Expert: Libby Bonner - 4/20/2007

Question
I have been seeing an amazingly passionate and sensitive woman for 5 months. About two months into it (Januaryish) she got on oral contraceptives and quit smoking. Over the next few months she began having unstable emotional episodes and I withdrew after emotional fatigue began overwhelming me a couple of weeks ago. I realised I was in love with her however and went to her to declare it last saturday. We had a wonderful day together and then she told me she had been diagnosed with bipolar disorder and had begun taking meds that week. I flipped. I dated a woman years ago who was bipolar and had been on meds for 7 years and she ended up sleeping around on me and had a suicidal episode. I promised myself back then that I would never do this again. So my reaction was fear. I bolted. I have been frantic all week, barely able to function myself. I have a deep distrust of the pharmaceutical industry and the casual application of antidepressants to deal with emotional issues. I was following the FDA disclosures about antedepressants very closely a few years ago when information was coming out that these drugs may actually induce a higher risk of suicidal behavior in the long term in some people. After considering her Mother`s death at her own hand, I can`t stand in her way if she needs releif, but isn`t it possible that the oral contraceptives and nicotine withdrawals are the underlying issue here? She has agreed to meet with me sunday and I have decided i want to stand with her thru this. I hope she will take me up on my offer to get a second opinion. I can take her for better or for worse, but what I can`t do is love someone who is emotionally detached or catatonic due to antidepressants. Isn`t there hope that this could simply be the Birth Control pills and nicotine withdrawals working her over?

Answer
You had best begin by getting comfortable w/ prescription drugs, which are THE hope for bipolar control. Tho depression is more common than mania in bipolar disorder, bipolar depression is treated quite differently in BP than in major depression and, in fact, anti-depressants are used sparingly and w/ caution in bipolar pts.

I don't imagine quitting smoking and going on BC pills was a big help to her emotional nor pharmacologic stability.  If the meds she is on now are right meds, right doses, and IF she takes them, and has an attentive doc who adjusts them as needed, order should be restored soon.  Psychiatrist needs to know about the smoking and the BC pills.

Your note is charming, and highly romantic, but I suggest you defer your meeing Sunday, or comittments Sunday, while you get a grip and get a better picture of the spectrum of bipolar disorders.  

Most people, in fact, cannot take bipolars for better or for worse - unless they themselves are very highly stable, optimistic, grounded people themselves, and 110% committed to the relationship and to being the person in the relationship likeliest to have to do most of the heavy lifting.

Since bipolar disorder is THE mood disorder, you are likely to see all manner of behaviors from your lady love over many years of illness....all mental illnesses, btw, are characterized by remitting and relapsing, even w/ compliant pts under excellent care: your better and your worse right there! and that doesn't even begin to include the mood swings that occur in bipolars generally considered to be stable and doing well.  [The aim of drug treatment in bipolar is mood stabilization.]

Take a deep breath and step back a bit.  You need a crash course in bipolar illness, you need to talk to some spouses [there aren't many], and you need to take it easy.  The best and most honorable course for you to take at this point is to listen to her tell you how bipolar is and has been for her, meet some persons who care about her who have been helpers/onlookers through some of this and, if possible, start attending a NAMI family support group, www.nami.org

I'm glad you wrote.