Medication and a PD chosen relationship journey

[Smooches]

I came across this forum while looking for "mop up" strategies, as we are figuring out the last behavioral hang overs from untreated PD.

I am the non PD member of the couple. My partner had antisocial, which, when they had bad anxiety, produced paranoid behavior.

From the outset of dating, I was clear that if we were to have a future together, it would be with working medication, as their PD emerged in concert with anxiety levels.

It took a year but everything PD goddamned vanished. The blame, the gaslighting, the inability to remember what happened when they were at their worst.

For me, I had a very heavy level of distrust for my partner's therapist. An MD holding psych doctor, the therapist had prescribed a lot of medicines that all did the same thing, modifying seratonin and dopamine.

And after 20 years, my partner, whom I was casually dating at the time, had internalized that nothing could be better.

The PD came with a depression and ADHD diagnosis. For me, that was a bit of a red flag that there was an unaddressed nuerotransmitter issue, because the problems were so massively affecting every facet of their life, but they did a big DNA test via a medical doctor and there was no disorder. This had been from early childhood onward.

My partner decided to try a glutamate antagonist drug. These have been popularized by the ketamine boom, but there's a bunch of glutamate antagonists, like amantadine for a non-controlled generic, or dextromethorphan for an over the counter option (with Dr's. oversight, obviously)

So we tested with cough syrup, which was okayed by the doctor, 35mg, extended release. And within an hour and a half, the raging machine that drove the antisocial actions and reactions, it quieted.

The long term benefit of a glutamate antagonist is that the brain generates more connections. This can take a few months of cumulative healing to add up, but the social skills that never developed, the inability to remember things, those healed alongside the brain.

Now, we have a really cool nurse practitioner who oversees the glutamate antagonist treatment as a specialist who focuses on anxiety, alongside the regular therapist, who oversees the depression. And it's incredibly good. My partner is an introvert forever but now an introvert who can enjoy a party for an hour before needing a break, or can be on a group phonecall without craving a Xanax or a beer to get through it.

I am a long time Al-anon meeting attender, so I did a lot of the grey faced responses, boundary setting, no JADE, avoid thee "merry go round". But that just kept me from going nuts and getting pulled in, it helped my partner not be enabled but it did nothing for their day to day suffering, which was significant.

In the end, we were able to move forward with our relationship in a healthy way because the underlying disorder thoughts and feelings were addressed with generic drugs.

I think it helped that from very early on, I called them out on their behavior and said "not sustainable. We are great when you are stable but the majority of the time you are not stable. If you are willing to work creatively with a doctor, even if things get radical, I will be behind you 100%".

We got lucky that the cough syrup test identified the problem, and the problem was really limited to one big nuerotransmitter problem. There's more possibilities for improvement, in both of us, but it's now manageable and we are happy, instead of me constantly "on read", waiting for the good day, the stable morning, where the person I love can be the person they want to be.

I wanted to share that just because a doctor says something is untreatable doesn't mean they are right.

As we waded through the complicated history of disordered personality and mood, retrospectively, we found a pattern that the way my partner had abused alcohol (specific binge drinking pattern), a muscle relaxer, and cough syrup, all had the same effect: glutamate antongist.

Their psych doc had never looked at the pattern and said "wow, what might all this self medicating have in common?"

So, looking backwards, my partner had been most productive when they were abusing substances. Now we know why my partner was the only person I ever met who functioned BETTER as an addict, which was bizarre, and they were deeply, deeply ashamed of bring a serial addict.

If a PD partner is open to treatment and doesn't want the circular arguments and never ending pressure and conflicts, they want relief, it can be possible to work through it.  Modern neurology is not what it was 20 years ago. While there's not a lot of neurophychologists out there, they exist and it's worth a shot if you love the person in between the rages and retreats and stonewalling and panic attacks.

I don't think it is likely to maintain a healthy relationship with an unmanaged major PD. But if management is realistic, a relationship can be the support system that gets the PD person enough remission where healthy is an option.

[Defiantdaughter1]

It's very interesting that the medication improved memory and concentration. I'm glad your relationship is in a better place,  and I hope it continues to grow into something sustainable and healthy. I wonder if your partner had childhood trauma. I think memory loss and lack of concentration are affected long into adulthood.

[MaxedOut]

Thanks for sharing and interesting details. My SO started Auvelity (which has dextromethorphan) about a year ago and some of the behaviors and depression are better. Not great, but better. She still has the same PD traits but a few of the more extreme splitting and volatile behaviors have not happened lately. I am hesitant to label it change as she often goes through longer cycles on those.