How to break up with bipolar DP?

[tigerbear]

I've posted on here before about my DP, who is bipolar. (Apologies to all of the lovely posters who took the time out to advise me a few months ago, who had experience of being with someone with the illness. I'm afraid I disappeared from the thread when the general consensus - aside from a handful of posters who'd stayed with their DP/DH long term - told me that being with someone who has it is totally draining. At the time - about 6 months ago when DP was first diagnosed - I wanted to believe that he'd somehow, miraculously get better quickly on his medication, and that we'd get through it.

Now, 6 months down the line, he seems to be getting worse, not better. He says he feels that the medication (he's on the highest dosage of Lithium safely possible) isn't doing anything for him, and his mum and I agree.

Things have come to a head over Christmas, as he refused to come to stay with me and my family in my hometown, or to go to his mum's several hours from where we live (not together), saying he wanted to be completely alone in his flat for the entire festive period. What I thought might happen did happen, he had an episode, went off radar in terms of no/scant contact with me or his mum, and basically worried all of us senseless.
Over Christmas, I was with my 4 year old DD at my mums house (so couldn't just dash back to London to check on him), I had pneumonia, and also had a massive falling out with my brother on Boxing Day, which upset me massively, yet DP didn't contact me for 24 hours after I'd told him of the falling out, and didn't contact me for 12 hours after I told him Id been diagnosed with pneumonia.

God, I've just realised that this has turned into a massive post, so the upshot is, I'm so tired of the constant ups and downs, the lack of support when I need it, the worrying, etc, but how do I break up with him in a kind way? He's only just coming out the week long episode now, and is quite fragile. He already knows I'm upset with him for the lack of support and contact, and I feel guilty for being hurt and angry, when I know he has no control over his actions...

Psychiatric nurse here. The first thing I thought on reading this, and I think I remember your previous thread, is that is is not taking his medication.

It's such a great feeling being elated and euphoric, feeling special, that there are usually major compliance issues with people who have BPAD.

I'm thinking that this is why he is not getting better, and in fact getting worse. Feel free to ask me any questions.

He is not taking his meds!

It must be nigh on impossible to be in a relationship with someone who behaviour is so erratic and chaotic.

MrsChanning, thanks for your replies. He assures me and his mum that he is taking them, but of course we have no way of knowing this. This did occur to me over the past few days, as when I asked why he goes AWOL/doesn't get in contact, he says he has no concept of time, what day it is when having an episode, and I did wonder as to how he can then take his meds on time or at all. When first diagnosed, he gave up drinking, but now says he's been told that he can drink. Is he lying? Surely drinking whilst on Lithium isn't good??

Is he having blood tests to check lithium levels? I think they'd flag up if he wasn't taking them, but Mrs probably knows better!

Anchor, he was for the first few weeks, but I'm not sure if he's had them recently.

I'm a CPN OP, lithium bloods should be taken 3 monthly at a minimum. If he's not complying, they won't prescribe. Of course, it could be that lithium isn't an effective treatment for him. A medication review would be his best course of action in that case.

If you feel that you need to leave the relationship, do it. I've seen so many spouses driven to the brink with carer stress - your life and well-being is just as valuable as his. Do what you need to do to safeguard it.

Telling him you are leaving is never going to be nice. There is no nice way to do it but he is in all probability aware that it is coming. Do it face to face and as soon as possible.

Tell all his mental health team and the GP and anyone else who might need to know - possibly the bank or whatever.

Then just separating your stuff out. It takes ages anyway as you will probably be doing it from home without running away if you see what I mean.

BUT - pneumonia is grim - I've had it twice - and it can take up to 3 months to get over, so for gods sake dont hurry yourself.

MrsSmith - I believe that the practioners have noted that Lithium isn't doing much for him, and that he will be having a review to see what would work best instead.

We've only been seeing each other a year, and its been such a roller coaster (he was diagnosed 6 months after we got together). I think what is also swaying my decision to break up, is that we're on such different paths in a day to day basis: I have a 4 year old DD and am divorced (was with exH for 12 years); DP has never had a relationship lasting beyond 9 months before meeting me. I have a very demanding but very well paid fulltime job; DP is freelance and works very sporadically (increasingly less, as the illness has affected his capacity to work. I'm under the impression that his main client is on the verge of telling him there's no more work for him as the last few pieces he handed in were below standard); I own my own very nice flat; DP rents and has no intention of ever buying anywhere (nor has the means to), and frankly his place is like a student flat.

He's in such a low place, that I don't know how to tell him it's over...

Wally - thank you, but we don't live together, thank goodness, or have any joint finances.

Seeing as ye don't live together and he seems to be spending a lot of time on his own could you gradually just reduce contact and phase the relationship out. Rather than a dramatic break up in the middle of him having an episode. This is more for your sake as he may go all dramatic and cause you no end of hassle when he is in an elated mood. So when he finally comes back to normale levels you can have a definite split.

Just do it then. Inform everyone who is his support network and make peace with your decision. You are not up to saving him right now, so stop. Stop tonight, tell him you are going incomunicado (sp) for a while because you are just too ill yourself. He will understand and is unlikely to blame you.

June and Wally - thanks for the advice. As much as just phasing it out gradually is tempting, I think I'd feel worse if I just keep him hanging and unsure. He already kept asking me today before I left his flat, when he'd see me again and if I was going to leave him. We've already arranged to meet up after I finish work on Wednesday, so I guess I'll have to tell him then. I think he's already coming out of the episode, albeit very tired and hungover from NY...
His mum already knows that I'm unsure as to continue things, so I'll call her after I've seen him on Wednesday.

He'll have had frequent blood tests whilst the dose of Lithoum is titrated. Then tests every three months to check compliance, and that he isn't Lithium toxic. Would his care team be telling you if he wasn't complying? The Dr could prescribe other mood stabilisers like Sodium Valproate or Depakote, amongst others. Is he on an antipsychotic as well?? Tablet or injection?
No he shouldn't be drinking alcohol.

I agree he may be very good at secreting his medication (not taking it).

If you've got the energy tell him that the Lithium obviously isn't working and that his treatment regime needs changing. Maybe an antipsychotic injection is required to augment the Lithium. If he is v against this it may indicate he is not taking his medication. As it's more difficult to refuse the injection form of medication.

I wonder if he is heading for an inpatient admission the way he is going.

Sodium Valproate levels are monitored as well.

It needs treating properly. And maybe then you can make a decision about whether you can stay in the relationship without it impacting on your mental health too.

If he doesn't turn up to blood test appts it won't get prescribed. As well as if he is lithium toxic it won't be prescribed. The tests may show it not at a therapeutic level and he may be encouraged to take it by CPN, consultant before they decide to discontinue it.

Thank you Mrs Channing.
His mum goes with him to each appointment and is very involved in every step of his care, so I'm sure she would have been told if he was intolerant to Lithium or if the levels weren't of the right amount. he has told me he is desperate to get well and at a loss as to why the meds aren't working, so I don't think he's missing taking the medication by choice. As far as I'm aware, he isn't on anything else apart from lithium and sleeping tablets.

He may well be admitted if he continues like this. When he was first diagnosed, it began with him being admitted to a mental health unit for about 5 days.

MrsChanning, may I ask, in your experience, if having/being bipolar (I'm not sure what the correct term is), contributes to people being wildly innappropriate/saying inappropriate things, even when not having an episode?
He has said some really strange things to me, and I don't know if it's him or the illness saying it...

Yes to inappropriate stuff from someone with bipolar. Remember he may have been in a minor episode as it's one of the signs to watch out for.

Thanks June, that's interesting to know, as I've been really freaked out by some of the things he's said in the past, but didn't think he was having an episode.

I think you should end it gently. You have only been together a year and you have a small child to think of. I can't see what you're getting from the relationship. It is a sad state of affairs as he is obviously unwell but you are not that tied to him so I would leave him.

ThankGod - Yes, I have to put DD first. She's at the age whereupon she's very aware if I'm upset/worried/stressed, and picks up on negative vibes easily, as I guess all children do.

But I feel so guilty and sad at the thought of ending things with DP when he's already fragile.

My ex was in your position. He ended the relationship two weeks before Christmas because it became too much.

Strangely, your posts have been cathartic to me in helping me understand what went wrong, as the relationship ended so quickly. I'd have never wanted to have that much of a detrimental effect on his life and it's useful to read it from the other perspective.

Sorry this isn't adding to your thread! In terms of advice I'd probably tell him what you've said here. It'll be hard for him to hear (I hate myself for the end of my relationship) but it's better to be clear and final rather than keeping him hanging on.

I have bipolar.

If you're going to break up with him, break up with him the way you would anyone else. Personally, I think quicker is better - the sooner it is done, the sooner you can start to stabilise and the sooner he can rebuild his life around the people (his family maybe?) who can give him the structure and support he needs.

In my experience six months into diagnosis is nothing - I have now been stable for two years (no episodes at all!) but it's been a long journey in terms of finding the right meds and getting stable on them, not to mention coming to terms with the diagnosis and incorporating it into my life.

I like to think that BPAD isn't impossible to live with or hold down a relationship with. My lovely OH and I have managed 12 years so far, but we would both agree it has been a rough road at times and the two years either side of diagnosis were not a barrel of laughs for either of us. There's no shame is saying this road is not for you.

Lampshady and Tabsicle, thank you so much for your posts and for giving a different perspective. It is interesting - and heartening, if I may say so - that neither of you are bitter about your experiences, and that Tabsicle you have been able to sustain a long term relationship (I hope I don't sound patronising by saying that). DP has often said that he wouldn't blame me if I wanted to walk away. It's just a case of telling him now. It's so sad, we only celebrated our year long anniversary on the 21st December, when he took me out for an amazing meal.
Now I'm wavering, wondering if I should hang on a few more months to see if things change if he goes onto different medication...

Hello again :-))
Yes when a person has BPAD there interactions can be very inappropriate due to being disinhibted. But also because when unwell people with BPAD suffer with delusions, usually of a grandiose nature, sometimes paranoid or persecutory. They can also become psychotic. Hence a lot of people with BPAD take anti psychotic medication as well. It helps with psychotic symptoms and helps stabilise a persons mood. Hope this helps!

It must be so hard for you. Feel free to PM me if you need to.