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[quote=Anonymous][quote=Anonymous][quote=Anonymous]OP - I’m interested in how you figured out about the BP and the infidelity. I understand that you got an STI - is that what triggered it - that you got tested for some reason and then came home and confronted him and he confessed?  or did you have to drag it out of him?

Similarly - how did he get diagnosed? By primary care doc? By psychiatrist? By therapist (LCSW? PhD? other therapist)? Is he taking meds currently? If so, what kind - mood stabilizer? Anti-depressant? Is he taking them willingly? regularly? transparently? Do you attend psych appointments for at least part of the appointment? Does he also see a therapist regularly?

Answers to these also point to likely future outcomes. [/quote]
Yes, I had symptoms, got tested, got diagnosed, confronted him, and he confessed to the Craigslist encounters, which he said ended in 2018.  (I believe him for various reasons.)  Frustratingly, he never had symptoms and he tested negative.  Which apparently can happen.  There's nowhere else I could've gotten it.  But it still adds yet another layer of confusion to the whole ordeal.

He had been diagnosed with Bipolar II about 6 months ago by a psychiatrist.  His primary care doc had been prescribing meds for anxiety (Lexapro), but his anxiety was only getting worse, so she sent him to a psychiatrist, who immediately suspected Bipolar II and put him on lamotrigine.

DH never told the psychiatrist about the hypersexual episodes because he feared I'd find out somehow and because he downplayed in his own mind their significance.  I was actually the first one who tied the cheating to the bipolar diagnosis because I have a relative with bipolar disorder and am familiar with the hypersexuality component to mania.  I just didn't think DH had mania that extreme.  Like I said, I can't even discern when he's manic.

He has since told his psychiatrist about the sex, and the psych added mania to his diagnosis and prescribed lithium.  That was 2 weeks ago.  Yes, he takes his meds willingly, but I don't watch over him.  He has his first therapy appointment next week, which he's going to alone.  We both agree I should be included in the appointments eventually, but it's early days -- I have no idea how often these appointments will be.  So far, it's been very hard to get mental healthcare.  But he does agree that he can't self-report his own symptoms.

[/quote]

Your DH's prescription history really jumped out at me.  It is similar to my now exDH.  The primary care doc misdiagnosed him and put him on Lexapro, which is an SSRI.  SSRIs are known to trigger mania or make it worse.  This also happened to my DH (being misdiagnosed and prescribed an SSRI).  It definitely made his mood swings worse -- higher and more dysphoric and more sexual.  The first doc was entirely unaware that the medication was making things worse because the doc didn't incorporate me into treatment and because my DH was probably lying about the sexual aspects and thought the hypomania meant he was getting better.

The first psychiatrist your DH saw prescribed Lamotrigine, which is know as a "mood-elevating" mood stabilizer.  It's usually prescribed to bipolar patients or those who have had repeated episodes of depression or who haven't responded to SSRI trials (usually more than one).  If your DH was still hiding the hyper sexuality/hypomania, then that was a reasonable choice, I suppose.  But, it could be that the Lexapro accentuated the hyper sexuality because of its mood-elevating properties.

The lithium is the oldest medication (historically), but that also means that it has tons of research backing it's mood stabilizing properties.  At this point, I assume he is off the Lexapro and the lamotrigine and is only taking Lithium?  I think that is the right move.  If he is still manic or hypomanic on Lithium then he made need to have an anti-psychotic med like Seroquel to complete end the mania.   If he's only been on the Lithium for a few weeks, it might be a reasonable decision to put off making any long term decisions about the relationship while you both see how he responds to the medication and whether he seems committed to taking it independently and transparently.  It takes a while for the Lithium to build up to an effective level in the blood, and a patient has to take it consistently to maintain that effective blood level.  At the same time, you can be addressing your financial, legal and other vulnerabilities.

Your description is actually a really good example of why doctors who treat patients with bipolar should invite close family members into the treatment process.  Many psychiatrists believe they can't due to federal privacy regulations and in order to build a successful relationship with the patient.  But, TBH, incorporating caretakers into treatment is a "best practice" in APA treatment algorithms and good psychiatrists have ways of doing this, both in terms of getting patient consent and in terms of setting up the actual meetings.

My ex DH and my kids all have some kind of MI.  The drill has always been that I go to psychiatrist appointments as well and am invited in for the first 5 minutes to give my perspective my family member's mood and behavior. Then the family member talks privately with the psychiatrist for the rest of the appointment, and I am invited back in for the last 5 minutes, when the doctor shares with me the treatment plan agreed upon by patient and doctor and answers any questions.

Of course, now that I am not married anymore, I don't go to ex's appointments.  As my kids grow older and more independent, I have less input to their sessions, but I still know that if I am concerned I can call their psychiatrist or therapist.  And, my kids understand that it is to their benefit to have a close family member who is not judgmental but supportive know about their mental health issues in case they decompensate.  [/quote]

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