General practitioners (GPs) should not be treating bipolar disorder. It’s as simple as that and I have no idea why GPs don’t get this. If it’s obvious to me, a little ol’ mental health writer then it should be more than obvious to a medical professional that GPs are simply not equipped to treat bipolar.
In the world of chronic illness there is a concept of “caregiver fatigue.” This is where caregivers of people with chronic illness get burned out because they just spend so much time and effort caring for another person. This is a real thing and a real problem.
I would suggest there is also such as thing as “bipolar treatment fatigue.” Bipolar treatment fatigue is when a patient with bipolar disorder becomes burned out because of all the time and effort it takes to fight the bipolar disorder. I think this is a real thing and a real problem.
Some people with bipolar disorder are lucky in that when they get treatment, they find something that works for them within some reasonable period of time (and this might be in a year or two, maybe not altogether reasonable, but on the whole, good). However, not all people sick with bipolar are so lucky. Some people with acute bipolar symptoms don’t find anything that works for them for prolonged periods of time. In fact, for many people sick with bipolar, it seems like they will never find any treatment that will work.
So if you’re in this latter group (and I am) what keeps you going? If you still suffer from acute bipolar symptoms and the treatment isn’t working, how do you keep trying to get better, day after day?
Raise the Bar on Bipolar Treatment – Hold Your Doctor to Task
Let me be honest. Even when my treatment is at its best, I never get to the place of zero bipolar symptoms. I’m well, I can handle the remaining symptoms with coping skills, I can be happy but there are always lingering symptoms of bipolar disorder.
And this may be an indicator of being difficult to treat because what we know is that the more you can successfully treat all the symptoms of bipolar disorder, the more likely you are to have fewer relapses. In other words, if you continue to experience bipolar symptoms during treatment, you’re more likely to experience future episodes and we really want to avoid that as each future episode tends to make your bipolar harder to treat.
For this reason, it’s critical to aim for zero bipolar symptoms during treatment, whenever possible.
If you know my story of bipolar disorder treatment, you know that it hasn’t been a pleasant one. Doctors have fired me and given up on me. I have tried a host of treatments that didn’t work. I have experienced almost every side effect under the sun. I have bumped into holes in the healthcare system that have denied me access to a psychiatrist. I’ve spent years wanting to die. I have seen, and lived through, it all. And I would say there are many unmet needs in the treatment of bipolar disorder. I would say these unmet needs are part of bipolar treatment and part of the system in which treatment is delivered. I don’t blame psychiatrists or psychiatry, specifically. I would say there is plenty of blame to go around.
So when I think about unmet needs in bipolar disorder treatment, there seems to me to be many.
When people ask me about bipolar treatments or bipolar therapy here, I tell them about the research on the therapy or treatment and I tell them this, “different bipolar treatments and bipolar therapies work for different people so try it and see if it helps.”
And I consider this good advice. It’s absolutely true. Different bipolar treatments and bipolar therapies do work for different people – but that doesn’t mean that I, personally, believe in them.
And, to be clear, it’s not so much that I don’t believe in them entirely, it’s more that I don’t believe in them for me.
Enter mindfulness-cognitive therapy or mindfulness meditation.
Ah psychiatric medication. I know; it’s really what we all love to hate in mental illness. Psychiatric medication can fix you up or pull you down and many of us have experienced both these things.
But there are more risky psychiatric medications and less risky psychiatric medications, in my estimation anyway. And one of the major ways to judge risk is based on history.
As I’ve said, mental illness treatments often don’t work. And you have to keep trying treatment anyway. Because without doing anything new, you are condemned to being stuck in the same mental illness mire you are currently in.
But in all honesty, mental illness treatment requires faith. Trying psych med after failed psych med requires a belief that something will work in spite of the evidence to the contrary. It requires a belief that is not based on personal experience.
I hate that.
Why Does Mental Illness Treatment Require Faith?
Faith has several definitions, one is:
A strong or unshakeable belief in something, especially without proof or evidence.
And let’s face it, that describes a lot of what we do in mental health treatment. Don’t get me wrong, that doesn’t mean it isn’t going to work, but it does mean that trying treatment after failed treatment requires more faith than logic.
Faith in Polypharmacy (Multiple Medications)
Seriously-ill folks, often with bipolar, schizophrenia and treatment-resistant depression, are typically on lots of medication: One or two antipsychotics plus one or two mood stabilizers plus an antidepressant. Some of us get by with less medication, but many don’t.
And there is little evidence about the efficacy of polypharmacy, or indeed, how to go about applying it.
And yet, many people are on multiple psych meds.
[push]For bipolar, there was a recent recommendation against antipsychotic polypharmacy stating multiple antipsychotics are not more than effective than one, and they pose greater side effect risks.[/push]
Sure, you could blame an evil drug company conspiracy, but I suspect the answer is much simpler: it just works better for some individuals. But those people need faith to believe that. These people need faith that using these medications provides their best treatment outcome.
And all those people on antipsychotics plus anticonvulsants plus antidepressants are really going it alone. These just are no studies in these situations.
Studies on Polypharmacy
But of course there are few studies on polypharmacy. There are innumerable combinations and trying to find funding for this kind of research is extremely difficult. And even if you could, the outcome would be extremely hard to interpret due to the number of variables involved.
(There are a few exceptions. For example, fluoxetine (antidepressant) and olanzapine (antipsychotic) have been tested and approved together under the name Symbyax. Of course that is only two medications and not the many on which many of us find ourselves.)
You Gotta Have Faith
(Feel free to hum George Michael at this point. I can’t seem to stop doing it.)
My personal cocktail is on the ridiculous side of treatment. It’s that kind of cocktail doctors despise. And my doctor, being responsible, would like to reduce the number of meds.
I get it. I do.
But I really, really don’t want to get worse. Or, you know, dead.
So I have to have faith. I have to have faith that making an alteration to this cocktail will be beneficial in the long run.
But I Hate Faith
But I’m not big on faith. I’m not big on anything that isn’t logical and evidence-based. Unfortunately, that just isn’t an option here.
I have to fake faith. The idea of which make me smile.
I suspect if George had written that oxymornic statement, his song wouldn’t have been such a hit.
(Of course, he was faking heterosexuality, so maybe he’d appreciate the irony.)