Treating Bipolar Depression: Psychiatry is Changing

Many thanks, Hopeful Mom.

Hey, Kathy. First thing I learned about this illness: We're all unique. We are individuals. Susan Bergeson very recently on this site posted a quote from Jame Audubon:

"When the bird and the book disagree, always believe the bird."  

General rules will help most of the people most of the time, but there will always be exceptions.

Here's a little irony: Not too long ago, you would have been considered the rule and I would have been considered the exception. That has changed, but our uniqueness hasn't.

Here's a rule with no exceptions: Always respect the individual. (Just made that up :) )

Hi, Ctrygirl. Very glad you found my blog useful. I don't have any experience with tactile delusions, so I dare not venture a comment.

I do know this: For people with bipolar, an antidepressant can bring on psychosis (tactile delusions, I would presume, are considered a form of psychosis). Also, an antidepressant can create the feeling of mental agitation, like feeling that you want to crawl out of your skin. I don't know if the tactile delusions you experience are a severe form of extreme discomfort, but you might want to play around with the idea.

I do know this for a fact: A lot of the meds we get put on can make us worse, not better. This comes in loud in clear in my latest blog. I'm not opposed to meds, but I do make a clear distinction between smart meds strategies and dumb meds strategies. Psychiatrists, unfortunately, know the pharm reps a lot better than they know us. Far too many psychiatrists, unfortunately, regard US as THEM, and this is the recipe for disastrously dumb meds strategies.

The good news is that you are smart and vocal. Smart meds strategies don't come overnight, even with smart patients forming partnerships with smart psychiatrists, but you are on your way. Please keep me posted ...

You are more than welcome, you bring so much knowledge to the forum it is so refreshing!!!

Thanks for being flat out honest with me and telling me about tactiles and how you aren't sure...much rather hear that than an answer pulled out of the air ya know, that is why i trust ya so much on your posts/answers etc....your a VITAL part of this forum.

I will keep you posted.......found out I also have Lyme disease now, but think we caught it in time, on antibiotic, but my MD's husband is also a psych doc so she is aware of the possibilities this could have created havoc on my system since it does affect the CNS....soooooo dealing with that and believe that was part of a tactile horrid experience i had...but not sure for they DO come and go...even in spite of all the different meds i've been put on and off , on and off....and so on.....

I did have a discussion with my pdoc about WHY none of the mood stabilizers seem to be working for me as they are supposed to, almost like i have the OPPOSITE response to some of them that the average or MAJORITY seem to have....what is the deal with that??? he called it Medication resistant.....uhm ......then are ANY of them working as they should was my next question....but as to date it seems that Lamictal and Risp and KLONOPIN>>>thank GOODNESS for that medication literally pulled me from the brink so many times when way over the top manic!!  seem to be doing the best as of yet...NOT perfect but uhm not sure there IS a perfect med....

AND OH you are so right that the pharm. companies are interested in selling the meds not in focusing on the individuality and diversity of each of our biological and chemical makeups offering a variety of meds, instead focusing on ONE particular or what is second best....and so forth...I so appreciate you bringing that to light, been a pet peeve of mine for years!!!

BUt i know they are trying and i know that there is a HUGE hurdle in their way of understanding bp in the WHOLE sense of the word...Personally i think that it is far to complex for EACH individual that it is nearly impossible to have ONE cocktail ....as you said....for this disorder......it is a roulette game basically and we are the betters on our own ability to overcome and level off per say...

thank you again for all you do....

oh and yeah, i do have a very very caring and very open minded pdoc, he knows i utilize NATURAL products (mostly from the bee hives pollen, propolis, royal jelly, and honey) and agrees but CAN"T prescribe anything not in the gammet of approved drugs per say

......but being an apiarist i KNOW the benefits of these naturals along with theothers that i utilize (for instance we dig our own ginseng, yellowroot, and etc ) it amazes me WHY they never seem to test and investigate the NATURAL things that are right here for us to utlize and that our gparents and great gparents so forth used for so many years ya know ( and i'm so curious as to the diagnosis of bp in their era been researching that to see a correlation.......no results as of yet)

....SOOOOO EDucation for all is very important and there are some naturals that don't mixwith the prescribed: like sister or brothers often do one can irritate the other...so one has to be careful.

...however, if i could i'd go ALLLL natural....but as of yet have yet to find a natural product that thwarts the symptoms with the power of the prescribed....so i stay on both (and make sure that mine are in concert with the prescribed i take) just a little tidbit......did you know that pdocs can't prescribe NATURAL PRODUCTS??????

 i didn't ,,,,,,hope my pdoc was straight up with me onthat one.....but that is what he said.... "I can't prescribe them but can tell  you if they interact negatively with your prescribed meds..........but i'm glad you checked these out and are using some of them" and none of mine did cause a problem. Hemp seed oil helped a lot with the aches/pains/stiffness of a lot of my physical illnesses......and ginseng, yellowroot, goldenrod, and so forth it goes....but with both 15 physical illnesses (and NOOW LYME which I'm on antibiotics for ) and the various mental illnesses, well I only take the prescribed meds for the bp, have went all natural for the physical for i don't like taking meds for this and that and at one time had over 12 meds they wanted me to take in a DAY!! I finally sai WHOAAAAAAA no more...NO MORE>>>.but then again guess i'm considered more VERBAL than most when it comes to just taking without asking questions, he KNOWS when i come that there will be a gammet of questions so he is very patient and very interested in what i have to ask...so fortunate there BEYOND WORDS !!!
thanks for all you do once again!
your friend looking forward to your next post!
ctrygirl

Hey, ctrygirl. A quick response to your Lyme disease comments. Check out this link:

http://www.ncbi.nlm.nih.gov/pubmed/7943444?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

There is good evidence that in some people, mental illness may be caused by certain animal-borne viruses. Certainly, animal-related afflictions complicate the course of one's mental illness. The good news is - perhaps - if you clear up the Lyme disease a lot of your other complications may be resolved.

My guess is the Lyme disease experts know more about the psychiatry end of the illness than the psychiatrists. You're not likely to find much info, but please let me know what you find out. Hope this helps -

Hi. Cretin. Funny you should mention Symbyax:

When I attended the APA annual meeting in San Francisco in 2003, Eli Lilly unveiled numerous posters about their new studies showing positive results with Zyprexa and Prozac together. At the time, they didn't have a name for the drug.

Oddly enough, Zyprexa without the Prozac also produced good results.

At the time, I made this my lead story in my Newsletter.

In 2004, Eli Lilly got FDA approval for its combo med under the trade name Symbyax. It was the first med cleared specifically for bipolar depression. But the drug was a commercial flop.

In talking to psychiatrists, they explained to me that basically they like to "do their own cooking." They don't like something "pre-mixed" for them. What they figure is that if Symbyax works, then any antipsychotic-antidepressant cocktail is likely to work. This assumption is logical, but may or may not be accurate. Thus, if a patient is already on say Risperdal, it makes sense to keep the patient on the Risperdal and prescribe a Paxil or Lexapro or Prozac or whatever SSRi may be in the sample cabinet.

Even if the pdoc favors an antipsychotic-antidepressant combo, he or she prefers to prescribe both separately - so the exact amounts for each med can be adjusted.

So that's one reason pdocs don't prescribe Symbyax.

The other is that Zyprexa has a significant side effects burden, particular metabolic side effects that may cause diabetes.

Finally, in 2005 (I think) Seroquel with nothing added produced outstanding results for treating bipolar depression, at least in the initial phases of an episode. And compared to Zyprexa, Seroquel is a much more benign med. So if an antipsychotic has to be used, it makes far more sense to start with Seroquel rather than Symbyax.

Dr Hirshfeld did mention Symbyax in the APA symposium, and I reported it in my Newsletter, but I left it out of this report. According to Dr Hirschfeld, the APA will be recommending Symbyax in the context of trying it only after Seroquel fails.

It is my understanding that the APA is recommending Seroquel as a first choice and Symbyax as a qualified second choice only for the acute (initial) phase of bipolar depression. In their current guideline for mania, they only recommend keeping a bipolar patient on an antipsychotic as a last resort. This is due to side effects issues. Similar reasoning is apparently going into their upcoming revised guideline for bipolar depression.

I neglected to mention in my blog that I posted my complete Newsletter report on my mcmanweb.com website. The article there goes far more in depth on treating bipolar depression, and raises many important issues that space considerations did not allow me to raise here.

You can check out the article at:

http://www.mcmanweb.com/treating_bipolar_depression.html

Hi, Dr Dalto. I'm rather bewildered by your "beware" comment. Dr Post and the other psychiatrists I've listened to are clearly unambigious about the potential for harm re treating bipolars with antidepressants. By UPenn, I take it you are referring to Dr Amsterdam, but he appears to be a lone voice amongst published researchers. No doubt, the views of Drs Post and Goodwin and Sachs and Ghaemi and others will take time to percolate down to the rest of the profession. But the leaders in the field all appear to be on the same page as you. So why beware?

Yes I am aware of Dr. Sachs and the other doctors you mention as well.  I don't want to let all the secrets of my work out until my book gets published, but all I can say to those reading this is for those on medications make sure to be getting very good psychotherapy as well because sooner or later you might be finding yourself wanting to get off them... The dangers of medications both side effects and withdrawal effects are very much downplayed and/or confused with being manic/hypomanic... everyone who has been on mood stabilizers for a long time and try to get off them will go through a period of time being emotionally labile.  Past studies of patients on prolonged lithium were then switched to a "placebo" and every single patient became emotionally labile and was written off as being Manic...instead of being properly viewed as withdrawal from the medication.   Lithium as well causes patients to become Hypoxic... A VA patient in Boston died in the hospital secondary from hypoxia due to being on lithium.... This was downplayed as well and instead of being confirmed a problem due to a side effect.. it was written dismissed.  There are several other cases of people being on a respirator due to the hypoxic effects of lithium, zyprexa, and other mood stabilizers... And these hypoxic effects causes much of the neurocogntive sequelle. I have discussed this at length with some doctors at UPENN but they want to downplay this as much as possible fearing increased liability that psychiatrists will face... Anyways thats why I tell people to "Beware"...it can all be found as well in my book.. That I'm working on finishing up and securing a publishers as well. till then, feel free to check out either my <a href=" http://profile.myspace.com/index.cfm?fuseaction=user.viewprofile&friendid=234845779"> myspace site</a> or <a href="http://www.bipolarbeware.com">my Website Bipolar Beware</a>

Hi, Dr Datto. Point taken. Mindfulness is my real mood stabilizer, along with other recovery tools. My chemical mood stablizer is an extremely low dose. My recovery tools (including diet, exercise, sleep, support, self-awareness, etc) do all the heavy lifting.

But this wasn't true back when I was first diagnosed. Back then - with no knowledge and no recovery tools in place - I needed full doses of more than one med.

Even psychiatry acknowledges there is no evidence base to speak of for long-term meds treatment for bipolar. Long-term treatment is based on unsupported assumptions made from short-term treatment, which translates to the type of high doses meant for emergency room treatment.

I encourage individuals to work with their doctors toward reducing reliance on meds over the long term, but with this proviso. It takes a long time to learn and implement recovery tools. It also takes discipline. Changing bad habits into good ones will always be a challenge.

To readers: Yes, it is possible to reduce and perhaps even wean yourself off your meds completely. But first you need to be leading a disciplined life, with your recovery tools well-established. Don't even think about it, otherwise.