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Mood Tracking for Bipolar Disorder – Why Track Your Mood? (1/2)

→ July 25, 2011 - 17 Comments

Ask a Bipolar: What about mood charting?

Most doctors (mostly psychiatrists) will ask you to track your mood if you have a mood disorder like bipolar disorder or depression. And while most people (psychiatrists and patients) would agree mood tracking is good, most people would also admit to not doing it.

I understand why mood tracking doesn’t get done. It’s like a homework assignment when you’re already working full-time. You just happen to be working full-time at being crazy. Homework tends to get left in the book bag.

However, there are easy, painless, simple ways to track your mood that can offer real benefits. Sixty seconds a day. Promise.

What is Mood Tracking?

Mood tracking is pretty simple. Mood tracking is just a way of writing down various aspects of your mood and mental illness symptoms on a daily basis to look for trends.

Mood tracking attempts to look for variables that affect a mental illness like bipolar disorder or depression. You generally want the results in a graph so it’s easier to see mood trending.

Why Track Your Mood in Depression or Bipolar?

It’s easy to tell your doctor your mood right? Depressed or manic? Severity: one-through-ten. Simple.

Except it isn’t. At least not in the most helpful sense. Telling your psychiatrist what your mood is when you’re sitting in front of him might be useful, but that’s only one tiny data point and these was probably a month between that answer and your last appointment. You can’t see trends when you track moods by months unless they absolutely smack you in the face.

Ups and Downs and Mood TrackingPeople Can’t Remember Their Mood (Even When Paying Attention)

People are terrible at remembering mood. This is pretty much what happens:

“What was your mood last week?”

“Um, mostly OK, I guess.” Or you might say, “Depressed.”

This is not accurate mood reporting. In reality, everyone’s mood fluctuates to some degree. You were more depressed on Thursday because they didn’t air a new episode of Burn Notice. You had a visitor that lifted your mood a little for two days. That sort of thing.

Benefits of Mood Tracking

By tracking your moods for depression or bipolar disorder (or any mental illness, really), you can find:

And about a million other things. Not to mention the fact you will have a record of your mood (and hopefully side effects) and when some future doctor asks how you reacted to med X from two years ago, you’ll have the answer. (Yes, an endless frustrating reality.)

How to Track Your Mood in 60 Seconds

So, have I sold you on mood-tracking? Good. In part two I’ll talk about how to track your mood, what to track, how to remember to track your mood and I how I track my mood in 60 seconds a day.

Ask a Bipolar – What Mental Health Topics Are You Interested In?

→ July 22, 2011 - 56 Comments

What bipolar articles would you like to read?If you’ve been around for the last couple of weeks either at the Burble or at Breaking Bipolar, you know it’s been pretty much all suicide all the time. And there will probably be more to come on suicide as it’s an awfully big topic.

But I do have a question for everyone:

What topics would you like to see on the Burble?

Are there questions about me? Bipolar? Mental illness in general? A timely topic?

A reader recently suggested a topic on mental illness and euthanasia / right to die. A great idea. (Although really hard. Someone is clearly wanting me to tackle a rather large challenge.)

I can’t promise I’ll address all your questions / suggestions, but I would like to hear them nonetheless. Because if there’s one thing I’ve learned by writing the Burble for so long: Readers will surprise you.

So, you have the microphone. What mental health topics are you thinking about?

Warning Signs You Need to Know – How to Predict a Suicide Attempt (2/2)

→ July 20, 2011 - 36 Comments

Warning Signs You Need to Know – How to Predict a Suicide Attempt (2/2)

In part one I discussed the details of a study about 100 people who attempted suicide in Florida. Part two outlines the predictive factors for suicide attempts identified in this study and how we can use this information to predict who will attempt suicide.

And perhaps more importantly, how you can prevent a suicide attempt in a loved one.

Read more

Suicide Warning Signs You Need to Know – Who Attempts Suicide? (1/2)

→ July 18, 2011 - 14 Comments

Suicide Warning Signs You Need to Know – Who Attempts Suicide? (1/2)

Some of us in the mental health field have heard the suicide warning signs so often it’s practically tattooed on the back of our skull: suicide note, suicide plan persistent thoughts of suicide, previous suicide attempt and so on.

But if you think you know the warning signs for a suicide attempt you’re probably wrong, at least according to a study out of Florida. For example, fewer than 1-in-10 people leave suicide notes and fewer than one-third of people have persistent thoughts of suicide before their suicide attempt.

Read more

No Hospitalization after a Suicide Attempt?

→ July 13, 2011 - 167 Comments

No Hospitalization after a Suicide Attempt?

As I mentioned, a friend of mine attempted suicide last Friday. His life was saved by his friends, the police and hospital staff. I’m grateful his suicide attempt was not successful.

But one of the oddest things about this scenario is after the suicide attempt he was not hospitalized. The hospital stabilized and released him. Just like that. No psychiatric hold. No psychiatric treatment. Nothing.

What the hell is up with that?

Read more

To The Mentally Ill Who Attempt Suicide

→ July 10, 2011 - 50 Comments

It is a depressing reality most people with a serious mental illness will attempt suicide at some time. Yes, more than half will attempt suicide. That’s a very large number. More women will attempt suicide but more men will commit suicide. Women will overdose while men will use firearms. More than half of these people will not leave suicide notes.

We are lucky most suicide attempts fail. Most people who attempt suicide will be rescued by others.

A Suicide Attempt

Last Friday night a man I met online tried to kill himself. He posted his suicide note online. Thankfully, some friends of his called 9-1-1, the police entered his apartment and took him to the hospital.

I am very grateful he is still alive.

The Shame of Attempting Suicide

After a suicide attempt, many people are thankful they didn’t succeed. Most people who attempt suicide later realize the moment they attempted suicide was a particularly brutal part of the fight against their mental illness and death is not truly what they want. They end up feeling ashamed of their suicide attempt.

Suicide Attempt isn't ShamefulPlease Don’t Feel Ashamed of a Symptom of Your Illness

I understand the shame that goes with doing something you later regret. I understand the shame of realizing you did something because of your mental illness. I understand the shame of acknowledging you admitted defeat at the hands of pain and depression.

But a suicide attempt is not shameful.

A suicide attempt is a symptom of an illness. It is no more shameful than sneezing from a cold. Attempting suicide is brutal and hard and painful on you and those around you. No one wants to see you die, see you gone. But the fact for one moment you gave in to the pain isn’t shameful, it’s human.

Those who do not know the pain may not understand. But sometimes you hit a wall. A wall of pain. And sometimes that wall tries to kill you.

You Are Not Who People Say You Are

Some people try to hurt you because you have attempted suicide. Some people try to use this symptom as evidence you are, in some way, “bad.”

But you are not bad. You are sick. Anyone that would use an illness to hurt another person is an abuser. Anyone that would try to use a suicide attempt as a weapon does not deserve a second thought. Or a first one for that matter. You are better than that. They are not worthy of you.

Humans Make Mistakes

Every one of us has done things we later regret. Some of us (most of us) have been complete assholes at one time or another. Humans are selfish, crass, hurtful, awful people sometimes. We’re like that. We’re wildly imperfect beings.

But these mistakes make us human. Recognition of frailties is a strength. It’s only after realizing what we don’t like in ourselves that we can change it.

A Suicide Attempt Isn’t the End of the World

Yes, a suicide attempt is horrible; a suicide attempt may run roughshod over your life; a suicide attempt may hurt those around you. A suicide attempt is painful but it isn’t the end of your world.

Attempting suicide puts you in the company of many of your fellow crazies. If you look to the left and to the right of you, you will see thousands of people just like you. Who made the same choice. Who now live to tell the tale.

A suicide attempt is horrible, but it is part of mental illness and not the end of the world.

Save Yourself Now

If you feel unsafe, don’t wait, contact someone right now. Here is information on how to get help. Let these people help you. You need to fight your mental illness.

I am extremely grateful my friend is still here. The people in your life want you to be here too.

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Know that there is zero latitude when commenting on this post. I will not tolerate negative, hurtful or sarcastic comments.
 

Share Your Tips on Talking to Doctors / Psychiatrists

→ July 8, 2011 - 22 Comments

Communication with Psychiatrists

I’m working on my first ebook. It’s going to be about building a relationship with your doctor. Essentially, it’s about getting what you, the patient, need from the person behind the prescription pad.

Why Write About Doctor-Patient Communication?

I’m writing this book because of the plethora of mental health questions I get on the subject. I believe people with bipolar disorder, depression and other mental illnesses don’t get optimal care due to dysfunctional medical relationships. This is not necessarily the fault of the doctor / psychiatrist or the patient. It just means the relationship isn’t as good as it could be. Think of it like couples counseling between doctor and patient.

So, I have some questions for you; please weigh in. (Oh, you don’t have to answer all the questions. Any that interest you would be great though.)

What Do You Wish You Had Asked Your Doctor When You Were Diagnosed?

Pre-diagnosis, before you understood your mental illness, what do you wish you had known? What do you wish you had asked your doctor about your diagnosis? What do you wish you had said to your family doctor or psychiatrist specifically?

Communication with Psychiatrists

What Do You Wish You Had Asked About Your First Treatment?

What do you wish you had known about treatment? What do you wish your doctor had told you? What do you think new patients should know? Who do you think should handle treatment?

What Do You Think Patients Should Ask About Treatments / Side Effects?

When you get a new treatment or change your treatment, what do you ask your doctor? What should people ask? What do you want to ask but always forget? What do you want to ask but are too afraid too? What do you wish your doctor would tell you?

What Should You Tell Your Doctor / Psychiatrist?

What is most important for a doctor / psychiatrist to know? What do you always tell your doctor? What are you too scared to tell your doctor? Is there something you think you shouldn’t tell a doctor/psychiatrist?

What Makes a Relationship with a Doctor / Psychiatrist Work?

After dealing with doctors for over a decade, I have my own ways of making the psychiatrist-patient relationship work. What are your tips for patients? What works with a doctor and what doesn’t?

What Other Questions Would You Like to See Addressed?

What else do you think I should put in the book?

Why Am I Asking?

I’m asking because I would like to represent the real voice of the real patient as much as possible. I know what I want to write and why, but I’d like to hear varying opinions. Every one of you is different and every one of you has a different insight to share. Whether you love or hate doctors, this book is designed to make your relationship with them work better for you, and maybe for them as well.

I look forward to hearing your thoughts.

Note

By responding here you agree to be quoted in the book should I choose to do so. I’ll only use aliases to identify people so you don’t have to worry about people identifying you. If you don’t want to be quoted, that’s no problem, just say so.

If you have something to add but wish to do so privately, contact me here.

Why Aren’t Doctors More Honest With Patients in the Hospital?

→ July 1, 2011 - 33 Comments

Inpatient Prescriptions of Antipsychotics

Yesterday I received this comment from Leah,

. . . At the mental health clinic [where] I stayed, they were really into prescribing low doses of Seroquel [quetiapine] for unipolar depression . . . after reading up on this stuff I became somewhat angry for the widely prescribed off-label use of these antipsychotics since side effects can be strong. Especially since I was not told. Do you maybe have any thoughts on this practice?

Thoughts? Yes. Far too many. Ask anyone.

I have, over and over, lamented about the lack of honesty and transparency in the doctor-patient relationship. Specifically, why is it doctors prescribe antipsychotics, often off label, without disclosing their risks? It’s happened to me many times. In the hospital may be a special case, however.

Prescribing Antipsychotics

Antipsychotics (by which I mean atypical antipsychotics) are being prescribed for all sorts of things these days. Traditionally schizophrenia, but now frequently bipolar disorder and major depressive disorder (MDD) too. There is considerable evidence for atypical antipsychotic treatment in all three disorders.

Antipsychotics and Risk

Antipsychotics are not pleasant medications. Antipsychotics turn down the dopamine and serotonin in your brain, those neurotransmitters typically considered to be “happy chemicals.” Why does that help depression? That is extraordinarily fuzzy, but we know they work for some people.*

Trouble is antipsychotics carry very serious risks. Risks like permanent movement disorders, weight gain and diabetes. I have had fits about such things.

Antipsychotics FDA-Approved for Treatment of Depression (Unipolar)

  • Aripiprazole (Abilify) is an antipsychotic “indicated for use as an adjunctive therapy to antidepressants for the treatment of major depressive disorder (MDD).”
  • Olanzapine (Zyprexa, antipsychotic) and fluoxetine (Prozac, antidepressant) come combined in one medication called Symbax. Olanzapine and fluoxetine, when used in combination is “indicated for the treatment of treatment resistant depression.” **
  • Quetiapine Fumarate Extended-Release (Seroquel XR) is an antipsychotic “indicated for use as adjunctive therapy to antidepressants for the treatment of MDD.” *** (Study of quetiapine monotherapy for MDD)

Prescribing of Antipsychotics

[push]Antipsychotics do work quite well for many.[/push]

Often when multiple antidepressants fail for depression, antipsychotics are up next, typically as an adjunct (like aripiprazole, above). And in all honesty, in a case of severe or treatment-resistant depression, in my opinion this practice is quite reasonable.

Antipsychotics in the Hospital

One of the places people are often introduced to antipsychotics is in the hospital. There are generally three reasons for this:

  1. Patients in the hospital are there because treatment has failed thus far
  2. Patients are in the hospital because they are in crisis
  3. Patients need something that will stabilize them so they can leave the hospital

Those are the realities of being in the hospital. Under these circumstances it’s quite reasonable to prescribe powerful, more risky medication as the person is in more danger. This doesn’t mean it’s pleasant. As I remarked after having been given quetiapine in the hospital:

Seroquel [quetiapine] is the new med . . . 50 fucking milligrams a day. That’s ridiculous. He had to know that would kill me. And yet, somehow he doesn’t care.

I will say though, he looked like I had punched him in the stomach when I saw him today. I don’t know what he was expecting but I did look pretty bad. His medication made me that way for fuck’s sake, where’s the surprise there?

Doctors and Honesty in a CrisisHospital Prescribing

Here’s the thing about hospital prescribing – doctors really, really want you to take the medication. No, they can’t make you (bearing legal exceptions) but they do want you to. And this is not for some dark, sinister reason, it’s because they want you to get better.

You’re sick. You don’t have the mental capacity to be considering antipsychotic study data comparisons. You don’t have cognitive ability to make good choices and assess risk. You’re already overwhelmed. You’re in a psych ward. It’s not the place to be discussing the nuances of treatment.

Skip the Messy Medication Details

So doctors often overlook things like telling patients a drug is being prescribed off label (if it is) and there may be serious side effects. They choose the treatment they feel gives you the best chance at recovery. (By the way, doctors do this all the time, not just in psychiatric cases.)

Because if you don’t accept treatment, how will you get better? And if you don’t get better how will you leave the hospital? And if you don’t leave the hospital, how will you get back to your life?

Doctors Have a Tough Call When Prescribing in a Hospital

That’s the choice. Do you tell the patient more information and run the risk of them refusing treatment and not getting better? Or do you tell the patient less information to increase the chance they will accept treatment?

Antipsychotic Prescription in the HospitalI feel for doctors in this scenario. From personal experience I can tell you, being in a psych ward is seriously unfun. And when I was there I was incapable of making good decisions. He could have given me heroin and I probably would have taken it. But that’s the game folks. Your brain isn’t working. Your brain is in crisis. That’s why you’re in the hospital. You can’t expect your brain to make good choices at that moment.

I understand the conundrum. I understand why doctors do it and I understand why patients get made about it. But what the heck else is the doctor supposed to do? ****

Antipsychotic Prescriptions after the Hospital

But, of course, then there’s the problem of what happens once you leave the hospital. You should be more stable and more able to make good decisions. So it’s time for the doctor to cough up whatever it is they skipped over while you were busy being crazy.

I find doctors tend not to do this. I can’t really say why. They don’t want to rock the boat if you’re doing well? They’re lazy? Who knows? I’m not a doctor and really couldn’t say. I consider it to be unprofessional, unethical and bad practice, but that’s me.

Honesty and Doctors

I’m sorry to say doctors are often only as honest as we make them. We have to question them. We have to get the information even if they don’t offer it. It’s our responsibility. Not because it should be but simply because we’re the ones with the most invested. Like I said, the time to do this isn’t likely going to be in a hospital ward, but at some point, the unpleasant information has to be dealt with. And it may only happen if you force the issue.

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Notes of the Foot

* I actually have a pet theory on this regarding depression and mild psychosis, but that’ll have to be another day.

** Treatment resistant depression is defined as “major depressive disorder in patients who do not respond to 2 separate trials of different antidepressants of adequate dose and duration in the current episode.”

*** Quetiapine fumarate (the non-extended-release form) is not FDA-approved for unipolar depression (making that information extremely hard to find).

**** An answer, by the way, might be to have a patient’s proxy or advocate make the decision, as they are not ill at the time. However, as time is an issue, and decisions have to be made extremely quickly, it’s unlikely a proxy could get up to speed on the treatment fast enough. Not to mention, many of us don’t have such people.

 

Are Psych Meds Addictive? – Antipsychotics (Part 2)

→ June 28, 2011 - 14 Comments

Are Psych Meds Addictive? – Antipsychotics (Part 2)

In the first of this series I discussed antidepressants and addiction. Some people contend antidepressants are addictive; however, not only is the term “addiction” not defined medically, the use of antidepressants does not generally match the symptoms of any defined substance use disorder either. (More information on substance abuse and substance dependence.)

This time antipsychotics are up to bat. Are antipsychotics addictive? Are people dependent on antipsychotics? Do antipsychotics cause withdrawal?

Read more

Five New Bipolar Depression Treatments You Don’t Know About – Part 2/2

→ June 22, 2011 - 6 Comments

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.

New Bipolar Depression Research AreasN-Acetylcysteine for Bipolar Disorder Depression – The Good and The Bad

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.

Information Reference

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.

Notes

* 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.

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Five New Bipolar Depression Treatments You Don’t Know About – Part 1

→ June 17, 2011 - 17 Comments

Five New Bipolar Depression Treatments You Don’t Know About – Part 1

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.

Read more

Antidepressants and Addiction, Dependence – Talkback

→ June 12, 2011 - 43 Comments

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.)

Antidepressants and Addiction and DependenceComment on Are Antidepressants Addictive?

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.

Psych Meds for Bipolar and DepressionAntidepressants (and Mood Stabilizers) Are Not Life-Saving

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:

  1. Those who would have killed themselves if not been treated. (Often those who previously attempted suicide and failed.)
  2. 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:

  • Headaches
  • 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.

Dependence on Antidepressants Makes You a Walking PillI Need Psych Meds to Function so I’m a Walking Medicine Cabinet

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.

 

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