Expert: Ivan Goldberg, M.D. - 3/21/2008

Question
QUESTION: Hello, I am going to start by giving our story.
My hubby and I are pretty sure he has bipolar disorder. He has been to two
regular doctors and a therapist and they were pretty sure he is bipolar. Then
we went to a psychiatrist yesterday...he said he thinks my hubby has it but its
milder than what his father had.

My hubbys grandfather had it but it went untreated and not properly
diagnosed his grandmother has it and his father has it. His father is doing
very well and has been for 16 years. So we have hope.

I was a little upset with the psychiatrist because for our first visit in he had a
student take all the info and he was not even in the room. Then they met in
the other room and came back and said my hubby has it probably on the
milder side.

The thing that is upsetting me is they did not get a clear enough picture. The
psychiatrist told the student that she also has me in the room for info....but
most of everything was directed at my hubby. And she didnt give me a
chance to really tell whats been going on. And my hubby kept going off onto
other topics that were of no use. Here is what I wanted to get out to the
psychiatrist but never really did....

About a year ago my hubbys father was diagnosed with colon cancer... but
told its very treatable and in the very early stages so the outcome looked
good. My hubby did not do too well, which was to be expected, but he was in
a pretty low depression he told me there were days where all he did was sleep
and cry. He also told me he would drink to get happy but it didnt work. and
then he started smoking marjuana everyday. He was driving very recklesly
160-180 km he started skateboarding, dressing weird, he bought skater
clothes, 2 guitars , drums he bought another car so he owned 2, skate
boards, a condo (which he still says was a good idea) then he decided to leave
me and the kids,and date another person who was not good for him she has
her own mental illnesses that she does not deal with( he actually started to
date her before he left me) his money spending kept on going he went to
jamaica too. He was also doing dangerous activities jumping over a bon fire
on a skateboard, and then he had an accident skateboarding. It was our
oldest daughters b-day he took the kids to the rec center where her birthday
was going to be. while i went to get the cake and stuff..... he thought he
would go to the skate park cause there was a little time.... he gave our middle
child his helmet and a board to use while he went off on the ramps to do
tricks and push his limits. My oldest daughter said he didnt pay much
attention to them. Anyways he injured himself pretty bad 6 broken ribs
broken elbow and wrist. when I got to the pool he was sitting there pale I
asked what happend and he only sort of told me....at first he would not go to
the hospital but eventually he did. He left the hospital before they let him go
too. then the next day he drove back to the city he works in (We live in
seperate cities because of work but that will be changing in a month) he still
kept going with doing stupid things like punching his windsheild a dozen
times because he was upset. but then he got sad ...he called me crying saying
he didnt know what he was doing he wasnt sure of his choices. He started to
seem ok and then he wanted to come home to me and the kids, i was starting
to think there was something going on with him at this point. on a couple of
visits he was very emotional a lot of crying hated where he was. Hated the
whole city he was in. Then his mood lightend and got better and better and
better but he was drinking more again driving faster again and a very high
ego again , and he drove 160 km/h to a city 600 kms away after work to go
to a tatoo convention that night and the next morning he got 6 tatoos (which
I know he likes them but he got 8 going on 9 in a matter of 2 and a half
months) after getting his other tatoos in the morning and not sleeping much
he drove back to the city he lives in and went to work and he started talking
about some woman at his work...red flags went up right away.... I told him i
think there is something going on with him and he said in that moment the
world felt like it was crashing down on him. he went to the doctors and thats
when the doctor there said yes sounds like bipolar then the doctor here said
the same and so did my therapist. He has had much smaller waves of odd
behavior and moodiness till now.
his boss told him a little while ago his job preformance is slipping.

None of this is him.

I am sure I am missing some details because there is so much. Like pulling
away from the kids too. And at times it is like he is obssesed with sex...which
normally he like alot but there have been a few periods of time where he is
obssesive about it.

what do you think?

He is taking lithium now for the past 5 days.

Help.

ANSWER: Hi Daisy . . .

I am not really sure what the question is that you wish answered.

From your description is seems quite likely that your husband has some form of bipolar disorder. Periods of overactivity accompanied with poor judgment and other periods of introverted withdrawal are characteristic of people with this disorder.

There is no way I can say that he has bipolar disorder any degree of certainty as a psychiatric diagnosis can only be made after taking a full psychiatric history and doing a mental status examination.

Lithium is an appropriate treatment for those diagnosed as having bipolar disorder.

Best regards . . .
Ivan
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---------- FOLLOW-UP ----------

QUESTION: He has been taking lithium for 6 days now. He says he feels more
overwhelmed at times and he is sleepy and gets a bit confused. He also said
he thinks his mood swings are a little less.....Is this what we should be
expecting? Is what he is feeling normal? Will his decision making be better?
.And also once he get used to taking lithium what other therapy would be
helpful??? And when will we know when a good time to deal with the mess in
our relationship that this has caused?

Answer
Hi Daisy . . .

Lithium usually take a while to work and often people experience side-effects before feeling significantly better. What ever side-effects your husband is experiencing should be reported to the doctor who prescribed the lithium.

IN addition to the lithium people, and families of people with bipolar disorder, should be in some kind of psychotherapy to help them with the feelings that this illness induces in the patient and in the family. Too often the emphasis is on the medication rather then on the psychotherapy that in the long run is just as important as the medication.

Best regards . . .
Ivan
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