Psychiatry & Psychology--General/Cyclothymia


I suspect my husband has cyclothymia and it is getting worse with age. His sister and a number of first cousins have bipolar disorder. He has a predicable low period every fall, with weight gain. Spring he is happy and loses weight. He is in his early fifties. Mostly acceptably stable at work but has always been irritable with slowly progressing mood changes as in not on a daily basis but seasonal. Because of his sister he has always been concerned about bipolar disorder. As he has passed the age of usual onset he thinks he has dodged that bullet but admits to having shades of it . "like a shadow do bipolar disorder". It is November when his mood is usually low. no energy, depressive, talks about leaving our marriage, says never loved me. He had an episode like this two years ago and displayed uncharacteristically extremely emotionally abusive behaviour in front of witnesses. All recognized this as something completely out of character ( they were all amd still are the best of friends) . He is going though a similar episode but without all of the symptoms of cyclothymia that he displayed before. He isn't angry or grandiose. He is calm but depressed and driven to destroy things he holds dear.

Major complication: he is a psychiatrist and is secretly treating himself. With what I'm not sure but he confided in a doctor friend what the medication was. Not sure if it is an antipsychotic or SSRI. But this medical friend is concerned. This medication may be keeping him from displaying the ful blown symptoms of dysthymia. The usual psychiatrists he feels he can confide in are his sister and brother in law, one is bipolar, the other bipolar or cyclothymia . Both family and compromised in having an objective opinion. They treat themselves too.

My question is what are my options?  How can i help. In my life I am surrounded by psychiatrists we know personally.but i cant approach them about this as it is such a small community where we live. I can understand he wants to keep it under wraps or even deny it alltogether. That is further down the road because he thinks I am the source of all his troubles. Enlist help of friends? Not to push but just to talk to get him to open up a bit or at least have witnesses that his mind isn't working properly. He is bolstered by acquaintances and friends through the Internet or by phone who only see the picture he gives them, not the one people who live with him see.

Hope you can give some suggestions

I'd suggest the first and best option is to talk with him -- at the right time.

The theme would be to request his advice for how you can be most supportively helpful when he inevitably [describe the symptoms].  Should you call somebody? Administer some drug? Move out? What exactly should you do for him?  And longer-term, what provisions should be made for necessary changes and taking care of him when neither of you can.

Let him know that you love and respect him and his opinion, you don't want to bring this up again, nobody would have a better answer than he would, you will follow his instructions, ....

If some compassionate reality-testing doesn't work, you might ask yourself if you do not owe it to him, yourself, and his patients to bring your concerns and questions to someone in a position to advise and intervene as necessary -- regardless of any social awkwardness. After all, even an oncologist can get cancer, and shame would not be appropriate or helpful.

A report of your concern does not have to be local. You know that there are professional-practice bodies both provincially and federally. And there is a federal psychiatric association and possibly a provincial or regional one too. They are experienced experts in handling such cases, and their procedures are fair to all sides.

I only hope that's somewhat helpful in this devastating situation, Maria.

With thanks for asking us,

Psychiatry & Psychology--General

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Alan Auerbach


Taught psychology for 30 years, authored four textbooks. Specialize in introductory and industrial/organizational psychology, but will tackle wider range of areas.

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