On the Road in Edinburgh, Part II

John McManamy Health Guide
  • The first full day of the International Society of Bipolar Disorder Second Conference in Edinburgh has just wrapped up, and a clear theme is emerging. “Thirty to 50 percent of the patients in your clinic are not taking their meds as prescribed,” Jan Scott PhD of the University of Newcastle on Tyne warned fellow clinicians at a seminar.

    All day and yesterday, various speakers quoted the same studies in support of the critical efficacy-effectiveness meds distinction. Namely, it doesn’t matter how well a drug is supposed to work if the patient isn’t taking it as prescribed.

    Lithium, for instance, is supposed to be a lifetime medication, yet, according to one study, patients stayed on it an average of 72 days in a row. Yes, the patient may go back on the drug again a few days later, but lithium is not a very forgiving med in this regard.
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    Nonadherence has huge consequences, including a much greater risk of hospitalization.

    The two main reasons patients go off their meds are denial and side effects. Fortunately, the speakers did not blame the patients, but instead talked of solutions such as patient education and various talking therapies to raise patient awareness. One study found a form of patient education (psychoeducation) that resulted in patients better adhering to their meds after five years. Another study found blood lithium levels more stable in patients over an extended time with patients receiving psychoeducation. “The psychoeducation seemed to stabilize the mood stabilizer,” Dr Scott joked.

    Psychiatrists, of course, don’t have time to educate us, and health plans balk at footing the bill for talking therapy. That’s where we come in. If we want to get well and stay well, we all have to become expert patients. When someone put this to Heinz Grunze MD of Munich at a seminar, Dr Grunze fully endorsed the principle, and added, “It makes my job a lot easier.”

    Other conference observations: Try listening to brain scientists talk fast at 10 AM when your body is telling you it’s 3 in the morning in New Jersey. The take home message from the brain science seminar: Various regions of the brain are implicated in mood disorders and these regions are interconnected. For instance, the primitive limbic regions are talking to the higher developed cortical areas and vice-versa.

    Neurotransmitter to watch out for: dopamine. Dopamine is something of a paradox, Alan Young MD of the University of British Columbia pointed out. Antipsychotics block dopamine to reduce mania and psychosis, but dopamine enhancers such as Mirapex may work for bipolar depression without bringing on mania.

    Lamictal controversy. Dr Young noted that there are a number of unpublished trials showing Lamictal is not effective for acute (initial phase) bipolar depression. The one published study showed a positive benefit. The studies on which the drug received an FDA bipolar indication was an 18-month relapse prevention study. “I am personally hesitant about using [Lamictal] for acute bipolar depression,” Dr Young advised. But Guy Goodwin MD of Oxford was far more upbeat. He pointed out that because lithium needs to be tapered slowly, the benefit will take more time to show.

  • Interesting poster: A Turkish study that found that the rates of overweight and obesity in bipolar patietns were unexpectedly lower than the general population in that country and of course considerably lower than in the US. The study researchers speculated that the reason could be that antipsychotics are not widely prescribed in Turkey, plus the benefits of a Mediterranean diet.
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    On that hopeful note …

    This is John McManamy, reporting “live” from Edinburgh.
Published On: August 03, 2006