Coming off meds

[Inquisitive1]

My dBPD wife is a high functioning BPD with a history of substance abuse. We've been married for decades. Finding her diagnosis and this sight a few years ago has really helped. Recently, we've become empty nesters as our youngest has moved off to college.

For years she's been on multiple prescription meds to the point where I wonder if she's abusing them. On the other hand, I know she suffers a lot, and can't begrudge the meds that help. A couple of years back she went through a few difficulties including losing her father and a job. After that, she spent a lot of time in bed watching TV.

Recently, she's started to show a bit more energy. And she's talked about coming off her meds, which she feels dull her affect. She says she tried to make an appointment with a psychiatrist, but never got one--another doctor handles her multiple prescriptions. So, she decided to take herself off them several weeks ago. Last week, I started to notice her getting angry about little things. Any small infraction on my part was met with a strong response. Knowing she was coming off meds, I kept my mouth shut for a while. Then I said something about how recently she'd seemed to be getting angry very easily. She correctly understood the implication that it was due to her coming off meds. This made her feel betrayed, like i was using that against her. I really wasn't trying to use it against her, but I can see how it would feel that way.

How can I tell her when she's being over sensitive, without pissing her off? Maybe I need to study up on the SET technique or something like that.

I want to support her coming off meds, but she should be working with a psychiatrist. I've mentioned this a few times, but she ignores it. She's tried coming off meds in the past and it hasn't worked. I think it might work now as some of those bad things are further in past, at least decreasing the meds. But, I don't think she's giving it the best chance trying it on her own.

Any advice on how to express that to her in a way she'll hear?

Today, she called me several times at work. She was upset and wanted to fight. I guess I need to set some boundaries. Not calling me at work about 'hot' topics is definitely one boundary I plan to set.

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[Naughty Nibbler]

 
Hey Inquisitive1:  
Sorry for the situation with your wife.  :)o you know if she is using some strategy to go off the meds, perhaps titrating off them?  Quitting some psychiatric meds too quickly can send you in a tail spin.  Some people tend to get Fall/Winter depression.  If your wife ever had those tendencies, it might be a bad time of year to go off the meds.  If she is taking multiple meds, getting off them alone can have unintended consequences.

Your thoughts about consulting her psychiatrist are valid.  Some counseling might be helpful at this time, as well. Her meds may have dulled her emotions.  Going off the meds is going to test her emotional management and coping skills.  If she relied mostly on the meds to do the work, she probably needs the guidance of a therapist to transition. Although many people get their prescriptions from a primary care doctor, a psychiatrist is better equipped to relate to the specific issues with the type of meds you wife is likely on.

Here is a link to some possible things people can do when they feel distressed.

www.dbtselfhelp.com/html/panic_list.html

Some validation should be helpful to use along with SET.  Perhaps when you discuss a boundary with calling you at work, you can broach the subject that she may be feeling anxiety and perhaps discuss some alternate things she can do in place of frequent phone calls.

[Inquisitive1]

Thanks Naughty Nibbler,

my wife is using some sort of titration approach. She learned this from a psychiatrist she had in the past. The psychiatrist stopped seeing her because of too many missed appointments. In the past she's reduced her dose too fast. I've mentioned going super slow a couple of times to her, but she mostly ignores those comments. We'll see how it goes this time.

She does not self-harm. Sometimes she has suicidal ideation, but not lately. So I won't use the specific page on dbtselfhelp.com you provided, but I might share the overall site with her. Do you think that is a good DBT self-help site? Are there others of which you are aware? Any pointers on how to provide this material in a way that minimizes the chances of pissing her off and maximizes the chances of her giving it a try?

She seems to ignore my suggestions to connect with psychiatrists or therapists. So, I'd like to provide her with links to a few high quality self-help sites.

I took a quick look at the workshop on SET--Support Empathy Truth--definitely helpful.

[Naughty Nibbler]

The DBT Self Help link I previously referenced, seems to be the most inclusive one that I'm aware of.  Others might have some suggestions.  If you look more closely at the specific link I gave you, there are several categories of suggestions for various types of emotional dysregulation (not just for someone who is self harming)

HERE IS A BOOK AND ACCOMPANYING WEBSITE THAT CAN BE HELPFUL
THE HAPPINESS TRAP (Based on ACT Therapy):
You can buy the book in various forms at Amazon or other sources.  If you go to the website below, you can print out several handouts/workbook sheets:

www.thehappinesstrap.com/free_resources

This website is a cognative therapy website in Australia
https://moodgym.anu.edu.au/welcome

This website has some tools to track anxiety, moods and some some behavior changes
https://abctracker.anxiety.org/

Mindfulness, meditation and hypnosis can be helpful.  Here is a link to a visual meditation that could be a starting point.
https://www.youtube.com/watch?v=N0Lo5tUXkVI

What are her specific issues?  Stress management, depression, anger, fear, etc?

[Inquisitive1]

Thanks again nibbler. Of all the resources you provided. I think the DBTselfhelp.com site is the best match for she and I.

So how do I broach this with her? Is there a workshop related to that?

If I email it to her, she may ignore it or reject it out of hand. She seems to completely ignore me lately when I suggest she see a therapist. Not sure how to proceed.

[Naughty Nibbler]

Inquisitive1:
Try and find a time when she is more approachable.  Let her know that you realize it it important to her to be successful with lowering or getting off some (or eventually all) her meds, and you want to help her be successful with it.  Tell her you want to explore some self-soothing tools along with her. 

The first link on the DBTselfhelp website deals with "improving the moment".  Perhaps you could talk about her impulse to call you too much at work.  She may be doing it because she feel anxious and needs some comfort.  In order to set a boundary to limit her number of calls, it would be good for her to have some alternate things to do to sooth herself.

www.dbtselfhelp.com/html/improve_the_moment_worksheet.html

This 2nd link on the site, has some ideas of alternate thoughts.

www.dbtselfhelp.com/FindingAlternativeThoughts.pdf

Has she used any healthy means of self-soothing in the past?  Even mentally healthy people need those types of tools.  Does she get any exercise?  Maybe there is some form of exercise you can both do together?

[waverider]

Fear of handing control and judgement over to someone else is probably behind this reluctance. My wife is the same. Unfortunately the patient is not the best person to judge progress and effects as they are not objective enough.

Some side effects may be directly attributed to reduction in meds, others are more indirectly related to insecurities surrounding have these coping mechanisms taken away. This is one of the reasons for withdrawing slowly so that the patient gets used to the idea. Unfortunately the black and white nature of pwBPDs doesn't lend itself too well to this approach. Its either on them or off them.

The more you try to convince, the more it triggers the fear of handing over control. It has to feel like her idea. Most importantly you need try to avoid it becoming a major obsession.

Nearly everything my wife has withdrawn from she has jumped back on or at least substituted with something else just as bad. So now i just leave it to her, nothing I can say seems to have a lasting effect other than to drag me into the whole medication obsession.

Its not the specific med that is the issue, it is the process of needing external soothing that is the issue. addressing that is like swatting shadows

[Woods77]

Might be too late but you could do with a visit to the doctor as you shouldnt just come off meds it's a terrible idea to just stop, it's harmful to your system and can have massive side effects. You need to be weaned off, dose lowered over time otherwise it's full of side effects and will be just awful. It's a bit late now I imagine but you are meant to be weaned off at lower doses for weeks.

From my experience meds do not work with BPD but most BPD have depression so it helps with that, so they are needed.

DBT is available as therapy and is kinda the only recommended thing. How can you bring it up? You could say look you know she's not well and you've been trying to help and looked online and discovered BPD. Then find a site which lists the symptoms of BPD and ask her to see what she thinks. Then if agree go to doctor with it, say we think it's BPD and want DBT therapy.

Unless you make some suggestion to a doctor they will often suggest it's just depression.

You can also mention it's not her fault and BPD has intense, uncontrollable emotions and with DBT she can do things to lower these intense feelings.

[Inquisitive1]

Nibbler, she stopped calling me at work after that day. I'm really pleased she respected this boundary, shows self-control. The downside is we haven't talked on the phone since then in a meaningful way. So, suggesting she use dbtselfhelp.com site is going to have to wait until things are better between us. I will look for that opportunity.

She has increased her exercise recently, she knows that helps with her emotions, which is good. I have to walk a very fine line when encouraging her to exercise or I risk her annoyance for being too pushy. I would really like to establish an exercise routine with her, but my attempts at that have failed to date.

Waverider, i really appreciate your post. Like you, i find if I push her to do something, even if it's obviously good for her, like exercise, she pushes back and often doesn't do it. On the other hand, I think my off-hand comments may influence her. I'll state something once, like encourage her to exercise, but NOT go on about it, just state it when i know she can hear and leave it there for her.

[waverider]

The harder the sell, the harder the rejection, as the less they can take on credit for the idea.

Small nuggets do sink in even if there is no immediate reaction. This includes good suggestions as much as perceived "faults". These nuggets are then rebadged and reused down the track when, and if, they perceive benefit.

[Inquisitive1]

perceived faults, hmmmm, i'd never considered the small nugget approach to criticism... .criticism is generally not well received. Though I had some success the other night. She was getting very negative about one of our children. I wasn't buying into her scapegoating of our child and she was getting frustrated with my lack of agreement. Then I pointed out that I thought her approach of showing that child a lot of love, was going to be better than the current approach she was starting to take. She disappeared upstairs shortly thereafter, but I somehow think that point struck home.

She's been off meds for several weeks now. On the up side, she seems to have increased energy, which is a bit counter intuitive for someone coming off anti-depressants. This is exhibited by less hiding up in her room watching TV and more doing things around the house and going out for meeting for her business. On the downside, she seems a bit more manic, more intense about everything. More angry demands for instant compliance with her requests. The requests are reasonable, but it'd be much better if she could spend a little time trying to nicely convince me rather than jumping straight angry demands. I'll post more later.