Supportperson: helping my wife manage

[Supportperson]

My wife and I have been married for 31 years. She is 55 years old and has struggled with anxiety and depression for most of her adult life, with occasional bouts of hypomania. Her situation is complicated by the fact that she was born in another country and will get very homesick at times. Though she never has been completely incapacitated and has taught at college part-time for years, her condition limits her ability to work and engage in other activities. She has tried extremely hard to combat it, with varying degrees of success. We suspect a hereditary component. She has been taking Xanax on and off for about 9 years.

 

Managing her situation became complicated about two years ago when I decided to look for another house, which seemed to set off a period of hypomania in her for a few months, followed by depression when we actually moved into the house. She worried about the higher mortgage and felt a strong sense of solitude in the very quiet neighborhood. After a year, evidently back in a hypomanic state, she wanted me to find another, less expensive house. We discussed it at length and decided to move forward with the plan, and the period of showing the old house and looking for a new one, at the same time that I was having trouble at my job and our daughter was expecting a baby, became overwhelming to both of us. She would change moods on a dime, overspend, and slip into moments of rage directed at me or herself, which nearly led me to throw in the towel at various points. She did not believe she had a problem at the time and only consented to see a psychiatrist if that person was located in her home country. We did see the psychiatrist in December, who diagnosed her as Bipolar II and prescribed a low dose of Risperdal along with Topamax. He said that she could continue with the Xanax until the other medications started to help her. The Topamax made her feel very unstable and she went off it after only trying it twice, and the Risperdal didn't have much effect. Her mania gradually subsided by the end of January, as a comment at her workplace about her performance began a period of self-doubt and anguish.

 

I had retired from my full-time job in October to help her get through these situations and to remove the anxiety that my job was causing me. Last month we decided that it was too difficult to deal with the home country psychiatrist long distance, and found a psychiatrist close to home. The new psychiatrist increased her Risperdal dosage from 0.25 mg to 1 mg daily, added Lamictal, and replaced her Xanax with Klonopin. About a week into this regimen she started to have paralyzing anxiety daily which would start in the morning and only taper off in the evening. Anything that wasn't a routine activity - a minor decision like what to cook for dinner, or the need to plan for a class - would be a trigger. When she went on spring break the anxiety became unbearable and we went back to the psychiatrist a week ago to "recalibrate." He attributed her anxiety to Risperdal and took her off both that drug and Lamictal, deciding to focus on the anxiety rather than the mania. He also prescribed 25 mg of Zoloft to start and increased her Klonopin from 0.5 mg twice daily to 1 mg three times daily. He took away Xanax because of its short half-life and potential for rebound anxiety. She wants to beg him to put her back on Xanax, as the Klonopin even now can take several hours to kick in. She has hoarded her remaining Xanax supply and will take them if she is particularly desperate, but often even the Xanax, which was reliable in the past, will fail to put a dent in her current anxiety battle. (Zoloft worked for an anxiety bout she had 10 years ago, but she unwisely went off of it cold turkey several months into it and at about the same time had a hypomanic episode.)

 

Her anxiety hasn't abated and I see her becoming paralyzed over even simpler decisions, as well as feeling guilty over being a burden to me, in spite of my reassuring her that it's not her but the illness, and that I am more than happy to help her. I always reject categorically any suggestions she makes that it would be better for me if she were dead, and tell her time and again that she brings happiness to my life, which she certainly does, in ways too numerous to mention. We see the psychiatrist in another week, and while I believe that he is doing what he can, it is becoming increasingly difficult for me to manage her condition. She is terrified of seeing a psychologist to learn coping strategies, which in any case go completely out the window when she is in the middle of an anxiety episode.

 

I still have to work part-time mainly from home - about 20 hours a week - to help with the bills, and her suffering is beginning to wreak havoc with my schedule. I will call on my two grown children to spend time with her so that I can get on conference calls and keep the occasional business appointment away from home, but I feel that I need more information to be able to navigate through this minefield and help her on the road to recovery. I almost ordered The Road Back supplements in desperation but held off after reading the posts on this site. It is very hard to figure out what is causing this latest bout with anxiety: Risperdal withdrawal? Lamictal withdrawal? Xanax withdrawal? Rebound anxiety from either Xanax or Klonopin? A combination of some or all of the above?

 

I am convinced that it is not only the psychiatrist's responsibility to evaluate her condition but also ours to communicate to him accurately the ups and downs of her experiences. I have kept a detailed journal of her dosage and changes in mood since her hypomania started last August. Nonetheless, I feel that she is falling through the cracks between a patient who can manage their condition with professional assistance and someone who has to be hospitalized. The healthcare system does not seem to have any answers for her. What are your thoughts? Thanks for your patience in reading this detailed account; it has been very therapeutic for me to be able to articulate it in this way.

[brassmonkey]

Hi Supportperson--  Welcome to the group, I'm sorry to hear that your wife is having such a hard time.  It's a awful situation from both sides.  I'll have to admit that that was a long intro post and I will have to read it several times to get a grasp on what is going on before I can make any recommendations.  If you look in the listing for the introduction forum there is a thread about making a signature bloc right at the top. (I'd post a link here but my mouse has packed it in so I cant navigate too well)  Please fill out a signature with a brief history, it will really help us see what is going on.

 

It is wonderful that you're taking the time to care for your wife in this manner.  We have several other members doing the same thing.  On a side note, make sure that you're taking care of yourself and getting the support you need too.  You're in a very taxing position and can burnout quickly in not careful. 

[Meimeiquest]

I am one of the few here that believes I have a "mental illness", my doctor codes it as bipolar NOS. Really, antidepressants aren't good for many people with bipolar II. Messing around with all those med changes isn't good for anybody!

 

I have found the website www.psycheducation.org extremely helpful. Not being a fan of drugs, I just overlook that part, but it's there if you want it. A new book came out this week that you and your wife might find helpful, A Mind of Your Own, by Kelly Brogan. She practices in Manhattan (for amazingly high fees). Although it is about depression, she has stated elsewhere that she treats all mental illness the same.

 

You sound like an amazing husband! I hope you both can find peace soon!

[apace41]

 A new book came out this week that you and your wife might find helpful, A Mind of Your Own, by Kelly Brogan. She practices in Manhattan (for amazingly high fees). Although it is about depression, she has stated elsewhere that she treats all mental illness the same.

 

Meimeiquest,

 

I've received my copy -- big fan of hers.  I agree, however, that her fees are insane (even for NYC).  I think that virtually everything she does on the diet side is covered in the book.  The testing she would do is also expensive but I think much of the benefit can be derived just from the dietary changes.  By her own admission, a significant portion of her patients get substantially better within 30 days just by diet alone.

 

Supportperson -- your wife is very lucky you are so committed.  Many significant others are not as dedicated.  I would recommend you get the book on Kindle for $13.99 and read it.  Really sheds light on depression generally.

 

Best,

 

Andy

[Meimeiquest]

Interestingly enough,even Dr. Phelps at psycheducation.org has published a case report on two patients who did better on a ketogenic diet than meds. Which is not exactly the diet Dr. Brogan recommends, and one I can't tolerate because it raises cortisol, but their approaches agree in many ways. She has really written it out in a more clear manner, though,

[ChessieCat]

Hi SupportPerson,

 

Here's the link:  Please put your Withdrawal History in Signature

 

Please include ALL drugs, dates, doses and how she decreased/increased.  Giving as much detail as possible will allow the volunteer staff to make suggestions based on your wife's individual situation.

 

You can use this Intro/Update topic to ask questions and are welcome to use it as a journal of your wife's progress.

 

Brassmonkey said "On a side note, make sure that you're taking care of yourself and getting the support you need too.  You're in a very taxing position and can burnout quickly in not careful."

 

I agree.  Looking after yourself is not selfish.  If you don't look after yourself you may not be able to look after you wife in the way you want to.

 

Brassmonkey - the 3rd person with mouse issues.  NZ11 as well as me.  I've got a new one now.

[Fresh]

Hi Supportperson , welcome to the site.

As ChessieCat asked , we need more specific information about your wife's drug history before guessing what may be causing her symptoms.

 

" Last month we decided that it was too difficult to deal with the home country psychiatrist long distance, and found a psychiatrist close to home. The new psychiatrist increased her Risperdal dosage from 0.25 mg to 1 mg daily, added Lamictal, and replaced her Xanax with Klonopin.

" He attributed her anxiety to Risperdal and took her off both that drug and Lamictal, deciding to focus on the anxiety rather than the mania. He also prescribed 25 mg of Zoloft to start and increased her Klonopin from 0.5 mg twice daily to 1 mg three times daily. He took away Xanax because of its short half-life and potential for rebound anxiety."

 

Instructions for filling in a signature are in this thread  http://survivingantidepressants.org/index.php?/topic/893-please-put-your-withdrawal-history-in-your-signature/

 

best wishes ,  Fresh

[Supportperson]

Thanks to all for their support and helpful advice! I have added the medication history in the signature as suggested and am beginning to read A Mind of Your Own. I'll keep everyone posted on my wife's progress.

[Supportperson]

The last few days have been really difficult for my wife. Over this time span, she has had yet one more effect on top of all the others: a strange tingling sensation coming from her genital area that is extremely uncomfortable. The closest explanation for this phenomenon is one that has only recently been designated as "restless genital syndrome." She believes that it is a side effect of the Klonopin but I can't be sure that it is. We have left a message with her psychiatrist and are waiting for a call back. I also advised her to stop taking her 10 mg of Lipitor for the time being. The last time she took it was Friday night.

 

The scariest part is that on Saturday afternoon I found her in our guest bedroom with a belt wrapped around her neck. Now it's clear that this sensation is driving her to do this.

[brassmonkey]

Hi Supportperson-- I' sorry to hear that DW is still having such a hard time.  The new symptoms you describe sound a lot like what we refer to as PGAD (Persistent Genital Arousal Disorder) a very uncomfortable  thing to get. Go to google and search "survivingantidepressants.org PGAD" and you should get a lot of information on it.

 

Please make sure that she is kept safe.  We take suicide very seriously here.  Being just an online forum there isn't much we can actually do recommend getting face to face help to control the situation.  This is a very difficult and painful process at times but with persistence the results are very good.

[Supportperson]

I want to thank all of you for your support. Things are much better now. After our communication, my wife spent 6 days in the psychiatric ward of a local hospital. The result was that her medication was changed to Seroquel, 100 mg twice a day, and the impact of the stay led her to abandon suicidal thoughts and actions entirely. She was still suffering from depression and the sensations, and a week after her discharge from the hospital, we went to a specialist in pelvic medicine, who diagnosed it as atrophic vestibular vulvodynia instead of PGAD, which was a blessing because the former is very treatable. After two weeks on gabapentin and applying estrogen cream locally, she demonstrated significant improvement and from then on was able to live relatively normally. We changed psychiatrists, and the new psychiatrist increased the Seroquel to 150 mg, added Zoloft 100 mg and kept Klonopin for my wife to use twice a day at 0.5 mg. She will continue to use gabapentin and the estrogens. Initially, for about a month, she would get very sleepy with this regimen, but with a few changes in the timing of the dosage, the sleepiness diminished. Her cycles are much less extreme. She will probably not return to work, except on a very limited basis, and I will remain at home with her most of the time so that we can monitor her situation, but our quality of life is much improved. I am well aware that this happy result is not a given, and I am profoundly thankful to God and all the people who assisted us at different phases of this journey.

[nz11]

Greetings supportperson.

Thankyou for taking the time to do an update.

Ive just read your thread wow with all those changes in march 16 no wonder you stumbled upon sa in order to find some answers.

no wonder you said

It is very hard to figure out what is causing this latest bout with anxiety: Risperdal withdrawal? Lamictal withdrawal? Xanax withdrawal? Rebound anxiety from either Xanax or KIlonopin? A combination of some or all of the above?

i reckon you were spot on with 'all of the above' and most probably a CT off xanax after 9 yrs use would be a major player. ouch!!

I am sorry all of this resulted in a stay in hospital

 

My heart goes out to you and your situation.

[Supportperson]

Hi everyone, 

I wanted to provide an update. My wife has continued fairly stable over the space of the past year with minor changes in her medication. Fortunately, she is completely off Zoloft now, and continues with Seroquel 200 mg at night and Klonopin 0.5 mg once in the morning, as well as gabapentin and Estrace for the vaginal issues. The major issue now is that it has affected her desire for nearly a year. She has a new psychiatrist, the best she's had to date, who tried reducing her gabapentin to resolve this problem, but my wife could not handle the increased anxiety and went back to her earlier regimen. She will have another appointment next week, and maybe slightly adjusting the dosage of one of the other medications will work. Aside from helping her with intimacy issues, I feel that I need some more time alone, maybe getting away by myself for a few days periodically to decompress, as long as other family members are available to her. I've always said that her best therapy has been babysitting our grandson. 

 

She wants me to share information on the medications that resolved her vaginal discomfort, which was diagnosed as vestibulodynia (though she suspects now that it wasn't limited to that and may have had some elements of PGAD). I know I shared some of it here last year, but she asked me to quote the specialist's notes this time. I also would like to learn what other sites are good for sharing this information. Thanks as always!

 

1. Amitriptyline 2%/ketamine 2%  - fingertip amount to opening of vulva in am and after noon

2. Estrace - fingertip amount to opening of vulva at bedtime

3. Horizant 600 mg daily @ 5 pm with food (the insurance company didn't cover this and so it was replaced with gabapentin)

4. White Crisco applied to the vulva

5. Avoid scented soaps, body washes, bath gels

6. No fabric softener or dryer sheets on underwear