Garden variety bipolar disorder consists of moods that typically last weeks to months if not treated. People with bipolar experience a mood and settle in for a long ride. However, people with rapid cycling bipolar disorder experience moods that typically only last weeks. People with ultra-rapid cycling bipolar disorder have moods that only last days to weeks and people who have ultradian bipolar disorder may have moods that last from hours to days.
[It worth noting that when severe moods last only for a few hours this may be considered a mixed mood episode rather than a cycler, per se.]
So, if your mood cycles quickly and spontaneously, how do you live with it?
Today’s article is another in the series on inpatient treatment facilities. These questions have been answered by the staff at Timberline Knolls – the Bipolar Burble blog’s new sponsor. These questions were submitted by readers and cover bipolar treatments, length of stay, mental illness life skills, and use of discipline.
There’s a lot to know about bipolar and bipolar depression. How do I know? Because I’ve written about bipolar depression so many times it would make your head spin.
And what I try to do is either present the human side of bipolar depression or the evidence-based side. Here are a few of the articles I’ve written on bipolar depression:
- Atypical Depression More Common in People with Bipolar Disorder
- How to Handle Treatment-Resistant Bipolar Disorder
- Bipolar Disorder – When to Get Off Antidepressants
- Five New Bipolar Depression Treatments You Don’t Know About Part 1 (and Part 2)
- What is Treatment-Resistant Bipolar Disorder?
- Treatment and the Prevention of Bipolar Depression Part 1 (and Part 2)
- And on and on…
Well now I, and you, have the (FREE) chance to get a genuine look into bipolar depression from an evidence-based approach through the words of a leading psychiatrist.
Free Webcast on Managing Bipolar Depression
Here is the information on a FREE webcast by doctors (technically, for doctors) and Global Medical Education on an evidence-based approach to treating bipolar depression. I believe there will be a lot to learn here.
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.
Saturday, after sharing the story of someone who had been through electroconvulsive therapy (ECT). someone named Michele Montour left me this series of tweets (shortened words lengthened to improve readability):
Nothing will ever convince me that this barbaric, antiquated butchery is proper treatment. We know almost nada about the brain. Scientists admit very little known about our brain – even diagnoses are guessed. But zapping it and not REALLY knowing and irreversible!? I think ECT treats us like animals. Repackaged to remove ITS stigma. Let’s just go to the ice-pick lobotomy again! #disgusted
To this, I, admittedly shortly, responded:
That’s a convenient perspective when you’re not dying.
Well, Michele Montour did not like this response and it led to a bit of a diatribe on her part wherein she, among other things, called me a stupid and ignorant bitch.
I thought, perhaps, this stupid bitch could take a moment to explain her opinion.
[Note: I am running a survey on real patients’ experiences with, and perspectives on, electroconvulsive therapy (ECT). If you’ve had ECT and want your voice heard, please take the survey here. More detailed information on the ECT survey can be found here.]
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?
If you read the Breaking Bipolar blog over at HealthyPlace you might have seen a question earlier this week:
People have come down on both sides of this question on HealthyPlace and on Facebook but I think the overarching sentiment is that addiction is not just another mental illness as personal choices lead to its existence. No one causes bipolar disorder or schizophrenia through action but no one puts a drink in an alcoholic’s hand and forces them to imbibe. Moreover, addiction recovery is considerably simpler in that addicts get better by choosing not to use substances while other mental illness treatment involves months of treatment before any turnaround is seen and typically involves lifelong treatment. For addicts who are also suffering from a mental illness they are usually entered into an in-patient dual-diagnosis rehab program.
But whether you think that addiction (or, more specifically substance abuse and substance dependence) is simply another mental illness or not, there is this question:
- Should funds intended to be used on serious mental illness be used for addiction treatment?
I have been known to lament that there’s nothing new under the sun when it comes to depression treatment, and thus, there is little hope for people with true treatment-resistant depression. (And by treatment-resistant depression I mean people who really have tried everything, and there are few in this category.)
But I forget how far we’ve come and how fast. It isn’t fair to say there aren’t new approaches to treatment-resistant depression because there are new approaches being researched and approved every year. Here are a few noted by Current Psychiatry article Innovative approaches to treatment-resistant depression:
One of the criticisms antipsychiatry folks like to make of psychiatry is its lack of objective diagnostic criteria. In other words, there’s no blood test that says you have bipolar disorder or schizophrenia.
And this is true. While today we do have blood tests for biological markers indicative of mental illness diagnosis, there is no hard and fast test that can diagnose a psychiatric disorder (except Huntington’s, for which we have discovered a gene).
The fact of the matter is no matter what is written in the Diagnostic and Statistical Manual of Mental Disorders (DSM) or what blood we draw or which scans we do nothing diagnoses a person properly except a trained psychiatric professional.
But that doesn’t mean there’s nothing objective or meaningful about it.
In fact, using the diagnostic criteria from the DSM or even from a clinician’s clinical experience allows two experienced clinicians to arrive at the same diagnosis for a patient. (Is this always true? No, of course not. But there are second opinions in all of medicine so this is hardly rare.)
Psychiatric Diagnosis and Treatment
However, even if two clinicians were to arrive at slightly different conclusions, for example, one says unipolar depressive and the other says bipolar not otherwise specified, I would argue that it hardly matters as alleviating suffering is the goal and the diagnosis is only a way of getting to that end.
. . . clinicians do not in general fret over what does or does not constitute a disease. . . . If, for example, a patient’s arm is broken in a car accident, a doctor doesn’t lose sleep pondering whether this represents ‘broken bone disorder’ or simply an expected response to an environmental stressor—the bone is set and the arm is casted . . . mental disorder or not, clinicians working in ‘mental health’ see it as their calling to try to improve the lives of whomever walks through their office door seeking help.
Similarly, it is objective as to whether a person is suffering or not and thus it is obvious the person needs help regardless as to what the ultimate diagnosis is.
Do Psychiatric Diagnoses Matter?
Yes, of course psychiatric diagnoses matter as they direct treatment, however, just because there is no hard and fast test governing that diagnosis doesn’t make it any less valid nor does it mean that psychiatry doesn’t have a place in its healing.
In the world of mental illness we talk about “response” and “remission” and not cure for mental illness. The reason is very simple – we don’t know of a cure for mental illness. One may exist, but we don’t know of any such cure for bipolar disorder, depression, schizophrenia and other mental illness.
What are Treatment, Response, Remission and Relapse?
The words we use most often are treatment, as in I’m in treatment for bipolar disorder; response, as in I’m responding to treatment for schizophrenia; and remission, as in I’m in remission from depression.
- Treatment – treatment is whatever is applied to make an illness better such as therapy, medication, mindfulness and so on.
- Response – response is generally positive or negative and indicates whether a treatment is working. A positive response means you have shown improvement on a given course of treatment, it does not necessarily mean that all your symptoms have disappeared, only that there has been positive movement in some way.
- Remission – remission is the state in which all or most of your symptoms have “remitted” or gone away. People have remissions from cancer, and many other illnesses as well as mental illness.
- Relapse – relapse is a state in which the symptoms reassert themselves after a period of successful treatment or remission.
A cure for bipolar, depression, schizophrenia or other mental illness would be a state of recovery where no more symptoms were present and you were returned to health permanently. This is the one that is contentious in mental illness. Most doctors believe that even once a mental illness goes into remission, relapse is possible, and in some cases, even likely. It is thought that the mental illness – the fundamental neurobiological causes – never go away, but they may be successfully treated for a period of time. This amount of time could be forever, but it most often is not.
So if a disease goes into remission forever, isn’t that a cure?
I guess that depends on who you ask. If you have to be treated for the rest of your life, even if you’re in remission I’d say it’s hard to argue that you’re “cured.” On the other hand, if you get better, taper off treatment, and remain better, then maybe you would consider that a cure. I’d be hesitant to use the word “cure,” personally, but that’s me.
Who Goes Into Long-Term Remission? Who’s Cured of Mental Illness?
That’s a toughie. I’d start out by saying that it’s impossible to know who will go into long-term remission or get “cured” of mental illness, but that isn’t exactly true. We know that people with milder forms of the disease have a much better chance of full remission. We know that you have a better chance at a mental illness “cure” if:
- You don’t have a family history of mental illness
- You have a more mild form of mental illness
- You have a good support system
- You have access to quality medical (including mental health) care
- You have had fewer episodes of mental illness in the past
Unfortunately, most of us reading this right now do not fit into this category. It doesn’t mean that you won’t find long-term remission; it just means that you’re not in the most likely group.
Is a Cure for Mental Illness Possible?
Mental illness is not one thing and all mental illnesses are not created equal. Depression isn’t the same as bipolar disorder which isn’t the same as schizophrenia. And with different severity levels, these diseases become, yet again, different.
But in the case of severe mental illness, is there a cure?
Not if you ask me.
[push]I think suggesting there is a cure for mental illness overall just isn’t true. We don’t yet have a cure for mental illness. [/push]
I have no doubt that some people with a mental illness can experience long-term remission and some may even consider themselves “cured.” But I have yet to see a person with schizophrenia make that claim. I have yet to see anyone who suffers from psychosis make that claim. I have yet to see anyone with severe, long-standing symptoms make that claim. So it is possible? Maybe. In some cases. But maybe in those cases the disease just isn’t like the other cases. Maybe they are in a category by themselves. Maybe (undoubtedly) we just can’t recognize who is in that category.
So I wouldn’t want anyone to think that a cure absolutely is or absolutely is not possible for any given person, because I don’t know. But I think suggesting there is a cure for mental illness overall just isn’t true. We don’t yet have a cure for mental illness. We’re just going to have to live with that fact. But that’s OK. It puts us in good company with epileptics, Parkinsonians, diabetics and many, many others.
As an aside, the closest thing we currently have to a cure seems to be deep brain stimulation. For those who get it, and for whom it works, it seems to “cure” depression. But this treatment is still in its very early research stages.
I despise bad reporting and I don’t care if you write for a newspaper with a circulation of 3 people or the New York Times – there is no excuse to report badly on mental illness, there is quality information available everywhere.
Point in case is Depression can be treated through lifestyle changes by Danielle Faipler in West Virginia University’s student paper, The Daily Athenaeum.
Comments on Depression can be treated through lifestyle changes
This article contains some of the most widely-spread mistruths about depression and mental illness and is inexcusable. It doesn’t even pass a sanity check (even by an insane person).
Antidepressants are good for short-term treatment, but they do not facilitate with the long-term changes needed to treat the illness, and they add to the growing prescription drug abuse problem in the U.S.
That is absolutely false and I would enjoy seeing any research that indicates otherwise. As I have shown, depressed people who take antidepressants do better long-term and antidepressants are not addictive. Stating otherwise is ignorant or untruthful.
A side effect of antidepressants is hallucinations, and most of the time, different medication is prescribed to the patient.
If the number of people who experienced hallucinations from taking antidepressants alone were to get together for a party, they could fit in my freaking apartment. Yes, it can happen with some antidepressants, but it’s far from common. (And what was the second half of the sentence? What different medication?)
Further Stigmatizing Depression and Mental Illness
A walk in the park may be all it takes for someone with depression to get out of their funk.
If that isn’t one of the most stigmatizing statements, I don’t know what is. Depression is a medical illness and not a bad mood that can be cured by a stroll.
This type of reporting, even if by a student, is unacceptable. It spread lies and does so without scientific backing of any kind. This particular writer and editor should be ashamed of themselves and write a public apology for such nonsense.
It is not acceptable for a newspaper to spread mistruths and further stigma of depression and mental illness. Period.
Please view The Daily Athenaeum’s shameful response to this criticism.
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.)