The pain in drinking

My wife has been BP for awhile. She was just diagnosed with BP last week. She rapid cycles. She as always used some form of drug or alcohol. We have been married for 10 years and have 2 daughters. Some times she only drinks a little, but other times she can out drink anyone. Tonight i tried to tell her about her drinking and the affects it has on her, my 2 daughters, and I. When she drinks she gets very argumentative and and thats when she hurts me the most. She blacks out when she drinks. When I try to tell her how im feeling, she always comes back to say. If your so unhappy, why dont you leave. also, what are the effects of alcohol on someone with BP. Just need some word of encouragement. Trying to learn how to communicate without fighting. thx

She is seeing a therapyst once a month. like i said, she just was diagnosed last week. She started taking depakote last week. She says it help alot. She is able to concentrate and verbalize better. Instead of being adjetated. How does alcohol affect someone with BP? When she drinks when not in a manic state, what are the possible affects?

hey turbulance --

often the reason that people with Bipolar I/II have substance abuse problems are -- feel like they are able to take back control (in some manner of speaking) with their lives because they are able to comprehend (sometimes unconsciously) that they need to "calm" down. the body works constantly to maintain homeostasis. unfortunately - the chemical process that regulates bipolar disorder (primarily) is dopamine. this neurotransmitter also acts in the "reinforcement" & "reward" center of the brain. thus, when patients with bipolar d/o have hypomanic/manic episodes, this stimulates the brain to do act in a way that rewards them (i.e., drinking) and to try to balance out the activity of the brain (i.e., alcohol is a chemical depressant). often patients that have bipolar bounce back and forth between narcotic/amphetamine abuse (in the depressed phase) and alcohol (in the hypomanic/manic phase).

the best advise that i could give for you to recognize is learning how to interpret when your wife is entering what psychiatrists call a "prodromal" phase. simply, these are the symptoms that present themselves before a major mood episode occurs. recognizing, identifying, and treating aggressively at this stage will often result in an easier life for both of you. additionally -- recently there was a study which documented that the greatest predictor for a mood episode (either depressed or manic) was sleep. make sure that your wife gets at least 6-7 hours of sleep a night (to achieve this, I tend to reccommend drugs like Ambien CR or Klonipin for patients that i see).

how is the depakote working? i've seen some great results with depakote -- but often the effects take a few days to a few weeks to fully exert its effect. you mentioned that she has had trouble concentrating and being distracted. has her psychiatrist ever looked at ADHD? i have found that this is completely underdiagnosed in patients with bipolar disorder.

one last thing --- please urge her to limit the drinking while taking depakote. there is a severe drug interaction with alcohol. if this drug is not being prescribed by a psychiatrist, you may suggest to have your wife's valproate level checked. this is a measure of what concentration of the drug is remaining in the body (an adequate response level should be -- 50 to 100mcg/mL

hope this helps - and please let us know if you have any questions.

best,
ckgMD

i'm glad that it's working --- meds really do work when people take them consistently.

Turbulance, I am so sorry to hear of your troubles. I will pray for you right now and your dear husband. I have a friend, more than one , I am sure, who is bi-polar. When he takes his meds and drinks , it is like he is not even taking his meds. Any Doctor that he has ever spoken to has stated that you must not drink while on the medicine. I also have alchoholic friends and family members......have you tried a family intervention? How old are your daughters ?

My brother stopped drinking , when , with the help of his doctor, had a family interevention. His two young boys told their daddy how his drinking made them feel . He went into extensive treatment and 4 years later has not drank. He goes to AA meetings in our little town twice a week. He had a atroke at 33 , which left him paralyzed on the right side. He is a great inspiration to others, hope you find some in my story. I would love to be here for you anytime. Join us on the chat sometime too. Oakley

oakley -- i am an internal medicine physician who has a particular interest in how physical medicine translates into/from psychiatry. It is an area of medicine which, i feel, is completely disregarded in the internal/family medicine arena. i believe that many of the physical complaints that plague patients (chronically) often have or are affected by psychological well-being (for example, sleep disturbances, back pain, etc.).

turbulance -- well, it sounds like there has been a improvement even over the past couple days. keep in mind that the goals of mental health treatments are rarely based on this miracle-overnight approach. they are targeted at which i term, "real victories". small and gradual steps which lead to a better life. sometimes the steps are smaller when you viewing them subjectively (i sometimes analogize this to children growing -- you don't notice how quickly it happens until you take a step back).

i believe that we are all so happy to hear that! there are many ways of enjoying better sleep "hygiene" that are not forced by medication. simple things such as --- only sitting/laying in bed to sleep or have sex, making sure that your bed is exceptionally comfortable and a restful place to be, taking the TV out of the bedroom, avoiding any type of food/drink (except water) at least 2-3 hours before going to bed, and (probably best) is making a consistent sleep schedule (this allows the body to program when it will get tired and regulate the sleep-wake cycle).

a great website for more info on this is --- www.sleepeducation.org

hope this helps - and glad to see that things sound like they're improving. hang in there!