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Recovery is a Journey

By John McManamy

You are emerging from a crisis or emergency situation. Your clinician has informed you that you have bipolar disorder. The medications are kicking in. You are no longer bouncing off walls or chained to your bed. Your worst symptoms have abated. You have your brain back.

But you are not still not feeling yourself. Something isn’t right. And the side effects of the medications are making you feel worse in many ways. Is this it? you wonder. Is this my fate as someone with a severe mental illness? Is this what each day of the rest of my life will be like as an individual with bipolar disorder?

Clinicians cite high success rates for treating bipolar disorder, as high as 80 percent. Findings from the Stanley Bipolar Network, based on surveys of outpatients at participating clinics, however, paint a far different picture: Only a third of the patients in that particular study were currently married. Another third were single, and the rest were separated, divorced, or widowed. Despite the fact that approximately 90 percent had high school diplomas and a third had completed college, almost 65 percent were unemployed and 40 percent were on welfare or disability.

Admittedly, the individuals surveyed represented a population of struggling patients, but other studies corroborate these findings.

What is going on? Why the apparent disconnect between so-called treatment success rates and reality?  Time for a word lesson:

Response is a term commonly used to measure the success (or failure) of a clinical drug trial. Response means a 50 percent or more reduction in symptoms. A clinical trial is deemed to be successful if 50 percent of the people taking the test drug experience a 50 percent reduction in symptoms. But can we truly regard a 50 percent improvement as successful treatment?

Remission signifies the virtual elimination of symptoms. Very few drug trials measure for remission, as only a minority of patients gets well within the short time frame of these studies. The American Psychiatric Association, in its 2002 Bipolar Treatment Guideline, advises psychiatrists that remission is the goal of bipolar treatment. The Guideline also expands the definition of remission to include full functioning. More on functioning in a minute.

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