Why Are We Forced to Take Such Bad Medication for Bipolar?

Have you ever been given a direct choice of what medication you'd rather take or is it typically more of a doctor preference for what they've had best experiences with? The original message also mentioned differences in what type of bipolar women get diagnosed with--know that often these drugs don't get tested as much in women of childbearing age so curious about whether gender plays a role in terms of whether drugs work or how the disease plays out...

Hi MMC,
Different doctors are different but largely it depends on how you engage with them. They might give you the name of one drug but if you ask them why, and what the side effects are, and what the options are, they generally supply that information. And once you demonstrate a certain understanding of psychiatric treatment they tend to readily supply more general options like, "I think we should add a low-dose antipsychotic to increase the effect of the antidepressant."
Really though, if you want options, you should ask for them. It's your right.
I don't agree that drugs don't get tested as much in women of child-bearing years. I believe all drug studies include both sexes over a broad range of ages. What doesn't get tested is women during pregnancy. That's another ball of wax altogether.
While women do manifest depression more frequently than men (for a variety of reasons I wrote about earlier), I know of no differences in their reaction to medication. IE, when the study results are looked at, the sexes are comparable. Ethnicities also show no difference. Both of those facts have to be included when applying for FDA approval I believe.
How the disease plays out per se I think has a lot more to do with gender roles in society, not gender reaction to medication.
- Natasha

There's an article at psychcentral that just came out this morning that seemed to address this question as well from the clinician viewpoint:
Why Doctors Oversell Benefits, Undersell Risks and Side Effects
http://psychcentral.com/blog/archives/2011/01/04/why-doctors-oversell-benefits-undersell-…

That's a Scientology site. Is your point, MMC, that none of us should take drugs as part of our treatment?

Hi MMC,
I read that article and while it does bring up some good points I'd mention that it's a pretty strong opinion piece that doesn't really generalize to all clinicians.
The comments this blogger has is common to all medicine, not just psychiatry, but he is primarily using psychiatry as a whipping boy to make his point. I wouldn't really call that fair.
While I have, many times, riled that I would love to shove antipsychotics down the throats of the doctor's who prescribe them and then see how they feel about the drug, that's not a terribly reasonable point of view.
And the final point that "not every medical problem has a solution. Not every issue has a treatment. Some people may face an illness or disease that is untreatable. Or treatable only in a very painful manner that may be worse than the disease itself," is sort of ridiculous.
I don't understand how a doctor would look at someone who is going to commit suicide and say, "sorry, no help for you," thus leading to the person's death. Is that reasonable? Is that how you would like your loved ones to be treated?
I don't. I don't want people dying. I don't want people hurting themselves. I get how horrific treatment is. But dying is worse.
(Of course if one compares it to cancer treatment where doctors do cease treatment at some point understanding that death will result no matter what, then you have to admit that death is the end result of a mental illness. I'm not sure how comfortable most people would be with that decision.)
- Natasha

Hi Id,
I don't actually see any evidence of Scientology there. May I ask what makes you think that's the basis of that site?
- Natasha

My bad -- had it confused with another site.

Hi Id,
No problem.
- Natasha

Thanks for this article, Natasha.
I know I'm not alone when I say I don't want to have a mental illness. I want it to go away. I don't just want it improved, I want it gone. I get terribly frustrated with medication, therapy, the whole thing because gosh darnit, I'm STILL mentally ill. It's easy to focus my anger on the treatment, whatever treatment that may be. And from time-to-time I allow myself small temper tantrums. But overall I have an easier time when I think realistically and remember that, like it or not, I do have a mental illness. And no pill or therapy session is going to make it go away.
Really appreciate the perspective.

Hi Holly,
Thanks for the comment, I think that's exactly what I'm trying to say :)
"It’s easy to focus my anger on the treatment, whatever treatment that may be."
I think that's the important bit. We all have fits about the state of treatment, which I totally understand and have indulged in, but it's about moving beyond that.
Thanks for your perspective too.
- Natasha

Hello Shoshanna I have been living with Bipolar disorder for 20 years, and I most definitely share your concerns and some of your conclusions. I do happen to believe that the current psychiatry industry is corrupt. I also believe that the whole notion of treating that first manic episode that we experience with anti psychotic medication is misguided. Look up a web site on reverse psychiatry for information supporting this point of view. That's reverse psychiatry NOT reverse psychology! This phenomenon should be investigated further. I am not saying that many of us do not need our medicine or that we discontinue any we are presently on, only that when a person who seeks help on that first manic or psychotic episode, he/she be treated differently than the standard Haldol or Resperidol over response!

Hello. I am Angela, the author of "Surviving ED" on here. I find this topic interesting because of two reasons. First, as someone who is in in recovery from anorexia, I find it interesting that many of the medications used to treat eating disorders are the same meds used for bipolar illness (for example, I take a low dose of Seroquel, which was originally a anti-psychotic but has been approved for use in bipolar illness. My doctor is technically prescribing it off-label.) I know many other people with eating disorders who are taking other meds that are approved for bipolar illness. It makes me wonder if there might be a connection?
The other thing is that I was diagnosed with bipolar I in 2001 (my current doctor thinks it was a misdiagnosis, and I have not had any manic episodes.) I was placed on lithium and unfortunately because of a miscommunication between my doctor at the time and myself, I ended up with lithium poisoning. Conventional wisdom says once you have lithium poisoning, you should not take it again. However, the doctor I was seeing was an idiot and put me back on it two days after the excess was flushed out of my system via IV (I almost slipped into a coma.)
Anyway, I ended up developing a disease called hyperparathyroidism and it was directly linked to the lithium poisoning and the fact that I continued to take it. In fact, my endocrinologist said there have been many cases of hyperparathyroidism linked to long-term lithium use. I know lithium can be a lifesaver for many people with bipolar illness, however it is not a panacea. I thought you might find this interesting and a possible topic for a future blog post.

I used to have to take a mood stabilizer in conjunction with my anti-depressant for my bi-polar. During one of my med reviews I refused to take any meds that would cause me to gain weight. I flat out refused to take my meds if I discoved it was starting to make me gain weight.
They put me on the mood stabilizer Trileptal, I gained no weight and it worked great once you get used to sleepy side effects.

Hi Angelina,
Your lithium incident is really unfortunate. The doctors I know take prescribing lithium very seriously and make sure to monitor people all the time to ensure correct blood levels. The therapeutic range for that drug and the toxic range for that drug are quite close.
But I will say though, when lithium works, it's amazing. A "panacea" is technically a cure-all. I would say lithium comes close for a lot of people.
Eating disorders are linked to neurotransmittor dysfunction in the brain, specifically serotonin although there may be others as well. I think what research will find is that eating disorders are more linked to depression than bipolar.
- Natasha

Hi Kristi,
I certainly can understand your frustration and your desire to "put your foot down" regarding some medications. It's great that you've found one that works for you without weight gain.
- Natasha

Hi Natasha,
I just stumbled upon your blog, and am quite glad to see a fellow bipolar blogging so prolifically with the kind of biting humor I adore. :)
You come across as extremely self-aware and insightful, and as such, I'm wondering if you've heard of Anatomy of an Epidemic, by medical journalist Robert Whitaker. If not, I highly recommend it. It will definitely make you think twice about your statement that "...scientists and doctors are working with the best evidence they have right now." They actually aren't, and there is 50 years worth of data to prove that point - Whitaker is just the first to do an in depth review and to call a spade a spade in this regard.
I was diagnosed Bipolar I following a severe mania and psychotic episode in 2010, and after suffering what were deemed multiple manic and depressive episodes in the several years prior. I was desperate to get help due to the intense unrelenting physical, mental, and emotional pain you know all too well, and also to keep from losing my wife and my son. But at my core, I knew pharmaceutical meds were not for me. Something told me they would do more harm than good.
Thank goodness I'm so damn stubborn, because I stuck to my guns, and after finding a rigorous alternative treatment regimen that works, I can happily say I have been episode free for almost nine months. Not that it's been perfect or easy - I still have bad days, it's still a lot of work, and I still struggle to stick with my regimen at times, but I've not experienced the deep pain and fear of a full blown mania or depression.
Anyway, much longer than I intended, but check out Whitaker's work if you haven't already. It's disturbing, illuminating, and hopeful all at once.
Thanks for sharing your voice!
Natalie

Hi Natalie,
I'm glad you like it. Thank-you.
Yes, I'm aware of that book. I haven't had a chance to read it but honestly, I have such a hard time trusting anyone on such issues that I would have to fact-check the whole thing before I could believe it.
It's great that you've found a solution that works for you. I hope you stay in good health.
- Natasha

We share the need to validate data before we believe anything. :)
You can find Whitaker's sources here:
http://www.madinamerica.com/madinamerica.com/Bipolar%20Illness.html
And those are just the documents backing his bipolar findings, there
are similar pages for schizophrenia, depression, childhood disorders, etc.
His work is garnering huge acclaim and turning the mental health world
as we know it on its head.
Mental health experts from 13 states met last week in Oregon to "begin developing ‘medication optimization’ protocols and national and state policy reforms to help improve mental health care outcomes..." - in other words, to reevaluate psychiatry's intense focus on long-term medication. Whitaker's work is not anti-med, but rather advocates "selective, cautious" use of meds for short-term crisis treatment, using a program in Finalnd as a model. Psychiatric patients there have far better long-term outcomes than American patients.
Anyway, keep doing what you're doing and making people think outside the box - you're writing it priceless!

Hi Natalie,
Oh, I couldn't agree more on improving outcomes. I think the major problem is undertrained doctors handing out pills for years on end. The specialists I see make a conscientious effort to reduce medication to the minimum necessary amount. And they know how to use medications effectively and have years of experience to suggest treatment for hard-to-treat cases.
I always tell people, you need to see a specialist in your illness. I think it's key to recovery. (For a serious mental illness.)
I looked at that data and there's actually a lot wrong with his conclusions. He doesn't understand the studies he's looking at. The "Gateways" section is particularly bad.
As for antidepressants worsening bipolar, that is something up for debate right now and I've written about it here. It's a real concern although overstated in some cases.
And just as one final note, pre-drug would be pre 1950. In pre-1950 most people would not be doing something cognitively intensive. If you take the average bipolar and tell them to work on a factory line or take them and tell them to work at Microsoft, the outcomes _are_ going to be different. Today's world is not the same one from 60 years ago.
I could go on.
I'm not saying he's wrong in all cases just that he's slanting things in a way the evidence doesn't support. That's what happens when you try to write a controversial book. Good for sales, not so good for actual reason.
Of course, medicine looking at itself is certainly a good idea. We all want improved outcomes.
"Anyway, keep doing what you’re doing and making people think outside the box - you’re writing it priceless!"
Now that I'll take any day of the week. :)
- Natasha

Hi Natasha,
I think you misunderstand the link I included - it does not by any means illustrate Whitaker's conclusions, it merely lists the 24 studies he cited on bipolar illness in particular (all peer reviewed and published in major medical journals). Anatomy of an Epidemic is a 400 page scientific text, not a sensationalist headline grabber - with an epilogue of almost 50 pages of source notes. He actually went into this in an attempt to justify American psychiatry and its approach, and was shocked and disturbed at what he actually found. A quick read of just his foreword is extremely enlightening as to his motives and who he is in this journey to reevaluate our treatment system.
Change is always controversial and scary, especially in something as entrenched as our current mental health system. But his work is getting attention from psychiatrists nationwide, from the APA, etc., in addition to the countless scientists and mental health practitioners whose expertise he called on throughout the book. (The biggest critics are, of course, the pharmaceutical companies.)
One of the most telling quotes I've read in this respect recently highlights exactly why we must be willing to reevaluate our approach, no matter how uncomfortable that process may be:
"I would like to point out that in the history of medicine, there are many examples of situations where the vast majority of physicians did something that turned out to be wrong. The best example is bloodletting, which was the most common medical practice from the first century A.D. until the nineteenth century."
- Nassir Ghaemi, Tufts Medical Center, APA Conference (2008)
I'm really glad you've found a network of providers who medicate with care and discretion - that seems unfortunately rare in the treatment of mental illness. But no matter how good they are, they cannot change the long-term effects of psychiatric meds - drugs that were never intended to be used for anything other than short-term crisis treatment. People deserve to know the truth about what they're being prescribed, and Whitaker's work is a rare resource in that regard.
As for the praise, I have it in spades. You're a damn good writer! :)
Take care,
Natalie

Hi Natalie,
Obviously I haven't read the book and it sounds interesting. It's just that the link sites the studies as well as his one or two sentence or sum of the studies. Those summaries are what I'm saying aren't accurate.
And yes, pharmaceutical companies aren't known for playing nice. No doubt about that.
I'm not sure what to say about long-term use vs. crisis treatment. The issues seem no bigger nor no smaller than for other classes of drugs like statins.
Truth is relative and rarely singular.
You take care as well.
- Natasha

One other thing I should note. From Wikipedia:
"Chlorpromazine largely replaced electroconvulsive therapy, psychosurgery, and insulin shock therapy. By 1964, about 50 million people worldwide had taken it. The development and use of antipsychotic drugs like chlorpromazine was one of the forces that propelled deinstitutionalization, the systematic removal of people with severe mental illness from institutions like psychiatric hospitals and their reintegration into the community.
In 1955 there were 558,922 resident patients in American state and county psychiatric hospitals. By 1970, the number dropped to 337,619; by 1980 to 150,000, and by 1990 between 110,000 and 120,000 patients."
http://en.wikipedia.org/wiki/Chlorpromazine
Just sain'
- Natasha

I'll not even get into whether or not Wikipedia is a scientifically sound and unbiased academic resource...just sayin'. ;)
And the difference between treatment of physical diseases and mental illness is that not only do countless peer reviewed, academic, published studies show psychiatric meds to have negative long-term ramifications (both cognitively and physically), the same studies show them to actually worsen the long-term course of the disorders they are meant to treat. In other words, when used long-term, they often do more harm than good.
You're obviously extremely astute and so very talented - check it out from the library, flip through, and then tell me if it's not informative. Just because we as society (and we as individuals) have been doing something for years doesn't make it the best answer. Progress is called progress for a reason. :)

OK, Wikipedia has it's issues. That portion of the article is fully referenced.
(I actually find Wikipedia to be extremely accurate where references are sited. I have yet to research a topic there are find inaccuracies documented there. But I suspect that varies topic to topic.)
I'll see if I can get around to reading it, but not in the next little while as I'm proofing a book and have articles to write. Life of a starving artist I'm afraid. (No time for absinthe and pretty girls like they showed me in the brochure.)
- Natasha

I just had to give you a hard time because I'm a pain in the ass like that. Feel free to nod and smile, or ignore me altogether. :)
Give Anatomy a look if/when the mood strikes you and you have time for it - it is pretty dense with data, but still quite readable regardless. I sense we have a bit in common with our approach to this sort of thing - I have an endless thirst for knowledge and data (as long as it's thoroughly validated and well sourced), and an intense need for introspection and self-awareness. These qualities come across in your writing - and I've found them extremely helpful in my own journey on the bipolar path.
As an aside, I read an entry after the fact about your problems finding treatment that works - the book might give you some peace around that. I really have a hard time believing "treatment resistance" is only 10-25% now that I know the history of these meds and the long-term effects. I think more of us than not probably don't do well on meds over time. And for our doctors to let us think otherwise just feeds our already enormous guilt over feeling like failures and/or like we're never good enough, which of course is a huge episode trigger. The thing is, it's NOT us, it's the treatments. I know you know that, but still, knowledge and data are power.
And seriously, you're incredibly talented - keep it up, and chin up about your journey. You're headed down this path for a reason!
If you ever want to read a similarly irreverent approach from a fellow bipolar, feel free to check out my blog (this post lays out a bit of where I come from on the treatment front: http://www.rockpapershutup.com/2011/01/diagnosis.html; but it's a downer compared to most of my stuff). ;)

A quick side note on the Wikipedia link you cited previously (I didn't want to take it on directly until I had the proper citation at my fingertips to do so...which is why I, of course, deflected with humor). :) In all seriousness though, the Wiki reference simply reflects the dominant narrative that was constructed on the revolutionary nature of psychotropic meds, which in this specific instance is flawed due to a misattribution of the causal agent. Here's what actually happened:
"The discharge of chronic schizophrenia patients from state mental hospitals - and thus the beginning of deinstitutionalization - got under way in 1965 with the enactment of Medicare and Medicaid. In 1955, there were 267,000 schizophrenia patients in state and county mental hospitals, and eight years later, this number had barely budged. There were still 253,000 schizophrenics residing in the hospitals. But then the economics of caring for the mentally ill changed. The 1965 Medicare and Medicaid legislation provided federal subsidies for nursing home care but no such subsidy for care in state mental hospitals, and so states, seeking to save money, naturally began shipping their chronic patients to nursing homes. That was when the census in state mental hospitals began to noticeably drop, rather than in 1955, when Thorazine was introduced. Unfortunately, our societal belief that it was this medication that emptied the asylums, which is so central to the "psychopharmacology revolution" narrative, is belied by the hospital census data."
- Anatomy of an Epidemic, Robert Whitaker, p 93-94
(There are numerous studies showing that long-term treatment with antipsychotics, such as Thorazine, actually greatly increases relapse of psychosis, rehospitalization, and the rate of chronic mental illness. Rather than balance neurochemistry over time, they actually disturb it, and if administered for a long enough period, the damage becomes irreversible.)

Hopefully this comment won't be quite as illiterate as the previous one due to the fact that I am no longer on Lamictal. I read my last article with complete dismay; appalling grammar, spelling, phrasing, I even lost my ability to type. I was also falling every day, spilling everything and had a mind of a dolt; but my weight remained the same. This is from a drug with a very low side effect profile. Plus its the only mood stabilizer (except the "Gold Standard " lithium) which helps with bipolar depression.
When you absolutely can't take antidepressants and anti-psychotics make you feel like you're on a bad acid trip, whats a bipolar 11, rapid-cycler to do? And we haven't mentioned the cost of these medicines. Its not that I"m against medication; just bad, expensive, weight-gaining, diabetes causing medication. I know we can do better than that. I've read about MAO Inhibitors, Parkinson type drugs, even a low addiction pain killer (the DEA must of loved that one) that have been studied for bipolar relief. Yet when you read about new drugs, its always the atypical anti-psychotics that are considered the Bipolar breakthrough.
Why aren't specific types of exercise evaluated. Its stated that all exercise is a mood enhancer. Yet I found swimming and water aerobics to have amazing antidepressant properties, while strenuous workouts made me hyper and irritable. Why isn't the food we eat, the health of our bodies and the well-being of our emotions studied more in the Bipolar equation?
Finally in response to the comments that Natalie and Natasha made about the "deinstitutionalization" of mental hospitals, neither one of you mentioned the major effect - the huge impact it had on the homeless population. Many of the mentally disabled even with or without their meds simply couldn't cope. Is it any surprise.

Shoshanna - I'm so sorry to hear about the devastation you experienced from meds. I'm not anti-med either - I am, however, anti-long-term-medication. It simply destroys people both physically and cognitively. Every single study shows that any positive benefit from both anti-depressants and anti-psychotics alike only comes from short-term use, and that long-term use actually worsens the very symptoms they were supposed to help in the first place.
I'm following a regimen that includes yoga, meditation, therapy, EFT, a medication alternative called Empower, etc., and I've been doing nothing but getting increasingly stable. I'm not on meds, nor have I ever been on meds - even during a psychotic break. (The idea that mental illness must be a chronic condition is simply untrue - the prevailing treatments are often what make the conditions chronic.)
I agree, money and research need to be put into pinpointing therapies that actually work - the problem of course, is that the pharmaceuticals control the majority of research dollars, and they don't want non-medication alternatives to be supported as standard treatments.
Please feel free to check out my blog for some good resources and info, and perhaps to feel a little less alone in your journey to find stability without medications that make you feel worse: www.rockpapershutup.com
(And I agree with your point about homelessness, I was just citing a portion of Anatomy of an Epidemic to shed some light on actual cause of the stat Natasha had cited previously.)

I had to leave a comment here because reading the responses that MMC gave is really getting to me.
Your asking us if, "A doctor has ever given you the choice of what medicine to take, or is it just there preference?"
ah hem, who would be stupid enough to give a mentally ill person that choice. There are many people like you and you all are 100% wrong.
YOU don't have a PHD,
YOU are not a DOCTOR,
YOU simply read OPINIONS on the INTERNET and THINK you went to school for 8 years!
YOU DIDN'T, YOUR A PATIENT OF A WELL TRAINED DOCTOR, he will tell you what he feels is right, and you should do what he says. why? because hes smarter, more experienced, and HEALTHIER than the person at the other end of the desk.
thanks for making me more annoyed that there are people as thick headed as you in this world, who think they know whats better for them than a professional. you did give me a good laugh tho.

"ah hem, who would be stupid enough to give a mentally ill person that choice. There are many people like you and you all are 100% wrong."
this is HORRIBLE attitude. Just because I am troubled doesn't make me stupid.
Plus... many shrinks have their own share of crazy (so there goes healthier). And in a way, I find it preferable, because they may be more emphatetic... And some crazies are highly intelligent (yes, sometimes their IQ *may* be higher then their doctors, just imagine!). Experienced? Sorry, no doctor ever lived with me 24/7 as I do. Yeah, they may be more experienced in being shrink. I am more experienced in what it is to be me.
Doctors are just doctors. Not God Almighty. And they don't live in our minds and bodies. If the meds makes patient feel bad... then they should be listened.
"thanks for making me more annoyed that there are people as thick headed as you in this world, who think they know whats better for them than a professional. you did give me a good laugh tho."
thanks for telling us we are stupid for trusting ourselves more then somebody who we see average 15 minutes a month. Thanks for spreading more stigma then there already is.

Venus H. you are right. I had a doctor I really thought was great, but then she gave me Depakote. I gained so much weight after already having gained from Lithium. Some of them just don't have the patience to listen to your concerns, and just want you to shut up and take whatever they dole out. I switched to another doctor. The older the doctor I think, the worse it is. Loss of patience!

Thank you VenusH!!!!!!!!! I agree, doctors with all their training are not the Gods that people make them out to be, ie think thalidomide babies. I have a relative who was diagnosed and treated for cancer. The treatment nearly killed her. Later she was found to never have had cancer in the first place but instead was found to have a rare genetic disorder from birth that was made worse by a number of car accidents she'd been in. It had appeared as cancer on the xray when in fact it was not. Doctor's make mistakes all the time and they rely heavily on drugs for treatment. Yes medicines and other treatment options are evolving for mental illness but until I find one that doesn't have troubling side effects, such at cognitive impairment, weight gain, diabetes, thyroid problems and so on or cause unknown long term negative effects I will continue to remain skeptical. My overall health has deteriorated somewhat since being on medication (I am more depressed and more exhaused now than I ever was before). I'm currently looking for a more holistic approach to treatment. My doctor will never know me the way that I know myself because he doesn't walk in my shoes. It takes a while to get to know a person well and most doctors are too busy to spend the appropriate amount of time with you.

Don't forget about all the drug companies that have been successfully sued for millions of dollars by clients who took their psychotropic medicine, that was once approved by a government body, and prescribed by a qualified professional

Please don't get me wrong. I'm not anti doctors or anti medication exactly but I do believe that we have to trust our bodies and instincts to some degree and not blindly trust that the medical community has all the answers. To be fair I have been helped by some of the medication I've been prescribed but with some definatey not. One gets tired after a while of feeling like a lab experiment. You have to wonder what damage is being done by all the medications you've tried that have not been helpful. It's a fact that the scientist aren't even sure exactly how some of these medications work for our bipolar brain. The brain is a very complicated organ and there is still much to be learned...

I routinely out argue, and challenge doctors and lawyers. Many in my own family.
Mentally ill, Adhd, BPII or not...
So "Mr. Depressed", think for a second if Medical school or school at all makes someone a genius.
I had 99's in classes I skipped and taught to myself.....
I always had to "play catch up", with my ADHD.
I'm sure I'd be extremely overweight, suicidal, and possibly even dead if I listened to every single (arrogant, self righteous ) doctor I've ever encountered.
People THAT CAN make their own decisions , should.
Doctors that actually listen and that I feel are worth my time, DO give me some options for medications.
I chose dexedrine.
I'll choose what med for BPII if I think the risks aren't too severe.
When I blindly believed as a child and took an SNRI - within 1.5 Yeats later, I was almost murdered. That's how severe a manic state I was put in.
I graduated with degrees, lost tons of weight, quit drugs and alcohol with ZERO medical help.
So ... Yeah, some people fight and learn as much as they can.... Whether others believe they're capable or not.
You wrote a long time ago, but this is true.

Yeats* should be years, of course.

By the way there are TONS of stupid professionals.... Look at the bars or Vegas, or divorced alcoholics you see.
And there are tons of mentally ill , depressed doctors.
No one has the answers to every question.
And authority or title means very little. You could have a 140-150 IQ, still there are people way smarter than you or I.