As people who read this bipolar blog know, I’m on medication, lots of it, actually. Nevertheless, many people (philosophically, even me) wish to be medication-free. I’m the first one to say this usually isn’t possible; however, today I’m talking with CEO and Medical Director Dr. Kim Dennis from Timberline Knolls (a sponsor) about bipolar disorder without medication.
Earlier in the week I posted a piece by the lovely Hyla Molander on surviving death and depression. I thought in this piece she said something rather profound. She said that taking her antidepressants meant “choosing happiness.” And I think this is a really important point. Taking medication often means choosing happiness over pain or simply choosing life over death.
Recently, I wrote a piece for PsychCentral that outlined some recommendations for treatment-resistant bipolar disorder. This piece talked about first-line and second-line agents for the treatment of bipolar disorder but I wanted to delve a little further into the novel agents that are now being studied for the treatment of bipolar depression. These are medications that are not typically used to treat bipolar disorder, work in new ways and show promise in recent studies. This is cutting edge and if you’re treatment-resistant this is an area that can offer you hope.
Why Are Novel Agents Needed in the Treatment of Bipolar Depression?
The reason why this piece is about unusual bipolar depression medication and not medication for mania is because the medications we have for mania are quite effective for most people. It is the bipolar depression that, typically, is very hard to treat. Additionally the two Food and Drug Administration (FDA)-approved bipolar depression treatments (quetiapine and an olanzapine/fluoxetine combination) tend to carry very serious side effects like weight gain, risk of diabetes including diabetic ketoacidosis and others. We also know that most people with bipolar disorder spend vastly more time in a depressed state than in a manic state.
According to Dr. Prakash Masand, CEO and founder of Global Medical Education, “Less than 30% of bipolar patients achieve remission that is maintained long term. There are great unmet needs in the treatment of bipolar depression. Innovative approaches are needed rather than ‘me-too’ agents that offer little incremental benefit.”
Dr. Masand notes the following are new, novel agents that look promising in the treatment of bipolar depression.
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.
It is an unfortunate truth that many mental illness patients won’t take their medications at one time or another. This is known as treatment noncompliance or treatment nonadherence, if you want to be a bit more politically correct.
And also unfortunate is the fact that when a person with a mental illness refuses to take their medication they almost inexorably get sicker. People with bipolar disorder who won’t take their medication, for example, often become manic and then wind up hurting themselves or someone else and end up in the hospital. And watching this happen, as a loved one, is extremely painful.
So is there anything you can do when a person refuses to take their medication? Is there anything you can do about treatment noncompliance?
I’m on Twitter. Not a surprise there. And I have a pretty active following there. Most of the people are fans, but a few aren’t. A few quite disagree with me and what I have to say. Which is fine. People can have their views.
And recently, I was tweeting along, minding my own business when someone said this to me:
and have you been on antidepressant, mind altering drugs all these years. Making choices while under the influence
My first reflex was to reply,
and have you been making choices all this time while being an ignorant, sanctimonious ass?
But I’ve heard through the grapevine that wouldn’t be professional. So I said nothing. If Mr. Twitter wants to judge me for taking medically prescribed medication, that’s his right. Even if it is a small-minded, uncompassionate, hateful thing to do.
And really, I have snarky answers for many of the asinine comments people make to me. However, I don’t tend to share them as it makes people all pissy. That being said, this particular comment hit a sore spot – being under the influence of brain-bending medications.
It is politically incorrect to say medication “noncompliance.” I suppose this is because it gives the idea that the person taking medication is “complying” to some authority figure and not consciously making the decision on their own.
I get that. But whether you call it medication noncompliance or medication non-adherence, the result is the same – the person is not taking their medications as prescribed by a doctor.
And medication noncompliance can lead to devastating consequences not only in the short-term but in the long-term as well. One reader shares her experience in her own words.
A Story of Medication Noncompliance
. . . I got manic in September without being aware of it. I was over productive, spent a lot of money, barely slept, very irritable . . . While manic, I thought I was normal, since I was stable since several months. I was only on a small amount of an antidepressant, mood stabilizer and a tiny amount of antipsychotic.
All this disappeared suddenly. I was out of energy. I was barely able to move, depressed and the most important: productivity disappeared. Couldn’t move or concentrate . . . for the first time of my life maybe, I started having anger crisis, uncontrollable ones. It was like I push a button and become extremely angry. I went through irritability before but never knew such anger. It was all verbal, no violence but very embarrassing.
I got so angry and stupidly stopped my medication.
Why Were You Angry?
I was mainly angry because high productivity was over. I was angry and frustrated, thought I finally became stable. I was angry for being bipolar. I didn’t want to live (by the way I always think about suicide even when I am high). I hated myself and this life and wanted to punish myself.
I wasn’t thinking logically. What I was thinking: I was taking medication and all was fine for several months and in spite of all this, I had mania so why to continue to take the medication! Plus I wanted to suffer physically, to have tangible pain.
What Happened When You Stopped Taking Your Medication?
I stopped taking medication although I knew from previous experience (several years ago) that withdrawal is terrible. I thought that since I was on low doses, the effects won’t be that strong. Well I discovered I was wrong.
The first week I was doing more or less fine. Then I started feeling dizziness, nausea, restlessness. I started feeling than something inside me was boiling. I was extremely tired, empty. I could feel that even my eyes were empty. I was very irritable.
I told my therapist (psychologist) about messing with my medication. He tried for several sessions to convince me to take them again. At the beginning of the third week, I couldn’t continue anymore. Told the psychiatrist, he told me to take a mood stabilizer for few days and an antipsychotic and wait. But my situation was going worse. By the end of that week, I agreed with both the therapist and the psychiatrist that I needed to be hospitalized.
I had to be hospitalized because I couldn’t continue on my own. I was about to collapse. I was crying all the time, not able to work, extremely irritable and tired. And I didn’t trust myself that I could force myself to take medication as prescribed. Any single trigger would have pushed me to stop or to take an overdose. I was very suicidal.
I took me 4 days on an IV antipsychotic to start to improve. What helped me the most is that I knew I was safe there, protected against myself.
How Do You Feel Back on Medication?
I am on more medication now. I am still angry about being bipolar but dealing with this in the therapy. But physically I am doing better and I am less suicidal. And I trust myself that I can control myself concerning taking medication.
How Do You Wish You Had Handled the Situation?
I should have told my doctor first place that I stopped the medication. I should have been more aware about the symptoms of mania. I should have set a system or informed my family about the “warning” symptoms of mania. But overall, I took a good decision by asking to be hospitalized.
Wanted to share it with other bipolars and tell them that it is very very bad and harmful to stop medication.
If You Want to Change Your Medication
As always, it is your right to change your treatment plan but as this reader has shared, if you do it the wrong way, you may end up in the hospital or worse. Whenever you make a change it needs to be overseen by a doctor.
And if you do make a mistake and stop taking your medication – be honest and tell your doctor so they can help you. This person did the right thing by admitting she needed help. She got it, and now she’s able to share this message with you. Listen to her.
Before I started taking psych meds, one of the major concerns I had was addiction.
I didn’t want to be an addict of any sort as I’m quite familiar with the horrors of addiction, having addicts in the family. I’ve also read my fair share of substance abuse information. Will I get addicted to antidepressants?
And I knew people often took antidepressants for long periods of time, sometimes forever.
As you might have noticed, I’ve been writing about bipolar and mental illness for a really long time. Seven years in internet time is a lifetime or so.
I Write About and Research Mental Illness
And in all that time, in addition to the writing, I’ve been reading, or more commonly, researching, mental illness. I’ve been looking up information on mental disorders, psychiatric medications, mental illness treatments, supplements and everything else of which you can think. This is because I like to be educated about my bipolar disorder, healthcare and treatments. I often share researched information with my readers because I think others should be educated about mental illness too. I strive to make anything I write accurate and provide links to reputable information sources.
Who Do You Trust for Mental Illness Information?
But what information should you trust? Who should you trust for mental health information? Should you trust me, a random blogger? People on discussion groups? Information sites? Drug company sites? Doctor sites?
Almost always, no.
Here are a few ideas about trusting information online:
- Do not make any decisions about your mental health or treatment without talking to a real, live doctor in person. Period. You can take all the self-assessment questionnaires you want, but you can’t pick a mental illness treatment or a diagnosis without the help of a professional. These tools can help you bring information to your doctor, but nothing is a substitution for a real professional.
- If you can’t check out a person’s credentials, don’t trust them. Anyone can claim to be a psychiatrist, nurse or have a Phd, but that doesn’t mean they aren’t actually a teenage, mosquito trainer practicing pirouettes in a tent in rural Lesotho (although they’re probably not). If someone is offering you professional health advice, they should have no problem supplying their credentials. One of the reasons I love Jim Phelps’ site is the fact he is forthright about who he is, and how he’s funded.
- Check how a healthcare site is funded. If a site doesn’t tell you who’s supporting it, who’s funding it and where the information comes from don’t trust them. As a general rule, sites funded by drug companies or special interest groups should be treated with extreme suspicion. Special interest groups can include religious groups and even some charities. While they may have good intentions it’s likely their information is slanted and partial.
- If there are no links to actual data or research studies approach with extreme caution. I could be a doctor making the claim carrots cure depression, and that might be a very appealing claim to a lot of people as anyone can buy carrots. I can even say, “I’ve seen it work over and over,” but if I can’t back that up with real scientific data, then the claim holds no water. (That being said, there’s no harm in asking your real-life doctor about even questionable mental health treatments, if you’re interested. That’s what they’re paid for.)
- Any referenced study must be published in a reputable journal. Psychology Today is a magazine not a journal, the Journal of Clinical Pharmacology is a reputable journal. Real studies are listed here and are published in peer-reviewed journals. Also, in reputable studies any conflicts of interest must be disclosed. Implications from research can be confusing so print out the study and ask your doctor about it. Some groups are really good at making information look authentic but if it wasn’t published in a reputable peer-reviewed journal, it’s not to be trusted.
- HONcode accreditation. About.com’s Nancy Schimelpfening suggests that HONcode accreditation is also a good thing for which to look.
I have to stress, there are many medical sites out there that are trying to sell you a product or idea. Please keep in mind there are some groups that are very anti-psychiatry and anti-medication and try to push that agenda. They masquerade as self-help sites, discussion groups, individuals on discussion groups, and drug rehabilitation/addiction sites. There are people pushing products that use the same techniques.
Be Skeptical About Mental Health Information Sources
Be skeptical. If the information doesn’t sound right, ask a professional. Please don’t let random online weirdo’s make choices for you or influence how you feel about yourself and your mental disorder. You’re better than that.
[And just for the record, I don’t portend to be anyone other than a mouthy bipolar writer with a lot of tears, screams and things to say. I’m pretty smart and try to help people, but that’s about it. Oh, and I’m essentially funded by no one. Just ask my landlord.]
Mental Illness Resources I Trust
Curious about who I trust for mental illness information? See my resources list here.
Update: I just found this open-access peer-reviewed journal online. Interesting.
I like to think I know almost all there is to know about mood disorders, but I was pretty shocked when I read this:
The Surgeon’s General Report
Mood disorders are sometimes caused by general medical conditions or medications. Classic examples include the depressive syndromes associated with dominant hemispheric strokes, hypothyroidism, Cushing’s disease, and pancreatic cancer (DSM-IV). Among medications associated with depression, antihypertensives and oral contraceptives are the most frequent examples. Transient depressive syndromes are also common during withdrawal from alcohol and various other drugs of abuse. Mania is not uncommon during high-dose systemic therapy with glucocorticoids and has been associated with intoxication by stimulant and sympathomimetic drugs and with central nervous system (CNS) lupus, CNS human immunodeficiency viral (HIV) infections, and nondominant hemispheric strokes or tumors. Together, mood disorders due to known physiological or medical causes may account for as many as 5 to 15 percent of all treated cases (Quitkin et al., 1993b). They often go unrecognized until after standard therapies have failed.
I’m shocked. No one ever mentioned anything about birth control pills to me and I’ve been on them for years. YEARS. This is yet another reason why doctors so often get on my bad side.
This quote was taken from the Mental Health: A Report of the Surgeon General. The whole report is a good read, but very long. It’s everything you wanted to know but didn’t know you needed to ask.