While some disagree, it’s important that people understand that antipsychotics need to be used for non-psychotic depression treatment, when appropriate.
At any one time, 14 million people suffer from depression but only 60-70% of these people respond to antidepressant treatment. Of those who do not respond, 10-30% exhibit treatment-resistant symptoms including “difficulties in social and occupational function, decline of physical health, suicidal thoughts, and increased health care utilization.” Treating these people presents a huge issue for healthcare practitioners and one of the options they consider is the use of a medication class known as antipsychotics.
Recently, a group called the Therapeutics Initiative wrote a letter entitled Antipsychotics should not be used for non-psychotic depression. Their conclusions are as the title suggests: this body found little evidence to support the use of antipsychotics in the treatment of non-psychotic major depressive disorder.
And while I respect the work of this body and while they have considered some evidence (in the case of quetiapine [Seroquel], an antipsychotic), there is more to consider on the issue.
Some people with bipolar disorder are lucky in that when they get treatment, they find something that works for them within some reasonable period of time (and this might be in a year or two, maybe not altogether reasonable, but on the whole, good). However, not all people sick with bipolar are so lucky. Some people with acute bipolar symptoms don’t find anything that works for them for prolonged periods of time. In fact, for many people sick with bipolar, it seems like they will never find any treatment that will work.
So if you’re in this latter group (and I am) what keeps you going? If you still suffer from acute bipolar symptoms and the treatment isn’t working, how do you keep trying to get better, day after day?
Raise the Bar on Bipolar Treatment – Hold Your Doctor to Task
Let me be honest. Even when my treatment is at its best, I never get to the place of zero bipolar symptoms. I’m well, I can handle the remaining symptoms with coping skills, I can be happy but there are always lingering symptoms of bipolar disorder.
And this may be an indicator of being difficult to treat because what we know is that the more you can successfully treat all the symptoms of bipolar disorder, the more likely you are to have fewer relapses. In other words, if you continue to experience bipolar symptoms during treatment, you’re more likely to experience future episodes and we really want to avoid that as each future episode tends to make your bipolar harder to treat.
For this reason, it’s critical to aim for zero bipolar symptoms during treatment, whenever possible.
I have been wanting to write about the Truehope people (makers of EMPowerplus) for years but I haven’t because, well, I didn’t have anything nice to say, so I didn’t say anything at all. I knew that any critique I made of these people would be met with a slew of hate mail and, really, I get enough of that already.
But now I’m ready to go and at the bottom I’ll tell you why.
Recently, I wrote a piece for PsychCentral that outlined some recommendations for treatment-resistant bipolar disorder. This piece talked about first-line and second-line agents for the treatment of bipolar disorder but I wanted to delve a little further into the novel agents that are now being studied for the treatment of bipolar depression. These are medications that are not typically used to treat bipolar disorder, work in new ways and show promise in recent studies. This is cutting edge and if you’re treatment-resistant this is an area that can offer you hope.
Why Are Novel Agents Needed in the Treatment of Bipolar Depression?
The reason why this piece is about unusual bipolar depression medication and not medication for mania is because the medications we have for mania are quite effective for most people. It is the bipolar depression that, typically, is very hard to treat. Additionally the two Food and Drug Administration (FDA)-approved bipolar depression treatments (quetiapine and an olanzapine/fluoxetine combination) tend to carry very serious side effects like weight gain, risk of diabetes including diabetic ketoacidosis and others. We also know that most people with bipolar disorder spend vastly more time in a depressed state than in a manic state.
According to Dr. Prakash Masand, CEO and founder of Global Medical Education, “Less than 30% of bipolar patients achieve remission that is maintained long term. There are great unmet needs in the treatment of bipolar depression. Innovative approaches are needed rather than ‘me-too’ agents that offer little incremental benefit.”
Dr. Masand notes the following are new, novel agents that look promising in the treatment of bipolar depression.
I have had two doctors give up on my bipolar disorder (mostly depression) treatment. One almost a decade ago, and one just a couple of months ago. I didn’t take the most recent doctor abandonment all that well, as I’ve mentioned. In fact, if I saw the woman today, I’d still want to call her a cunt. An unfeeling, malpracticing, cold-hearted cunt. It seems I’m still a little upset about it.
A Doctor Giving Up on You is Unacceptable
But regardless as to my personal feelings about this woman, I feel that a doctor dismissing a patient without referral, medication, treatment or care, is unacceptable. It leaves the ill person with few visible options outside of suicide. A depression, suicidal person with no options. Peachy. These doctors are killing people through their own ignorance.
So, what should you do if your doctor gives up on your treatment? (You know, other than call them nasty names online, which I heartily recommend. It’s cathartic. HealthyPlace isn’t a fan of such things, however.)