Informed Consent

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Dear Dr. Darcy:

I have encountered situations where I have dated someone and ended up using their bathroom and seeing medications out in the open that are anti-depressant medications. Some [of the men] have been open about suffering from anxiety or depression, [however], the person I am [currently] dating did NOT share anything with me [about these] medications. I happened to remember the name and I looked up one and it is an anti-psychotic that treats everything from bipolar disorder (yikes!) to anxiety. He has also not mentioned being in therapy or anything (though maybe he is and is not comfortable sharing this.)

Being that certain psychotic disorders are really scary- especially if the person ever has to go OFF the medication (AS HAPPENED TO SOMEONE I KNOW- halfway through the marriage the woman went off the meds and became a monster and they divorced) how do I bring this up? Frankly, I’d rather find out now.

ANSWER

Anti-psychotics are no joke, and let me tell you: If I were dating someone and stumbled upon said medication, you better believe I’d be leaning into that conversation no matter how uncomfortable it made me feel – particularly if I were a heterosexual given the genetic component of psychotic disorders and bipolar disorder.

I don’t think the guy leaves the medication out unless he fully expects you to look at it and initiate a conversation about it. That’s my feeling. So I’d have very little hesitance in asking, “So how long have you been on Risperdal?” in the hopes that he would participate in a conversation about it. If he doesn’t, that tells you something about him. If he does, make sure you know what he’s being treated for.

Once you have all your information, it’s up to you to decide whether to continue seeing him or pull the plug – but at least you’ll be making an informed decision at that point.

Writer’s Stats: Female, Straight.

Dirty Little Secret

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Dear Dr. Darcy:

I spent my childhood in and out of hospitals and therapists’ offices because I was diagnosed with bipolar disorder. The amount of medications that I was on is too high to count. There were times when I was so drugged up that I was literally drooling and hadn’t noticed.

When I went to college I met a therapist who thought I was misdiagnosed and with his help I came off all my medications. That was 10 years ago.

I’m now in my late 20’s and in a very loving relationship with a man who has no knowledge of my former diagnosis. The problem is this: In the last year, I’ve come to think that I probably do have bipolar disorder, but I’ve been managing it by making sure I don’t give in to the manic impulses (I make sure I sleep even if I’m not tired, I don’t spend money I don’t have, I don’t cheat on my boyfriend even when I’m feeling super sexual) and by making sure I take really good care of myself during the dips in mood (I eat even when I’m not hungry, work out regardless of how I feel, never miss work).

I recently learned that my boyfriend is going to propose to me. My question is this: Do you think I need to tell him about my diagnosis? Even if I’m managing it OK?

ANSWER

Let me start by saying that what you’re doing to manage your disorder is 100% spot on. It takes enormous self-love and self-discipline to do what you’re doing without the help of medications and I’m deeply impressed by your commitment.

With that said, there is no shame in being properly medicated. If you’ve come to believe that you truly have this disorder, I would suggest seeking out a psychiatrist who is very conservative in what they prescribe (I can give you names in NYC if you’re local) because a rogue cycle could really put your relationship at risk. Which brings me to the boyfriend.

I think it’s bad for your self-esteem and for your relationship to keep this a secret. The message it sends to your self-esteem is that having bipolar disorder is something to be ashamed of. And it pretty much sends the same message to the boyfriend, who will eventually learn of the diagnosis, probably after you’re married – at which point he’ll feel lied to. Trust in him enough to tell him. He deserves to know your medical history. If you’re going to marry him, it’s his right.

Writer’s stats: Female, Straight.

Adult ADHD

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Dear Dr. Darcy:

My wife has been nagging me for years to see a doctor because she thinks I have ADD [attention deficit disorder]. She’s mad that I’ve been out of work for almost 6 months and am not Mr. Mom now that I’m home all day. Her attitude towards me has gotten so bad that I don’t even want to have sex with her anymore.

I’ve wondered on and off my whole life if maybe I have ADD, but I don’t want to see a doctor who’s going to put me on medication that will change who I am. I want to be Me, even if being me is flawed. Do doctors ever just prescribe therapy without drugs for ADD?

ANSWER

Good doctors do. Most do not.

It’s much easier (and more lucrative) for a psychiatrist to write out a prescription than to turn away a new patient / refer the patient out for therapy.  And most psychiatrists aren’t trained themselves to provide therapy, so the alternative to writing out a script would mean losing the patient. You can see how this sets up a conflict, right? But let’s get back to you:

You’ve got a problem, and it’s not just your wife. It takes 2 people to nag: One to ignore and the other to nag. If you’d do something different, she would too. You sound like you’re in a power struggle and that there’s a parentified dynamic going on with your wife playing the mom role and you playing the child role. No one wants to sleep with Mommy, so it’s no surprise to me that sex isn’t happening. Know that it’s within your control to make a decision to act differently which will, over time, result in her acting differently.

Now if your behavior is beyond your control, it’s time to see a shrink. Start with an ADHD specialist to determine whether or not you meet criteria for the diagnosis. If I were you, I’d see an LCSW or a PhD. I would not see an MD/psychiatrist for the exact reasons I described in the first paragraph of my response. If it turns out that you do have ADHD, I strongly recommend that you first work with your specialist on ADHD coaching to learn how to compensate behaviorally for your disability. Once you’ve got some new behavioral patterns in place, I’d suggest you consult with the shrink to see if he/she still believes that you need medication. At that point, I see no reason why you shouldn’t introduce a low dose medication to use in conjunction with the ADHD coaching. Used together, you are much more likely to have a positive prognosis.

I understand that you don’t want to change who you are. ADHD medication shouldn’t do that. I don’t think I’ve ever worked with a client whose personality changed as a result of ADHD meds. With that said, you keep yourself at a disadvantage in your refusal to determine once and for all whether you have this disorder. If you have ADHD and you're not being treated for it, it's like trying to drive a car on square wheels. Get yourself an evaluation so that you know what's what and then get to work on your marriage and on your career.

Writer’s Stats: Male, Straight.