Lack of Empathy

My husband has always had difficulty with empathy for the 6 years we have been together. He has recently been diagnosed with bipolar and will be starting his first bipolar med this evening. I'm am so excited for him and I really hope that it bring him back to a place that he feels more stable. However, I'm also worried that lithium will further inhibit his ability for empathy. Do anyone on lithium have any personal experiences they would like you share? Advise for spouses new to this?

I know nothing about lithium. Be patient, it takes time to find the right mix.

Lithium made me very blah...No highs no lows, no nothing. I had to come off of it. It is great for some people though.

I’ve been on Lithium for 4.5 years with no problem. In fact it’s the easiest drug I take. I think Lithium has nothing to do with empathy.
He MUST drink plenty of water/fluids every day to avoid toxicity and to look after his kidneys.

Is he seeing a Therapist?? Meds will only do so much. To me it’s just as important as medications it will help with coping skills.

Are you saying his bipolar is tied to his lack of empathy? Or is that what a doctor said?

Has your husband ever really shown empathy? If not, that may just be him and not the bipolar disorder. If he has, perhaps depression, hypo/mania or a mixture of both have been contributing factors. If the latter, Lithium may help ease his mood issues. You'll have to wait and see. Please give it a few weeks before judging its efficacy. Lithium doesn't always make changes overnight, so to speak.

Lithium at higher doses did slightly (slightly) cloud my thinking at times. Nothing major for me, and that may not be an issue for your husband or may depend on his dose.

I agree with the earlier poster suggesting that therapy might be helpful. Some issues are best helped with therapy. Medications plus therapy are often a necessary combination.

I'm so sorry you and your husband are struggling, ClarinetAndCooking I have never tried it, so unfortunately I don't have a lot of advice to give to you. I agree with what all the others have already wisely said better than I ever could. Just remember that different meds have different effects on different people! So perhaps your husband won't be affected that much by Lithium. If there are some problems with it, I'd suggest to talk to your Pdoc about this and see how it goes from there. Hopefully he/she will be able to help you. If the side effects get too overwhelming, you can always ask for a change of meds. I hope you'll be able to find the right meds combination for your husband. It will take time. But it can be done. Just be patient. Does he see a therapist? Maybe that could help. He could learn new ways to cope with his lack of empathy. I'm so sorry, I know it's hard. Please don't give up. I hope things will get better soon for you and your husband. Try to hang on. You can do this! You and your husband are strong, I know that. I believe in both of you. I hope you and your husband will feel better soon. Is there anything we can do to help you? Please let us know. Remember that we're here for you if you need it. Feel free to PM me anytime. Let me know if I can do something to help you. Wish you good luck! Let us know how it goes. I'm so sorry you have to deal with this

Hi ClarinetAndCooking!

I took lithium for a couple of months last year. I went off of it mostly because I tend to tell myself Im not bipolar and also because of a small tremor. I didnt find it to be a bad medication in general.

I think lack of empathy is definitely more of a therapy issue than a medication one though. Especially since the way you wrote it sounds like the instability and lack of empathy are two separate issues. I could be misunderstanding this though.

Any medication needs time to start working so try to be patient. Also while it is difficult sometimes things get worse before they get better. Side effects can be an issue especially in the beginning and the first med isnt always the right one(I am maybe at 10 or so in 2 years unfortunately)

He is lucky to have you by his side
I have a husband who cares and helps me, it makes my life so much better and I definitely feel thankful for that.
Feel free to update us, ask questions or message me if you ever want

Sorry for not being more clear, his lack of empathy is mainly just who he is. He works in the science field and his very logical mind makes emotional issues less relatable. This part of his personality is very exaggerated when he is going through a low period from his bipolar though.

He has tried some talk therapy but doesn't want to continue it until his moods are more stable, if at all. I don't fully agree with this but I am trying to respect his mental health journey.

Convincing the hubby to see a doctor without shame was one of the hardest things I have ever done in my life and unfortunately only keeps getting harder. His parents constantly criticize his doctors and very loudly voice that he would be "fine" with more excercise. As a science guy, my hubby knows this is just silly and not accurate but he also loves them and wants to make them proud. There was also an incident at our pharmacy recently. He went to fill his meds and the pharmacist heckled him for his mental illness and spoke down to him. He eventually left the pharmacy crying without filling the prescription (I filled it for him later).

I don't think lithium would make it worse. If he's bipolar and gets irritable when manic, lithium could help with that.

Pharmacist: tell him you'll use online pharmacies moving forward.

Husband: a lot of people with Asperger's have bipolar symptoms. Have you checked for this condition? Might explain lack of empathy.

My sister works in the medical field and warned us that she sees the same results in some of her patience. He will obviously give it a solid try but may I ask if there is any specific meds that you have found luck with?

He was given the option between lithium and another less sedative drug (not sure which) and he chose lithium because he felt like being blah was less risky than another med not working or making things worse.

Lamictal and depakote tend to be pretty good mood stabilizers with less of a blah feeling.

Thank you, I will definitely look into that.

I have never considered him possibly being on the autistic spectrum. From my limited knowledge of autism, I suppose it could explain his extremely high intelligence in only some subjects and his social awkwardness. I'm very glad you mentioned this as I will be looking into it now.

I don't know about lithium. I don't know if it's bipolar in general, but a lot of the times I come across as having no empathy, speaking in a stream-of-consciousness way almost, and I do have empathy, and once my husband says something about what I just said on the fly being hurtful to him or my daughter and/or lacking empathy, I will realize he is right, I just didn't think about it, and it will make me feel bad. However, my father is this way too. I do not think he is bipolar but am 99.9% sure he has Aspergers. So maybe it's tied up in that too. I don't know, but my seeming lack of empathy keeps getting worse as the years go by. I do not have Asperger's though my daughter has sensory processing disorder which she could have inherited from me as I had a couple weird quirks as a kid. However, I could feel & express empathy quite well all through my 20s, but not so much since then. Bipolar, however, runs again and again on my mom's side. I am 41 now.

I do have empathy, but so much of the time, I have difficulty expressing/showing/completely feeling it. I have no idea about my medication as I was 10 years misdiagnosed and on SSRIs for major depression (not a good choice to treat bipolar), and I think that messed me up too.

But sometimes, meds have a "flattening" affect on my moods, both high and low, though there have been some really, really low times when though I've been depressed, even crying a lot, this has saved me from self-harm (cutting) or suicidal behaviors, which I think would have happened otherwise, but it also flattens my display of emotion towards others, particularly if I get hypomanic or manic.

Do realize it is probably a challenge like this with your husband as well. He probably does have empathy but cannot fully feel it or express it. He might have inner struggles going on that he doesn't talk about. I rarely talk about this issue with my husband unless he brings it up.

I have Asperger's and lately been checking out the bipolar subforum because I suspect I might have both. Depression is common especially with high functioning autism and 27% of cases of ASD also have symptoms of bipolar. Narrow interests, awkwardness and lack of empathy are all autistic traits.

Welcome to the BP subforums, ClarinetandCooking and PsychoPhil!

I'm glad you brought up the possibility of Asperger's, PsychoPhil. Of course I do not know why your husband may have a lack of empathy ClarinetandCooking, but it is not a symptom of bipolar. In fact, it's interesting -- from time to time a thread will start up here asking people what positives they feel they experience on account of BP, and many, many people will answer about being very empathetic. Again, even in the opposite, not a trait/symptom of BP, but something that many have gained from their own suffering.

(I've never taken lithium, so cannot comment on that.)

I'm so sorry your husband was treated that way by that pharmacist, ClarinetAndCooking That's terrible! He didn't deserve to be treated that way at all. No one does. I'm so sorry. What a terrible person. I hope you'll never have to deal with this kind of people again. It hurts a lot when this kind of comments comes from them, especially since they should know better. Can't they just do their job and leave people alone? I agree with PsychoPhil. I'd suggest to try online pharmacies as well if you can. I agree with what all the others have already said better than I ever could. The only way to know for sure whether he has Asperger's or not is to go to a doctor and get a proper diagnosis. That way you'll know for sure. I'd suggest to talk to your doctor about this and see how it goes from there. Hopefully he/she will be able to help you. I hope you and your husband will be able to get the help you need and deserve. You've been given some great advice on this thread. I hope it will be helpful to you and your husband. Keep writing here if it helps. Remember that we're here for you if you want to talk about it. Stay strong, ClarinetAndCooking. Stay safe and take care of yourself. Most importantly, remember to take care of yourself as well! You can't fully help others if you're not taking care of yourself first. I'm so sorry, I know it's hard. Please don't give up. I hope things will get better soon for you and your husband. Is there anything we can do to help you? Please let us know. Remember that we're here for you. Feel free to PM me anytime. Let me know if I can do something to help you. Wish you good luck! Let us know how it goes. I'm so sorry you have to deal with this

Depression can cause a feeling of apathy that could be mistaken for lack of empathy, just saying.

Very true. Also, bipolar elevated mood may lead to increased irritability and self centeredness, very common for ASD. Especially those with high functioning autism conditions are aware of the social life they are missing out on, which can lead to feelings of worthlessness and depression. If that depression is episodic symptoms are hard to differentiate from bipolar. Also, autistic obsession with some special interest may result in episodes of high energy and goal oriented activity.

The best way to identify ASD in presence of bipolar symptoms would be the time of onset. ASD manifests at toddler age, whereas first manic episodes typically occur during late teens or twenties.

@ClarinetAndCooking: if possible, ask your husband's parents about childhood quirks and oddities.