My husbands pdoc prescribed Depakote for him with no mood stabilizer after diagnosing him Bipolar along with his PTSD.

Where I am wondering if the pdoc was correct, is in the medication. He was prescribed 1500mg. of Depakote and it only seemed to make the PTSD worse. He was very angry with the world, depressed, nightmares came back, and he was always tired on it too. Not to mention, previously he was taking Lexapro and was very stable besides a few manias and side affects in the bedroom (don't know why they took him off).

She has admitted to him that she has no experience in treating PTSD. His PTSD is from childhood experiences compounded with combat in Afghanistan. He wants to give her a chance so she can gain experience, I'm beginning to think it's not a good idea. He has almost totally given up on any kind of treatment. Not to mention, she wont let him see a therapist until he is stable, and he really wants to see one.

Anyone have any experience with combinations that work, or one medication that treats both conditions?

He has tried Prazosin and that didn't work. They tried Wellbutrin and Lexapro combination too, not good, ended up in the hospital for six hours with a massive headache, and concerns of a anuerysm.

So in doing a bit more research, I have found out that often Depakote is used for stabilization, however, it didn't seem to be working at all.

Very complicated cases where multiple medications are prescribed, like this, are best referred to a medication subspecialist. These folks are called a Psycho-Pharmacologist.

Your husband can ask for a referral to such a person.

NB Depakote, IIRC, is a mood stabilizer, often used in Bipolar or personality disorders or TBI/head injuries or PTSD (can look like bipolar/PTSD/personality disorder -- as all three syndromes are prone to rages and limbic instability/emotionality).

Yes, people with childhood stressors (via 'kindling effect') are more prone (vulnerable) to develop PTSD as adults.

Thank you for your response Queens. I will let him know, he pretty much has given up on meds, but is upset because he recognizes that he is a "jerk and anti-social" (his words) without them. I just hope I can help him find help that works.

What PTSD treatments has he tried? There are some newer and more effective treatments emerging.

Don't think the military (US or Canadian) uses them yet, though. As you likely know, the VA (veterans admin) health care system is pretty behind the times in many ways.

The newer programs I am talking about for PTSD include: (a) Dr. Peter Levine's 'Somatic Awareness' and (b) Dr. Pat Ogden's 'Sensorimotor Psychotherapy. (I am a personal fan of the latter as it really helped me a lot.)


Both of them have books out, too.

1. Dr. Peter Levine wrote "Waking the Tiger" and "Healing Trauma".

http://www.amazon.com/Waking-Tiger-Transform-Overwhelming-Experiences/dp/155643233X

http://www.traumahealing.com/



2. Dr. Pat Ogden wrote "Trauma and the Body".

http://www.sensorimotorpsychotherapy.org/articles.html

http://www.lifespanlearn.org/documents/Ogden-article.pdf

http://www.sensorimotorpsychotherapy.org/home/book.html

The VA wants him to go through group therapy with newly returning vets. He can't afford to sit in the hospital and wait so he hasn't gone. He also feels that it won't help, considering how his PTSD isn't dread of what he saw per-se. The only way he could see a psychiatrist without going to the group was in a study, and the meds (prazosin) in the study didn't work so he had to drop out.

His PTSD manifests with constant fixations on war itself, and nightmares. He also is hating everything that is mainstream due to his childhood abuse, long story, but raised in the south and his father did not support main-stream concepts, so teachers abused him.

Now he is using my insurance, mine is all we have since he is a contract employee. He can go just about anywhere but he is limited to 20 visits and this doc has already used 6 of them, and he feels no better off.


So now he ran back to his lexapro, and is temporarily tolerating the side-affects, though I fear he wont do it for long. So ultimately he has no treatment plan.

I will see if I recommend the books if he will read them

Thank you so much for the ideas.

Group Therapy (IPT) is one of the best therapies for PTSD, whether from childhood trauma or war.

Part of the reason is that PTSD people need to know they are not alone in their suffering, basically.

For me, 1:1 therapy for PTSD wasn't so good. (Although maybe I just had a lack of "trauma informed" doctors.)

Sounds like your husband has some help-rejecting complaining behavior issues, too. (e.g. people offer him help when he shows symptoms of suffering ['complaints'], and yet he 'rejects' it.)

That must be hard on you.

That must be hard on you.

To say the least.:p Thank you for being able to see that. A lot of people tell me "don't worry about it, it's not your problem, you have enough on your plate". How can I not?

Well, you seem to be taking on his stress and his action plan for recovery!

One thing that is often mentioned as good overall advice on this Board is reading up on the concept of BOUNDARIES. e.g. a husband does not have to worry about his recovery if you (and everyone else) will do it for him!

So, in a sense, 'property lines' are required. (Some of the co-dependency type vein of literature talks about this stuff, too. We can all easily fall into that at one time or another with people we care about. This can sometimes cause some rebellion, but we must protect ourselves, too, right?)

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"PROPERTY LINES"

A helpful tool in our recovery, especially in the behavior we call 'detachment', is learning to identify 'who owns what'. Then we let each person own and possess his or her rightful property.

If another person has an addiction, a problem, a feeling, or a self-defeating behavior, that is their property, not ours.

If someone is a martyr immersed in negativity, controlling, or manipulative behavior, that is their issue, not ours.

If someone has acted and experienced a particular consequence, both the behavior and the consequence belong to that person, not us.

If some one is in denial or cannot think clearly on a particular issue, that confusion belongs to him or her.

If someone has a limited or impaired ability to love or care, that is his or her property, not ours.

If someone has no approval or nurturing to give away, that is that person's property.

People's lies, deceptions, tricks, manipulations, abusive behaviors, inappropriate behaviors, cheating, and tacky behaviors belong to them as well. Not to us.

People's hopes and dreams are their property. Their guilt belongs to them too. Their happiness and misery are also theirs. So are their beliefs and messages.

If some people don't like themselves, that is their choice. And other people's choices are their property, not ours.

What people choose to say and do is their business.

What is our property? Our property includes OUR behaviors, problems, feelings, happiness, misery, choices and messages; our ability to love, care, and nurture; our thoughts, our denial, our hopes and dreams for ourselves. Whether we allow ourselves to be controlled, manipulated, deceived, or mistreated is our business.

In recovery, we learn an appropriate sense of ownership. If something isn't ours, we don't have to take it. IF we take it, we learn to give it back. We let other people have their property, and we learn to own and take good care of what's ours.

Today, I will work at developing a clear sense of what belongs to me, and what doesn't.

If it's not mine, I won't keep it. I will deal with myself, my issues, and my responsibilities. I will take my hands off what is not mine.

(Handout from Betty Ford Center)

Wow, I didn't ever think of it that way. Thank you! I will pass the info on to him and let him take it from there.

The thought of helping by not helping by not helping just seems so daunting to me.

Well I don't know how happy he will be to hear you are going to try to use some Boundaries. ;)

It was moreso posted for your OWN sanity. :)

A lot of times you will encounter resistance and rebellion, when you try to do some 'limit-setting'.

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re: support for yourself

IF he has 20 visits covered by insurance, do YOU also have 20 visits for yourself?

If so, you may want to go see someone yourself, for support. It can be very stressful caring for a sick partner with multiple diagnoses, and who sounds 'stuck', or who has 'learned helplessness', etc.

One thing that I do recall from my Public Health Nursing program is this: People who overcome (or master) adverse situations (illness, poverty, disability) *do* seem to take advantage of as many of the Resources in their proverbial 'toolbox', as they can. :)

Yes, luckily I do have 20 visits also. I actually am starting therapy on Thursday for my bipolar diagnosis. I was diagnosed four years ago, had been on meds for years and gave up on them. I never had insurance that paid for mental health sessions. Now I do, so I figure that learning how to cope with my illness as well as his will be all encompassing in my treatments. (not to mention constant check-ups on the meds should help)

She has admitted to him that she has no experience in treating PTSD....He wants to give her a chance so she can gain experience, I'm beginning to think it's not a good idea.

My first thought is to find another doc who knows what they're doing. It's admirable you guys want to let her learn on the job, but it's your lives she's using for training.

From what you've said, she's just grasping at straws and has no real plan for treating your husband. Sounds like he's at the end of his rope and you're about to run out of insurance, so you guys can't afford to go through the trial and error process.

..she wont let him see a therapist until he is stable, and he really wants to see one.

That seems like another red flag to me. Why would she deny him the help he needs? I'm guessing it's either that she doesn't want the therapist to see that she doesn't have a clue or she's trying to be the "hero" and save your husband herself.

Sorry if that was a little blunt...I'm sick of seeing people's lives ruined by bad doctors. Doctors are intimidating and sometimes we forget that we're the customer and can shop around for a better one.

Pretty much those were my exact sentiments to him when I began to see all of this starting to fail.

Pretty much those were my exact sentiments to him when I began to see all of this starting to fail.

Hmmm...and he still wants to stay with this doc?

If he's completely given up hope, he may feel like there's no point in switching docs because he doesn't think anyone will be able to help him.

If you did the research for him and found a doc, would he be willing to humor you and give it a try or is he totally dead set against it? Sometimes the thought of doing all that "work" to find a new doc & get an appointment can be too much if you're depressed.

I'm giving it a try to see if he will go to mine and my son's doc.

Part of the reason he went to this one in the first place is because of a referral. We don't need one, but he thinks that if another doctor refers him to them, then they would be the right doctor to handle the current issue.

If his appointment tomorrow doesn't go well, I hope he is willing to switch. He made comments today that he feels like he is doing the doctors work.

I used the boundary stuff last night and all of sudden he started doing his own research this morning (thank you Queens).

What would I do without the support and ideas of everyone here :)

Update:

He asked me to write a list for him of all his side-affects from his meds, so I did. To which his doc said "sounds like it's time for lithium." He had told her on numerous occasions that he does not want lithium, nor will he take it. He asked her about using Atypical anti-psychotics like Risperdal or something to counter the side affects of the lexapro since he feels like it works well. She responded "well, I will have to do some research, I don't know much about those drugs."

:mad: !!!!! I might be just guessing, but I think she is a new doctor (psychiatrist), and isn't using her colleuges like she said she would.

Anyways, he requested to see a counselor and stay on Lexapro, to which she said ok. He goes back tomorrow to see about meds to counteract the side affects.:D