Expert: Ivan Goldberg, M.D. - 10/23/2007

Question
Hi Dr. Goldberg. My situation is as follows; I have been married to my wife for 15 years and have always known that something was not right. After our daughter was born she was diagnosed with Post-partem depression. She was severely depressed for about 2 years until the right med was found (Prozac). She was 30 when our daughter was born and at the age of 33 she was diagnosed with Breast cancer and had a breast removed. She been on Femera for several years and I understand the impact that may play in this issue. In the last 5 years she seems to have gotten much worse as far as ups and downs. She has left me and my daughter 8 times in the past 5 years. It is always the same story, "I love you but am not in love with you". Each time she comes back she states that she really does love me and just does not know why she does what she does. In April she was in a Hypo mania state and left us again. In June she cycled into a very depressed mode where she did not want to live anymore. She came back home in July and begged me to take her to a hospital (I wish that I had). I was able to get her into see a phys (MD) in August and she was diagnosed as Bipolar mixed. She was put on Olanzapine but did not like the feelings so she cut the dose down from 12.5mg to 2.5 mg. She is also taking Prozac 20 one day and 40 the next. She does not take ether med correctly or sometimes not at all. Everything was great until two weeks ago. We went on a trip to Disneyland Oct 6th to the 10th and everything was GREAT. She was sexual, romantic, and full of fun and life. The day after we returned I could sense the mania coming back and as expected, last Saturday she moved out and rented an apartment. She has NEVER lived on her own and has a problem with spending. This should be interesting. My question is, how am I to handle this situation? I love my wife and do not want to give up. I understand the disorder and want to help, but she does not believe she has a problem. She thinks it is just our marriage (which when she is normal has been GREAT). She also lives for the weekends and has recently started drinking. Any suggestions would be greatly appreciated for myself and my daughter. P/S, I did sign up for a NAMI BP caregivers support group.

Answer
Hi Rob . . .

What you describe is a typical story of what uncontrolled bipolar disorder does to a marriage/family. When hypomanic or fully manic, your wife does impulsive things without being able to consider the possible consequences on you and your daughter. When not especially drpressed or manic she acts in an appropriate way.

The situation seems to be complicated by your wife not being on lithium, Tegretol, Depakote, or Lamictal. The drugs I have just mentioned are probably the best mood stabilizers for people with bipolar disorder.

There is a good deal of controversy in psychiatry as to the usefulness of an antidepressant such as Prozac in treating people with bipolar mood problems. While some psychiatrists prescribe antidepressants, others feel that some combination of the medications I mention above often does a better job stopping the cycling process than any combination of medications that includes an antidepressant such as Prozac.

The combination that use most often when treating people with bipolar disorder is lithium   Lamictal.

You can read about Lamictal at:
http://www.psycom.net/depression.central.lamotigine.html

Best regards . . .
Ivan