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Expert Q&A

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How can I help my bipolar husband not give up hope?

Asked by Jodi, Texas

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My husband's bipolar disorder was diagnosed several years ago. He has tried several medications and the side effects have far outweighed any benefits. Now he refuses to see a doctor about it because he thinks it's hopeless. Not to mention we have moved and discovered that there are few psychiatrists in the area, and the ones who will take him have a six-month waiting list. Our primary care doctor won't treat him for the bipolar (he asked). It is terrible to see him suffer from this disease without any relief in sight. Any suggestions?

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Mental Health Expert Dr. Charles Raison Psychiatrist,
Emory University Medical School

Expert answer

Dear Jodi,

Yes, I have a very simple and very important first suggestion, which is this: Look for another primary care doctor until you find one who will help your husband with his bipolar disorder.

Unfortunately, what you describe is quite common. In many places in the U.S. it is almost impossible to get in to see a psychiatrist because there are so few of us and such great need. If you live in a rural area the problem is intensified, because as a group psychiatrists prefer to live and work in big-city environments. Also, many primary care docs don't feel qualified or just don't want to treat serious mental illnesses such as bipolar disorder. I wander the country teaching other doctors about psychiatry, so I know what I'm talking about on this point from personal experience. On the other hand, some of the best psychiatrists I know aren't psychiatrists at all, but are primary care docs with a passion for treating mental illness. What you need to do is find one of those folks.

I don't have any magical formula for how to find a primary care doctor in your area who will treat your husband, but usually the best way to learn about doctors is to ask health professionals who work in your area. If you have a good relationship with your primary care doctor you might try explaining the situation and see whether a recommendation is forthcoming. Nurses often are excellent sources of knowledge about doctors. It is an open secret that within any given community, people who work in the health field know who is good and who is bad when it comes to caring for patients. And it has been my experience that nurse practitioners and physician assistants often are more willing (and more able) to treat mental illnesses than are M.D.s -- you should explore this possibility in your local area.

I don't know anything about your husband's condition, but I'm going to take your word and assume he has clear-cut and serious bipolar disorder -- that he suffers from repeated depressions and manias. For anyone in this condition, finding effective and tolerable medications is of utmost importance, because medications really are the first line of defense against this horrible condition.

Lots of studies show that medications not only treat depressive or manic episodes but also help prevent these episodes from happening in the future. In the case of lithium, data show that it reduces the risk of suicide. More than this, it seems to actually increase patients' life span above and beyond preventing suicide. This is important because, on average, people with bipolar disorder die anywhere from seven to 10 years younger than people without the condition.

All psychiatric medications have side effects, although some people have much more bothersome side effects than others, and everyone is different in terms of medication tolerance. This is why it is important that your husband find someone who can help him find a medication that helps -- and doesn't bother him so much that it isn't worth the trouble. No one knows in advance what that medicine will be; it is simply a matter of trial and error built around doctor-patient teamwork.

I started with a suggestion; let me end with a strong word of encouragement. I know from many years' experience that your husband is very likely to find something that will help him if he just doesn't give up. You can tell him that from me.

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