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Very much this.
The stimulants may be triggering manic/ bipolar episodes.
OP: You need to get her to the hospital ASAP. This has a high potential to escalate if not treated soon.
Have the conversation w him but be kind. Sounds like he is depressed and therapy isn’t the only answer. Maybe he needs a med boost. If that isn’t an option, (maybe he is anti-meds) then give him tasks he has to do each day and a timeline where he has to turn things around. Empathizing change is difficult for most, if you take baby steps and have patience you might snap him out of it. But bottom line the conversation needs to happen.
If you don’t want to have it, it sounds like you have your answer to move on. It needs to occur and effort needs to be made.
It’s helpful to hear both positive and negative stories. Can I ask how long you were in the relationship for?
Gosh that’s ok then.