Ask The Lacys

Hej, jag har en bror som är manodepressiv men han vill inte ta sin medicin och om man frågar honom om detta blir han föbannad. Han säger att han inte behöver den. Jag har på bästa sätt försökt förlara att han bör ta sin medicin men han vill inte lyssna.

Har ni något råd till hur jag kan förklara bättre så han förstår.

A:
Manic depression, otherwise known as bipolar disorder, is a chronic life long condition marked by periods of euphoric highs and depressive lows. Roughly half of bipolar patients have lack of insight and do not realize they are ill. Poor compliance with treatment is common. Patients often feel a natural high during the manic phase and it is very difficult to convince them that they need a med to bring them down to reality. Generally, patients have better insight into the depressive phase of the illness and are willing to take meds to improve their depression.

I view the issue of compliance in bipolar much like that of drug or alcohol addiction. There is little that can be done until the bipolar patient proves to themselves that they have the disorder. This process can take years and usually occurs as a result of much personal damage. Like alcoholism, family members often learn to avoid the bipolar patient in order to escape the cycle of problems brought by untreated bipolar. As an example, over 90% of those married with bipolar undergo divorce. Sorry to be pessimistic but this is a very hard area for a family memer to improve. Here are some recommendations:

1. Try to be helpful and loving when your family member needs support but do not go way out of your way to help someone who must make a decision to help themselves.
2. Avoid offering finances to help. If helping this way pay for product directly.
3. Do not bother rationalizing with someone who is already manic; they must come down from mania before being rational.
4. Take advantage of the periods of normal mood (such as the period following mania) to help improve insight and maintain the relationship.
5. There is some data to suggest that the patient should build a long-term relationship with their psychiatrist and that family members should be invited into the treatment (if the bipolar patient is willing to let this happen). This way family members can report to the psychiatrist when the patient is beginning to cycle into depression or mania. Here is a link.
--Dr. Lacy