![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 21 to 45 of 48. Go back in thread:
Posted by polarbear206 on May 11, 2007, at 8:54:47
In reply to Re: NIMH on Bipolar Spectrum Disorder--YES, posted by Johann on May 10, 2007, at 23:23:45
> Seems to me that the article states the situation well. Some researchers are genuinely attempting to help people.
>
> After almost 30 years of ferocious depression and strong anxiety, it wasn't until my psychiatrist and I realized that I had Bipolar Spectrum Disorder that I was prescribed the correct medication, lithium, and the depression ceased. One validation of this, aside from all the AD "poop outs," was my mixed bipolar response to Disiprimine, a TCA, which are known for causing cycling.
>
> I believe many people could make better sense of their experience and get more effective help if Bipolar Spectrum Disorder were taken more seriously.--Johann
Yes, I agree we need to take this more seriously so people like you get a proper diagnosis and treatment, not 5,10,20 or 30 years down the road.
Thank you for your valuable input.Polarbear
Posted by MaddieB on May 11, 2007, at 10:20:38
In reply to Re: NIMH on Bipolar Spectrum Disorder--YES » Johann, posted by polarbear206 on May 11, 2007, at 8:54:47
> > I believe many people could make better sense of their experience and get more effective help if Bipolar Spectrum Disorder were taken more seriously.--Johann
>
>
> Yes, I agree we need to take this more seriously so people like you get a proper diagnosis and treatment, not 5,10,20 or 30 years down the road.
> Thank you for your valuable input.
>
> PolarbearAh, yes, I see. "Valuable input" is one that agrees with your take on things. Also see that you are too full of your own self-image of correctness to accept an apology. That's OK, I support you anyway because I believe that your heart (and perhaps even your science) is in the right place. I tried to make a point. I'm sure that I went about it in a way that didn't communicate what I wanted to say such that it could be understood by you and refuted in a way that was at least educative to me, if not one that acheived consensus. I tried to explain that but was ignored by you. I guess that you are just too angry about this issue. I just wanted to say that I suffer too because the diagnosis and treatment of mental illness isn't as precise as I know it will be one day. Regardless of what you think of me, I do know your pain. Maybe one day we can be on the same page. I hope for that day. Best Regards.
Posted by polarbear206 on May 11, 2007, at 10:22:49
In reply to Re: NIMH on Bipolar Spectrum Disorder » polarbear206, posted by MaddieB on May 10, 2007, at 15:53:38
> > I don't appreciate your harsh attitude against me because I work in the field. There are many things I don't agree with!! As far as I'm concerned they can throw the DSM out the window. That should of been revampt years ago, and maybe people wouldn't have to walk around for years not knowing what is wrong with them. I acutually diagnosed myself with mild bipolar. I come here offer help and advice and stress to people to educate themselves.
>
> Yes, my attitude was harsh in disagreement but not intended to be harsh toward you personally.
> For that I do apologize sincerely. I am happy to agree to disagree. I support you in your struggles and I hope you can do likewise. I've been diagnosed with many labels all across depression the spectrum but no one has yet to be successful in medicating me (even the bright minds at Mclean and MGH.) This has been since 1992. My next trial is by MAOI.
>
> More work needs to be done. We are on the cusp of great change and if the study helps to enlighten some then where is the harm? But there is much more to the story yet to be oncovered. I am obviously frustrated. I know you are too.
> Best wishes to you and to us all. Maddie
>
>
>
>Thank you Maddie. If you don't mind, I would like to know about your about your history and course of your illness. Maybe I can offer some insight.
As you can see, I am very passionate about helping others, I don't want ANYONE to go through what I did to get to this point. My symptoms erupted after the birth of my son 18 years ago. The anxiety and depression was overwhelming and consumed me. I was diagnosed with severe PPD and was hospitalized for 3 days. I was put on imipramine and klonopin, which I had an immediate therapeutic response. This was prior to Prozac coming on the market. The doctors couldn't get over how well I improved. I was well enough to go home. Well, that was short-lived, then 2 weeks later the merri-go-round started. My cycling was not classic BP-2. It was more subtle and I was still functional. I cycled with periods of bursts in energy, getting so many things done. It was a good energy!! Nothing that looked like classic hypomania. I mostly had a mixture of anxiety, agitation, atypical depression, esp. in the winter. I threw myself into researching about mood disorders. I diagnosed myself and it took a while to get the right cocktail of medication. I thank God for the newer drugs, esp. Lamictal, which has given me my life back. I wonder how different my life would of turned out, if I had the opportunity to take these newer meds back then. I would of had more children and not feel guilty about not being there 100% for my son. I still require and AD because my bipolar is depression dominated. Effexor is the only AD that has worked well for me. So as you can see, as Johann said in the above post, the public and medical profession need to take this spectrum more seriously. So through research studies and clinical trials, the word is getting out there. I just wish it would of been sooner.
PolarbearPoarbear
Posted by polarbear206 on May 11, 2007, at 10:38:46
In reply to Re: NIMH on Bipolar Spectrum Disorder--YES » polarbear206, posted by MaddieB on May 11, 2007, at 10:20:38
>
> > > I believe many people could make better sense of their experience and get more effective help if Bipolar Spectrum Disorder were taken more seriously.--Johann
> >
> >
> > Yes, I agree we need to take this more seriously so people like you get a proper diagnosis and treatment, not 5,10,20 or 30 years down the road.
> > Thank you for your valuable input.
> >
> > Polarbear
>
> Ah, yes, I see. "Valuable input" is one that agrees with your take on things. Also see that you are too full of your own self-image of correctness to accept an apology. That's OK, I support you anyway because I believe that your heart (and perhaps even your science) is in the right place. I tried to make a point. I'm sure that I went about it in a way that didn't communicate what I wanted to say such that it could be understood by you and refuted in a way that was at least educative to me, if not one that acheived consensus. I tried to explain that but was ignored by you. I guess that you are just too angry about this issue. I just wanted to say that I suffer too because the diagnosis and treatment of mental illness isn't as precise as I know it will be one day. Regardless of what you think of me, I do know your pain. Maybe one day we can be on the same page. I hope for that day. Best Regards.
Maddie,I think we are getting our signals crossed. I did reply yesterday and thanked you for your apology, but I must of forgot to submit my post and anyway, I said I had to leave babble to go to a baseball game. So please don't assume that if I don't respond righ away, I am being "full of myself". Please give me a little more respect. I don't ever want to come across like that. I have said in prior post, that I agree there are many people out there that are that are treatment resistant, which I assume you are from you above post in your above post. I TRUELY sympathize with you and all the others who are going through this.
Polarbear
Posted by MaddieB on May 11, 2007, at 11:14:12
In reply to Re: NIMH on Bipolar Spectrum Disorder--YES » MaddieB, posted by polarbear206 on May 11, 2007, at 10:38:46
OMG...YES Signals Crossed!!!
You message came across RIGHT after I hit the send button. Thank you for your reply. Again, I am sorry. Mea Culpa. Would be happy to give you details of my history. Is this the right forum?
Don't want to bore anyone as I believe by now I'm "off message" on this thread. Please advise.
Maddie
Posted by polarbear206 on May 11, 2007, at 11:20:10
In reply to Re: NIMH on Bipolar Spectrum Disorder » polarbear206, posted by linkadge on May 10, 2007, at 16:54:05
> >The average person will not get a proper diagnosis for about 10 years
>
> I don't know how those types of statistics are arrived at.
>
> I just see it as the latest trend. Its a trend to try and compensate for both the lack of efficacy and outpourings of adverse reactions to antidepressants.
>
> Back in the day, bipolar meant *BIPOLAR*. Now we've got all this inbetween fluff, where everybody and their monkey's uncle can fit into the bipolar diagnosis. It all fits nicely with a trend towards the latest trendy meds abilify, seroquel, lamictal etc.
>
> Symptoms that *used* to fit under the umbrella of depression (irritability, anxiety, racing mind) are being thrown into bipolar now, just for the sake of it. (or because current antidepressants often exasperate things like agitation etc.)
>
>
> Linkadge
>
>
>Link,
If you do a search at pub/med on Akiskal, there is an abundant amount of literature about past time spans with undiagnosed bipolar disorders. There are also books written by highly respected psychiatrist in the field who recognize this occurs. Akiskal and others have been doing research on broading the boundaries of bipolar disorders for years, and finally the word is getting out there. I'm not arguing with you that there isn't any validity in what you are saying. For many people, drugs just don't work, and they shouldn't be lumped into the bipolar mix. Hopefully you an others will benefit from future drugs to come, which is not soon enough.
Polarbear
Posted by polarbear206 on May 11, 2007, at 11:27:07
In reply to Re: NIMH on Bipolar Spectrum Disorder--YES, posted by MaddieB on May 11, 2007, at 11:14:12
> OMG...YES Signals Crossed!!!
> You message came across RIGHT after I hit the send button. Thank you for your reply. Again, I am sorry. Mea Culpa. Would be happy to give you details of my history. Is this the right forum?
> Don't want to bore anyone as I believe by now I'm "off message" on this thread. Please advise.
> Maddie
>Maddie,
You can babble mail me. If your not signed up, there are instructions to do so. I will get back to you sometime today if you do so. I will be off for now, I need to study for an exam.
Cheers,
Polarbear
Posted by linkadge on May 11, 2007, at 11:30:26
In reply to Re: NIMH on Bipolar Spectrum Disorder--YES » MaddieB, posted by polarbear206 on May 11, 2007, at 10:38:46
I contend that the meds predict the diagnosis more than the diagnosis predicts the meds.
When a medication works, it is easy to think that one has the disease that it treats.
I have some questions though:
If coffee makes you anxious, does that mean you have an anxiety disorder?
If l-dopa gives you hallucinations, do you have psychosis?
If stimulants keep you up at night, are you an insomniac?
Of course not, because these are documented and established drug *side effects*
What bothers me about all of this bipolar spectrum stuff, is that it is a response to a lot of the *side effects* of psychiatric medications.
Many of the people who are being diagnosed as bipolar *do not normally have significant mood swings* prior to taking medications.Dr. Manjii, a very highly respected cellular biologist who is currently working for the NIMH,
on cellular targets for mood stabilizers said this (in response to the question of wheather antidepressants can make normal people manic)"it seems that given the right conditions, just about anybody can have a manic episode".
You're taking a group of people. You're feeding them powerful drugs, which can do all sorts of strange things include inducing manic episodes. And then you're telling them they have a more significant illness requiring harsher medications which pose significantly more long term risk.
That is what I call the garden path.
IMO, nobody, without a clear cut history of significant non-drug induced life impairing mood swings should have to endure mood stabilizer therapy.
Linkadge
Posted by Johann on May 11, 2007, at 11:35:15
In reply to Re: NIMH on Bipolar Spectrum Disorder » linkadge, posted by polarbear206 on May 11, 2007, at 11:20:10
> If you do a search at pub/med on Akiskal, there is an abundant amount of literature about past time spans with undiagnosed bipolar disorders. There are also books written by highly respected psychiatrist in the field who recognize this occurs. Akiskal and others have been doing research on broading the boundaries of bipolar disorders for years, and finally the word is getting out there. I'm not arguing with you that there isn't any validity in what you are saying. For many people, drugs just don't work, and they shouldn't be lumped into the bipolar mix. Hopefully you an others will benefit from future drugs to come, which is not soon enough.
>
> Polarbear
>
>
Posted by Johann on May 11, 2007, at 12:35:37
In reply to Re: NIMH on Bipolar Spectrum Disorder--YES, posted by linkadge on May 11, 2007, at 11:30:26
> Many of the people who are being diagnosed as bipolar *do not normally have significant mood swings* prior to taking medications.
The Spectrum Disorder doesn't require mood swings other than going from depression to what can be called euthymic, or particularly enthusiastic, states: "Bipolar without the mania."
> IMO, nobody, without a clear cut history of significant non-drug induced life impairing mood swings should have to endure mood stabilizer therapy.>I haven't found mood stabilizers (lithium and Lamictal) to be onerous; bothersome yes, but worth it, and no more than many ADs.
Posted by linkadge on May 11, 2007, at 13:29:59
In reply to Re: NIMH on Bipolar Spectrum Disorder » linkadge, posted by polarbear206 on May 11, 2007, at 11:20:10
>If you do a search at pub/med on Akiskal, there >is an abundant amount of literature about past >time spans with undiagnosed bipolar disorders.
All of this is in the stage of theory. There are obviously a number of controversies in the field. For instance there is a *strong* devide on the issue of wheather or not antidepressants can induce mania in non-bipolar individuals. Things like this are going to remain contoversial for a while. I don't see any large scale reformations of the DSM happening over night.
>There are also books written by highly respected >psychiatrist in the field who recognize this >occurs.
There are books written by people who have this particular oppinion. There simply is insufficiant data to conclude things like, "bipolar is vasly underdiagnosed". Sure you can conclude this based on certain samples, and certain populations, but there is no guarentee that this extends to the general population.
>Akiskal and others have been doing research on >broading the boundaries of bipolar disorders for >years, and finally the word is getting out >there.What good will it do? You honestly think that more people are going to get well on mood stabilizers? You're going to get more diabetes, more burnt out thyroids, more liver dammage, more zombies, more sapped creativity. A large portion of bipolar individuals are disabled. More bipolar diagnoses, means more impairing drugs. I know a number of people who find their previous jobs to be too difficult under the weight of theraputic doses of lithium etc. There are even authors who suspect that the high rate of disability within the bipolar population is *because* of the treatments, and not inspite of the treatments.
I'm sorry. I just don't really see the bipolar diagnosis as helping people who are only mildly bipolar, or "soft" bipolar (whatever that is).What are you going to take for *soft* bipolar? Soft lithium? Soft zyprexa?
Linakdge
Posted by linkadge on May 11, 2007, at 13:40:09
In reply to Re: NIMH on Bipolar Spectrum Disorder--YES, posted by Johann on May 11, 2007, at 12:35:37
>The Spectrum Disorder doesn't require mood >swings other than going from depression to what >can be called euthymic, or particularly >enthusiastic, states: "Bipolar without the >mania."
But what does that mean? You have a person who is periodically depressed? What depressive doesn't have better days and worse days? Many diseases follow patterns of changes in sevarity. Parkinsons disease, for instance, has periods of reduced symtpoms. MS is another example. It has periods of remission followed by periods of periods of normalacy. I really don't see how depression is any different. So now you have to be ill *all the time* in order to have depression? Nobody would say, oh you were feeling better last summer therefore you don't have MS. Lithium, (and more so depakote) have very limited antidepressant potential. We're finding out that the antidepressant effect of lamotrigine has also been greatly hyped. I really don't see why an individual whos depression periodically remits needs to endure heavy meds like lithium. Both are better antimanic agents than antidepressants. Depression is a documented side effect of treatment with depakote or tegretol in epilepsy.
My mother will shortly need dialysis because of kidney damamge from lithium. These aren't walk in the park drugs.
>I haven't found mood stabilizers (lithium and >Lamictal) to be onerous; bothersome yes, but >worth it, and no more than many ADs.Count yourself lucky. Not everyone can tollerate the side effects from lithium. My grades dopped from an A- to a D in the semester that I was on a theraputic lithium dose. They went back up after I stopped. It took me twice as long to do simple tasks.
Linkadge
Posted by Johann on May 11, 2007, at 13:59:47
In reply to Re: NIMH on Bipolar Spectrum Disorder--YES, posted by linkadge on May 11, 2007, at 13:40:09
So how would you classify people whose chronic depression (and minor mood swings) is only effectively treated with mood stabilizers (after trying many ADs over many years)?
Posted by MaddieB on May 11, 2007, at 14:33:21
In reply to Re: NIMH on Bipolar Spectrum Disorder--YES, posted by linkadge on May 11, 2007, at 13:40:09
Thanks Link. These are legitimate questions that I am seeking answers to as well. I was on many AD's and I have suffered greatly (and have chronic problems)as a result. I am lucky that my pdoc is not pushing for more mood stabs. On a tiny dose of lithium I had a severe reaction. On Depakote, I slept all the time. I was asleep more than I was awake. I am overjoyed that some people are getting help that were misdiagnosed but I do wonder how many 'misdiagnosed' bipolar cases were created by the cycling that AD can cause. There is a very nice discourse in a book by Jim Phelps on this. He's definitely on the 'spectrum' side but he has been brave enough to pose this very question.
Posted by kaleidoscope on May 11, 2007, at 14:53:03
In reply to Re: NIMH on Bipolar Spectrum Disorder--YES, posted by linkadge on May 11, 2007, at 11:30:26
Hi Link
>I contend that the meds predict the diagnosis more than the diagnosis predicts the meds.
This is very noticeable. Doctors tend to diagnose whatever conditions can be treated with the currently popular medications. Advertising and 'free' samples are clearly very effective. Conditions which have no recognised drug treatment tend not to be diagnosed.
Ed
Posted by kaleidoscope on May 11, 2007, at 16:07:46
In reply to Re: NIMH on Bipolar Spectrum Disorder--YES, posted by linkadge on May 11, 2007, at 11:30:26
Hi
>What bothers me about all of this bipolar spectrum stuff, is that it is a response to a lot of the *side effects* of psychiatric medications.
A major concern for me is that rather that stopping the offending medications, *adding* additional drugs (and diagnoses) seems to be the current fashion. These additional medications have significant toxicity of their own.
A little scenario........
Mr. X, a 30 yr old male, is prescribed Lexapro by his doctor for the treatment of a moderate depressive episode following the sudden death of his father. This is Mr. X's first depressive episode. Two weeks later he is much improved. By the third week however, he is getting increasingly irritable, restless and agitated. His family are very concerned about this. He has never behaved like this before. A psychiatrist is consulted and the diagnosis of Bipolar II is made. Lexapro is discontinued abruptly and Depakote is started. One week later, Mr. X's agitation has greatly decreased but depressive symptoms are prominent. Now that Mr. X is on a 'mood stabiliser', his psychiatrist considers it appropriate to start another antidepressant. Effexor XR is chosen. After four weeks on 75mg, Mr. X is still depressed. The dose is increased to 150mg. Two weeks later, Mr. X's depression has improved but sexual dysfunction is reported.......hence the addition of Wellbutrin. Unfortunately, Wellbutrin induces irritability so Zyprexa is started. Zyprexa is effective at controlling the aggression but weight gain occurs. Topamax is added but it causes substantial cognitive impairment and......
On Depakote, Effexor, Wellbutrin, Zyprexa and Topamax, Mr. X is not only unhappy but has no money.Scenario two..........
Mr. X, a 30 yr old male, is prescribed Lexapro by his doctor for the treatment of a moderate depressive episode following the sudden death of his father. This is Mr. X's first depressive episode. Two weeks later he is much improved. By the third week however, he is getting increasingly irritable, restless and agitated. His family are very concerned about this. He has never behaved like this before. A psychiatrist is consulted immediately. The pdoc advises that since major psychiatric symptoms emerged following the use of Lexapro, Lexapro is likely a causative factor and should therefore be discontinued. To reduce the possibility of symptoms being exacerbated by abrupt withdrawal, Lexapro is tapered over a period of five days. Bipolar disorder is not diagnosed because:
A. Mr. X has never suffered a spontaneous manic or hypomanic episode.
B. Mr. X, age 30, has never suffered psychitric symptoms prior to his current depressive episode.
C. Mr. X has no family history of bipolar disorder.
D. Mr. X's drug-induced symptoms do not clearly fullfill the criteria for either mania or hypomania.One week after stopping Lexapro, Mr. X's agitation has decreased substantially but depressive symptoms are still present. Mr. X is warned of the possibility that future antidepressant intake may cause similar side effects to Lexapro. Nevertheless, Mr. X requests further antidepressant treatment. His pdoc chooses bupropion SR: 150mg in the morning - increasing to 150mg twice a day after one week. Five weeks later, Mr. X is doing well on monotherapy, with no significant side effects.
Ed
Posted by kaleidoscope on May 11, 2007, at 16:10:36
In reply to Re: NIMH on Bipolar Spectrum Disorder--YES » linkadge, posted by Johann on May 11, 2007, at 13:59:47
>So how would you classify people whose chronic depression (and minor mood swings) is only effectively treated with mood stabilizers (after trying many ADs over many years)?
Response to a particular drug should never be used to make a psychiatric diagnosis.
Posted by Johann on May 11, 2007, at 16:37:33
In reply to Two scenarios to consider » linkadge, posted by kaleidoscope on May 11, 2007, at 16:07:46
Good delineation. Seems like any intelligent doc would choose the second. And yes, unfortunately there are too many that would choose the first, but they are the minority in my experience.
> Hi
>
> >What bothers me about all of this bipolar spectrum stuff, is that it is a response to a lot of the *side effects* of psychiatric medications.
>
> A major concern for me is that rather that stopping the offending medications, *adding* additional drugs (and diagnoses) seems to be the current fashion. These additional medications have significant toxicity of their own.
>
> A little scenario........
>
> Mr. X, a 30 yr old male, is prescribed Lexapro by his doctor for the treatment of a moderate depressive episode following the sudden death of his father. This is Mr. X's first depressive episode. Two weeks later he is much improved. By the third week however, he is getting increasingly irritable, restless and agitated. His family are very concerned about this. He has never behaved like this before. A psychiatrist is consulted and the diagnosis of Bipolar II is made. Lexapro is discontinued abruptly and Depakote is started. One week later, Mr. X's agitation has greatly decreased but depressive symptoms are prominent. Now that Mr. X is on a 'mood stabiliser', his psychiatrist considers it appropriate to start another antidepressant. Effexor XR is chosen. After four weeks on 75mg, Mr. X is still depressed. The dose is increased to 150mg. Two weeks later, Mr. X's depression has improved but sexual dysfunction is reported.......hence the addition of Wellbutrin. Unfortunately, Wellbutrin induces irritability so Zyprexa is started. Zyprexa is effective at controlling the aggression but weight gain occurs. Topamax is added but it causes substantial cognitive impairment and......
>
>
> On Depakote, Effexor, Wellbutrin, Zyprexa and Topamax, Mr. X is not only unhappy but has no money.
>
> Scenario two..........
>
> Mr. X, a 30 yr old male, is prescribed Lexapro by his doctor for the treatment of a moderate depressive episode following the sudden death of his father. This is Mr. X's first depressive episode. Two weeks later he is much improved. By the third week however, he is getting increasingly irritable, restless and agitated. His family are very concerned about this. He has never behaved like this before. A psychiatrist is consulted immediately. The pdoc advises that since major psychiatric symptoms emerged following the use of Lexapro, Lexapro is likely a causative factor and should therefore be discontinued. To reduce the possibility of symptoms being exacerbated by abrupt withdrawal, Lexapro is tapered over a period of five days. Bipolar disorder is not diagnosed because:
>
> A. Mr. X has never suffered a spontaneous manic or hypomanic episode.
> B. Mr. X, age 30, has never suffered psychitric symptoms prior to his current depressive episode.
> C. Mr. X has no family history of bipolar disorder.
> D. Mr. X's drug-induced symptoms do not clearly fullfill the criteria for either mania or hypomania.
>
> One week after stopping Lexapro, Mr. X's agitation has decreased substantially but depressive symptoms are still present. Mr. X is warned of the possibility that future antidepressant intake may cause similar side effects to Lexapro. Nevertheless, Mr. X requests further antidepressant treatment. His pdoc chooses bupropion SR: 150mg in the morning - increasing to 150mg twice a day after one week. Five weeks later, Mr. X is doing well on monotherapy, with no significant side effects.
>
> Ed
Posted by Johann on May 11, 2007, at 16:49:53
In reply to Re: NIMH on Bipolar Spectrum Disorder--YES » Johann, posted by kaleidoscope on May 11, 2007, at 16:10:36
This seems to me to be an avoidance of the question. No particular drug is mentioned, and there are symptoms and long-term history included. (Just substitute classic mania and depression. Would you say that the obvious BP1 Dx was contingent on a particular drug?)
> >So how would you classify people whose chronic depression (and minor mood swings) is only effectively treated with mood stabilizers (after trying many ADs over many years)?
>
> Response to a particular drug should never be used to make a psychiatric diagnosis.
>
>
Posted by linkadge on May 11, 2007, at 17:07:28
In reply to Re: NIMH on Bipolar Spectrum Disorder--YES » linkadge, posted by Johann on May 11, 2007, at 13:59:47
>So how would you classify people whose chronic >depression (and minor mood swings) is only >effectively treated with mood stabilizers (after >trying many ADs over many years)?
I would classify it as a person whos chronic depression (and minor mood swings) are only only effectivly treated with mood stabilizers (after trying many ADS over many years).
Classifications are useless. They are only implemented to simplify the treatment of certain diseases.
There are reasons why a bipolar med might help a unipolar person. For instance, recent research has focused on gabaergic dysfunction in mood disorders. Other research has focuse on the role of glutamatergic excess in bipolar disorder. Some of these abnormalities might be helped by mood stabilizers with intracellular action.
This doesn't mean somebody has bipolar disorder, only that a particular drug works. If a drug works, a diagnosis is really irrelivant IMO.
Linkadge
Posted by linkadge on May 11, 2007, at 17:15:21
In reply to Re: NIMH on Bipolar Spectrum Disorder--YES » linkadge, posted by MaddieB on May 11, 2007, at 14:33:21
>I do wonder how many 'misdiagnosed' bipolar >cases were created by the cycling that AD can >cause. There is a very nice discourse in a book >by Jim Phelps on this. He's definitely on >the 'spectrum' side but he has been brave enough >to pose this very question.
Well thats the thing. How much bipolar is just an attempt to right the wrong done to individuals who may respond adversely to antidepressants?
Whatever problems antidepressants caused, the best thing to get better for me was simply time off the drugs.
Its like if methamphetamine makes you psychotic, yes antipsychotics might help speed recovery, but the best thing for long term recovery is simply abstainance from meth.
I hated mood stabilizers too. They just brought me down.
Another consideration is this. I read a report that people with elevated cortisol may have more agitation, insomnia, mood swings etc in response to SSRIs (which elevate cortisol). There are a kazillion reasons (other than bipolar) that somebody might have an adverse reaction to an SSRI.
Other considerations are the possability that the underlying dysfunction is not helped by serotonin enhancing drugs / mood stabilizers. Opioid dysfunction, endocannabanoid dysfunction, hormonal dysfunction, dopaminergic dysfunction, HPA axis dysfunction, could all be possable abnormalities that may not respond to (or be exaserbated by) SSRI's.
Linkadge
Posted by linkadge on May 11, 2007, at 17:25:15
In reply to Two scenarios to consider » linkadge, posted by kaleidoscope on May 11, 2007, at 16:07:46
These two scenarios were very good to consider.
It is true that sometimes one drug can induce bipolar like symptoms but the next drug doesn't.
The interpratation of the situation can change the outcome, and perhaps somebodies life.I had this too. My first time on paxil made me very agitated, increased insomnia, heart palpatitions etc, when I was swiched to a lower dose TCA, the symptoms went away entirely.
Different drugs vary on their propensity to induce akathesia. Symptoms of severe akathesia may resemble those of bipolar, ie agitation, irritability, motor restlessness etc.
Even just significant insomnia for extended periods can induce psychosis, irritability, etc in just about anyone. So drug induced insomnia could create problems that resemble a lot of things.
Linakdge
Posted by linkadge on May 11, 2007, at 17:38:44
In reply to Re: Two scenarios to consider » kaleidoscope, posted by Johann on May 11, 2007, at 16:37:33
>Good delineation. Seems like any intelligent doc >would choose the second. And yes, unfortunately >there are too many that would choose the first, >but they are the minority in my experience.
But thats the problem. It all depends on how doctors are trained. Some doctors don't think for themselves and just follow the book. So if the book tells them to immediately suspect bipolar if a medication induces irritability, insomnia, akathesia, etc, then they will likely do it.
I feel that if classifications are followed too strictly then insight into the true problem suffers.
Thats what scares me about this "start suspecting bipolar" way of talking since for many (IMHO) it could mean a more complicated and possably burdonsome treatment algorithm when a simpler answer might be the sanest choice.
I honestly think most of this bipolar stuff is a reaction to the antidepressant backlash.
Think of it this way. Antidperessant prescription rates are down on account of black box warning of antidepressant induced suicidal behavior. Public oppinion of psychiatry has undoubtedly taken a hit over the issue. What better way does psychiatry have to try an turn the wheels around then to do what they do best? Rebrand the disease. I think it is now their strategy to convince people that the drugs were never to blame, but it was infact the patients being underlying bipolar.
I just see this all as a cheap attempt to try and regain public trust again.
People like Healy would reference studies suggesting that healthy people can become "arrogent, irritable, psychotic, and suicidal", after short term ingestion of antidepressants. Pointing to the very real possability that some of these behaviors are quite possably drug induced.
Linkadge
Posted by linkadge on May 11, 2007, at 17:40:48
In reply to Re: NIMH on Bipolar Spectrum Disorder--YES » kaleidoscope, posted by Johann on May 11, 2007, at 16:49:53
I would say that if you have had prolonged life impairing hypomanic/manic episodes than bipolar is quite likely. But for those who do not have a history of mania, I don't see why drug induced manic like ractions constitute anything.
Linkadge
Posted by Johann on May 11, 2007, at 18:31:55
In reply to Re: NIMH on Bipolar Spectrum Disorder--YES, posted by linkadge on May 11, 2007, at 17:07:28
Communication demands classes, classifications. You used these:
diseases
bipolar med
unipolar person
mood disorders
mood stabilizersTo say someone is in bipolar spectrum doesn't define them, it just provides a general way of referring that gives guidance and allows further exploration. Some things require being knowingly simplified due to their complexity.
But I'm getting off topic here by moving into language.> Classifications are useless. They are only implemented to simplify the treatment of certain diseases.
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