Expert: Ivan Goldberg, M.D. - 12/7/2008

Question
Hello, I am a 55 year old male.  I have never been fully diagnosed as being bi-polar, but my mother, to the best of my knowledge was--was on lithium, and I have been evaluated by the local MHMR preliminary folks and they seemed to think so.  Whether I like it or not I have every symptom of this disorder with the exception of hallucinations.  I have gone through moods all my life where I take an interest in something and then eventually just burn myself out and I quite whatever it is--from playing in bands to attending church, etc.  I attempt to motivate myself into postive moods and seem to remain so as though I have my world under control, but during these times I begin to feel driven at whatever I am focusing my attention upon.  I seem to have no balance, and after a while I simply walk away from real life and behave in ways that I believe to be wrong and are destructive to me and my family.  I may be the most devout religious man you ever saw today and tomorrow I may suddenly go off the deep end and go on a binge of drinking and drugs, during which time I have not a worry in the world.  Of course the worries return as does reality.

I am currently not on any medications.  I have been attempting to go it on my own, but this only works during the motivated or up cycle.  Eventually I seem to burn myself out or whatever, and then I walk off like a fool into a life I really do not want or desire.

My wife would rather not believe me to be bipolar, but rather think me a drunk and worthless person.  I think she may be right on the worthless part.  To her mental illness is a weakness.  I guess she is right.  All I know is that each episode leaves us in more dire straits financially as I spend money that we do not have, and I mean ridiculously spend money, and seem for the moment not to be able to care about the consequences.  

I have a prescription for a mood stabilizer from my family doctor but have not taken it as of yet.  My experiences with them are that yes, they stabilize my mood, but leave me in a constant low.  I guess that is better than the big highs and then big lows I am going through now, but does not seem so at the time you are on the medication.  I have also bee concerned about the side effects of most of these medications.

But, the simple truth is I am about to loose the only things I have in life worth keeping, and something has to give.  I cannot keep on going like this, and my wife and family cannot take much more of it either.

Any ideas short of suicide?  I have already thought of that one, and I really do not like the side effect it has to offer either.


Sincerely

M. T.

Answer
Hi . . .

As a psychiatrist with 45+ years of experience I have seen many people with stories similar to yours. Many people, and their families, are not sure if they are dealing with a moral deficiency or an illness. From the dramatic responses I have seen to proper medical treatment I am convinced that the pattern you describe is a medical illness based on faulty brain chemistry.

Even after as lifetime of symptoms I have seen many individuals in their 50s, 60s and even 70s finally regain control of their lives through proper medical treatment. Generally to control a mood disorder it requires a combination of mood stabilizing medications. Combinations such as lithium + Tegretol + Lamictal are often used.

Please get back to me if you have additional questions.

Best regards . . .

Ivan
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