Wednesday, May 14, 2008

Bipolar Medication: A Prelude

Caveat: I am a layperson with no medical training. This series on medication is based on research and personal opinion. If you plan on making any changes to your medication, consult your doctor.

How do I write a series on psychiatric medication without offending those who can't survive without it and those who can't survive with it? Maybe it's important for me to say I'm neither pro- nor anti- medication. I do have a lot of issues with the heavy handed way in which it's prescribed, the lack of testing on its clinical applications (particularly before STEP-BD), and the emphasis on medication to the exclusion of other treatment options. But I do take medication when I need it, and I'll discuss that in future posts.

The difficulty of writing on this topic is that each and every one of us may have started using medication for different reasons. Some people heard voices. Others didn't sleep for days. Some were speeding so fast they were out of control. Others may have been exhibiting grandiose behavior, spending too much money, or having sex with strangers. Some were so depressed they couldn't function. Others were suicidal. Some were self-medicating with alcohol or drugs.

Or perhaps like me, it was none of the above. In my case, I had undiagnosed depressive episodes for 25 years, and they were getting progressively worse. Maybe, like me, you tried therapy (with a number of different people with different credentials) over a period of years, and it didn't help. Perhaps you sought psychiatric help because you were feeling so depressed or manic that you couldn't stand it for one more day.

Maybe you didn't seek help at all because you didn't feel there was a problem. Perhaps your loved ones felt your behavior was harmful and recommended treatment.

I can't possibly cover all the possibilities of why you sought help, nor do I know how long it took for you to get a diagnosis, or whether it's the right diagnosis. Also, I don't know if you come from a healthy family in which you were loved (like I was), but had a major life stressor (in my case, going away to college) that caused the first depressive or manic incident. I don't know if you come from an abusive family, and/or have suffered abuse later in life.

I mention all these factors before delving into the topic of medication (tomorrow) because I disagree with the current bipolar treatment protocol with its emphasis on medication, and the supposition that you must take it for the rest of your life.

I believe that who we are, what our backgrounds are, what kinds of lives we've lived, how committed we are to healing, and how actively we're willing to pursue wellness, should factor into the treatment process. Among us, there are people who passively accept their treatment (I would imagine this is a small percentage of those who read this blog).

Among us, there are also "exceptional patients." This is a term I learned about from Bernie Siegel, M.D., an oncologist and author of Love, Medicine, and Miracles. He defines them as people who take charge of their illness. "Exceptional patients do indeed want t0 be educated and made 'doctors' of their own cases. One of the most important roles they demand of their physicians is that of teacher."

Among us are those who may or may not be taking medication, but also are participating in important adjunctive treatments, which have become an important part of our lifestyle, whether it's exercise, spirituality, expressive writing, nutrition, meditation, art therapy, music therapy, movement therapy, talk therapy, biofeedback, neurofeedback, and a wide array of other possibilities.

Why do I mention all this in a prelude to a series about medication? Because every psychiatrist I saw--but one--believed none of this mattered. They focused on medication, they didn't believe in adjunctive treatments, and they never considered utilizing my strengths and insights as part of the healing process.

To me, nothing matters more. After taking such highly toxic medication for so long--and getting sicker and sicker--I must admit that this illness almost destroyed me. (Despite my strengths, the suffering, grief, and loss still have a residual affect.) And I finally realized that if the medication and treatment (and I use the word loosely) could affect me this way--a lot of other people don't have a chance.

This is not to say I don't believe that some people require medication. They certainly do, and as I said before, I use it as well. And I certainly don't believe that those of us who need medication for survival are any less determined, skilled, talented, intelligent or motivated than those of us who don't.

But I do believe we are all different, and until the psychiatric and mental health establishment includes us in the decision-making and healing process, we will continue to see higher and higher levels of unprecedented suffering that is sometimes medication-induced.

After a lot of thought, I've decided I don't intend to focus on specific medications other than to include them if they played a prominent part in my own journey. But, if you need an unbiased look at medication from the consumer's viewpoint, you might check out Dr. Bob's (he's a psychologist from the University of Chicago) website, and Crazy Meds.

P.S. This is a slightly edited version of the piece I posted at midnight. As I reread it, I felt it needed editing and clarification.


Jazz said...

This is one of the things that drives me crazy about the "bipolar community"--so many people have such fierce and rabid opinions about medications. It seems like it's either everyone should be on them, or no one should be on them. I agree completely with you--some of us need them all the time in order to have any kind of chance at life. Some of us only need them occasionally. Some of us can get by without them. To each his own.

I'm reading this series of yours with great interest!

Bipolar Wellness Writer said...

Dear Jazz,
I couldn't agree more. My objectives in addressing this subject are to discuss that medication--whether it works or not--is only one part of the wellness process.

It's to talk about the way medication is prescribed and perhaps the way it should be prescribed.

It's to share some of my own experience, provide information I'm not sure everyone knows, and discuss whether there's a better way to do all this.

We'll see how effective I am.


Jazz said...

I think it's an important discussion that needs to be had. So many people are not aware of the lifestyle changes that can make a huge difference to the amount of medication one might need. When I was first diagnosed, about the only lifestyle element my doctor was interested in was sleep. If I wasn't getting as much as he thought I needed, up went my doses of trazodone and Depakote, because, gosh, I was getting hypomanic.

Psychiatrists only seem concerned with the medication aspect of this disorder, and as you say, it is only one piece. And how effective that piece is can be profoundly influenced by all the other pieces that they don't tell you about--sleep, exercise, stress management, good nutrition, etc.

P.J. said...

I take medication to even me out, to help me feel like myself, and to help avoid major depressions. I see the bipolar ups and downs showing its head on a daily basis though, where I NEED those things like my background, the life I lived, my desire to be well, and my spirituality to aid me in controlling those episodes. When I start to feel myself getting low, I need to make choices for myself that are going to aid in my staying well. The same is true when I am feeling irritable and stressed. I make conscious decisions to calm down, take a break, breathe, nap, whatever I can.

All that to say that for me, it's medication and lifestyle/choices working together. And, to each their own.

P.S. At one point after my diagnosis, during a medication switch, I remember thinking,
"Why can't there just be a bipolar pill that people take once they know that's what they have??" I didn't realize then just how many facets there are. and that NO ONE PILL will EVER work for everyone. We are all unique. Doctors would probably like the "one pill for all" idea...

Bipolar Wellness Writer said...

Dear P.J.,
Thanks for sharing your story. I'm hoping that others will do the same. I think it's really important to learn why people take medication, how it helps them, and what role they feel it plays in their lives.


Bipolar Wellness Writer said...

I agree. Medication, even when it works, isn't a panacea. All one has to do is to look at all the bipolar blogs to see how many people spend their days, months, and years, cycling up and down.

And the moment they feel slightly worse, their doctors increase their medication rather than discussing what stressors in their lives might be causing their distress!


Bradley said...

I'm conflicted on the issue. On the one hand, I think medication is handed out like candy, on the other hand I believe bipolar is an illness no different than any other diseases which we wouldn't consider taking drugs for. I take mine without hesitation.

I am thrilled, however, that my psychiatrist is also my therapist. In addition to working with me on what medications are and are not working, we delve in to my past experiences (which weren't plesent) to have a better understand of how my anxiety and other issues may have had an effect rather on my life, rather than assuming I just have a chemical imbalance.

All things need to come into play for successful recovery, and I think you made a great post.

Bipolar Wellness Writer said...

Dear Bradley,
Thank you for participating. Actually, all the literature suggests that the most effective treatment is "talk therapy" combined with medication.

However, some psychiatrists only provide medication. Some lack insight, and therapy with them is a waste of time. And some insurance policies have a cap on how many sessions they will pay for, or pay such a low percentage of the total fee that many people can't afford therapy.

I'm so glad it's working for you!


Marissa Miller said...

I'm looking forward to reading more on this series and your experience.

Bipolar Wellness Writer said...

Dear Marissa,
Thank you. I'm not sure how much insight I can provide, other than my own experience, and presenting different points of view. Hopefully, other bloggers will take up the mantle and write companion pieces on their own blogs. It would nice to somehow link them all together!


Coco said...

Hi Susan, I posted this morning on a visit yesterday to my pdoc, and how releived I was that he wasn't interested in pushing any meds at the moment. My goal is to go off meds, after being on antidepressants for 14 year. I had a brief fling with lamictal recently, after getting the bipolar diagnosis, but went off that too.

I want to see whether or not I can be one of these people that can make it without the meds. I want to know FOR SURE, rather than continuing to blindly consume them. I have tried 3-4 times in the past to come off them, but severe depression has always claimed me and brought me back to antidepressants.

I'm ready to take an active role in this whole thing, and try some adjuncive treatments.

And I do believe there are those who cannot and should not make it med-free, but I also believe that too many perhaps think this without knowing for sure....without looking at all their options and choices.

I'm happy you're talking about this, thanks and I look forward to hearing other's stories. said...

I really am glad I'm not a psychiatrist. I think they seek their job to help others, atleast the ones I have seen. My pdoc says there are so many factors in the high usage of medication. A major one is insurance and managed care. When insurance companies offer 10 lifetime visits to therapists, it is unbelievable anybody gets well. The reality is some folks just can't afford alternatives to medication. I am glad you are talking about this. I wish we could all get together and look for ways to resolve what appears to be a delima.

Bipolar Wellness Writer said...

Dear Lizzie,
Yes, insurance plays a big role as well. This seems to be one of the few illnesses in which the insurance companies and pharmaceutical companies have more to say about our treatment than anyone else. The pharmaceutical companies provide the major funding for many of the studies--thus, they test medications rather than, say, walking.