One Year Medication-Free with Bipolar Disorder

Although he doesn’t recommend it for others, Philip over at Furious Seasons describes what kind of year it’s been since he’s been off of his medications for bipolar disorder:

I’m comfortable saying that if I were going to crash and burn and wind up back at square one, it likely would’ve happened by now. Things haven’t been perfect–there was a bout of depression/seasonal affective disorder a few months back, and my metabolism went haywire after I got off Lamictal and I put on 20 pounds–but I did come through an extremely cold, gray winter (one of the worst ever in Seattle), have been under loads of professional and life stresses and so on. And, yet, things are pretty good.

This isn’t supposed to be happening, not by the standards of medicine and psychiatry. Bipolar disorder is a lifetime diagnosis and you take medications pretty much forever. If you don’t follow through, you are dangerous, a person best kept at arm’s length by one and all.

I know I am lucky, but luck only accounts for so much. The rest is all questions: Did I ever have bipolar disorder? Was my initial diagnosis wrong? Am I a false positive? Did I cure myself? Am I simply a bipolar who does well without meds? Am I in a lengthy remission that will crumple on me someday? Is the diagnosis of bipolar disorder bullshit to begin with? Does the disorder ebb with time? Or am I just a medical freak show, the lone exception that proves the rule?

In his followup post, he describes what led to his decision to try his psychiatrist’s advice to get off of medications altogether, after trying a number of combinations of medications that didn’t seem to be helping him all that much.

I don’t think bipolar disorder has to be a “lifetime diagnosis” — people can and do get better with it over time. And while I don’t think going off of meds for bipolar is for anyone to try on their own (Philip did it with his psychiatrist’s help), it may be something to discuss with your doctor if you feel like you’ve hit a treatment wall. The problem with medication compliance in bipolar disorder is primarily when a person is in a manic phase and feels like they no longer need the medication, and discontinue it on their own, without consulting their psychiatrist or doctor.

The conventional wisdom is that for someone to be successfully treated with bipolar disorder, they must be on medication for a very long time. Sometimes the conventional wisdom is wrong.

Congratulations, Philip! We hope you have many more fruitful years to come.

Read the first post: Losing my religion
Read the followup post: How I got off meds

One Year Medication-Free with Bipolar Disorder

Although he doesn’t recommend it for others, Philip over at Furious Seasons describes what kind of year it’s been since he’s been off of his medications for bipolar disorder:

I’m comfortable saying that if I were going to crash and burn and wind up back at square one, it likely would’ve happened by now. Things haven’t been perfect–there was a bout of depression/seasonal affective disorder a few months back, and my metabolism went haywire after I got off Lamictal and I put on 20 pounds–but I did come through an extremely cold, gray winter (one of the worst ever in Seattle), have been under loads of professional and life stresses and so on. And, yet, things are pretty good.

This isn’t supposed to be happening, not by the standards of medicine and psychiatry. Bipolar disorder is a lifetime diagnosis and you take medications pretty much forever. If you don’t follow through, you are dangerous, a person best kept at arm’s length by one and all.

I know I am lucky, but luck only accounts for so much. The rest is all questions: Did I ever have bipolar disorder? Was my initial diagnosis wrong? Am I a false positive? Did I cure myself? Am I simply a bipolar who does well without meds? Am I in a lengthy remission that will crumple on me someday? Is the diagnosis of bipolar disorder bullshit to begin with? Does the disorder ebb with time? Or am I just a medical freak show, the lone exception that proves the rule?

In his followup post, he describes what led to his decision to try his psychiatrist’s advice to get off of medications altogether, after trying a number of combinations of medications that didn’t seem to be helping him all that much.

I don’t think bipolar disorder has to be a “lifetime diagnosis” — people can and do get better with it over time. And while I don’t think going off of meds for bipolar is for anyone to try on their own (Philip did it with his psychiatrist’s help), it may be something to discuss with your doctor if you feel like you’ve hit a treatment wall. The problem with medication compliance in bipolar disorder is primarily when a person is in a manic phase and feels like they no longer need the medication, and discontinue it on their own, without consulting their psychiatrist or doctor.

The conventional wisdom is that for someone to be successfully treated with bipolar disorder, they must be on medication for a very long time. Sometimes the conventional wisdom is wrong.

Congratulations, Philip! We hope you have many more fruitful years to come.

Read the first post: Losing my religion
Read the followup post: How I got off meds

One year medication-free with bipolar disorder

Although he doesn’t recommend it for others, Philip over at Furious Seasons describes what kind of year it’s been since he’s been off of his medications for bipolar disorder: I’m comfortable saying that if I were going to crash and burn and wind up back at square one, it likely would’ve happened by now. Things haven’t been perfect–there was a bout of depression/seasonal affective disorder a few months back, and my metabolism went haywire after I got off Lamictal and I put on 20 pounds–but I did come through an extremely cold, gray winter (one of the worst ever in Seattle), have been under loads of professional and life stresses and so on. And, yet, things are pretty good. This isn’t supposed to be happening, not by the standards of medicine and psychiatry. Bipolar disorder is a lifetime diagnosis and you take medications pretty much forever. If you don’t follow through, you are dangerous, a person best kept at arm’s length by one and all. I know I am lucky, but luck only accounts for so much. The rest is all questions: Did I ever have bipolar disorder? Was my initial diagnosis wrong? Am I a false positive? Did I cure myself? Am I simply a bipolar who does well without meds? Am I in a lengthy remission that will crumple on me someday? Is the diagnosis of bipolar disorder bullshit to begin with? Does the disorder ebb with time? Or am I just a medical freak show, the lone exception that proves the rule? In his followup post, he describes what led to his decision to try his psychiatrist’s advice to get off of medications altogether, after trying a number of combinations of medications that didn’t seem to be helping him all that much. I don’t think bipolar disorder has to be a “lifetime diagnosis” — people can and do get better with it over time. And while I don’t think going off of meds for bipolar is for anyone to try on their own (Philip did it with his psychiatrist’s help), it may be something to discuss with your doctor if you feel like you’ve hit a treatment wall. The problem with medication compliance in bipolar disorder is primarily when a person is in a manic phase and feels like they no longer need the medication, and discontinue it on their own, without consulting their psychiatrist or doctor. The conventional wisdom is that for someone to be successfully treated with bipolar disorder, they must be on medication for a very long time. Sometimes the conventional wisdom is wrong. Congratulations, Philip! We hope you have many more fruitful years to come. Read the first post: Losing my religion Read the followup post: How I got off meds (Source: World of Psychology)

PTSD’s Effect on Chronic Pain and Depression

Post-traumatic stress disorder (PTSD) and depression are commonly experienced by individuals living with accident or trauma related chronic pain.

However, how PTSD relates to mood disorders and pain severity in chronic pain patients has remained a mystery.

As a result, scientists from the University of Michigan researchers examined the contribution of PTSD to the pain experience, functional disability and frequency of depressive symptoms.

They studied 241 patients referred to the university hospital’s pain rehabilitation program who reported their pain began after a traumatic injury. The subjects completed the McGill Pain Questionnaire and were administered the Pain Disability Index and the Post-traumatic Chronic Pain Test.

Results showed PTSD and depression are significantly correlated and both disorders are associated with perceived disability attributed to chronic pain.

Therefore, in cases of disabling accident-related chronic pain with comorbid depression, symptoms of PTSD may be critical to understanding both disorders.

The authors concluded that increased attention to treating PTSD as a primary focus in the rehabilitation of patients with chronic pain and comorbid depression is important when prior treatment efforts for pain and depression have not been successful.

Source: American Pain Society

Speak Up for the Women Who Suffer Perinatal Mood Disorders

Hey there World of Psychology readers.

You’re probably saying to yourselves “This is NOT Dr. John Grohol. I detect a Southern accent.” Very intuitive.

My name is Katherine Stone and I write Postpartum Progress, the most widely-read blog in the U.S. on perinatal mood disorders, including postpartum depression, antepartum depression, postpartum OCD and postpartum psychosis. For some reason, Dr. Grohol has seen fit to give me the keys to his blog. Before he changes his mind, I thought I’d sneak in and talk to you while I had the chance …

The timing of my post is very important. Later this week, the United States Senate may be voting on the Advancing America’s Priorities Act. This package of bills, introduced by Senator Harry Reid this morning, includes the Melanie Blocker Stokes MOTHERS Act, which would fund increased research into the causes of perinatal mood disorders, better training of healthcare providers and more public awareness. I can’t tell you how important this is.

Of the 800,000 women in the U.S. who get postpartum depression each year, only 10% of them are ever diagnosed and treated. As I wrote on my blog today, we know from research that untreated perinatal mood disorders are a serious public health threat –they can lead to chronic depression in the mother, behavioral problems in the child and stress-related health problems in both. This is an enormous financial cost to our health system and even bigger social cost to our families and communities now and into the future. It will continue on perpetually until we break the cycle and take the lead to proactively educate pregnant mothers, conduct more research and train our doctors. I know this because I am the child of a mother who went through PPD. Her mother, my grandmother, had it as well, and I suffered postpartum OCD myself. I also know because I hear from hundreds of women across the country who read Postpartum Progress and send me emails about their terrible experiences and the lack of knowledge shown by many in the healthcare community.

If you’d like to help, please visit the Depression & Bipolar Support Alliance’s Advocacy in Action Alert and send a letter right now to tell the U.S. Senate to pass this bill. Along with DBSA, it is supported by Postpartum Support International, the Association of Women’s Health, Obstetric & Neonatal Nurses, the March of Dimes, Mental Health America, the Suicide Prevent Action Network, the Children’s Defense Fund, the American College of Obstetricians & Gynecologists, the American Psychiatric Association, the National Alliance on Mental Illness and many others.

Not every mother gets PPD. But the ones who do need and deserve effective help. And just so you know, the bill does not advocate any specific treatment for perinatal mood disorders and neither do I. What I care about is mothers recovering as quickly as possible so they can have healthy relationships with their children, regardless of whether it’s via therapy, meds, a combination of both or some other method.

I hope you will support those of us who go through this and speak up. Thanks for listening.

How i got off-meds

I wanted to clear up a few misconceptions that seem to have cropped up around my posting on being off-meds for bipolar disorder for one year. First, it is not a path I am suggesting others follow. There's no way I could make that kind of suggestion from a distance for other people (I should note that if I did pro-meds advocates would likely call me irresponsible and a murderer, but one wonders what I should call them when they press people to take medication, especially when it's medication that isn't working, without knowing much about the person they are suggesting it for. We see this all the time, don't we? Paging Fuller Torrey, paging NAMI). If there's any implication in my own experience, it's that others should be open to this possibility for themselves or others, regardless of where they stand on the on-meds/off-meds divide. Doctors and other mental health providers should have an open mind as well. Second, some people think this is a path I chose for myself. Not really. My doctor pressed it upon me, two times in separate appointments before I agreed to give it a go. Yes, psychiatrist haters, a psychiatrist did this. That said, my own case and my own choices about what I would and wouldn't take certainly backed my psychiatrist into a clinical corner. I didn't do this wittingly. It was the by-product of my frustrations with anti-depressants and antipsychotics, and in the end that's what guided my treatment. When I began seeing a new psychiatrist in 2004, I was taking Depakote and Wellbutrin. I wasn't doing very well, but I wasn't doing very badly either. I was very clear with the new doc that Wellbutrin wasn't working for me at all and that I was tired of Depakote. Did I want to try another anti-depressant? he asked. I told him I didn't think that made much sense since I'd already been on six different ones, none of them had worked and several of them had fucked me up. Why would a new one be any different? He took me off those meds and I went onto Lamictal and a low dose of Seroquel. He also gave me a small scrip of Ativan to take as needed, and I promised him I wouldn't let myself get addicted to benzos (the scrip was small enough to where that wouldn't happen). One thing I should mention is that after years of bouts of suicidal ideation--largely driven by anti-depressants in my opinion--I hadn't had a suicidal image in my head for about a year. I'd driven them out somehow. Or maybe being off anti-depressants ended them. Who cares which? The next year, I lost my patience with Seroquel--the weight gain, the bad dreams, the agitation, the fifth of whiskey head in the morning, the TD and so on were too much to tolerate--and I took myself off it before visiting my doctor to discuss the situation. He felt I should be on a low dose of an atypical and I told him I'd give it a try and so I took Geodon for about three weeks until I was so agitated and hypomanic that I couldn't sleep (lost a lot of weight though). I took myself off that particular poison pill on my own also. And so, in late August of 2005, there I was talking with my psychiatrist and he said, "What do we do now?" I was on Lamictal and taking Ativan perhaps twice a month. "Nothing," I said. I was sick and tired of polypharmacy and my gut hunch was that I wanted to simplify things and see what happened. I already knew how more meds and more meds worked out. "Let's see how I do on Lamictal alone." And when I did very well on Lamictal only over the next 18 months or so that's when my psychiatrist started pressing me to get off meds altogether. That's how I got off-meds. I hope other patients can work out a similarly beneficial relationship with their docs. And, I hope I cleared things up instead of muddying the waters further. (Source: Furious Seasons)

Judge weinstein : fda: eli lilly: accountability!

(Source: soulful sepulcher)

Suicide and the Japanese

On Sunday, USA Today published an article detailing the epidemic of suicide that is gripping Japan. Unfortunately, like many stories on suicide, the article is thin on actual data to back this idea of an “epidemic.”

When crossing international boundaries, one has to understand different cultures’ takes on taboo topics. Suicide is one such topic, and one where culture has a significant impact on how it’s viewed. For instance, in Japan suicide has practically been raised to a virtue, where committing suicide is seen as the honorable thing to do when one’s life seems to be going wrong:

A suicide fad is sweeping Japan: Hundreds of Japanese have killed themselves this year by mixing ordinary household chemicals into a lethal cloud of poison gas that often injures others and forces the evacuation of entire apartment blocks.

The 517 self-inflicted deaths by hydrogen sulfide poisoning this year are part of a bigger, grimmer story: Nearly 34,000 Japanese killed themselves last year, according to the Japanese national police. That’s the second-highest toll ever in a country where the suicide rate is ninth highest in the world and more than double that of the USA, the World Health Organization says.

Honor or not, suicide is not the answer. An economic downturn takes your job? Guess what? An economic upswing is just around the corner and virtually everyone finds another job in time. Girlfriend or wife leaves you? That’s no reason to end your life when a million other women are out there waiting for you. Suicide is an immediate reaction to a momentary life question that will haunt your friends and family for a lifetime.

But the problem isn’t just in Japan. It plagues many Asian cultures, including the South Korean one, where things are far worse. South Korea has the unlucky distinction of having the highest suicide rate amongst developed countries: 24.7 deaths per 100,000 people.

The solution? Make people better appreciate the life they have now by sending them on a “fake funeral” of their own. The Financial Times has the story:

“Korea has ranked number one in many bad things such as suicide and divorce and cancer rates, so I wanted to run a programme for people to experience death,” says Ko Min-su, a 40-year-old former insurance agent who founded Korea Life Consulting, which offers fake funerals as a way to make people value life.

Korean corporations — from Samsung Electronics and Hyundai Motor to Kyobo Life Insurance and Mirae Asset Management — send their employees on Mr Ko’s courses regularly, partly to encourage them to question their priorities in life and partly as a suicide prevention measure.

People who experience the course first-hand find the experience terrifying and eye opening at the same time:

Yoon Soo-yung, a manager at the Cheonnam Educational Training Institute, who was considering sending her staff on the course, said the experience was terrifying. “I felt like I was suffocating. I cried a lot inside my coffin,” she told the FT. “I regretted so many things that I had done in my life and mistakes that I had made.”

While some experts are skeptical:

Some medical experts are less convinced of the value of such programmes as a suicide prevention measure. “I think treating the fundamental causes like depression and impulsive behaviour is more important and should come before such programmes,” says Chung Hong-jin, professor of neuropsychiatry at the Samsung Medical Centre in Seoul.

My take? The suicide issue is very different in these cultures and the rate is so high, creative techniques like this may hold some potential. The real test is conducting a simple study on the course, assessing participants’ thoughts and attitudes toward suicide before and after, with a random sample of people (those who work in high stress, competitive jobs, and those who do not). It would be a simple study to conduct and one that would show whether there’s more than anecdotal evidence to support the course’s use.

Sadly, the president of the company marketing the course appears to be more interested in expanding into additional markets rather than examining whether his course actually works.

I think such interventions, possibly categorized under the treatment techniques of “psychodrama” (an established field here in the U.S. and Europe, though not well understood or popularized), have potential. Death holds a terrifying mystery to many people. By experiencing first-hand the ceremonial rites associated with death, it may be enough to reach people on an emotional, irrational level as a response to irrational feelings of killing oneself.

It’s an intriguing concept and one I’d like to see the research done on. Because anything that helps change people’s minds about taking their own lives is something that should be more widely understood and disseminated.

Read the full USA Today article about Japanese suicide: Suicide epidemic grips Japan
Read the full Financial Times article: When death is a reminder to live or view the photo gallery, which takes you on an eery step-by-step tour of the fake funeral process

What About Lithium for Bipolar Disorder?

Often overlooked in the conversation about things that work for bipolar disorder is the old stand-by, lithium. Lithium is a naturally occurring salt that was, prior to the past decade or so, the medication treatment of choice for bipolar disorder. It is now seen more as a secondary treatment with doctors instead preferring the pricier atypical antipsychotics. That’s because lithium has some unpleasant side effects (but hey, what medication doesn’t?).

Our new blog, Bipolar Beat has a great entry about lithium that’s worth a read: Bipolar Medication Spotlight: Lithium.

It’s a great informational piece about this medication and how it’s regaining some renewed interest and prescribing popularity as the downsides to the newer atypical anti-psychotics are becoming better highlighted and understood.

What about lithium for bipolar disorder?

Often overlooked in the conversation about things that work for bipolar disorder is the old stand-by, lithium. Lithium is a naturally occurring salt that was, prior to the past decade or so, the medication treatment of choice for bipolar disorder. It is now seen more as a secondary treatment with doctors instead preferring the pricier atypical antipsychotics. That’s because lithium has some unpleasant side effects (but hey, what medication doesn’t?). Our new blog, Bipolar Beat has a great entry about lithium that’s worth a read: Bipolar Medication Spotlight: Lithium. It’s a great informational piece about this medication and how it’s regaining some renewed interest and prescribing popularity as the downsides to the newer atypical anti-psychotics are becoming better highlighted and understood. (Source: World of Psychology)

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