Medication advice?

[tm006f]

My husband has BPD. I believe he also has an anxiety disorder.  He has panic attacks and he is constantly stressing out about something.

I really feel that he could benefit from medication (and that our relationship could benefit if he were on medication).  However, I'm worried that if I bring up/insist that he go on medication, it will not go well.  He is very anti-medication in general and I feel like if I am the one to tell him he needs medication, he will either not take it just to spite me or he will go on the medication, take it for a week, declare it has done nothing and stop, or even if he continues to take it, he will periodically throw it in my face when he gets upset ("I'm on medication because of you, you do nothing for me!".

I asked our primary care physician to discuss with  him.  I didn't mention BPD, but did tell him about the panic attacks and general anxiety.  Our doctor did evaluate my husband and recommend medication, but my husband has done nothing about it.

I know some people have given ultimatums ("take medication or I'm leaving".

Are there any folks who have found a more gentle way to encourage their partner to take medication?

Has anyone had good results?

I'm not sure if I'm hanging my hope on something that may make no difference.

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[Ceruleanblue]

BPD/NPDh did exactly some of the things you said your husband might do. Threw it in my face, and went off meds. He ended up back on them after his psychiatrist prescribed them. It has helped "some". I think in some cases it might make in big difference, but in BPDh's case, it wasn't a huge game changer. The first doctor that gave him meds, said it would help take the edge off, and I think that's all it has done, even with the high dose he's on.

I think those who do best are not in denial, and really want to get better. DBT also didn't help BPDh much, mostly because he is in denial, and because he didn't really put in any effort. He used it as another place to vent, and complain, and blame me for all the issues in his life. In other words, there was no ownership or effort to work on himself. He even managed to triangulate that therapist, I feel. She was "let go", and there was some shakedown at the DBT place, and we have yet to hear back as to when BPD can get a new therapist.

My thinking is that meds are always worth trying, but the trick is how to get someone so anti drug to want to take them. BPDh made the decision on his own, but I do think he has moments of blaming me. Funny how he can discount all the craziness, and chaos in his life, way before he ever knew me.

[TheRealJongoBong]

The only way I got my wife on meds (for a brief period, but it did help) was when they were basically forced on her while she was in involuntary psychiatric evaluation. I wish she would have continued the meds and therapy for longer than she did afterwards, but that's another story.

[maxsterling]

This is a difficult subject to approach. Other than letting him know medications are available and could help him feel better, there is not much more you can do.  Question - does he self-medicate at all (drugs/alcohol)?  Does he complain about feeling depressed or anxious?  If he complains about depression or anxiety, at that time you can very gently suggest he consider meds.  THEN DROP IT.  An ultimatum will do you or him no good.  Any further pressuring will be telling him something he already knows, and will upset him. 

My wife has been on meds for a few months now.  She had been on meds previously, claiming they didn't work, or abusing Xanax, and that got her nowhere.  It took a few friends to admit they take antidepressants to convince her it was worth another shot.  I completely stay out of it if I can. 

[tm006f]

Hi Max, he does not self medicate.  His coping device is blowing up with anger and hitting himself/belittling me.

I feel like he has poor insight, so even hearing other people are on medication, I don't think he would get it.

He does have other issues, such as anxiety.  He has panic attacks.

Thanks for your feedback.  This is a tough one.

[maxsterling]

Hi Max, he does not self medicate.  His coping device is blowing up with anger and hitting himself/belittling me.

I feel like he has poor insight, so even hearing other people are on medication, I don't think he would get it.

He does have other issues, such as anxiety.  He has panic attacks.

Thanks for your feedback.  This is a tough one.

What helped my wife was hearing about friends who are on medications and claimed they help, having our MC repeatedly ask her about medication, and enough people helping her understand there is no shame in taking meds.  Not that she is thrilled about taking SSRIs, because she is a "quick fix" type of personality.  She is a former heroin addict and wants to feel a "rush" or numbing effect.  Xanax calms her instantly - she likes that.  But the up and down becomes hell enough that eventually she becomes dependent and irritable. 

I think the very best that could happen is if your H could meet someone who has similar issues to him and has been helped through medication.  The problem is, you can't be in that role, because he will view you as having ulterior motives and become resentful. 

[waverider]

Meds can be ok for crisis management to get them to a stable state so that they can better apply themselves to more therapeutic management skills.

The all or nothing nature of BPD often means the meds themselves become a crutch to lean on. Xanax is a panic med, but is highly addictive and can cause more problems than it solves. Valium and similar are slower acting versions that doesn't have the quick fix of xanax, but it does become a dependency crutch.

Psychiatric meds need to be monitored by a psychiatrist, GPs can often be out of sync with them.

Ultimately meds are not the answer, just a stabilizing aid until better methods can be learned.

It could be that your H has an insight/fear about becoming dependent on meds.

[maxsterling]

+1 to what waverider said.  Meds won't solve the problem.  But meds can be part of the solution.  I don't think my W stood any chance of working on her problems when she was self medicating with street drugs and alcohol.  And I don't thing she stood any chance of working on herself when she was 100% off everything.  She's just too unstable.  It was actually urgent care that got her on Xanax, then GP prescribed it to her after that.  Before that, she was getting meds from a mental health clinic.  The meds were free, but she didn't get too much 1 on 1 attention.  If W complained they weren't working, they'd just start her on something else.  Prior to meeting me, she lived overseas, and said she was on Xanax for years - given by GP because Psychiatry was expensive there.  I think her current (relative) success with meds comes from having an actual, regular Psychiatrist who knows his meds and knows what he is talking about.  W trusts him and I don't push her.  I have commented that she seems much calmer now, and I think W agrees.

Is your H open to any kind of help?  Even online help or a peer support group?

[tm006f]

Hi again Max, my H is open to some help, sort of.  A year and a half ago, I threatened to leave him because he broke a glass by throwing it.  He happened to throw it right near our cat and I told him I was leaving before anyone got really physically hurt.  He, of course, pleaded that he would change and begged me to stay.  Stupidly I did.  I was pregnant at the time, but didn't know it.  I think that may be the biggest regret of my life.  Why didn't I leave?

Now I feel I can't leave because we have the baby and while his behavior is very disturbing to me, even our couples' therapist has said that if we split up, neither one of us would likely be able to get sole custody and I don't want to risk having to spend one day without the baby.

Anyways, when I threatened to leave, I told him I would only come back if he went into therapy.  He did.  However, recently he has told me his therapist is "helping" him see that he is not really the problem.  He says that for 12 years, he always felt like he was the one with the problem, but now he sees it's me.  First, he has always told me I'm the problem.  Second, I really don't like that what he is getting from therapy seems to be the idea that he has no responsibility for our problems.  I doubt the therapist is telling him this, but this is the idea he's getting.  Another issue I have is that his therapist seems incredibly flaky.  She cancels only very frequently, often at the last minute.  I did end up texting her today to ask her to contact him about an appointment (he hasn't been to see her for 3 weeks) and I told her he has hit himself twice since the last time they met.  She agreed to contact him.  I'm sure if she tells him I contacted her, I'm going to have hell to pay, but I just didn't know what else to do.  Even if I don't think his therapist is that great, I at least feel she is giving him some level of support, which is something.

I have also pushed him into going to couples therapy.  We have seen three couples' therapists in the past few months.  The last one was a DBT specialist, which I sold to him as "she can help us learn to communicate".  He only agreed to go because he says I have a communication problem.  At first he told me I should go by myself, since I'm the one with the communication issue.

So, basically, he is "open" to getting help if he is pushed and prodded to me, but so far nothing has been particularly helpful.

[waverider]

I dont think he is open to help in therapy, he is seeking support and empathy to validate his victim stance. My partner did this for a long time, and still does to a degree.

It prevents ownership and hence recovery. Looking for quick fix rescuers, rather than learning self help skills. It is an avoidance coping mechanism

No doubt he tells the therapist leading nonsense, her judgement is based on this, and whatever she does say is translated through his nonsense filtered hearing, and related to you. So yes, you are right to not take too much notice of what he says she says.