May 2009 – Married To Mania

14 Questions To Ask Your Future Bipolar Husband’s Psychiatrist-Part 1

Contemplating marriage to someone with bipolar disorder? Your marriage will not be like any of your friends’ or family who do not have to deal with this extra relationship challenge.

Here are 15 questions to ask the psychiatrist about your future husband or wife if he/she has been diagnosed with bipolar disorder.

How can I participate in my future bipolar husband’s/wife’s therapy plan?
What are the potential long-term side effects of lithium and/or other psychiatric drug treatements?
Is there a chance that the medication prescribed now will become ineffective? If yes, what happens then?
How will other medications or alcohol affect my fiancee over time if he gets sick, has bad allergies or drinks too much?
What if the dosage on the medication(s) is too high? What does medicinal toxicity look like? Is a blood test twice a year enough to detect this?
Will my bipolar future husband or wife ever be “cured?” Will he/she ever be able to stop taking medication?
Are there other treatment options besides medication?
What are the bipolar disorder “warning signals” I should watch out for?
What are the risks to our marriage? What’s the worst that could happen? What are the chances of that happening?
Should we have children? What are the chances we’ll pass bipolar disorder to them? Is that an ethical consideration? Or a medical one?
Will bipolar disorder medication affect my future bipolar husband’s or wife’s ability to have children?
All things being equal, what percentage of a “normal” life can we hope to have together if he/she stays on a treatment plan?
How will bipolar disorder affect my future husband’s/wife’s ability to get medical insurance?
Does medical treatment for bipolar disorder shorten somebody’s lifespan or damage health or organs?
What should I be asking you about marriage to a bipolar husband or wife that I haven’t asked you yet?

Obviously, this is a lot of ground to cover with a medical professional. But even if it takes more than one session with your future bipolar husband’s/wife’s psychiatrist to get these questions answered, you’ll want to take your time in absorbing the enormity and ramifications of the answers.

No doubt you’ll want to discuss the answers with your future spouse, as well. Better to be informed as possible before you walk down the aisle than to be surprised with information you hadn’t considered after the wedding.

Bipolar Disorder Can Leave Permanent Emotional Scars on Husbands and Wives

“If recent research has taught us anything,” says Carol Jacobson, psychiatric social worker, “it’s that families also pay a price from bipolar disorder in the form of emotional pain, social isolation and stressed interpersonal relationships.”

Children may withdraw from the family unit, couples pull away or drift apart, individuals become isolated within their own families, she said. These situations leave scars on the family unit and affect the way family members deal with the needs, demands and often manipulations of the patient.

Husbands and wives can become overly involved or too distant, too permissive or too restrictive in an effort to gain relief from the bipolar husband’s or bipolar wife’s pathology or their own discomfort.

Jacobson offers 6 steps to prevent permanent emotional scarring:

Establish limits. Know what you are capable of giving. Don’t allow yourself to be pushed, forced, cajoled or intimidated into doing what you do not want to do. Giving more than you are willing to breeds resentment. Resentments are often then expressed inappropriately toward ourselves, the bipolar husband or wife or toward other family members.
Deal with your guilt and/or grief over your bipolar husband’s or wife’s illness. In other words, she advises, put the past to rest. Previous mistakes, angers, deficiencies cannot be changed. When you bring them up and berate yourself over them, you are left feeling helpless and angry. You cannot be reminded not to do this often enough, Jacobson says.
Forgive yourself your sins. If you don’t forgive yourself, you will continue to allow and excuse inappropriate behavior from your bipolar husband or wife. This leaves you open to “emotional blackmail,” which is extremely dysfunctional.
Do not tolerate inappropriate behavior. Illness is not an excuse for bad behavior, rudeness or manipulation. If your bipolar husband or wife is uncontrollable, seek immediate treatment or hospitalization. If you’re not sure if he or she needs treatment, ask yourself if you would accept this behavior from a non-sick family member. Far too often we excuse behavior from a bipolar husband or wife that we would never tolerate from anyone else.
Respect a bipolar husband’s or wife’s range of emotion, as you would anyone else’s. Living together in peace requires respect. A sick spouse can get well and may have normal periods of irritability, sadness and happiness. Keep your own anxieties and concerns under control and not label hbehavior “sick” because it disturbs you or brings back memories of previously ill times. Respond to today’s behavior honestly by dealing with what you see today.
Do not become an “in home therapist.” You may often find yourself spending time and energy talking about, thinking about, planning for or around the bipolar husband or wife and his/her problems. Don’t do this, Jacobson says. It is not healthy for you, your sick spouse or your family. The sick person has a qualified therapist or doctor. He/she needs the family to act as it would ordinarily. This teaches him/her through action and modeling what behaviors are appropriate for the greater world outside the home.

Jacobson says these 6 suggestions are easier to accomplish when you remember that you did not cause your bipolar husband’s or wife’s illness and your cannot cure their illness. But it is your choice to encourage health and responsible behavior.

Coping with a Bipolar Husband Is a Family Affair

With a bipolar husband in the family, sometimes avoidance is easier than communicating. That’s what Mary J resorted to with her bipolar husband. “His verbal abuse got so bad I just avoided him,” said Mary J. of her husband, who was recently diagnosed with bipolar disorder.

It’s not uncommon for wives of bipolar husbands, like Mary, to instinctively shut down all lines of communication rather than to address the negative behaviors that bipolar disorder causes. Unfortunately this can make a bipolar marriage situation worse by triggering more dysfunctional behavior.

Online research about bipolar disorder and, especially searching for help in dealing with a bipolar husband, was how Mary found the book, “70 Signs of Depression: Recognize and Cope with Your Loved One’s Clinical or Manic Depression.”

The book provided her with proactive tools for dealing with a bipolar loved one. “70 Signs of Depression gave me the knowledge, even the words to use, to start really helping my husband and our marriage get back on track,” she added (Mary’s full name has been withheld to protect her family’s privacy.)

Crafted from the hands-on knowledge of thousands of bipolar victims and their family members by Marlee Fisher, a best selling ghostwriter-turned author and Certified Faculty Member of NAMI, the National Alliance For the Mentally Ill, “70 Signs of Depression” takes readers into the minds of bipolar disorder sufferers by uncovering the illness’ 70 Signs, 4 Emotional Trip Wires and 2 Defense Mechanisms. It then provides proven step-by-step strategies and techniques to help co-manage each of them.

“The non-communication between Mary and her husband is all too common,” stated the author. Members of the medical and mental health communities endorse this book as a page-turning must-read for anyone with a bipolar spouse, family member or friend.

Fisher wrote her book to offer an easy-to-understand look inside bipolar disorder, alongside firsthand know-how from thousands of bipolar co-victims that readers can use to help themselves and their own ill loved ones immediately.

Then she details the step-by-step strategies and proactive techniques, including the exact words, that have already helped others deal with a bipolar loved one.

This book is based on the author’s personal experience as a bipolar co-victim, including her years of extensive research meeting with psychiatrists, M.D.s, psychologists and social workers; actively participating in NAMI support groups; serving as a NAMI faculty member and interviewing thousands of bipolar victims, their family members and friends.

The result is an in-depth and easy-to-understand look inside bipolar disorder, often written in its victims’ own words, that reveals valuable first-hand insights and expert hands-on knowledge.

Researchers Pool Resources in Largest Study of Genetic Factors Leading to Bipolar Disorder Episodes

For a long time now, researchers have suspected a genetic link to bipolar disorder. But they’ve not been able to find it conclusively.

In a new study, doctors pooled resources to create the largest genetic analysis of its kind to date for bipolar disorder and discovered machinery involved in the balance of sodium and calcium in brain cells as a root cause.

“Faced with little agreement among previous studies searching for the genomic hot spots in bipolar disorder, these researchers pooled their data for maximal statistical power and unearthed surprising results,” said NIMH Director Thomas R. Insel, M.D. “Improved understanding of these abnormalities could lead to new hope for the millions of Americans affected by bipolar disorder.”

Researchers supported in part by the National Institute of Mental Health, part of the National Institutes of Health, found an association between the disorder and variation in two genes that make components of channels that manage the flow of the elements into and out of cells, including neurons.

2 Proteins at Fault in Disrupting Ions that Regulate Neuron Firings

Doctors found that two proteins may be involved in disrupting the ions that regulate whether neurons can fire properly. “Finding statistically robust associations linked to two proteins that may be involved in regulating such ion channels — and that are also thought to be targets of drugs used to clinically to treat bipolar disorder — is astonishing,” said Pamela Sklar, M.D., Ph.D., of Massachusetts General Hospital (MGH) and the Stanley Center for Psychiatric Research at the Broad Institute of MIT and Harvard, who led the research.

Sklar, Shaun Purcell, Ph.D., also of MGH and the Stanley Center, and Nick Craddock, M.D., Ph.D., of Cardiff University and the Wellcome Trust Case Control Consortiuum in the United Kingdom and a large group of international collaborators reported on their findings online on Aug. 17 , 2008 in Nature Genetics.

In the first such genome-wide association study for bipolar disorder, NIMH researchers last fall reported the strongest signal associated with the illness in a gene that makes an enzyme involved the action of the anti-manic medication lithium. However, other chromosomal locations were most strongly associated with the disorder in two subsequent studies.

Bipolar Disorder Thought To Involve Many Gene Variants

Since bipolar disorder is thought to involve many different gene variants, each exerting relatively small effects, researchers need large samples to detect relatively weak signals of illness association.

To boost their odds, Sklar and colleagues pooled data from the latter two previously published and one new study of their own. They also added additional samples from the STEP-BD study and Scottish and Irish families, and controls from the NIMH Genetics Repository. After examining about 1.8 million sites of genetic variation in 10,596 people — including 4,387 with bipolar disorder — the researchers found the two genes showing the strongest association among 14 disorder-associated chromosomal regions.

Variation in a gene called Ankyrin 3 (ANK3) showed the strongest association with bipolar disorder. The ANK3 protein is strategically located in the first part of neuronal extensions called axons and is part of the cellular machinery that decides whether a neuron will fire. Co-authors of the paper had shown last year in mouse brain that lithium, the most common medication for preventing bipolar disorder episodes, reduces expression of ANK3.

Variation in a calcium channel gene found in the brain showed the second strongest association with bipolar disorder. This CACNA1C protein similarly regulates the influx and outflow of calcium and is the site of interaction for a hypertension medication that has also been used in the treatment of bipolar disorder.

The National Institutes of Health (NIH) — The Nation’s Medical Research Agency — includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. It is the primary federal agency for conducting and supporting basic, clinical and translational medical research, and it investigates the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.