Anti-Psychotics?

[NBRiverGuy]

My PDw has been seeing a therapist for about 10 years off an on, but weekly for about a year. Her therapist referred her to a psychiatrist and her appointment was yesterday. Her therapist has made it clear that she is NOT a pill pusher, but that therapy alone is not working for her. The psychiatrist, based on a long evaluation and the therapist's notes, prescribed her an anti-psychotic. I don't know if she officially diagnosed her with anything, although my wife said that she ruled out schizophrenia and bi-polar disorder. When I asked, my wife said that the psychiatrist just said she had a general mood disorder. Now, I don't know if the doctor actually said that or if that's what my wife thinks she heard. Sometimes, she does not hear exactly what people say, and the doctor did not write anything down so who knows. I guess it doesn't really matter. I do not have any experience with prescription meds and I'm just wondering if anyone can tell me what to expect moving forward. I appreciate that she is trying, just a little nervous.

[moglow]

He may or may not have said anything of the sort, as you noted. She may have heard the voices in her own mind or could be underplaying the whole mess. Who knows. That said - no one can tell you what to expect. Whatever medication she's prescribed -and there's a HUGE selection to choose from depending on information provided to doctors- the effects can vary greatly depending on the person or the depth of their issues. There's typically a wearing-in and a weaning-off time while the mind and body adjust to this new intruder.

Thing is, from my personal experience, one needs to work closely and be very honest with prescribing physician on what's needed. It's not one size fits all by any means and can take some trial and error. Back when I was in need of medication to stabilize some ugly depression, the doctor was pretty diligent to match me with something that would help me and not jack up other problems [ex: prozac was mentioned but known to create sleep disturbances. Since sleep was an ongoing issue for me, that one was off the list immediately]. Then I think we tried zoloft, where I definitely leveled off but had a long string of days -not good or bad, high or low, just days. I flatlined mentally and THAT wasn't necessarily good either! Seems liek third time was the charm and even then dosages needed adjusting a few times. They were very upfront that I needed to try and take meds at or close to the same time each day, NOT skip doses or just stop taking them cold turkey.

For your purposes, I'd stay out of it. That's between her and her physicians, and if she fails to be forthcoming with information that's all on her. We're talking about brain chemicals here, it's all a crap shoot on what works best for whom.

[NBRiverGuy]

Thanks for the insight, moglow. I do not intrude on her therapy sessions other than the times when she has asked me to sit in, and have no intention of getting involved here. Sometimes she shares, sometimes she doesn't. I don't ask any questions or offer any insights when she talks about it because both of those things set her off, so I just listen and give little affirmative responses. Agree that it's between her and her doctor. I'm just hoping for the best.

[moglow]

Unless I'm badly mistaken -and I definitely could be!- no medication "fixes" personality disorders. It's not going to shotgun and fix everything, and "general mood disorder" can cover a whole lot of territory. Whatever the doctor ultimately decides upon, presumably the meds are intended to alleviate some of the more troubling behaviors she's experiencing so she can get more out of her ongoing therapy.

All you can really do is be encouraging and ask that she discuss any problems with her doctors.

[NBRiverGuy]

I'm definitely keeping expectations realistic. This new treatment doesn't change anything about my future decisions in the relationship.

[Cat of the Canals]

A generalized or unspecified mood disorder would usually be diagnosed when the doctor feels the patient meets the criteria for a mood disorder but they don't necessarily fit neatly into one of the main categories, like Bipolar or Major Depressive. It's pretty common for PDs to be misdiagnosed as mood disorders. (My maternal grandmother was diagnosed Bipolar, but was probably actually BPD.) It's also possible to have a mood disorder AND a personality disorder.

It's not unheard of for PDs to be treated with anti-psychotics, which are supposed to help control things like impulsivity, anxiety, and aggression. That being said, treating something like Bipolar with these meds make sense because that disorder arises from funky brain chemistry. With a PD, on the other hand, where the root cause of the dysfunction is less about "simple" brain chemistry and more about unresolved trauma and deep emotional immaturity, I can't see any drug fixing that the same way.

One other thing about anti-psychotics: I worked in a clinical setting where a large percentage of the patients were on one or more. These drugs can have some pretty gnarly side effects, and making sure patients were compliant (taking their meds) was a constant struggle. I would not be surprised if your wife takes the meds for a short while and then quits them because she hates how they make her feel.

[NBRiverGuy]

Thanks for the info, Cat. I honestly do not know how compliant she will be. She picked up her prescription last night, but has not started the meds yet. She said that she was nervous about them. I encouraged her not to jump right in out of desperation and that if she had any concerns about the medication (Abilify) to do as much research as possible, write down questions, and schedule another appointment with the psychiatrist before starting. She keeps saying, "I promise that I'm trying to get better." I have known this woman for 23 years and I believe her when she says that. I did, however, caution her that the pill was not a magic button that she was going to be able to push and fix everything. She still has to do the work.

[square]

With my husband, the antipsychotic gives him a bit more of a margin. So things that might set him off, he might feel only mildly irritated by, or perhaps will even roll right on by. He then has the option of exercising a bit more self control over his response.

He has in the last couple of years chosen to exercise more control. But it doesn't change his underlying resentments, suspicions, outlook of me owing him (for what, I dunno, it just seems to be baked into the personality), and so on.

So, it's nice that he just storms out of the room instead of yelling at me for hours. It's nice that he just glares at me instead of actually telling me he hopes I die.

And I'm serious, it really is an improvement. It's given me the space to change myself and improve myself. I've really regained a lot of myself over time. I remember the absolute horror I was living in, where I could not do basic self care or think about the future.

But it's not enough. The relationship broke. I know what the glare means, he's told me enough times, as loudly and forcefully as possible. I know what he's thinking as he stomps out. It's not so horrible but it's not enough. But it sure is helpful because now I'm strong enough to have started my plan to leave hopefully by end of year, hopefully sooner.

Just sharing my experience.

[NBRiverGuy]

Thanks for sharing that, Square. It sounds like your husband is a more outwardly hostile than my wife. She definitely has her angry outbursts, but they are usually delivered in a more self-pitying, self-victimizing and passive-aggressive way. You'll never understand my problems because you've never had REAL problems. Shortly after her mother passed away and I was trying to comfort her, she said, "Just you wait. When your mom dies, you'll know what real pain feels like." That kind of thing. All this stuff has been coming back to me recently. I haven't yet been able to process whether or not the relationship is too broke to fix.

[square]

Yeah, that's nasty. Incredibly nasty.

It took me a very long time to process and come to the conclusion I did. And due to being disabled and having a child (recently crossed into legal adulthood but not flown the nest) I've been slow about leaving.

We all walk our own path and this is mine.

[NBRiverGuy]

Yeah, that's nasty. Incredibly nasty.

It took me a very long time to process and come to the conclusion I did. And due to being disabled and having a child (recently crossed into legal adulthood but not flown the nest) I've been slow about leaving.

We all walk our own path and this is mine.

It is incredibly nasty, but I am just now seeing it that way. At the time, it stung but I was very dismissive. Just wrote it off as part of her grieving process. Sadly, that was 11 years ago and she is still "grieving".

[NBRiverGuy]

NB, have you looked up terms like Covert Narcissist, Covert Malignant Narcissist, and also cluster C PDs like AvPD, DPD ?

The passive, self-pitying approach sounds like it could be one of those.

I have studied up on covert/vulnerable narcissism quite a bit. She definitely has those traits. I came across this article the other day and it also fits her pretty well. https://crappychildhoodfairy.com/2021/12/08/cptsd-behaviors-that-look-like-narcissism/ Her mom was incredibly abusive, both physically and psychologically, up until the day that she died.
I'll look more into those other clusters. Thanks.

[1footouttadefog]

My spouse had a PD plus other diagnoses.

He takes an antipsychotic.  He is back on Quitiepine. He took Latuda for several years between.  At one time he was on ability/ aripiprazole.  It was early in the process of figuring it all out and was pretty horrible for us. 

I hope you have better luck. And if it's not a match, know they have a lot of things they can try.

[NBRiverGuy]

My spouse had a PD plus other diagnoses.

He takes an antipsychotic.  He is back on Quitiepine. He took Latuda for several years between.  At one time he was on ability/ aripiprazole.  It was early in the process of figuring it all out and was pretty horrible for us. 

I hope you have better luck. And if it's not a match, know they have a lot of things they can try.

How is he responding to the meds? Any improvement?

[moglow]

@NBRiverGuy - More to the point how is yours responding so far? Granted it's early days but are you noticing any difference, has she mentioned side effects etc?

[NBRiverGuy]

@NBRiverGuy - More to the point how is yours responding so far? Granted it's early days but are you noticing any difference, has she mentioned side effects etc?

She has not started taking it yet. She scheduled another appointment with the psychiatrist because she had a few questions that she wants answered before starting the medication, which I think is good. She is supposed to go back tomorrow.

[MaxedOut]

. Shortly after her mother passed away and I was trying to comfort her, she said, "Just you wait. When your mom dies, you'll know what real pain feels like."

Going through some very similar stuff to this *right now.* It is incredibly nasty and hurtful. It implicitly or explicitly can carry a lot of messages about us not being good enough (of course, again) about meeting their needs, that we don't care, that we should not expect emotional support when we need it, that we are ok to hurt just because we are hurting, etc.

[sunshine702]

I have a tightness in my chest right now because of the psychological stress.

My anxiously attached brain is panicking.  No safe place.  As an infant baby in danger as the adult I am going to survive this but I may need a therapist.

Hey guys// they keep telling us how awful we are and how we can't do anything right and aren't meeting their needs

How are things going for us?  Are we happy?  Are we getting our needs met? Are they doting and focused on us?  Trying to make sure we are pleased.

Because I am terrified to lose my relationship but this is the relationship and it is awful.  I don't feel heard.  I don't feel respected.  I don't feel cherished.  I want that going forward.  I don't want to be in pain any more