Bipolar blog

How to Get Off Antidepressants Effexor/Pristiq (Venlafaxine/Desvenlafaxine)

→ September 12, 2011 - 94 Comments

How to Get Off Antidepressants Effexor/Pristiq (Venlafaxine/Desvenlafaxine)

Or other bothersome antidepressants.

Generally, following the rules I wrote about last week on how to stop antidepressants while minimizing withdrawal work, and most people can successfully withdraw from antidepressants with few side effects.

Some Antidepressants Are Hard to Get Off Of

Unfortunately, some antidepressants are not so easy to get off of no matter what you do. (You can learn more about this through http://drugabuse.com/ and other similar sites.) Some antidepressants:

  • Resist a taper strategy
  • Have intolerable withdrawal effects anyway *

People Have Trouble Withdrawing from these Antidepressants

Any antidepressant can feel impossible to withdraw from, but the antidepressants people have most trouble withdrawing from are:

But by far, venlafaxine and desvenlafaxine (Effexor and Pristiq) are the ones I hear about. In my opinion, these two drugs are a nightmare to come off of for most people. ^ (I’m not saying everyone has trouble with these antidepressants, just that many do.)

Here are tips on how to get off of horrible~ drugs like venlafaxine (Effexor) and desvenlafaxine (Pristiq).

Did I mention yet I’m not a doctor? Ah, well I’m not. None of this is to be considered medical advice; this is an informational article only. Never alter your treatment without talking to your doctor. Thanks.

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Antipsychotic Warning, Saffron for Depression, Polypharmacy – 3 New Things

→ September 8, 2011 - 2 Comments

It’s a bit of a short week what with the holiday and all, but still, there is time for three new things about mental health. Today’s three new things are:

  • A safety warning on the atypical antipsychotic drug asenapine maleate (Saphris)
  • Saffron and depression
  • Multi-drug (polypharmacy) treatment of mental illness

Serious Allergic Reactions Reported with Asenapine Maleate (Saphris)

Asenapine maleate (Saphris) is an atypical antipsychotic drug recently approved for use in the treatment of bipolar type 1 mania and mixed episodes (as well as schizophrenia).

In slightly less than two years of approval, about 87,000 people have been prescribed asenapine maleate. The FDA’s Adverse Event Reporting System (AERS) has had a significant number of serious allergic (hypersensitivity) reactions reported. These serious allergic reactions were reported in 52 cases and are considered Type 1 hypersensitivity. From the FDA:

“Signs and symptoms of Type I hypersensitivity reactions may include anaphylaxis (a life-threatening allergic reaction), angioedema (swelling of the deeper layers of the skin), low blood pressure, rapid heart rate, swollen tongue, difficulty breathing, wheezing, or rash . . . Several cases reported multiple hypersensitivity reactions occurring at the same time, with some of these reactions occurring after the first dose of Saphris.”

Any such reactions require immediate medical attention.

You can report serious allergic reactions to the FDA’s MedWatch program here.

FYI, asenapine maleate’s label has been changed and updated with this new information.

Saffron used to treat depressionCan Saffron Help with Depression?

Saffron (crocus sativus) is the most expensive spice by weight and is integral in French bouillabaisse. And someone asked me this week, “Can saffron help with depression?” Initially, I did a search on the Alternative Medicine Index at the University of Maryland Medical Center and turned up nothing. This alternative index lists most everything so my immediate answer to “can saffron help with depression,” was no.

However, I may have spoken slightly too soon.

Upon closer inspection I did find one study that asserts, in treating mild-to-moderate depression:

“Saffron petal was significantly more effective than placebo and was found to be equally efficacious compared to fluoxetine and saffron stigma.”

Now, hold on a minute. This is not a good, particularly scientific, study. This is just a review of studies, some of which are very questionable in nature. The above statement is premature at best. All that can really be said (in my opinion) is that saffron deserves further study and that some formulation of it might work.

Prescribing More Than One Drug for Mental IllnessWhy Are People Treated With Many Drugs At Once?

Good question. This is called polypharmacy and most doctors agree it’s a bad thing. The reason polypharmacy is bad is because it greatly increases the chance, and severity, of side effects. (There are other reasons too.) People who have been through rounds of polypharmacy will tell you this is true.

However, doctors continue to prescribe many drugs simultaneously for a condition. This article explores why polypharmacy is so common.

The article may make you take a look at your drug regimen and talk to your doctor about reducing some of your medication. This isn’t always possible, but a good idea if you can get away with it.

Note on Polypharmacy

It’s worth noting some conditions do warrant polypharmacy.

According to the Psychiatric Times article, the best indications for polypharmacy are few and well established:

  1. Bipolar depression
  2. Psychotic or agitated depression
  3. Co-morbid conditions that require independent medications (e.g., ADD and major depression)
  4. When partial response to the first medication requires adding another adjunctively
  5. When there is a combination of psychiatric and pain problems

OK all. Until next week when I will learn more and try to do better.

Saffron pictures provided by Wikipedia.

How to Stop Antidepressants While Minimizing Withdrawal

→ September 6, 2011 - 15 Comments

How to Stop Antidepressants While Minimizing Withdrawal

While antidepressants can absolutely be life-saving medications, sometimes antidepressants aren’t the right medication at the right time for you. Or sometimes, it’s just time to try to get off of antidepressants. (For simple depression, this is often done if you have been stable for 6-12 months.)

Can't Get Off Antidepressants

But the key to getting off antidepressants successfully is to minimize withdrawal symptoms because otherwise you may feel like you’re trapped on the antidepressants. Additionally, the withdrawal symptoms may get mistaken for returning illness symptoms, which you do have to watch for, but if possible, it’s best not to get withdrawal and returning symptoms confused.

So, here are some tips on the best way to get off antidepressants while minimizing withdrawal.

Learn About Getting Off Antidepressants

Firstly, by reading this you are taking the first step. Learning about your antidepressant, the time it takes to get off, and what might happen, is an excellent first thing to do. Your doctor can guide you in this process.

DO NOT STOP ANTIDEPRESSANTS SUDDENLY.

DO NOT STOP THEM ON YOUR OWN.

ALWAYS TAPER ANTIDEPRESSANTS UNDER THE SUPERVISION OF A DOCTOR.

(And as always, I am not a doctor and none of this should be considered medical advice. Only your doctor can offer that.)

Taper Antidepressants More Slowly

How to Stop Antidepressants

I can’t comment on individual doctors, but I will say in studies and in the literature they take people off medication, including antidepressants, way too fast. This is likely because they don’t want to wait around to do it the right way, but still, it gives people the false sense that you can get off antidepressants quickly – you shouldn’t.

Track Your Mood During Antidepressant Decrease

I know, it seems like I’m trying to strong-arm you into tracking your mood, but during medication tapering, it’s essential. You need to track your mood every day during medication changes – this goes for all mental illness – as well as write down when you change dosages because:

  • You need to know if you’re getting worse
  • You need to know if you do better at a lower dose, but not off the drug completely
  • You’ll have those records should you try to do it again in the future (or with another medication)

Please, please, please, even if you track your mood at no other time, do it when withdrawing from medication. (More on mood tracking here.)

(If you don’t want to track every part of your mood, then at least track the global assessment of functioning (GAF).)

Wait Six-Eight Weeks between Antidepressant Dosage Decreases

Seriously.* You are waiting so long between antidepressant dosage decreases because:

  • You want to prevent withdrawal
  • You do not want to induce mania, cycling or a mixed mood which is a real danger in bipolar

Changes to the Antidepressant Taper Schedule

You may want to slightly alter the antidepressant dosage decrease schedule:

  • Increase speed if feeling better as dosage decreases
  • Decrease speed if anxiety is a factor
  • Decrease speed if feeling worse on a lower dose
  • Decrease speed if feeling good at a specific dose (that might be the right dose for you)
  • Decrease speed for any reason if you feel the need

Never try to decrease or get off an antidepressant when:

  • You’re in a time of stress
  • There is an upcoming holiday

Decrease the Antidepressant in the Lowest Dose Possible

Slow Antidepressant Taper

This does not mean cutting your current pill. Some pills cannot be cut for safety reasons. This means getting a prescription for the smallest increment available and decreasing the antidepressant dosage by that much.

When you’re closing in on getting off the antidepressant completely, slow down even more. Cut the pill if you can. If you can’t, alternate on the higher dose for one day and then the lower dose for one day.

Exceptions to the Antidepressant Withdrawal Rules Above

As with all things in life, there are exceptions:

  • If you’ve been on the antidepressant a very short time you may be able to get off of it quickly
  • Fluoxetine (Prozac) may sometimes be tapered more quickly
  • Venlafaxine (Effexor), desvenlafaxine (Pristiq) (and sometimes other antidepressants) can be too hard to get off of using this method (see next article in series)

Getting Off an Antidepressant Takes Too Long

Look, you are getting off a medication that has altered the chemicals in your brain. This is not a minor event. While this method is slow, it gives you the very best chance of successfully getting off the medication without inducing withdrawal or worsening illness symptoms.

Don’t Freak Out When Coming Off Antidepressants

Remember not to freak out. Some withdrawal symptoms and some bipolar/depression symptom fluctuation may occur and you’ll still be all right. Just maintain a close relationship with your doctor to make sure it isn’t the start of something more serious

How to Get Off of Antidepressants with Minimal Withdrawal Series

Previously we saw:

Up next is:

—————————————————————————————————————————————–

If Your Doctor Doesn’t Get This, Send Them to Psycheducation.org for Their Own Education

* This information (and other information in this article) is provided by psycheducation.org and Dr. Jim Phelps.

New Antipsychiatry Discussion, L-Theanine, Rapid Cycling Markets – 3 New Things

→ September 1, 2011 - 2 Comments

This week’s three new things include:

  • A new supplement that may help brain health and mental illness: l-theanine
  • A poor comparison between rapid cycling bipolar disorder and the financial markets
  • A new discussion of antipsychiatry

1. New to Me: L-Theanine as an Antidepressant

Maurya, a commenter, asked if I knew anything about l-theanine. Well, I didn’t. Every once in a while even I run across something of which I haven’t heard.

So, for those of you in my boat, here’s a bit about l-theanine:

As always, as this is a supplement it is not FDA-controlled and there is no guarantee as to what you will get in the bottle and you should never take any supplement without first checking with your doctor.

More studies on l-theanine can be found here.

Rapid Cycling Brings Out Stigma Comments2. What I Don’t Like – A Half-Assed Comparison Between Bipolar Disorder and the Financial Markets

I’m a writer so questionable metaphors irk me. And rapid cycling bipolar disorder as a metaphor for the financial marketplace? Really? That’s a whole new level of irk.

If you really want to make that comparison then the bulk of the article should be on the markets and not mental illness, and not the other way around like Lloyd I. Sederer M. D. did in Rapid Cycling Bipolar Disorder: In the Office and On ‘The Street.’

Comments of Mental Illness Stigma

All this poorly-written article did was confuse people and elicit a bunch of anti-bipolar comments like:

“The foundation of the Bi-Polar epidemic is based in suppressed biochemist­ry, outdated understand­ing of genetics and a complete misunderst­anding of our true spiritual nature.”

And,

“So how exactly is this different from saying some people dramatical­ly over-react to external circumstan­ces?

Sorry folks, but this one goes into the notebook for the next philosophi­cal discussion of “medicaliz­ation” as a way of discussing deviance.”

Seems to me he just wanted to use mental illness as an eyeball-grabber, tricking readers onto a topic they would never otherwise read – with the extra bonus of eliciting remarks of stigma.

Gee, thanks.

3. What I Find Interesting – New Discussion of Antipsychiatry

As you might know, I’m not a fan of antipsychiatry folks. I have written a lot on this topic and I’m sure I will write much more in times to come. But I can across this article, Getting It From Both Sides: Foundational and Antifoundational Critiques of Psychiatry which has an interesting discussion of antipsychiatry viewpoints.

Two Sides to Antipsychiatry

It astutely notes there are two sides of antipsychiatry – those who feel that nothing can be defined and thus no mental illness can be defined; and those who feel illness is rigidly defined and mental illness doesn’t meet that definition.

Both sides, as the author says,

“. . . have had the effect of discrediting and marginalizing psychiatry and of delegitimizing psychiatric diagnosis and nosology.”

It’s a very intelligent view of antipsychiatry criticism that is elevated far beyond what we normally see online. Check it out.

Until next week: Smarter and Better.

Bipolar Disorder – When to Get Off Antidepressants

→ August 31, 2011 - 18 Comments

I try not to give medical advice here because I am not a doctor. But so many people ask me about this I felt I had to address getting off antidepressants without withdrawal. So many people with bipolar disorder (depression and others) need information about getting off psych meds and they are not getting it from their doctors.

This is the first in a three-part series:

  1. When to Stop Antidepressants in Bipolar Disorder
  2. How to Stop Antidepressants in Bipolar Disorder While Minimizing Withdrawal
  3. How to Stop Taking venlafaxine (Effexor) and Desvenlafaxine (Pristiq) – as they are particularly nasty to get off

This is an informational article only and should not be considered a recommendation. Talk to your doctor before any and all changes to your treatment. I’m not kidding about this.

These recommendations are primarily from PsychEducation.org and Dr. Jim Phelps with some commentary by me.

Bipolars Shouldn’t Take Antidepressants

Some doctors are on the fence about this, but more and more bipolar specialists are recommending people with bipolar disorder not take antidepressants. There are lots of reasons for this, and I have to tell you, they are compelling.

Why Shouldn’t People with Bipolar Disorder Take Antidepressants?

Some reasons people with bipolar shouldn’t take antidepressants:

  • Antidepressants may not work in bipolar disorder – believe it or not, the literature is mixed on how well antidepressants even work for bipolar depression.
  • Antidepressants can induce mania or hypomania (known as switching) – most of us have seen this and it happens all the time to bipolars who are prescribe antidepressants by non-psychiatrists because they just don’t understand the danger. And it is very dangerous because once switched, this type of mania or hypomania can be treatment resistant.
  • Antidepressants can induce rapid-cycling or mixed moods – same as above, this cycling can be treatment-resistant.
  • Antidepressants can worsen a bipolar’s illness overall – this is more controversial and I suspect varies case by case.

Bipolar Disorder and No AntidepressantsTo be clear some people with bipolar disorder will always need antidepressants temporarily, or long term, for their mood, but more and more, doctors are saying to avoid them whenever possible. (Alternatives will be presented in a future article.)

When to Stop Taking Antidepressants

Here are some guidelines from Dr. Phelps about when to stop taking antidepressants in bipolar disorder:

  1. If they have been on antidepressants a short time, I stop them.
  2. Less than a week, stop; two weeks, cut in ½, a week later stop.
  3. Likewise, if they just increased their antidepressants dose I will do the above, decreasing to their previous dose and get rid of the rest later.
  4. If manic or severely hypomanic, get rid of antidepressants now.  Usually can stop abruptly.
  5. If cycling or mixed get rid of the antidepressants.
  6. If they are not getting better after several add-on meds then slowly decrease.
  7. There are more exceptions to the above rules than there are rules.

When to Stay On an Antidepressant if You’re Bipolar

More guidelines from Dr. Phelps: When a bipolar should stay on an antidepressant:

  • If the patient is doing well, no mixed state symptoms or cycling, leave it.
  • I usually wait until the patient is doing better to much betterto stop an antidepressant; why:
  • Trust is an issue.  If the first thing we do is make them suffer more they will be unlikely to stay around long and may not even go to another psychiatrist.
  • Even though we know the antidepressant is causing harm often time the patient thinks either the antidepressant is helping or every time they try to go off they feel much worse.
  • Waiting until they are better is usually a good thing.
  • Also waiting longer usually means that the patient is going to be more educated about bipolar in general.

When to Get Off an Antidepressant Recommendations

I think Dr. Phelps’ recommendations are good ones, otherwise I wouldn’t have them here, but note where he says there are more exceptions than he has listed, so keep in mind, you might fall into one of the unlisted exceptions.

And I think the part above where Dr. Phelps talks about trust and making sure the patient is better before messing around with their cocktail is key. It shows he’s respecting the patient and their health, not to mention the doctor-patient relationship which is very important.

Talking to Your Doctor about Getting off Antidepressants is Scary

I know it’s scary to think about going off antidepressants, even if you do think they are causing problems. But think about it, discuss it with your doctor and make the right decision for you. And don’t do anything until you read the next part about how to get off antidepressants without withdrawal.

Bipolar Disorder – Getting off Antidepressant Series

  • Bipolar Disorder – When Not to Take Antidepressants

Coming up:

Selling True Hope to People with a Mental Illness

→ August 29, 2011 - 24 Comments

The Bipolar Burble doesn’t sell anything, not to people with a mental illness, or anyone else.

It will one day. One day soon it will be selling my book. And then another book after that. We writers do stuff like that.

And maybe one day there will be ads here trying to sell you other things too – therapeutic lights or omega-3 supplements for mood.

But one thing I do not now, nor will I ever sell:

Hope.

I will never, ever try to sell you hope, true or otherwise. Hope is free and selling it is a lie.

Read more

Linky-Madness, Drugging Children and Anxious Hat Makers – 3 New Things

→ August 25, 2011 - 4 Comments

In my line of work I come across the most obscure information, which is why I love sharing it with you. This week’s three new things about mental illness include:

  • A weekly mental health link-party
  • How scientists want to drug children who might get a mental illness
  • How hat makers used to experience social phobia

How could you not want to know the details about that?

1. What I Like – Madness Mental Health Linky

I’ve been participating for a few weeks in the Monday Madness Mental Health Linky over at the WordsinSynch blog by Shah Wharton. As the name implies, there are fresh links every Monday.

[push]Anyone can contribute a useful mental health link. Shah features her own work or the work of others and then lists useful links.[/push]

(No offence to Shah, but the layout is awful and kind of hard to understand.  Here’s how it works: Simply read the Monday Linky article and at the bottom there are featured links. Below that is the “blog hop” where the reader-submitted useful mental health links are posted and below that you can enter your own link.)

Click. Read. Enjoy.

2. What I Don’t Like – Drugging Children (or anyone unnecessarily)

Drugging Children with AntipsychoticsI could just leave it there but what I especially don’t like is the drugging of children who might get a mental illness. This is one of the troubles with that fad diagnosis I mentioned last weekpsychosis risk syndrome. While we do, honestly, know what puts a person at risk for psychosis, that’s a far cry from actually being able to accurately predict who is going to get a psychotic disorder.

For example, I know smoking puts you at risk for lung cancer, but you still might not get it. (Although smoking’s a lot more clear cut than psychosis. Don’t smoke. Seriously.)

In this study, people age 15-40 were to be given an antipsychotic (quetiapine) to see if it would delay or prevent the onset of a psychotic disorder like schizophrenia. And – here’s the kicker – up to 80% may never get the disorder anyway.

So I ask you, is it worth exposing a 15-year-old to a powerful antipsychotic associated with an increased mortality rate on a guess? I think not. (More next week.)

3. What is Just Bizarre – Hat Makers, Mercury  and Anxiety

Think you have social phobia? Do you make hats?

Excessive shyness, embarrassment, self-consciousness, timidity, social-phobia and lack of self-confidence are components of erethism, which is a symptom complex that appears in cases of mercury poisoning. Mercury poisoning was common among hat makers in England in the 18th and 19th centuries, as they used mercury to stabilize wool into felt fabric.

(From Wikipedia, where else?)

See you all next week for an attempt at a smarter and better me.

PS: Have you entered to win yet?

Bipolar Blog Feedback – Update

→ August 24, 2011 - 3 Comments

Hi all.

You might recall, I’m taking part in a reader engagement and feedback program through WEGO Health.

Thanks to all of you who have taken the time to give me your opinion, but there’s more to do. Only about half of the people who have clicked on the survey have filled it out. We can do better than that!

So, Please Take One Minute to Fill Out This Survey

The goal is to find out more about you, my reader.

The more information I can gather, the better this blog can be for you because I want this to be a place that you find useful and engaging.

Hate something? Love something?

That’s what I want to know.

A Bribe

Two of you will be the first to receive my new ebook – for free!

Please take 60 seconds and fill out the survey. I appreciate it.

– Natasha Tracy

PS: And not to worry, this is the last nag article :)

Mixed Bipolar Disorder – How to Treat Mixed Mood Episodes

→ August 23, 2011 - 23 Comments

In the final installation of my mixed moods series, I talk about how to treat mixed moods in bipolar disorder. If you need a refresher on mixed moods in bipolar 1 or bipolar 2, see the first three articles in this series:

Treating Mixed Moods in Bipolar 1 – Mixed Mania

We know most about treating mixed moods in bipolar type 1 as that’s what has been classically defined as a mixed mood in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Because mixed moods in bipolar disorder type 1 are considered a type of mania, one could think of treating them in the same way bipolar mania is treated. Typical mania treatments include:

  • Lithium
  • Some anticonvulsants
  • Antipsychotics (normally atypical)
  • Benzodiazepines (for acute anxiety, commonly seen in mania and mixed moods)

Often a combination of an anticonvulsant and an antipsychotic is used.

FDA-Approved Drugs for Treating Mixed Moods in Bipolar 1

Since mixed moods are defined in the DSM, there are specific medications approved by the Food and Drug Administration (FDA) to treat mixed mania. FDA-approved drugs for treating mixed moods in bipolar disorder type 1:

  • Carbamazepine extended release (Equetro)
  • Aripiprazole (Abilify)
  • Ziprasidone (Geodon)
  • Risperidone (Risperdal)
  • Asenapine (Saphris)
  • Olanzapine (Zyprexa)

Bipolar Type 1 and Mixed Mood TreatmentWhy lithium didn’t make the list I’m not entirely sure;* because, as I’ve mentioned, mixed moods and acute anxiety carry a significant risk of suicide and lithium seems to have a particularly strong anti-suicide effect.

Electroconvulsive therapy (ECT) is also indicated for the treatment of bipolar disorder mixed moods.

Treating Mixed Moods in Bipolar 2

As I mentioned in the article on mixed moods in bipolar disorder type 2, mixed moods can either have hypomania or depression as the primary mood. This primary mood then, dictates the type of treatment chosen.

Treating Mixed Hypomania

According to this two-part Psychiatric Times article by Steven C. Dilsaver, MD, mixed hypomania in bipolar type 2 can be treated similarly to treating a mixed mood in bipolar type 1.

Specifically noted is the concern of acute anxiety during mixed hypomania and the fact not all patients readily admit to psychological and physical symptoms of anxiety. However, this is critical information to your doctor and should always be offered, even if not specifically asked.

Other mixed hypomania treatment tips include:

  • Comorbid (co-occurring) anxiety may decrease the effectiveness of mood-stabilizing agents, so benzodiazepines may be a better choice.
  • Not treating anxiety aggressively can reduce overall long-term treatment outcomes.

Treating Mixed Depression

Mixed depression is particularly hard to treat as mixed moods often predict a lack of response to antidepressants, not to mention the fact that antidepressants can make hypomanic or manic symptoms worse.

A suggested treatment strategy for mixed moods in bipolar 2 with the primary mood of depression is the following:

  • Begin by suppressing hypomanic symptoms by using an mood stabilizer or antipsychotic (antipsychotics may work in 1-2 weeks)
  • Start medication at low doses and titrate (raise the dose) quickly – this is generally necessary due to the severity of mood symptoms
  • If depressive symptoms persist after response to the above medication, add a selective serotonin reuptake inhibitor (SSRI) antidepressant very slowly while watching for signs of hypomania – this requires very close monitoring and likely weekly doctor visits (impossible for some, obviously)

This is very similar to what many doctors are now recommending for bipolar disorder type 2 in general. First, stop the cycling (or hypomania) and see if that also corrects the depression. Avoid the use of antidepressants whenever possible.

Preventing Mixed Depression in Bipolar Type 2

How To Prevent Bipolar Disorder Mixed Moods

Obviously, no one can guarantee prevention of any mood, but there are some recommendations given in the article, as people with mixed depression are known to be at high risk for reoccurrence.

Tips on preventing mixed depression in bipolar 2 include:

  • Lamotrigine is the favorite prophylactic medication as it seems to prevent depression without being an antidepressant
  • Ongoing scheduled benzodiazepine doses can help prevent panic attacks^
  • A combination of an antipsychotic, plus lamotrigine, plus a benzodiazepine is often “highly effective” (words Dr. Dilsaver’s)
  • Lithium is known to be a highly preventative agent; however, in many cases divalproex (Depakote) is superior and has fewer side effects

Series on Mixed Moods in Bipolar Disorder

Whew. OK, there turned out to be a lot to know about mixed moods in bipolar disorder. I hope you learned something reading it as I certainly did writing it.

For your convenience, here are the links to the other three parts in the series:

——————————————————————————————————————————-

Notes

* I suspect there wasn’t enough money to be made on a generic drug to fund the studies, especially when doctors are going to use it anyways.
^ Yes, I know, long-term (sometimes any term) benzodiazepine use is controversial. Personally, I’m not against them and neither are many doctors – when used responsibly.

Reference

Psychiatric Times, Mixed States in Their Manifold Forms. Part one and part two.

Safety Warnings for St. John’s Wort

→ August 21, 2011 - 14 Comments

Safety Warnings for St. John’s Wort

Including the Dangers of Using St. John’s Wort to Treat Bipolar Depression

I mentioned last week that St. John’s wort has been shown ineffective at treating mild depression as well as moderately severe depression (major depression).

Nevertheless, St. John’s wort is the most well-known alternative treatment for depression and many people take it. However, there are absolutely some dangers in taking St. John’s Wort that you should know about, especially if you’re bipolar.

Warning – the following is information provided by me, a non-doctor. Please check all information out with an actual doctor if you’re at all concerned. Thanks.

St. John’s Wort is not “Safe”

One of the problems with herbal remedies is that people think they are “safe” because they are “natural.” Well, so’s lithium and I wouldn’t recommend chomping on that without a doctor’s supervision either.

Herbs do things. If they didn’t, people wouldn’t take them. St. John’s wort may not be FDA-regulated (a whole other problem) but it is, for all intents and purposes, a drug. This means it should be treated with the same caution as any other drug.

Read more

Alternative Medicine Resource, Fad Diagnoses, St. John’s Wort – 3 New Things

→ August 19, 2011 - 4 Comments

In today’s 3 New Things series I talk about:

1. What I Don’t Like – Fad Diagnoses in the DSM

Psychosis Risk Syndrome (AKA attenuated psychotic symptoms) and Temper Dysregulation (AKA disruptive mood dysregulation)

See, I’m not a scientist, and I honestly can’t tell you with any degree of certainty these conditions don’t exist or that they shouldn’t be specifically diagnosed. I just don’t think so, particularly as they may be pediatric diagnoses. The concern expressed in the article* is that these diagnoses have little scientific backing and will lead to yet a further increase in prescriptions of antipsychotics to children (and others) – and that I can tell you with certainty, that I am against.

There are many issues with the new version of the DSM, due out 2013, some positive, some negative, but honestly, if I started writing about them it would take until 2013 to finish. Best to take a millimetre at a time, I say

2. What I Do Like – Alternative Medicine Index from the University of Maryland

St. John's Wort no Better than Placebo in Treating Depression

From Wikipedia

I’m not a huge fan of alternative medicine, mostly because it, as a rule, doesn’t work. However, if you’re going to wander down that path, you need a reliable source of information and I believe the Alternative Medicine Index from the University of Maryland is it. Now, keep in mind, when you do a search for something you’re going to come up with multiple documents, and some of them are going to conflict, but nevertheless, it’s the best place I’ve found to look up the real information on alternative / supplement / herbal treatments.

3. What I Could Have Told You – St. John’s Wort Doesn’t Work for Depression

OK, technically St. John’s Wort doesn’t work better than a placebo in mild depression and earlier it was shown St. John’s Wort doesn’t work better than a placebo in moderately severe depression either. (There could be reasons for this, such as formulation and strength, but it’s what we know for now.)

Important – Please read the warning about using St. John’s Wort

(FYI, the studies were undertaken by the National Institute on Mental Health, a widely-regarded agency with (in my opinion) no conflict of interest here.) (Curious about mine?)

Until next week when I will learn more and try to do better.

* As always, the Psychiatric Times articles require a membership – but it’s free.

Polypharmacy Treatment Requires As Much Faith As Science

→ August 18, 2011 - 24 Comments

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)

Bipolar Disorder and Polypharmacy

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

Taking Multiple Psych Meds Requires 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.

Faking Faith

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.)

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