Some sobering statistics: Depression has a much greater impact on marital life than rheumatoid arthritis or cardiac disease. Ninety percent of marriages where one person is bipolar ends in divorce. Person diagnosed with bipolar disorder have three times the rate of divorce as the general public, which is about 50 percent. This is all to communicate this message: marriages in which one person suffers from depression or bipolar disorder are extremely fragile. I know, I’m in one. Here are seven tips that have helped us and other couples I know defy the statistics.
1. Cut Through the Crap
If you are married to someone who is in denial, you have quite a job ahead of you. “I’m not crazy.” “There is nothing wrong with me.” “I am not taking meds.” These statements do little to move your marriage into the happy zone. In her book, “When Someone You Love Is Bipolar,” psychologist Cynthia Last, Ph.D. dedicates a chapter to the subject of denial and what you can do. She suggests giving your partner a book that he can relate to and providing literature on the topic. You could also try a scientific approach and provide some evidence in the form of feedback from his friends and family, a list of compelling symptoms (embarrassing photos are great), or a run down of the disorder in his family. He could balk at that, and tell you that you dress like his mother for even implying such things; however, you’ve done your job to try to educate, and that’s really all you can do.
2. Find the Right Doctor
I consider shopping for the right doctor much like buying your first house. Many components need to go into the decision—it’s not enough to like the bathroom tiles and the bedroom closet–and some bickering is to be expected. If you rush the decision, you might wind up living in a house that you hate for a long time except for the great bathroom tiles. Good doctors save marriages. Bad doctors destroy them. Good doctors help you get better. Bad doctor worsen your condition. If your partner is bipolar, this is especially important because the average patient with bipolar disorder takes approximately 10 years to get a proper diagnosis. About 56 percent are first diagnosed with unipolar depression. I know this topic well. I went through seven doctors and a ton of diagnoses before I found the right fit. She saved my life and my marriage.
3. Enter into a triangle relationship.
In any other situation, I hate threesomes. Someone always gets left out and people play dirty—at least they do at my daughter’s play dates. But for marriages that involve an illness like depression and bipolar, a triangle relationship with a doctor or mental health professional is essential. It keeps your partner honest, or to at least unfudge the truth. He reports:“ Feeling perfect. Meds really kicking in. All is going better than it ever has.” Then wifey comes in and spills the beans. “He has been curled up on the couch in tears for the last two weeks, not taking calls from any friends and skipping important meetings at work.” The triangle relationship also allows you some education about his condition. For example, you might not be aware of what a hypomanic episode looks like until you hear the doctor describe it. In some cases a mutual understanding of symptoms is enough for a couple to avert a full-blown manic or depressive episode because together you can take steps to change the course.
4. Abide by some rules.
My husband and I have several rules: I call the doctor after three days of incessant crying or no sleep. I tell him when I’m suicidal. He stays with me when I’m a danger to myself. However, the most important rule is this: I have promised him that I will take my meds. It’s like how Jack Nicholson told Helen Hunt in the movie “As Good As It Gets” that she makes him want to take his meds, she “makes him want to be a better man.” The truth is that many marriages get stuck on this one. Without a doubt, the biggest challenge we face in treating bipolar disorder is medical adherence, according to psychologist Kay Redfield Jamison. “I’d like to make the obvious point that I don’t think is made enough, which is that it doesn’t do any good to have effective medications for an illness if people don’t take them,” she said at the Johns Hopkins 21st Annual Mood Disorders Symposium. Approximately 40 – 45 percent of bipolar patients do not take their medications as prescribed. Come up with some rules, and be sure to include in there “medication adherence.”
5. Learn the language of the illness.
Sometimes I forget how hurtful my words can be when I’m expressing how anxious or depressed I feel. “I just want to be dead.” “I don’t care about anything.” “If only I was diagnosed with cancer and could make a graceful exodus out of this world …” Oh, no offense. Thankfully my husband knows that it’s my depression speaking, not me. He has been able to separate his wife from the illness. That is the result of lots of research on his part and a few conversations with my psychiatrist.
6. Keep yourself sane.
Spouses of persons with depression and bipolar unwittingly become caretakers for major chunks of time. And caretakers are at high risk for depression and anxiety. Researchers at Yale University School of Medicine have found that nearly one third of caregivers who are nursing terminally ill loved ones at home suffer from depression. A study in Great Britain found that one in four family caregivers meets the clinical criteria for anxiety. Pay attention to these symptoms: feeling tired and burned out much of the time; physical signs of stress like headaches and nausea; irritability; feeling down, deflated, reduced; changes in sleep or appetite; resentment toward your spouse; decreased intimacy in your relationship. Remember that if you don’t secure your oxygen mask first, no one gets air. If my husband didn’t take time to run and play golf he would be hospitalized alongside me.
Published originally on Psych Central.