Expert: Libby Bonner - 8/15/2007

Question
Hello, my sister has been on the drug cymbalta for about 6 months and I believe (after doing a lot of research) that she has had undiagnosed (and therefore untreated) bipolar disorder her whole life and this drug is enducing a manic state that I see no end to. I have talked to her phychiatrist and psychologist and neither of them will listen to my concerns for she is very good at manipulating and they do not think things are as bad as they truly are. Here is the situation. She decided she didn't want to be married anymore so she has been internet dating, having sex with anyone and everyone and smoking pot . . . all in the presense of her 3 small children (3, 6 & 8) and her husband. Granted, her husband has some mental issues of his own for letting this go on, but I can only help one person at a time and she is much worse here. I don't know who to go to, to express my concerns. I am 150% sure she is manic but she is IN LOVE with cymbalta because "this is the best she has felt her whole life" and is unwilling to go off. I am feeling hopeless and any suggestions would be very helpfull.  

Answer
Bipolar is often first expressed, diagnosed, and treated as depression, as I would guess has happened to your sister.

Anti-depressants must be used w/ great caution w/ bipolars [who are already on other appropriate meds for bipolar] because they can trigger mania....and apparently cymbalta has, in this probably undiagnosed bipolar person taking no other meds.

She is in love w/ being manic, the world's greatest legal high, and only thinks it's the cymbalta because the mania began so soon after.

"Husband has...issues...for letting this go on"?  If that's your only reason for asserting mental problems w/ husband, there is no good way for ANYONE to control someone in full-blown mania.  Would be like trying to stand in front of a a train to stop it.

You have spoken directly w/ the psychiatrist about her present actions/symptoms?  Talked w/ them about "whole life" behavior?  And were given a good hearing but your concerns were dismissed??   

Need a new doc, but may be hard to do.  First of all money.  Is she covered by someone's health insurance?  If so, you have several tasks.  She must want to quit the first doc and go to a better one, or at least want to ask first doc for a second opinion.  I don't think another doc would see her if she is presumed to be under another doc's care.

Before we get to trickier solutions.....  IF the doc actually had a spoken dialogue w/ you about her, then it sounds like you have somehow gotten through the privacy wall that usually stands between docs and family.  IF that is true, could you go w/ her to her next appt [and sched one soon, if her next is very far away.]  If you are able to do this, write back and I will tell you how to make a success of this w/ both your sister and the doc.

Failing that, the only ploy I can think of to get her to make a change is to LIE and tell her that the next doc will have meds even better than cymbalta.  Then be sure she/you has secured an appt, telling them that she has left/is leaving other doc's care [ and notifying present doc of same], and go from there.

You also need to check your state's laws on involuntary treatment:  www.psychlaw.org

And perhaps consider getting a court order for committment, harder than it sounds, and I think the husband would have to initiate this.

By now the husband is likely a wreck and probably hates her [pretty normal] BUT he is the only person of the couple who would accept help and needs help, and an ally, badly.  I hope you can manage to work w/ him on this.  Your sister  needs as many people as possible who BELIEVE she is sick and not just misbehaving, to become a network of help for her and for each other.

Meanwhile, what of the children.  That's your other big, big issue - bigger, really, than helpling your sister right now.  You DON'T want them snatched into foster homes.  I hope you and the husband can work on this.  They may need to be parceled out among friends and relatives for awhile, but the sister must be told an acceptable reason [acceptable to her, doesn't have to be true] why this is true, why it's only for awhile. Get creative here.

Meanwhile try a local sources of help.  Local NAMI?  www.nami.org

Also - pls buy the 2007 edition of the book by Amador called:  I am not sick; I don't need help.  It will provide some information and some ammunition.

Meanwhile, the dad and you should waste not a drop of time trying to pursuade her of anything - you cannot persuade irrational people w/ reason.  It will waste your energy and create new anger.  You also should not admonish her, belittle her, goad her, provoke her: it's her train and she's the engineer.

Do write w/ more info or questions.  These situations are just ghastly.  Do try to remain calm and non-committal w/ her.  Pls do try to form an alliance w/the husband if you possibly can.  Right now, he is the easier person to help, and needs it so badly.