I’m always going on and on about how there are only two medications approved to treat bipolar depression (quetiapine and a fluoxetine/olanzapine combination) and about how we need new, novel ways of treating depression in bipolar disorder.
Lurasidone (Latuda) has now been approved both as monotherapy and as adjunct therapy (with lithium or valproate) in the treatment of bipolar depression by the Food and Drug Administration (FDA). Lurasidone was tested and approved for people with bipolar I.
About three years ago I attempted suicide. It’s a long story but it involves a doctor denying me access to healthcare. I’m still alive; so I guess I got lucky.
But the question is, now, three years and many treatments later, am I still suicidal?
The Bipolar Burble blog welcomes guest poster Michael Cahill of Vista Health Solutions. Michael discusses the critical implications of the Affordable Care Act for people with mental illnesses.
Since the 2008-2009 financial crisis, America has put funding for mental health treatment on the back burner. Consequently, mental health services and facilities nationwide have suffered.
In the wake of tragedies like Aurora and Sandy Hook, the government is now determined to address the issue of mental health policy in the United States, which will be no easy task.
What will surely go a long way towards helping those suffering from a mental illness will be getting them access to treatment and making that treatment affordable. According to the Substance Abuse and Mental Health Services Administration, the high cost of mental health care is the number one culprit for people not getting treatment. Even those with health insurance often have significant limitations on their access to mental health services.
The Affordable Care Act (ACA), sometimes more commonly referred to as Obamacare, has great potential to improve access to mental health treatment and make it affordable. Here are five ways it can do it:
This is an interesting question: how does a person with bipolar disorder think? Of course, it’s hard for me to compare it with your average person as I have bipolar. I don’t have the two thought processes in my one brain to compare.
Nevertheless, I do have some ideas on how people with bipolar disorder think that seem to stand out amongst the “normals.”
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.
Do you feel broken? I sometimes do. I sometimes feel very broken. I sometimes feel like the bipolar disorder has damaged me beyond repair. I sometimes feel like the bipolar disorder has damaged me beyond reason.
I sometimes feel like it would be impossible for another human being with a functioning brain to want me.
And this is too bad because it can lead to some very bad decisions regarding relationships. I’ve seen people with bipolar who feel this way stay with people who were entirely beneath them because they feel like that broken toy. The person with bipolar disorder feels like she/he doesn’t deserve any better.
This may be wrong. This definitely is wrong. But it doesn’t mean that some part of our brains doesn’t still believe it.
As I’ve mentioned before, people with bipolar disorder, statistically, spend more time depressed than they do manic or hypomanic. People with bipolar II have it the worst. People with bipolar II can spend up to 35 times more time depressed than hypomanic. This means that if you’re a symptomatic bipolar II, you’re probably feeling depressed right now.
And, of course, depression is a big problem in bipolar disorder as there are only two Food and Drug Administration-approved treatments for bipolar depression (although other treatments are prescribed off label).
While that picture is dark, I would argue there is one aspect of depression that’s more within our control but is equally debilitating. It’s (often obsessively) feeling bad about feeling bad.
This is an interesting question that was recently posed to me by a reader: Am I feeling better, or am I feeling hypomanic? Feeling better, of course, is the goal. Feeling hypomanic, of course, is not. One can be something to celebrate while the other can be something to be afraid of. So how does one tell the difference between plain wellness (or happiness) and hypomania?
People ask me if they can treat their bipolar disorder without medication all the time. They think that I have some secret answer to give them. Like I secretly know something that doctors don’t. Like there is a giant conspiracy to keep non-medication treatments away from people with bipolar disorder.
So let me answer the question: Can you treat bipolar disorder without medication?
The quick answer is: no, not really. The long answer is: sort of, a bit.
So here I outline the treatments I’m aware of that treat bipolar disorder without prescription medication (or neuromodulation, like electroconvulsive therapy or repetitive transcranaial magnetic stimulation).
Many of us hear condescending, stigmatizing and prejudicial remarks about bipolar disorder in the workplace – a place where everyone should be treated with respect and as an equal. This lead one reader to ask me this question (reprinted with permission):
I’m not sure how to deal with an incident at work. The company brought in a trainer who when talking about difficult coworkers said “for example have you ever worked with someone who is bipolar.” I spoke with him afterwards and he said he meant to say when unmedicated. I’m disturbed because that seemed very stigmatizing and prejudiced either way yet it was accepted as appropriate . . . I hear how difficult people with bipolar are frequently, like we are 10 to 100 times more difficult than other people just because of our illness. Can you please offer any insight so I can stop feeling like a plague on humanity?
I read this question and I was pretty much incensed.
I was driving in my car yesterday morning, groceries in the back, a freshly frothed latte in the front, when I flipped to a radio station, heard one line of a song and started crying. The song lyric is inconsequential; I knew that then and know it now. What is consequential is that my bipolar disorder heard the song and used it as an excuse to be upset. My depression, my loathing, creeping, squirming depression, popped its fucking head up and made me burst into tears for no reason on a perfectly functional Wednesday morning. I had a breakthrough bipolar event.
Today, the Bipolar Burble blog welcomes guest author Kevin Hines, a fellow mental health advocate. Kevin is one of only 33 people who have survived a jump from the Golden Gate Bridge. I met Kevin recently at a conference and I can tell you, his story is incredible and he uses it to help others.
I always try to remember that life is but a state of mind and if that state of mind can be altered by an imbalance of chemicals, it becomes extremely hard to function. After all, I was diagnosed with bipolar disorder when I was 17 years old. Since that day, I’ve come to learn that life literally is a state of mind, and how, without the love and support of friends and family, life would be a lot more difficult.
I am so thankful for the support of family and friends who have helped me whether the hard times at are inevitable when one has– like I do – a mental illness. With all the years that have passed since I attempted to end my life by suicide, I have learned that we all make mistakes in life, but now it is time to put the past where it belongs, in the rear view mirror. We cannot control the future, but we can help one another – and ourselves – today and every “today” that follows.
After My Bipolar Disorder Diagnosis at 17
After my bipolar diagnosis I struggled, suffered, and attempted to understand the metamorphosis I was going through. I hoped that it was just a phase, maybe I was going to “grow out of it.” I was going through the motions of trying to find the right medications for my particular kind of manic depression. Some days the medication would feel like it was working, but on others, it would not.
Driven to Suicide
This lasted until I was 19-years old when thoughts of suicide unfolded. I wrote a suicide letter and the next day, I prepared for another day of classes at City College in San Francisco. But that was a blatant lie, even to myself. This morning my plan was to go to the Golden Gate Bridge to end my life.
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