My blog Knowledge is Necessity features two posts on staying well, inspired by two studies five years apart that surveyed "successful" bipolar patients for what worked for them. We will go into these studies in more depth in a future post here. Right now, we will focus on one salient point involving medications.
Eighty-five percent of the patients in the first study were on meds, but it was clear that the meds did not figure so prominently in these patients' overall wellness. For instance, one patient had Zyprexa handy as a standby med with the permission of his psychiatrist. He had used the Zyprexa twice in the past year. More important to this patient were meditation and exercise and other practices.
The authors of the second study identified six key strategies that corroborated the stay well practices in the first study. Successful patients, for instance, paid attention to sleep, rest, diet and exercise, closely monitored their moods, engaged in reflective and meditative practices, educated themselves and others, connected with others, and had various emergency plans on tap.
Note that meds management was not on the list. It is reasonable to assume that most of the patients in the second study would have been on meds. It was just that there were more important things these patients had to contend with. Getting one's sleep right, for one. Taking time out when stressful events threatened to overwhelm the brain, for another. Choosing to change careers or friends to accommodate living with a severe chronic illness, for yet another.
What is fairly obvious from these studies and my own experiences listening to patients in support groups and other venues is the diminishing role of meds in our lives as we learn to manage our illness. We may still have to remain on meds, but they are no longer doing all the heavy lifting. Unfortunately, psychiatrists appear largely ignorant of this fact of life.
Psychiatry excels at getting patients out of crisis and into stabilization. Over-medication and onerous side effects are not major issues when our lives are in danger. Things change soon change. The patient is better and wants to move on to being well, hopefully on much lower meds doses. He or she is in a position to intelligently discuss his or her illness and treatment options, but is a long way from mastering the recovery tools involved in getting to well.
This means the patient may have to stay on overly high meds doses for much longer than he or she wants to, and this poses a major problem that psychiatry is not addressing. Two years ago, I gave a grand rounds to a group of clinicians in Princeton, NJ in which I observed that the drop-out rates over the long term for the cancer med tamoxifen were much lower than for Zyprexa (which was fairly representative of other psychiatric meds studies).
In fact, the drop-out/compliance rates in both studies were almost exact opposites. Nearly eight in ten stayed on the cancer drug. Nearly eight in ten stopped taking the Zyprexa. Here's the kicker: the makers of tamoxifen stopped the study in its second year as they felt the drop-out rates were unacceptable.
