losing_hope

My wife is depressed again. I should have seen this coming, the signs were there. First, the energy, hypersexuality, staying up late. Then the crash.

Today, she spent most of the day in bed, save for texting some really hurtful things to me, while I was in the middle of a very important project at work.

So the question is, how much should I help her when she's depressed. I've always made it clear that I'm here if she wants to reach out. But she doesn't want to.

I give her space. I usually cook, but when she's depressed, I get pizza or some other comfort food. But all she does is be angry, snap at me and our child or just sulk and lie in bed.

So at some point, I feel that I'm actually helping her stay depressed - she has no reason to not be depressed. I know you can't reason your way out of depression, I've been depressed myself. But the opposite is true too.

827Aug

I'm not familiar with your situation. Is your wife receiving counseling? Is she on medication? How often are these episodes?

losing_hope

Yes and yes. She sees her psychiatrist weekly, and is on Buspar for anxiety and Risperdal for anger.

The episodes happen every couple of weeks, and the doctor has tried to see if it correlates with her cycle, and the evidence is inconclusive at this point. There seem to be triggers, which I feel that are often somehow connected to me. But then again it just could be that there's that underlying current that's waiting to bubble up with any excuse.

She also talks about suicide and hurting herself, but she does not appear to be suicidal, and the doctor knows about this. She has hurt herself before by way of picking skin and purging.

But regardless, when she is in one of these moods, the things she says swing between telling me that I'm hurting her and saying that she's worthless and wondering why I tolerate her.

And this is emotionally very taxing for me.

827Aug

That's what I was wondering--if there was any correlation with her monthly cycle. Has she always been this way?

Unfortunately it sounds as though her psychiatrist may be treating symptoms. Back when I owned a pharmacy I saw that a lot. Those patients made very little progress. If she hasn't been properly tested by a psychologist, you may want to consider doing so. I've had a lot of problems in recent years which we just couldn't identify. My therapist referred me to a neuro-psychologist for a complete evaluation. After two days of testing, he really homed in on my problem areas. He then made recommendations to both my therapist and doctor. It has helped.

losing_hope

Actually, I think it is the opposite. He is not treating the symptoms, but trying to find the underlying disease. Even when she asked for more medication his comment to it was that "Taking more medicine is not going to fix the underlying problem." He has sent her to a reproductive endocrinologist. But of course, she's really bad with follow-ups, and even got angry at the RE doctor. And those aren't easy to come by.

Frankly I like him, and more importantly my wife does, and that's important so that she'll keep going to him.

But I do admit that it is taking a long time to find the root cause of it all. Maybe that's just how it is, since there's no simple lab test you can take for these things.

827Aug

That's awesome she was sent to an endocrinologist. He must be suspecting she is insulin resistant. That can definitely cause all kind of mood swings, and irritability. Fortunately that is very easy to treat.

Good luck!

County

Have you/the doctor considered whether a brain MRI would be useful? For two people I know, a friend's wife and a relative (male) of mine, their MRIs revealed brain damage. The friend's wife had similar symptoms to your wife; the male relative had depression too but it manifested differently and he had some additional diagnoses. They had different types of brain damage (including the causes) and in different areas of the brain. This hasn't led to any cures for either of them, but it was helpful in determining treatment/management strategies, and in just the relief for their spouses of having more of an explanation.

County

p.s. for both of them, they saw a string of psychiatrists and psychologists over many years before they each ended up with one who referred them on to a neurologist.

unbelievable

You didn't give her clinical depression and you aren't going to cure it unless you can figure out how to alter brain chemistry in another human being. My wife suffers from depression, bipolar, etc. It has gotten bad enough that she had to quit her teaching career. She's in a dark place most days and I get the brunt of her, hostile/suicidal/accusatory/apologetic/etc comments. Guess it just comes with the job. I make sure she eats, takes her meds, attends to personal hygiene, etc. I try to keep the triggers down. About the only thing I'm able to do that seems to help is getting her outdoors, away from the bed, the phone, the TV, the internet, etc. We go for walks with the dogs. She likes going for motorcycle rides. When she's in a funk even little surprises or changes throw her into an immediate spiral. I try to keep these down to a minimum and I just have to make most decisions. There's just so much you can do. Maybe the most important thing you can do is to just keep reminding yourself that she doesn't hate you, she's suffering from an awful disorder. If any other man on earth replaced you as her husband, she'd still be frequently unhappy, hateful, and suicidal with him because she has depression. She has doctors. You're just her husband. Do what you can to be supportive within reason but try not to let her depression define your life or who you are. If you don't have a thick skin, grow one. If her depression lasts long enough and you hear these ugly comments long enough, you might start believing that you really are a worthless piece of crap and the cause of her unhappiness. I've been dealing with this over 10 years and sometimes it's a struggle just to stay sane myself and to keep in the game. I hate to see my wife unhappy or angry and like most guys, my gut response is to want to fix everything. I can't fix this. I made a promise and I have to cling to that because very honestly, she's normally unpleasant to be around, typically switching between extreme indifference or extreme rudeness and hostility. There are a few very nice moments. If I had it to do over, I wouldn't have knowingly married someone with Bipolar and severe depression. I wouldn't recommend anyone do so. I did and I can handle it. It aint fun, though.

827Aug

A nuro-psychologist can really help here when it comes to sorting out brain damage and other stuff.

Pluto2

I am so sorry you have to deal with this. How is your child handling this? My STBX suffers from depression with paranoid traits and is on meds and counseling. I tried for years to support him, but his disease caused him to viciously strike out at anyone around, which meant me and the kids. I tried to protect the kids as long as possible and remind them that Dad has a disease that keeps him from thinking clearly and from making the decisions you or I would make. It just became too much. He'd lash out and our innocent children and then run screaming into the closet and cry and ask why doesn't daddy love them. I couldn't fix him, but I had to protect my children.
There are some support groups for family members that are dealing with a loved one in depression/bi polar state. Are you and your child getting help?
You can support your wife and more power to you for that. But you must take care of you and your child. The stronger you are, the easier it will be to live with your wife while she's in this state. I wish you nothing but peace and happiness.

losing_hope

She is on Metformin too, but it does not seem to have much of an effect. The problem is that the evidence is inconclusive, that's one possible reason. Other could be family history of BPD, then there is the possibility of not grieving for her father's death, could be her childhood's instability...

Or all of them.

losing_hope

Thanks, I understand you fully. And I know all this. Yet, when the funk comes rolling around, it seems that I'm seeking for extra reassurance myself. Maybe it's my childhood too, or maybe it just that for so many years I got used to walking on eggshells that it had an effect on me...

I'm seeing a therapist, and I've taken steps to work on myself.

And it does seem a bit harsh that I need to concentrate on myself, when my wife is the one who has the disease.

Actually, come to think of it, what you said pretty much reflects what I've told others in the same situation before. Funny how still I doubt it when it comes to myself.

losing_hope

I think he's starting to be in the age where it is starting to have more of an effect on him. And that worries me. Not to mention like yesterday she was home all day with our son. I think she probably slept most of the day, and so did he. So when the night time comes in, he's not tired at all. He stayed up past 11 pm. So now everybody's cranky. It's like a spiral.

Uptown

LH, the behaviors you describe exhibit traits of both BPD and bipolar disorder. I am not a psychologist but I did live with a BPDer exW for 15 years and I've taken care of a bipolar foster son for longer than that. Moreover, I took both of them to a long series of psychologists for 15 years. My exW, for example, saw six different psychologists in weekly visits throughout that period -- at great expense to me (and to no avail). Based on those experiences, I have found many clear differences between the two disorders.

One difference is that the mood swings are on two very different spectra having different polar extremes. Whereas a bipolar sufferer swings between mania and depression, a BPDer flips back and forth between loving you and hating you. You describe the mania-depression swing when talking about "the energy, hypersexuality, staying up late. Then the crash." You are describing the love-hate swing, however, when talking about her "texting some really hurtful things to me" and the times she will "...be angry, snap at me and our child."

A second difference is seen in the frequency of mood changes. Bipolar mood swings are very slow because they are caused by gradual changes in body chemistry. They are considered rapid if as many as four occur in a year. In contrast, four BPD mood changes can easily occur in a month. The latter therefore is consistent with your description of numerous temper tantrums. Specifically, you state that "the episodes happen every couple of weeks." (Although hyper-rapid cycling is a possibility with bipolar, it is very rare and -- when it does occur -- usually precedes a transition to psychosis).

A third difference is seen in duration. Whereas bipolar moods typically last a week or two, BPD rages typically last only a few hours (and rarely as long as 36 hours). Again, these short-duration rages seem consistent with with the tantrums and hissy fits you describe.

A fourth difference is seen in the speed with which the mood change develops. Whereas a bipolar change typically will build slowly over two weeks, a BPD change typically occurs in less than a minute -- often in only 10 seconds -- because it is event-triggered by some innocent comment or action. Significantly, the behavior you describe is consistent with these event-triggered outbursts.

This is evident in your remark that "There seem to be triggers, which I feel that are often somehow connected to me." Actually, they are because you are one of the few people who can trigger the anger. This triggering usually can be done only by posing a threat to a BPDer's two great fears: engulfment and abandonment.

This is why casual friends, business associates, and complete strangers rarely trigger her anger. They pose no threat. Specifically, there is no close relationship that can be abandoned, and there is no intimacy to produce a suffocating feeling of engulfment. The result is that a high functioning BPDer -- as your W may be -- can be generous and caring all day long around those other folks -- but will go home at night to abuse the very people who love her.

A fifth difference is that, whereas bipolar can be treated very successfully in at least 80% of victims by swallowing a pill, BPD cannot be managed by medication because it arises from childhood damage to the emotional core -- not from a change in body chemistry. This may explain, then, why her doctor concluded that "taking more medicine is not going to fix the underlying problem."

A sixth difference is that, whereas bipolar disorder can cause people to be irritable and obnoxious during the manic phase, it does not rise to the level of meanness and vindictiveness you see when a BPDer is splitting you black. That difference is HUGE: while a manic person may regard you as an irritation, a BPDer can perceive you as Hitler and will treat you accordingly. This seems consistent with your description of very hateful, spiteful behavior.

A seventh difference is that, whereas a bipolar sufferer is not usually angry, a BPDer is filled with anger that has been carried inside since early childhood. You only have to say or do some minor thing to trigger a sudden release of that anger. If your W has strong BPD traits, she has carried enormous hurt and anger inside since childhood. You therefore don't have to do a thing to CREATE the anger. Rather, you only have to TRIGGER it -- or, as you state so clearly, "...there's that underlying current that's waiting to bubble up with any excuse."

An eighth difference is that a bipolar sufferer -- whether depressed or manic -- usually is able to trust you if he or she knows you well. Untreated BPDers, however, are unable to trust for an extended period. Before they can trust others, they must first learn how to trust and love themselves. Indeed, BPDers have great difficulty trusting even their own therapists.

It therefore is common for a BPDer to love her doctor for a while and then suddenly feel betrayed by him, causing her to drop out of treatment entirely or switch to another doctor. This may explain why you've observed that "she's really bad with follow-ups, and even got angry at the RE doctor."

Finally, a ninth difference is that skin cutting, picking and other self mutilation is strongly associated with BPDers (when they are in a low functioning state) but not with bipolar sufferers. This difference is significant because you say that "she has hurt herself before by way of picking skin and purging."

Yet, despite these nine clear differences between the two disorders, many people confuse the two. One source of this confusion seems to be the fact that a substantial portion of BPD sufferers (about 25%) also have the bipolar disorder. I caution that, if your W exhibits a strong pattern of BPD traits, you should have been seeing red flags all through your marriage. Such traits are persistent and do not disappear for years at a time.

If you would like to read more about BPD traits, LH, I suggest you check out my brief description of them in Maybe's thread at My list of hell!. If that discussion rings a bell, I would be glad to discuss it with you and point you to excellent online resources. Take care, LH.