Expert: Libby Bonner - 5/22/2008

Question
Hi Libby,
My name is Kate, I am 31 years old and the mother of two amazing girls, ages 10 and 12. My boyfriend, who is 32 is bipolar and currently taking depakote ER 1500mg daily and zoloft 150mg daily. He was officially diagnosed about 12 yrs. ago.
Jason (my boyfriend) and I grew up together and reconnected as adults and have been together for a year.
Jason is very compliant with his medications, dr. appointments and therapy sessions. However, I am afraid because he has been so healthy, how will I know when/if he becomes manic? Could he even have an episode while on his meds? He also attends AA meetings regularly and has been sober for 3 years.
He is a wonderful man and we are very happy. I want to be the best partner and supporter that I can be to Jason. This is all new to me, and any help you could offer would be appreciated.

Kate

Answer
Suggest you become intimately acquainted w/ bipolar disorder.  Places to start:  nami.org  and mentalhealth.com

NAMI has much to offer you and also Jason: educations, speakers, classes, support groups, etc.  Life will not always be as it is now, more than likely.  I would begin some serious learning now and I would become regularly involved w/ NAMI.

Serious mental illnesses, treated and untreated, tend to remit and relapse.  You, or his doc, would likely notice that his he is less stable, that his personality has changed a bit - that would be a good time to think about getting meds adjusted, and relatively soon - not waiting for weeks til next appt.

I'm not sure if he has been mostly manic or mostly depressed when very ill, or perhaps it alternates???  Nor do you say when and how often he has been hospitalized for biplar since diagnosis....sometimes that is a fair guide to how stable things will remain.

The single change that I would suggest at this time is that you begin attending his psychiatrist appts w/ him.  The doc may want you there for only part of the appt....but three heads are definitely better than two here.   And, should he suddenly become ill, you will be a familiar person to the doc.   You should also talk w/ Jason and w/ the doc about getting a signed 'release of information' allowing you and the doc to freely exchange MEDICAL, not personal info.  IF there is none, and he becomes very ill, you will find yourself entirely shut out of info and treatment decisions, because of privacy laws.  These releases need to be renewed q year, I believe.  Get one signed w/ the hospital that his doc would likeliest use.

How will you know he is hypo-manic or manic...?  His thinking will change and his behavior will become very uncharacteristic.

If mania, rather than depression, has characterized his illness in the past, I am wondering why lithium is not among his meds....unless he is unable to tolerate it.  Even then, one might expect Lamictal to be used in place of lithium.

Good luck.  The odds are good that his meds will need some tinkering sooner or later, so start your learning and participating now.