QUESTION:
Dear Dr. Heller,
My daughter age 31 was diagnosed with bipolar disorder after having been hospitalized with a manic episode. She had recently been divorced and had to quit her job because she could no longer concentrate. She had convinced herself that a superior at this job was in love with her and was bordering on stalking him. There was no truth to this as far as we know. Prior to the hospitalization she demonstrated sleeplessness, picking at her face, paranoia and delusions. She has demonstrated strange eating behavior since adolescence (binge eating, occasional anorexia but no bulimia or any hospitalizations). She is a gifted writer and works as an editor and does some free lance writing. When she was very ill she was writing some very dark poetry.
She was placed on Depakote 1000 mg daily, and initially on Zyprexa 15 mg which was slowly decreased in strength until it was completely stopped about 1 ½ months ago. She appeared to be slowly normalizing her life ( ie. working a normal routine , doing some community work and seeing a few friends). During the past month, coincident with the seasonal decrease in daylight, she has been isolating herself in her room when not at work and is "working on a novel". She comes out only to eat and to exercise once a day. Her affect is flat, she doesn't care as much about her appearance as she did a month or so ago and she gets virtually no recreation at all. When not at work she is in her room. She refuses to go to her doctor which we have encouraged her to do but is taking her meds religiously. She has recently gotten new health insurance with this new job and is afraid to jeopardize her future with this new job by going to a new psychiatrist. She has informed us that it is none of our business. She had a hard time getting the job with benefits because of her having been out of work for 8 months following her hospitalization. She also takes vitamins , watches her diet stringently and is diligent about getting to bed at a reasonable hour. It takes her an hour to get to work and she won't leave home to be closer.
She seems overly dependent on us (her parents) and we are made to feel guilty if we go away for a weekend or to visit our other children. She doesn't do anything to contribute to her being at home. She will do her own laundry and will fix her own food if we aren't here to do it. She pays nothing for rent, food , phone , internet, etc. We have taken her on two vacations. She has her own car and pays for everything related to that. She had to come to MN when she first got ill and has virtually no friends here but has made no effort to find any either. She speaks to her friends back east on the phone in an animated fashion but has little or nothing to say to us. We are afraid that she will relapse if we ask her to get her own apt. She briefly looked for one when she got this job but decided that the stress of the new job was as much as she could handle. We fear that her over-dependence on us is unhealthy. She doesn't seem to be aware that her behavior is odd. What should we do?
Thank you . We are desperate.
ANSWER:
While bipolar disorder may indeed be present, it appears likely other diagnoses are
also present. The
screening test I use for my patients may be
of assistance.
Using a dawn simulator and light box seems an excellent choice for her to keep her out of
the seasonal depression.
Many patients complain that Zyprexa takes away their feelings, and that there is no joy in
life on it. Trying other options may be useful.
As a loving parent you need to be careful not to "enable" behavior patterns that
will result in her getting worse. It would be an excellent idea for you to see a therapist
and discuss this in detail.
