. It gets tolerable with meds, but they go off the meds or they get anxiety or drink with the meds or other things can happen that set them off even with the meds. I am not putting down people with bipolar, I am just stating the reality of living with someone who has the disease. It does not go away and it can get worse.

If you are having doubts about being able to deal with this now, get out now. We developed a weird sense of humor in my family, and my mom has a good sense of humor, and she's a very lovely person. My ex is a lovely person. But I can't live with either one of them and function as a human being. Everyone has their limits and only you can decide yours. But to blindly think you can convince someone with manic depression to just take their meds and you will get through this is like thinking you can just get someone with diabetes to take one shot of insulin and they will be okay. It doesn't work that way, it takes a huge toll on the people involved and it's a marathon, not a sprint.

I wish you well. I really do know what you're going through. It's rough.
posted by Marie Mon Dieu at 6:52 PM on July 27, 2011 [1 favorite]


By the way, my ex quickly found a girlfriend, and then another, and then another. He is on his 5th or 6th now. I think the latest one is actually a nurse. He is on meds but he is still not someone I could ever live with again. So don't worry that your bf would be all alone without you. He won't, trust me.
posted by Marie Mon Dieu at 7:23 PM on July 27, 2011


I'm with Marty-I've been diagnosed as bipolar after 20+ years being treated for depression and anxiety disorders. I finally have the right meds - and am self aware enough to know that I can't control bipolar without them. I also don't want to inflict my crazy on my husband or children, so I'm happy to take my meds. I don't like the side effects or the monthly blood draws, but I do like being balanced, calm and rational.

Basically, he doesn't hate the way he feels enough to take treatment seriously. Until he does, everyone who cares about him will be going through all sorts of hell. If I were you, I'd leave.
posted by hollygoheavy at 12:06 PM on July 28, 2011 [2 favorites]


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