I take psychiatric medications daily and what I want to know is, why do people refuse to try psychiatric medication for serious mental illnesses? Why do people think they don’t need it? Why do people think they should ignore their highly-trained doctor’s advice? Why do people feel that taking psychiatric medication makes them less of a person? Why is it okay to take heart medication but not psychiatric medication? Why do people think that psychiatric medication doesn’t work? Why do people think that I know of some secret alternative? Why do people refuse to even try psychiatric medication?
And Why You Shouldn’t Tell People about Your Bipolar Medications Either
At least once a week someone asks me what medication I’m on or what my bipolar treatment plan is, but I have a policy not to talk about my treatment plan or medication. I typically won’t even get specific about my experience with specific medications. I don’t tell people what medications I’m or what my treatment plan is for a good reason – it’s no one’s business but mine and my doctor.
I get a little peeved that people ask me about my medications and treatment plan because it’s private people. But people think that just because I’m a writer I’m a public commodity and people should get to know whatever they want about me. Well guess what, you don’t. You get to know what I choose to tell you, nothing more, nothing less.
Again, a commenter last night popped onto the blog to tell me how psychiatric medications “do more harm than good” and how “I [the commenter] know for a fact that these meds no not work.”
I’m not sure how so many people confuse “fact” with “opinion.” It is the opinion of some people that psychiatric medications don’t work. It is the opinion of some people that psychiatric medications do more harm than good.
I am not of that opinion. And I actually have facts on my side.
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.
As I mentioned, people with bipolar type II spend 35X more time depressed than hypomanic, and yet there are very few treatments available.
As we discussed last time, the neurotransmitter glutamate and the inflammatory complex are two new, badly-needed areas of bipolar depression treatment research. Here are three additional bipolar depression treatment areas you probably don’t know about: diet, antioxidants and modafinil.
Diet, Insulin and Bipolar Disorder
There are quite a few people talking about diet and bipolar disorder, and diet and depression. And for all the words they say, the one thing we actually know through study is: no diet is known to treat bipolar disorder. Period. We know an unhealthy diet will possibly make you worse, but the only thing science can recommend is to eat a healthy, balanced diet.
Diet and Insulin
[push]The only thing science can currently recommend is to eat a healthy, balanced diet.[/push]
That being said, insulin interacts with many parts of the body responsible for much of the brain functioning. For example, insulin regulates the concentration of neurotransmitters and monoamines in the central nervous system; and these chemicals are thought to impact mood disorders, Alzheimer’s and schizophrenia. It appears a lack of insulin can produce mental illness symptoms.
This area is in extremely early development but there is currently testing of insulin increasing drugs in treatment of bipolar disorder and depression. And yes, other dietary issues are being studied (more carbohydrates and less carbohydrates are being studied) but as of yet, there is nothing concrete.
Antioxidants and Bipolar Depression (N-acetylcysteine (NAC))
We know something unfortunate about the brain and mental illness: mental illness shrinks the brain. (Mental illness decreases neuroplasticity, technically.) And we know that some drugs protect or reverse this effect (SSRI antidepressants, lithium, electroconvulsive therapy (ECT)). [pull]We know something unfortunate about the brain and mental illness: mental illness shrinks the brain.[/pull]
And one of the possible causes of brain shrinkage currently being considered is oxidative stress. Oxidative stress represents an imbalance that prevents detoxification and repair within tissues. (It’s complicated. See Wikipedia.) Some amount of oxidative stress is normal (and important) but this stress combined with cell abnormalities is implicated in bipolar disorder. Evidence suggests lithium and valproic acid protect neurons against oxidative stress.
(Still with me? Good. It’s going to get easier. Just hang on a bit longer.)
This oxidative stress can be caused due to decreased levels of antioxidants. One in particular, glutathione, is known to have abnormal levels in bipolar disorder. And in order to make enough glutathione, a body must have enough of an amino acid, cysteine.
Increasing cysteine levels using N-acetylcysteine (NAC) has been reported to be neuroprotective and impact glutamate (which we think is good, see here). NAC has been able to alleviate depressive symptoms in people with bipolar disorder in a double-blind placebo-controlled study as an add-on medication.
The good? NAC is cheap, over-the-counter, and from what we know, safe.* The bad news? NAC can take up to five months to work and study on it is limited. (See bipolar disorder type 2 depression and NAC notes by Dr. Jim Phelps.)
In a completely non-medical, Natasha-only-based opinion, NAC seems like something you could talk to your doctor about adding. There doesn’t seem to be a downside other than waiting for five months to see if it works. This doesn’t mean try it on your own. It means talk to your doctor.^
Modafinil and Bipolar Depression
Last, but not least, is the research into modafinil treatment of bipolar depression. Modafinil is a “wakefulness promoting agent” prescribed to people “with excessive sleepiness.” This is not an amphetamine but is a stimulant. Basically, we don’t understand this medication but it increases monoamines like norepinephrine and dopamine, which we generally like.
Modafinil has been shown effective in treating bipolar depression (without inducing mania or hypomania) by week two of treatment. In the study, modafinil decreased depressive symptoms and increased remission rates.
This medication is one some doctors are already using off label for the treatment of bipolar depression.
Summary of Bipolar Depression Treatments You Didn’t Know About
Basically, under all of this, the message is: we’re working on it. It’s long and slow and frustrating for us crazies but the doctors have their lab coats out and they’re thinking up stuff all the time. Will any of these help you? I don’t know. But what I do know is these five areas should be a reason to hold onto hope, even if what you’re doing right now isn’t working.
The information in this article is primarily from: Novel Treatment Avenues for Bipolar Depression By Roger S. McIntyre, MD and Danielle S. Cha. Clinical Psychopharmacology. April 19, 2011.
See the article for all the nitty gritty details about the above.
* Safe in this case means no known drug interactions (to the best of my knowledge and according to a doctor). In the drug database used by doctors up here in Canada it reports no side effects. In the study they note it as “safe” but report change in energy, headaches, heartburn and joint pain as possible side effects – these being basically the same in the placebo and NAC group. Keep in mind though, so little study has been done on this there may be all sorts of gotchas we haven’t seen.
^ Remember: your doctor should know about all medications, vitamins and supplements you take. Just because it’s over-the counter doesn’t mean it’s harmless.
People with bipolar disorder 2 spend 35 times more time depressed than hypomanic. As a person with bipolar type 2, I can tell you how true this is. Bipolar type 2 is more like a depressive disorder than a bipolar one. However, this doesn’t mean bipolar disorder 2 can just be treated like unipolar depression. If only life were that simple.
Bipolar disorder type 2 depression treatments must not induce hypomania or mania, and antidepressants used alone often do that. For this reason bipolar 2 depression treatment is generally like happy hour (full of cocktails). And many of us are very frustrated with the fact no new medications are being developed for our mental illness.
So here’s some hope. Here are five bipolar depression treatment areas you probably don’t know about.
The Bipolar Burble recently received a couple of comments on the antidepressants and dependence / addiction post from Tabby. My response to her second comment ended up being so long I decided to put it in it’s own post.
Here is an excerpt from Tabby’s comments (edited for length). If you would like to read them in their entirety, please see here and here. (Symbol […] indicates removed text. Other ellipses are from the original text.)
I know of people who cannot go not 1 day without their medication and the medication not be a life saving med like a blood thinner but be a Anti-depressant. They become all anxiety ridden and panic filled because they just know that if they miss that 1 dose or those 2 doses for that 1 day […]
They can’t sleep and they get agitated and they get quite vile until they get that dose or doses. They resort to sobbing, they resort to melodrama of threatening suicide…
[…] I’m talking a cymbalta, or a lexapro. I work in a MH agency and we have patients call cause they’ve gone 1 day without their prescription. […]
I am also one with Bipolar and when your entire day, or entire life, is solely dependent on whether you took your pill or pills that 1 day… I dare to say, you have a dependence.
Now… you have blood clots and you miss 1 day of your blood thinner.. then we may have a major issue. You miss 1 day of your Seroquel, or your Cymbalta, or your Depakote… seriously, it will be okay… if not, use your psychotherapy techniques. Oh, that’s right… not too many actually do psychotherapy… it’s all the meds baby.
[…] I am well aware of the benefits of medication compared to no medication for those with Mental Illness. My point was – too many people seek out the comfort of the medication to handle their daily life’s issues […] than to try and work on figuring why they are having the problem in the first place.
Folks do not wake up, naturally, anxious. Something has to have occurred to trigger that emotion and anxiety is an emotion that triggers a physical response. Yet, too many run to the cabinet and down pills to “calm” the anxiety rather than try to do something else non-medicated that […] The first reaction is to kill the emotion/feeling… not to try and figure why it’s happening.
No therapy doesn’t work in all settings or all situations but if you never try, then it will certainly never work. In that your blogs are predominately med supporting… I could say that you mock those who try to use more psychotherapy than meds.
Seroquel and Depakote are not equivalent to Warfarin or some of the other medications needed for literal body functioning. Yet, if you have been on a med for a long period of time, for example Seroquel to put you to sleep every night.. and then suddenly you miss a dose or 2… YOU WILL HAVE SYMPTOMS. That’s med dependence and you’ll have a psychological dependence because you’ll become frantic wanting your med.
[…] Many folks suffer with their Bipolar symptoms, or any MI symptom, long before they ever take the 1st pill. So, the life-saving aspect is only a “feeling”.
I know the meds help but have they literally saved me? No. They take away the uncomfortable and the frightening… but they don’t keep me from dying. If they were the sole and only reason, then I’m a walking med cabinet.
Even folks that take a plethora of meds, every single day and swear on a stack of their most revered book… still kill themselves […]
Thanks Tabby for your response. I think your thoughts on the issue represent a perspective of many.
Naturally, I would beg to differ. While yes, people live with a mental illness before treatment, and obviously, they don’t successfully kill themselves, that is not proof psych meds do not save lives.
There are two types of people (at least) for whom psychiatric medications are life-saving:
- Those who would have killed themselves if not been treated. (Often those who previously attempted suicide and failed.)
- Those for whom the medication keeps them from falling into a tremendously dangerous mood such as severe depression or mania which is unpredictable and can easily kill a person (or even those around them.)
In neither case can you “prove” whose lives were saved, but many of us on this side of the illness believe we wouldn’t be here but for the medication.
(Quick FYI on suicide. When autopsies are done of suicide victims it is almost always the case that they do not have a full concentration of psych meds in their system. They either didn’t take the drug or hadn’t taken it regularly.)
Mental Illness Isn’t a Physical Problem
You suggest a blood-thinner is a necessary medication because it fixes a physical problem. Well, so do psych meds. I’ve talked here many times about the biology of mental illnesses like depression. But on top of that, mental illnesses have many physical symptoms like:
- Join and muscle pain
- Hypersomnia / insomnia
- Eating far too much or far too little
- Cognitive and memory problems
- An inability to make reasonable decisions
- Delusions, hallucinations, psychosis
Those effects alone can lead to death, particularly the psychotic symptoms which can be present in mania, depression schizophrenia and other illnesses. These effects lead people to do things like jump off a roof. All of that sounds pretty physical and much of it life-threatening.
Mental Illness is “Just” a Feeling
I can’t comment on how you experience mental illness, but it certainly isn’t “just a feeling” for me. On top of whatever physical symptoms I may have the feelings themselves are completely out of control. Being driven to slice your wrist with a razor blade is not simply a “feeling.” Driving with your eyes closed isn’t just about a “feeling.” Spending $10,000 that you can’t afford on clothes you don’t need isn’t just a “feeling.”
And on, and on, and on.
While spending what you earn in four months on clothes may not kill you, it sure may kill your life.
You Do Not Just Wake Up with Anxiety
Certainly, you can feel that way, but a person with an anxiety disorder would likely beg to differ. Anxiety may be the sign of a troubled marriage, a bad dream or Starbucks running out of scones, but it may also be a real, organic mental illness, like any other.
I Mock People Who Do Therapy
[push]I’ve done more therapy than anyone I know.[/push]
Um, no, I really don’t. I don’t mock people for it in the slightest. I think it’s a good idea. Some people have problems that can be solved through quality therapy. You’ll get no argument from me on that.
As for non-medication treatments, I have talked about many. Light therapy, triple-chronotherapy, the importance of strict schedule, the importance of sleep and so on and so forth. This week, in fact, on Breaking Bipolar I talked about six areas to increase mental wellness that are not pharmacological.
If you say so.
As you’ve mentioned, you draw a line between psych meds and other meds which you deem “acceptable” to be necessary. That’s your call. But a mental illness is just an illness and medication for it is just as critical as it is for any other illness.
I’d say the distinction there is not fair, accurate or supported by data.
People on Antidepressants Are Dependent
In the non-disordered sense of the word, yes, people are physically dependent on antidepressants. Like all people on all long-term medications.
As for psychological dependence, well it’s a grey area. For psychological dependence the drug must produce pleasure for the user. Antidepressants do not produce pleasure; they treat an illness and reduce pain. This makes them very different from a drug like cocaine, which does produce pleasure.
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.
Not infrequently, at the Bipolar Burble I get comments about how if famous artists with mental illnesses had of been medicated, we would have no art today. For some odd reason their go-to example is always Vincent Van Gogh. Without his untreated mental illness, they argue, Van Gogh wouldn’t have been the great artist we know him to be today.
Right then. Let’s all go off our meds and paint. And chop off our ears.
Creativity and Mental Illness
There is no doubt that being crazy makes you see things in a new way. I know I can see things in ways that others can’t. It’s both a benefit and a dramatic hindrance. I’m constantly dealing with people looking at me in odd ways as they try to wrap their head around whatever-the-heck logic my thoughts are trying to make. It’s no mean feat.
But that’s not necessarily all the bipolar. That’s creativity. I was creative before I was crazy, before I was medicated. And I’m creative now, on psych medication.
Creativity and Hypomania
I have had hypomanic times where I have written and written and written and written. Thousands and thousands of words pour out of my skull. And they are brilliant.
Or at least, so I think at the time.
Hypomanic (and manic) people think they are brilliant. Think they are unbelievably talented and creative. Think they are genius. It doesn’t mean they actually are.
Creativity and Psychiatric Medication
Since being on psych meds I have written thousands of pages. Thousands. Some professionally, some not, but many fairly laudable and creative. Believe it or not folks, I do have talent and that talent hasn’t magically been removed because of the medication.
Of course, if I’m too depressed because of the bipolar to get off the couch, that has a rather adverse effect on producing anything, talented or not.*
Artists, Psychiatric Medication and Death
But so you don’t agree with me. You have personally found you’re brilliant off meds and not on. OK. Fine. And maybe you think you’d be willing to part with your ear to be Van Gogh. OK. Fine.
But you might want to keep in mind some truly brilliant people who killed themselves due to mental illness, including Van Gogh whose depression worsened over the course of his lifetime, making him unable to paint, leading to his suicide at the age of 37.
And then there are other famous artists dead from suicide:
- Sylvia Plath, suicide at 30
- Kurt Cobain, suicide at 27
- Ernest Hemingway, suicide at 62 (and just in case you’re doubting genetics, his father, brother and sister also committed suicide)
- Diane Arbus, suicide at 48 (both a drug overdose and slashed wrists)
- Arshile Gorky, suicide at 44
- Alexander McQueen, diagnosed anxiety and depressive disorders, suicide at 41
- Virginia Woolf, suicide at 59, part of her suicide note to her husband:
I feel certain that I am going mad again. I feel we can’t go through another of those terrible times. And I shan’t recover this time. I begin to hear voices, and I can’t concentrate. So I am doing what seems the best thing to do. . . I don’t think two people could have been happier ’til this terrible disease came. I can’t fight any longer. . . I can’t read.
And a whole bunch of other talented people both known and unknown who had their lives cut short by suicide.
And my guess is the loved ones of every single one of those people wish treatment had of been available for /used by their loved ones.
Psych Medication Destroys Creativity and Art
So don’t give me the bullshit argument that medications are “bad” because they hamper creativity. Because you know what really kills your creativity?
A Little Bit More
* There’s a study showing this but I seem to have misplaced it.
I’m not saying it’s never the case that medication inhibits creativity, just that it’s a poor argument and misses some of the fundamental reasons why people get treatment in the first please.
Creative people who have publically stated they are in treatment for a mental illness. Including Patty Duke, “She says that she’s more creative now because she can organize a thought.”
One of the crazy things that will happen to you when you seek treatment for being crazy, is doctors will ask you what treatment you want. Usually your psychiatrist/doctor will give you two options: Would you like to try psych med A or psych med B? This provides the mirage of control over your mental illness and your mental illness treatment.
Patients Choosing Psych Meds Has an Air of Hilarity to It
This choice, of course, is ridiculous.* How should you know which medication to pick? They’re the doctor, the fancy psychiatrist, aren’t they supposed to know?[push]Do you pick the one that’s your favorite colour or matches your hair?[/push]
What criterion could you possibly use to pick a psychotropic medication that would conceivably compare to an actual doctor? Most patients, bipolar or otherwise, don’t even know the chemical name of their psychotropic medication. And why should they? All the di’s, tri’s, methyl’s and dride’s don’t really come in handy on a day to day basis.
The Doctor Is Fighting Learned Helplessness
What the doctor is doing here, is using basic psychology similar to the type parents use on their children.
Your child won’t go to bed. You say to little Billy, “which pajamas would you like to wear, the Spiderman or the Superman ones?” The child then focuses on the fact they get to make a decision, they feel empowered and are less likely to refuse to go to bed. The adult, of course, has given the child a choice the parent doesn’t care about. Superman or Spiderman, the kid is still getting into bed.
This is what doctors are doing. They are giving the person with a mental illness a choice that doesn’t matter. Sure, it seems like it matters because they’re drugs, and your life is on the line, but either way, you’re agreeing to a treatment, and that is all the doctor cares about. (It is why you are there, after all.)
Psychiatrists are Trained to Prevent Learned Helplessness
Doctors have been trained to do this because of the concept of learned helplessness. Learned helplessness is seen in lots of areas of life, but the basic principle is: the person comes to believe they are helpless, whether or not they truly are. A common example of this would be a battered spouse. Because they have been repeatedly abused and controlled, they start to think they don’t have control over anything in their life, even when they do. (Abusing people programs them this way and is one of the reasons an abused person doesn’t leave an abusive relationship.)
As Wikipedia puts it:
[a person] has learned to behave helplessly, even when the opportunity is restored for it to help itself . . . Learned helplessness theory is the view that clinical depression and related mental illnesses may result from a perceived absence of control over the outcome of a situation.
Learned Helplessness is Dangerous in Mental Illness
And this is a very real concern for the mentally ill because not only are you controlled by your disease, but then you’re controlled by the drugs put on top of that. If you then add the layer whereby you doctor is in complete control over your care, the patient begins to feel helpless in increasing areas of their life. This is problematic, particularly for the crazy, because that kind of helplessness, leads to hopelessness, which leads to suicide. When you can’t control anything, there is just no reason to stick around.
Choice of Psychotropic Medication Treatment Feels like a Game Show
But choosing between psychotropic pill A and pill B is akin to choosing to be hit on the head by a baseball bat or a two-by-four. I’m pretty sure there is no good option there. But it gets worse. Choosing a psych med is really more like choosing the blunt object behind curtain A or the blunt object between curtain B. You don’t know the ramifications of the decision. You don’t even have a shaded outline of what to expect. It’s like choosing a car based on how far apart the headlights are. It’s ridiculous. It’s laughable.
Control of Mental Illness, Control Over Treatment
[push]You can choose whether to get treatment or which pill to take, whatever that’s worth, but often these things feel surprisingly similar. Even a person who doesn’t exhibit learned helplessness can reasonably feel completely out of control.[/push]
And you can feel as empowered as you like, but the truth is, you really don’t have control. You didn’t have control over your brain when you got sick, you don’t have control over getting worse and you don’t have control over how your treatment goes, no matter the window dressing provided by the doctor.
You can pick doctors, therapists and pills, but feel helpless in all the ways that matter. It feels like you can’t get better, can’t have a normal life and can’t even figure out why you should want to be on this planet. It feels like picking Spiderman or Superman pjs, but either way, it’s bed time.^
Notes:* Choice of medication is, in fact, critically important. And if you haven’t been treated for long, there are many objective ways to select a treatment. However, for cases of treatment-resistant bipolar or major depressive disorder, the choice becomes more and more random as the objectively correct choices have already been tried. ^ I’m not suggesting that you shouldn’t choose, or that choice isn’t important, I’m simply the frustration inherent in the choice.
I grit my jaw. I bite the skin around my nails. I pull at my hair. I bunch my fists. My breaths are shallow. I twitch and clench erratically.
I tell myself not to grit, bite, pull, bunch, twitch and clench. I tell myself to intake more air. Those instructions are followed. For moments. And then they’re not. While I wasn’t looking I started gritting, biting, pulling, bunching, twitching, and clenching all over again.
These are tiny, little words. The barely seem to warrant entries in dictionaries bloated with words like crunk (a type of hip-hop or rap music) and yogilates (a combination of Pilates and yoga), and yet somehow they have achieved great significance in my life.
Anxiety and Depression, Like Peas and Carrots
Anxiety and depression always come in pairs. The each cover half a sphere. How much you feel of each of them depends on your point of view of the sphere.
I was never an anxious person before. Or at least, I was never inordinately anxious, I think. But then came the psych meds and so the anxiety. Anxiety – the side effect that’s it’s own mental illness.
And now I worry. And I’m overwhelmed. Frozen with the fear of things not getting done . . . leading to the very obvious result of things not getting done.