Last night I participated in the first tweetup for the Society of Participatory Medicine. In their words, Participatory Medicine is a cooperative model of health care that encourages and expects active involvement by all connected parties (patients, caregivers, healthcare professionals, etc.) as integral to the full continuum of care. Not surprisingly, this is something with which I firmly agree. I believe in patients as active participants in their own healthcare. I say it all the time - the doctors aren't the ones taking the pills, you are. The issue with pushing for patient "participation" is not everyone is capable of wholly participating in their own healthcare. Sick people are busy being sick. They don't have time to read research papers. While some in the tweetup agreed, two notable exceptions occurred: ""too sick"? -why Patient support groups are key took 4 building the 'plumbing'." "One can't be busy getting well & busy being sick at the same time. The patient has to choose." Sounds like blaming the patient to me.

Today I read another article on a reasonable person's assertion psychiatric medication doesn't work. The evidence is thin, they say, and the studies don't always show a meaning difference between the drug and the placebo. According to them, everyone with a mental illness doing better on psych meds is experiencing the placebo effect. OK, so let's look at this for a minute.

Recently I switched from antipsychoticX (aX) to antipsychoticY (aY). I despise changing medications; however, this change was necessary due to the general lack of success of the previous cocktail. And in spite of the fact that given the tiny doses there shouldn’t have been any dramatic effects from this change, naturally, there were. A medication change is pretty much always pain on a stick (that hits you, a lot).

People with mental illness have various levels of functioning. Sometimes a good day is when you talk in your group therapy session at the psych ward. Sometimes a good day is getting out of bed. Sometimes a good day is going to the doctor. And sometimes a good day is giving successful presentation to a bunch of executives. It varies from person to person. And while anyone can tell you to “take your meds,” that doesn’t really tell you how to get from non-functional to functional. It’s true no one has the exact answer, 33 high-functioning people with bipolar disorder identified six things that keep them moving forward.

I’ve written about what to do when your doctor gives up on you and while I consider this to be unacceptable, it does happen. And you have to deal with it. But sometimes, you need to give up on them. Sometimes you need to fire your doctor.

As most people know, when a drug is developed, the drug manufacturer receives a patent on that drug. The patent means no one else may produce that drug for a period of time. Drug patents in the US are 20 years, but these patents begin before clinical testing, so really, the drug manufacturer has about 7-12 years of patent protection once the drug is on the market. After the patent expires, other companies may produce the drug, these are called generics. Do you really need to pay the high price for brand name Prozac or is the generic, fluoxetine, just as good?

Recently I read a great article on the use of brand names when referring to drugs. The author, a doctor, decries the practice and says doctors should use the name of the drug rather than the brand name. The brand name of the drug, after all, was chosen by a marketer and a focus group and is really just advertising for the drug. The only trouble is, patients don't know, or can't remember, the actual names for drugs.

I recently read an impassioned plea from a doctor for health care professionals to stop referring to drug by their brand name. The brand name, he argued, was basically just an advertisement for the drug. This got me to thinking, how do drugs get their names anyway? The answer is marketers, researchers, doctors, focus groups, the FDA and about $2 million. Really.

In response to some of the comments I see here and elsewhere, here is my response to another ten myths about bipolar disorder.

Antipsychotic medications were so named as they were initially used to treat psychosis in disorders like schizophrenia. Antipsychotics include medications like Haldol, Thorazine, Seroquel, Abilify and Zyprexa. These medications are now being used, more and more, in the treatment of other disorders like bipolar disorder and major depression. One of the major problems with these medications is a side effect called tardive dyskinesia. Tardive dyskinesia is a disorder involving involuntary muscle spasms and can be (but isn’t always) permanent – even if the medication is discontinued. How can you and your doctor look for the signs of tardive dyskinesia?