# Time for professionals?



## DeepPurple (May 22, 2012)

My wife suffers from severe anxiety, depression, has been diagnosed as being biploar and has a multitude of other personality disorders (according to our PCP), and - we believe - she also has fibromyalgia. She has been trying to get through things on her own, with my help of course, but it always ends up with her falling back into her rut, and leaves me worn out from trying to help her and stay sane at the same time.

We've seen a psychiatrist, a therapist, our PCP and a few other doctors, but all they do is give her prescriptions and send her home. So, she's finally decided that she can't do it on her own and wants professional help.

My question is, what do we do at this point? Do we check her into a nursing home? Do we put her in a mental health facility? Do we get in-home health care? She's not a threat to herself or others, so I certainly don't want to baker act her or anything like that. I'm just not quite sure what to do at this point, and would love some advice from others that have been through the same or similar situation.

Thanks!


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## kindi (Apr 28, 2012)

You've seen a psychiatrist, therapist, PCP and a few other doctors and not one of them gave you any suggestions as to how to proceed further?

It's a sad day when a person has to get answers from helpful well meaning anonymous internet strangers because they can't get them from the doctors who are supposed to be trained in exactly those types of things.

All I can tell you is that some medications work better than others with different people and it might be a matter of going back to the doctor on a regular basis to try different meds, dosages and combinations until you find one that works, along with bringing her to a competent talk therapist to work through the unresolved childhood issues that are the root of at least some of the issues.


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## Mavash. (Jan 26, 2012)

What was supposed to happen is she was to learn new coping skills while on said medications with the eventual plan of getting OFF of them. Although some need to be on them forever. It depends on the severity of the problem.


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## EleGirl (Dec 3, 2011)

Has she been in any kind of counseling? therapy? The drugs themselves do not solve the problems.

How on earth does one person have all of that? Was she diagnosed with all of that by one doctor? or did different ones give her different diagnosis?


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## DeepPurple (May 22, 2012)

Yes, unfortunately, this is how doctors seem to work nowadays. They throw pills at whatever ails you and hope they stick.

She's been through all kinds of medications (Zoloft, Lithium, Potassium, Effexor, Wellbutrin, etc.) and while the current ones (Pristiq, Klonipin and Tramadol) help with the depression, anxiety and BPD (to a point), they aren't helping to get her back on her feet.

I asked my former PCP what I should do, and he said "Get a divorce", of course that's why he's my former PCP. 

The problem with the therapist is that she'll go for a while, get depressed, stop going, then go for a while, get depressed, stop going again. Right now it's been several months since she's seen her therapist and she's canceled her last two psychiatrist appointments for various reasons.

Honestly, I think she needs to spend a few months in a nursing home or ALF myself, just to have professionals there to tell her what she needs to do and how to do it. I'm no professional and can only help her to where my limits end, which is pretty much just taking care of her until the next doctor or medicine comes along. 

But, at least she's at the point where she has come to the realization that she needs professional help, and that she can't do it by herself anymore. That was a big hurdle itself.

We're just not sure what the next step should be...


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## kindi (Apr 28, 2012)

DeepPurple said:


> Yes, unfortunately, this is how doctors seem to work nowadays. They throw pills at whatever ails you and hope they stick.
> 
> She's been through all kinds of medications (Zoloft, Lithium, Potassium, Effexor, Wellbutrin, etc.) and while the current ones (Pristiq, Klonipin and Tramadol) help with the depression, anxiety and BPD (to a point), they aren't helping to get her back on her feet.
> 
> I asked my former PCP what I should do, and he said "Get a divorce", of course that's why he's my former PCP.


Well I gotta tell you this much, your doctors have certainly run the gamut when it comes to trying different meds, it sounds like they tried just about every single medication available.

Now that's dedication.

It sounds like your wife has major issues, so bad that after trying a whole slew of medications she's not much better, and she refuses to keep up with the talk therapy.

I'm not telling you to divorce her but I'm giving thoughts to my post above when I suggested that your doctors are lazy and incompetent. Including the one that suggested divorce.

I'm not telling you to divorce the woman, but I am saying that some problems can't be fixed.


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## DeepPurple (May 22, 2012)

Mavash. said:


> What was supposed to happen is she was to learn new coping skills while on said medications with the eventual plan of getting OFF of them. Although some need to be on them forever. It depends on the severity of the problem.


She's pretty bad, so getting off of them would probably be out of the question. 

When she first found out she was biploar, she was VERY depressed, to the point of her having thoughts of suicide.

As far as the coping skills, where does she get these? All the therapist does is talk to her, and the Psychiatrist asks her a few questions and refills her prescription.



EleGirl said:


> Has she been in any kind of counseling? therapy? The drugs themselves do not solve the problems.
> 
> How on earth does one person have all of that? Was she diagnosed with all of that by one doctor? or did different ones give her different diagnosis?


She was initially diagonosed with bipolar disorder by one doctor many years ago. And based on what I know about BPD, she definitely has it. She would stay up for days, then have REALLY bad down, depressed times. She would be cheery, and then fly off the handle for no reason. She would be happy one second, and crying her eyes out the next.

Her PCP never really diagnosed her with anything, but stated to me (he's my PCP as well) that she has MPD's. 

And her psychiatrist is the one that says she also suffers from severe anxiety and depression.

She's kind of self-diagnosed the fibro, but she does have hypersensitivity (to the point if I barely touch her she feels pain), and she suffers from bodily pains constantly. This could be psychosomatic, but she's never been officially diagnosed with it.

She also seems to think she might be borderline aspergers. Which would make sense because she's anti-social and gets very anxious around others and when she does can become combative very quickly. And, when I talk to her she engages in one-sided conversations and usually never lets me get a word in edge-wise. She's obsessed with virtual worlds, and that's all she pretty much talks about. If I try to change the conversation or say something she doesn't like, she either becomes depressed, combative or cries.

But, other than the last two, everything else has been diagnosed by a doctor or three.

I guess what we really need to do is have her spend, perhaps, several hours/days with a few psychiatrists and find out what the issue really is, because I'm not even sure anymore...


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## EleGirl (Dec 3, 2011)

It sounds like the different docs are just punting here. Each seemsto have their very own diagnosis. Sometimes the medications themselves cause problems. Especially when a person is put on multiple meds.

She probably needs to be backed off of all meds and then diagnosed. How anyone can do a baseline diagnosis while she's on mind and behavior altering drugs is beyond me.


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## Pluto2 (Aug 17, 2011)

I've not had to deal with BPD, by STBXH suffers from recurrent major depression/anxiety and possible personality disorder (whatever that is). My advise would be to stop enabling her to end treatment. You've indicated that she goes to counseling for a while then stops, then returns. It will never really help that way. I understand that you don't want to end the marriage at this point, but you have a right to a life as well and having to deal with the stress of your partner's mental illness is one of the most stressful journeys to take. Be firm and say that you are unwilling to continue in the relationship unless she goes back to counseling and stays. She must be responsible for her own health care. You need your own support system, are you in IC. I hope you both find peace.


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## Mavash. (Jan 26, 2012)

DeepPurple said:


> The problem with the therapist is that she'll go for a while, get depressed, stop going, then go for a while, get depressed, stop going again.


This is on your wife. If she quits how is she ever going to get better?

I've had a lot of mental issues and it's taken me THREE YEARS of therapy to learn how to cope. I did it without meds but I've got a friend who needs lots of them just to keep from ending up in the ER with panic attacks. She needs anti anxiety meds just to be able to GO to therapy since it triggers her so bad. But the difference between her and your wife is she keeps going no matter how depressed she gets.


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## COGypsy (Aug 12, 2010)

DeepPurple said:


> *She's pretty bad, so getting off of them would probably be out of the question.*
> 
> When she first found out she was biploar, she was VERY depressed, to the point of her having thoughts of suicide.
> 
> ...


If her primary diagnosis is indeed bipolar disorder, then she will need to stay on meds permanently. It's a matter of chemistry, not history. 

Having successfully (overall, anyway) managed my bipolar disorder for more than a decade, I would strongly suggest that you guys _quit the doctor-shopping _and find ONE psychiatrist and ONE therapist. If the priority is to improve her skills in coping with her disease, then look for a therapist specializing in Cognitive Behavioral Therapy. Work with one psychiatrist who can start over and re-screen her for a diagnosis at this point in time. That way you'll know what you're dealing with and can proceed accordingly. 

While they may refer you to specialists, you need a single point of contact to coordinate care if you're truly looking at multiple diagnoses. And yes, psychiatrists pretty much only do diagnosis and medication management, but I think if you can find one to start fresh, knock off the self-diagnosis and work with them on an overall care plan, then you might get further.

Ultimately however, like Mavash said, it's up to your wife. You can support her efforts, but in the end, it's her choice to work on getting better. She needs to stick with her meds, stick with the therapy and follow the care plan. 

I think that putting her in any sort of facility if she's not a threat to herself or others won't do much for giving her a greater ability to function in every day life. It won't cure her, she'd just get sheltered for a while and still have to return to a life with work, kids and day-to-day stress. 

Sadly, there just isn't a magic bullet. I will however point out that bipolar is a progressive disease when left untreated, or sporadically treated. Cycles get more severe and more frequent over time. So if she's engaged in seeking treatment and making changes, sooner is definitely better than later.


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## Mavash. (Jan 26, 2012)

COGypsy said:


> If her primary diagnosis is indeed bipolar disorder, then she will need to stay on meds permanently. It's a matter of chemistry, not history.


This is a very good point. I've yet to read or hear of someone beating this without meds. My sister is bipolar and she MUST be medicated. Forever.

I'm also not sure about fibro either. The women I know with that have to take meds for that too.


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## Miss.Mystified (Aug 7, 2012)

I've had to deal with mental illness for most of my life, its no fun. And you're right, doctors want to throw meds at us and hope they stick, but if they don't, well just try another one... never mind the side effects of them. It took over 10 years for them to find a medication ****tail that worked for me. I was misdiagnosed with BPD, in my opinion because Im no longer on meds and I cope fine. Years of therapy also helped and yes I went through many many doctors until I found the one who would listen to me and help me get to the root of my illness (PTSD). I still have lapses, but am able to cope with them now. The biggest thing that helped me was my dr suggested a group therapy with others and similar ails. It helped to know I wasnt alone and also helped to learn what techniques others used to help with situations that arose and erupted triggers. 
I sincerely hope she finds a dr. to help her through. FM can cause depression symptoms also, not to mention the drawbacks of the medications. I know it gets hard, but you seem very supportive so don't lose that quality, but be firm in her keeping apptmts and following through with treatment as planned. Thats one thing with not only BPD, but any disorder, we think we are cured and want to stop taking the medications or lower our dose ourselves and end up back at square one.
My prayers go out to you both, its a battle within itself and affects everyone who cares.


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## Mavash. (Jan 26, 2012)

Miss.Mystified said:


> Thats one thing with not only BPD, but any disorder, we think we are cured and want to stop taking the medications or lower our dose ourselves and end up back at square one.


This is true. Sadly my therapist told me yesterday that I will never be free from mental issues. My disorders will be with me for the rest of my life. The best I can do is learn how to manage them. That depresses me but what can I do? As hard as this is at times I can't quit as I've got a family that needs me.


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## TheMarriageandFamilyClini (Mar 3, 2012)

As a marriage counselor for The Marriage and Family Clinic in Denver, CO I have seen too many couples lilke you who have come to me after seeing several professionals but have never got a clear answer from them. A lot of professionals are uncomfortable talking about hard truth with patients and instead just give them medications for 'symptoms'. 

If you have seen a PCP, psychiatrist, etc. They probably do know what diagnosis they're treating your wife for. Call their office and request their records. You have the right to request them and they cannot deny you that. You may have to pay a small fee for them, though. Scan through them and look for diagnoses. Docs have to document diagnoses and symptoms that they're treating for. You have just have to know where to look for them. Bring the records with you to your therapist and they can help you scan through them if you need. 

Hope this helps.


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## heartsdelight (Apr 2, 2012)

First of all, your opening sentence is a little unclear, but that may have been because the professionals you've been seeing have been unclear. Depression and bipolar disorder are mood disorders. Bipolar disorder has periods of depression, so usually a doctor should have pretty convincing evidence to say someone has BPD AND a separate diagnosis of major depressive disorder (or some other depressive disorder). Personality disorders are a very different class of mental disorder and should never be diagnosed by a PCP in my opinion. There is a lot of debate about their validity and should only be taken seriously from a therapist/psychiatrist/doctor/whoever who has seen a person on numerous occasions for a period of time, hopefully at least a year. 

That being said, she's probably been seeing a therapist who operates under a different treatment modality then you probably need or want. As COGypsy said, CBT is probably a good bet (it's kind of a catch-all for mental health issues). Dialectical Behavioral Therapy (DBT) also could be promising. Try to find a therapist that has training and uses these treatment methods. If your insurance covers it or if you're willing to pay, ask about psychological testing (has to be done by a psychologist, a therapist is unfortunately not qualified to run the battery of tests). This can help narrow down her symptoms and give a more clear answer of what meds should be an option or not.

If she doesn't connect with her therapist, keep looking. The therapeutic relationship is key to a patient's success.


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## DeepPurple (May 22, 2012)

Well, her current Psychiatrist pretty much "diagnosed" her on her first visit after talking with us for about an hour. He said she had severe anxiety and depression. But, she had already been on Pristiq and Xanax (PRN) for several years, so that may have hidden her bipolar disorder. And although we tried to tell him everything from the beginning, he seemed to still think it was anxiety and depression. However, he wasn't there when she had the suicidal thoughts or the manic/depressive states or anything like that. (On a side note, I had found out - only recently - that she had been baker acted once prior to our meeting/getting married for the same reasons). 

Her PCP, after seeing her for several years and witnessing a few of her severe anxiety attacks (to the point that she was crying uncontrollably in the doctors office), stated that she had multiple personality disorders.

And her initial diagnosis of bipolar disorder came from a psychiatrist that she saw many years ago even before she started any medications whatsoever (he's the one the originally put her on Zoloft, Lithium and Potassium).

As far as her Therapist, he was an LCSW/MSW in Behavorial Health/Social Work. Not sure if that falls under a CBT. 

But, after reading all of this input, I think what we're going to do is pretty much start from scratch.

Going to make a new appointment with her Psychiatrist and start from square one again, re-explaining everything from pre-bipolar diagnosis to today.

Then we're going to find a therapist that specializes in CBT. Not sure if her old therapist would take her back at this point, or if he would even be the right choice.

And, I think we're going to find a new PCP for her as well. I think it's time to find a doctor that's more understanding of her problems. He is a good doctor, but he has no bedside manner and he's too quick to diagnose.

I want to thank everyone for helping me (us) figure this out...wouldn't have known what to do without the help. :smthumbup:


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## heartsdelight (Apr 2, 2012)

Psychiatrists are medical doctors and in most parts of the field have to give a label to prescribe a med, whether or not someone 100% meets the criteria or not. I can't tell you how many teens I work with who have "insomnia". But honestly, I would not take their brief diagnoses as law. Even if a therapist gives someone a diagnosis, I would clarify with them. Often clinicians have to put a DSM diagnosis to bill your insurance. A sad fact of life, and the reason why couples therapy is so hard to get covered.

An LCSW simply means he is a licensed clinical social worker and can therefore practice therapy autonomously. This has nothing to do with what type of therapy he practices. A licensed therapist can practice pretty much any form of therapy that they can show evidence as being within their ability to carry out. CBT is a form of therapy, a modality. It's very popular but not universal. There are many other forms of therapy her therapist may have been utilizing. 

I would focus the most on what a therapist uses as their modality and how you click with them. Like I said, CBT/DBT would probably be a good start. There are therapists that are psychologists (LCP, Psy.D, PhD), social workers (LCSW), or LPCS (masters level of counseling). These differences don't matter as much as the person and how they practice. 

I'm working on my LCSW certification, so I'm a little partial to that. 

Above all, don't be afraid to ask. What you get on a printed piece of paper for your records or the insurance may not be really what's going on in your doc's head (any of them). They may put bipolar but really just can't come up with a better classification at the moment. Try to get as much info about 1) their philosophy on applying a diagnosis (this is still very debated) and 2) what they are currently thinking in terms of treatment options and what else they need to find out. A good therapist should always be upfront about asking what you guys are hoping to get out of therapy, what has worked in the past, and what you think makes therapy successful. 

Good luck!


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