Expert: Jurriaan Plesman, Nutritional Psychotherapist - 4/30/2007

Question
This is a recent journal post I put on another bipolar site, that includes the background of my situation.  Please comment.


Hello all,

I am 'madalena;' that's my mental health sites nickname, anyway. I was just diagnosed with bipolar disorder during the first few days of my first inpatient stay at a really great mental health facility in the Louisville, Kentucky metropolitan area, where I live. It's Wellstone Regional Hospital, in Jeffersonville, Indiana, right across the Ohio river from Louisville. My stay was from Monday, April 16th, to Tuesday, April 24th.

At first, I thought that, what I thought was my first manic episode (looking back, I realized later it's not) was only temporary, and was that it was brought on by a too high dose of Prozac, which was raised to 80 mg, gradually, to treat my newly diagnosed OCD. I later learned that if you have bipolar disorder, taking regular SSRI's, especially Prozac, can trigger manic episodes.

The manic episode, on Tuesday March 20th, was preceded by an hour or two of intense depression. I guess it was transitioning to mania when I acted on some obsessive thoughts about a man I was attracted to, but barely knew, when I called him at the end of those two hours, and asked if we could meet up. He said yes, even though he knew I was married and had a baby girl that was almost a year and a half old. We ended up going straight to an empty house he had access to, being a contractor, and had intercourse, using a condom.

This began a two-week long affair, which only ended because my husband became suspicious. This was the third affair of my marriage, and my husband was also under a lot of stress at the time, and was on medication for depression and ADD. It helps control his anger, which was often directed at me at the past; but for most of our 14-year long marriage he was emotionally abusive, which had lately been exacerbated by the fact that it seemed that my mental state was continually worsening.

The OCD type I have can be best described by the type of ADD I was diagnosed with when I first started seeing a psychiatrist, about 7 years ago - "cognitive inflexibility." This is mainly 'irrational stubbornness,' and adherence to a fixed, often dysfunctional way of doing things. Plus, my depression had worsened over the past few years, to the point where I was sleeping all the time, getting barely any housework done, and mostly just taking care of the baby, 'Laura,' the best I could. Plus, I had begun a new job where I was trying to work full-time at a 2nd shift office job, while my husband worked full-time 1st shift as a systems administrator at his new job that began around the same time as mine, in May 2006. By Christmas 2006, my anxiety had really increased, to the extent that I was having panic attacks at work. I then went on FMLA, and will soon be on Short-Term Disability (STD) for that.

In February, I decided that I'd better get some psychological testing done, to determine what all my conditions currently were, and to gather some evidence to further back up my STD case. Up until then, it was thought that all I had was relatively serious OCD, some ADD, and Generalized Anxiety Disorder. The testing just confirmed this, but the ADD test indicated a 50/50 extent of inattentiveness. I still had a lot of impulsivity, though, and 'pressured speech,' or rapid speech, and racing thoughts from time to time. I began seeing this psychologist for individual therapy.

I admitted to the affair to my husband on the night of March 31st. I had, up until then, worried that my husband was about to confront me about the affair, and that he would probably be able to guess who it was with. I feared that he would, considering all the aforementioned circumstances, possibly attack me, and go into a rage. I knew I was going to have to leave in order to try to prevent that, and also wanted to insure the safety of my daughter, as well as the other man. I talked with my psychologist, and told him that I wanted to go to the Center for Women and Families. I had already developed a plan with a friend of mine who said she would hold onto my essentials, and that a friend of hers would take me to file a restraining order, and then take me to the Center. She also said that, since I control the household finances, that I'd better liquidate as much of our checking account as possible, and transfer the funds to a new one. I was pretty overwhelmed by this, and knew that my husband would react badly to discovering that I'd left, and what all I had done. I worried that he would go and interrogate my parents as to my whereabouts. I worried that he would lose his job upon his reaction at being served the restraining order at work, if he didn't just quit under the stress of the situation. I decided that all of this would cause too much damage to him and our relationship. I was not yet ready for immediate divorce.

So, I decided to try to alter the truth a little bit in order to see if I could put the situation to him in a way that would defuse any possible anger. I told him that my psychologist had suggested that I go to the Center for Women and Children to be alone in a supportive environment to work on healing from all the trauma I’d been through in the past few years and to start dealing with what I could do to manage my conditions. I told him this could just be on a temporary basis, and that I wouldn’t have to outright accuse him of anything. I did say that I realized that he had been emotionally/verbally abusing me, and that we both needed to take measures against it now. He was receptive this, so then I also decided to tell him that I had been obsessing over a number of men in the past few years, and could probably no longer be in a committed relationship, that I wanted to become separated, and that I’d had a sexual affair for the past week and a half. He was initially sad, but not really angry.

We talked about all this at length, and he admitted to the abuse, and said he wanted to work on our marriage, since he felt he could not be happy coming home without me there, or living without me. He said he’s been improving in his feelings toward me for months, but hadn’t really gotten to a point where he would communicate them just yet. He said he hoped I could let go of the other man, but understood if it couldn’t be right away. He also kept saying he really hoped I could put off any further contact until we put some time into working on the marriage and going to the marriage counselor we’d already been to see once before then, who was also my current psychologist.

Well, there’s a lot more to the story after this point, but I need to spend time with my husband, and get to bed. I will say that I have started and stopped the affair multiple times since then. At this time, it is still occurring, but I am making a concerted effort now, and will be this week, to see the other man as little as possible, since I believe that I also have a sex, love, romance and fantasy addiction to men, and I really need to start working on getting better as soon as possible. I am still living with my husband, and we are working hard to deal with, first, managing my bipolar condition (as well as waiting for the meds to fully kick in and for my mood to stabilize; i.e., for the manic episodes to reduce in frequency and intensity, then trying to set bottom lines surrounding communication and my addiction, our codependency issues, and to try to heal some of the pain we’ve caused each other over the past few weeks. Laura has been cared for by my mother and my mother-in-law most of the time since all this happened, but we are now ready to have her here for the weekend. : ) Thanks for your attention; please comment if you want. More later.


second posting:

Please read my first journal post, and the information in my profile.  I really need some feedback from someone who can tell me what to expect in this stage, when married; in my type of situation.  I'm really struggling with my intrusive, obsessive thoughts right now, which seem almost impossible not to act on, as far as contacting other men, and my husband knows everything.

Here's some more stuff I just wrote earlier:

It seems more and more that my hypersexuality, in the form of a 'sex, love, romance and fantasy addiction, is really brought on by and exacerbated by the mania from being bipolar...I've got way too many incessant, intrusive, obsessive thoughts about these two other men in my life, one of which I'm having an affair with.  I plan to call the other man once he gets out of the mental hospital i met him in.  I was there all the week before last, where i was diagnosed bipolar.

It's taking me forever to get the necessary doctor's appointments, since I couldn't make them until I knew when I'd be discharged from the hospital, and i've forgotten to take part of my meds in the last two days.  Both times that brought on a manic episode, during which I 'acted out' as far as my sexual behavior with 'my boyfriend.'

And the books I've been reading say most people with this kind of mania, even when one's trying to treat it, often 'crash and burn,' what with the 'drivenness' of the thoughts and behavior, the cravings, and the strong urges to act on the thoughts and fantasies.  Supposedly it's a constant, very intense struggle to keep control of oneself and one's behavior, what with the brain chemical cascades.

Also, since bipolar's one the most misdiagnosed mental illnesses, it makes it that much harder to treat if it's been going on since childhood, like mine was.  I feel like a bug in a jar, what with my husband and my parents wanting to impose all this external control on me, since i can't control myself right now, as far as acting out.  So, i just feel stuck feeling like a raw nerve; especially with my husband's constant neediness.  But we'll be addressing that when we go to the marriage counselor on Monday evening, and we'll see what we can do about getting him his own therapist, and maybe going to some Al-anon meetings, or COSA meetings - for the spouses of sex addicts ('Co-sex addicts anonymous).

All for now - please help if possible, by commenting or whatever.

And now, as of the time of the 'asking of these questions,' my husband and I are going to our marriage counseling appointment tomorrow/Monday night with my psychologist, at which time I will also ask if he can start seeing me again for individual counseling as well; and my husband and I are going to a bipolar support group on Tuesday night.  Also, I've felt more stable all day today than I have in a while now that I took both of my Depakote pills together, right before bed, last night/Saturday night, and still have access to the psychiatrist I was seeing at Wellstone until I have my first appointment with my new psychiatrist, in one month.


Thanks,

Madalena


Answer
Hello Madalena,

I have read your long post and I can see that there are a lot of issues to be ironed out.

Let me first tell you that as a Nutritional psychologist I look upon "psychological" problems as a manifestation of a biochemical disorder BEFORE considering psychotherapy.

For instance it is known that many Bipolar people have hypoglycemia, which is a sugar handling problem. Now you may wonder what sugar consumption has to do with Bipolar disorder. Sugar is one of the forerunners of biological energy that is essential in the manufacture of feel good neurotransmitters.

Biologocal Energy called ATP at:
http://www.google.com.au/search?hl=en&sa=X&oi=spell&resnum=0&ct=result&cd=1&q=de...

Thus when a person has problems metabolizing biological energy, they have problems in the manufacture of feel good neurotransmitters.

Bipolar people do benefit by going on a hypoglycemic diet.

In the manic stage of Bipolar disorder, you may benefit from taking lecithin. This contains phosphatydilcholine, which is the forerunner of acetylcholine, a neurotransmitter that induces tranquility (it activates the parasympathetic nervous system). Lecithin SHOULD not be take in the depressive stage.

Your supposed sexual "mania" I see this as simply an attempt by yourself to look for happiness. Being depressed and emotional unstable causes a low self-esteem, and your sexual dalliance seem to be an overdriven need for love, that you have not been able to find in your marriage.

There is no doubt in my mind that your husband's behaviour towards you also stems from a metabolic disorder and I would not be surprised if he proved to be hypoglycemic, if tested for hypoglycemia as described at our web site.

Thus you and your husband would both benefit from Nutritional Therapy.

If you are Bipolar it is best to follow the advice of your psychiatrist, but nevertheless I suggest that you ask your doctor to be referred to a Nutritional Doctor or a Clinical Nutritionist to supplement conventional treatment with nutritional therapy.

Nowadays a lot can be done by means of nutritional therapy to help Bipolar people or people with a "mental" illness, since after all, neurotransmitters are produced from the food we eat.

It is only AFTER treatment of the metabolic disorder that psychotherapy can be useful.

We have a Self-help PSYCHOTHERAPY course at
http://www.hypoglycemia.asn.au/i-psychotherapy.html

at our web site that is completely free of charge.

Please read:

What is Hypoglycemia? at
http://www.hypoglycemia.asn.au/articles/what_is_hypo.html

The Serotonin Connection at
http://www.hypoglycemia.asn.au/articles/serotonin_connection.html

Depression is a Nutritional Disorder at: http://www.hypoglycemia.asn.au/articles/depression_disorder.html

Depression: a Disease of Energy Production at:
http://www.hypoglycemia.asn.au/articles/depression_energy.html

Principles of Psychonutritional Therapy, My approach at;
http://forums.delphiforums.com/clinutrition/messages?msg=181.1

and discuss with your doctor or therapist.

Please consult a Nutritional Doctor or a Clinical Nutritionist.

_________________________________
Jurriaan Plesman, BA(Psych), Post Grad Dip Clin Nutr
Editor: HYPOGLYCEMIC HEALTH ASSOCIATION OF AUSTRALIA at
www.hypoglycemia.asn.au
Author: “Getting off the Hook” at
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