Over the last six or seven weeks, we have focussed on the issue of meds compliance. This is a dialogue, a conversation, and thanks to you I am asking questions I never thought I'd find myself asking. Last week, for instance, in response to a comment by Donna, I queried whether in certain instances noncompliance or partial compliance could be acceptable.

That question, in turn, inspired this penetrating comment from Tabby:

If I have never had the symptom, not prone to having it, not currently having it, just because I have bipolar does not mean somewhere down the road I may develop it. Why add more chemicals to my system - that are known to cause damage to my organs, that can cause psychiatric symptoms of their very very own to manifest - when I'm not experiencing said symptom or ever ever have?

Tabby goes on to contrast the difference between the way psych meds and meds for physical conditions are prescribed. For instance, she says, with blood thinners, chances are the blood clot will not grow bigger. With cancer, we will be sick as a dog on the meds but we can expect the cancer to remit. Are we taking our psych meds with that same degree of certainty?

Thank you, Tabby, for raising the issue. This is huge. I am aware of the topic having been raised with statins. Here is a CBS-BusinessWeek take, from 2008:

"We have no evidence that taking a cholesterol-lowering medication like a statin will prevent them from getting heart disease," said Elizabeth Nabel, director of the National Heart, Lung, and Blood Institute. Dr. Nabel oversaw government guidelines that say don't consider statins in patients with low risk factors unless their bad cholesterol is over 160. That hasn't stopped the statin craze.

In the psychiatry field, I am only aware of the issue being raised in the context of "at risk" populations. For instance, if psychiatry gets better at identifying kids at risk for schizophrenia, should antipsychotics be given to these kids, even though the odds are good the illness may never manifest, anyway? You'll be hearing a lot more on this in years to come.

The issue also comes up in seeking to identify those "at risk" for suicide. Should we, for instance, routinely screen kids in school for signs of depression and various behaviors? Following from that, once we've singled out these at risk kids, what actions would we take?

Tabby's query strikes a lot closer to home, so let me give you a personal example: My bipolar I diagnosis is based on the one floridly manic episode I had 23 years ago. I only sought help 12 years after that, following a series of severe depressions, with no intervening manic episodes. So, should I be taking a mood stabilizer to prevent mania?

After all, I had a bipolar I diagnosis. Obviously, I was a case of mania waiting to happen.

Or was I? My one manic episode occurred during an unusual time in my life, soon after a move to a new country, to a new job, working crazy hours under a lot of stress, anxious to make a good impression, with little sleep.