Last time, I wrote about the terrors of getting on new bipolar medication. Many people identified with this, including one commenter who said: Sounds all too familiar. I’ve been drug free for several years and seriously doubt that I will ever put myself through that trial and error program again . . . at least for me, that relief is not to be found at the bottom of an orange vial with a childproof cap. I hope you find something to relieve the pain. I also hope you consider the notion that you’re likely stronger and more resourceful than you think you are. Now, I’m not calling out this commenter for doing anything wrong. I have no problem with his comment, nor with him. However, I find this comment insulting. Not because the commenter meant it to be, but because it suggests that people who don’t take medication for bipolar disorder are “stronger and more resourceful” than those who do.

I have been on every bipolar medication you can name and likely a few you could not. I have been on more medication combinations than I can remember. I have spent years dealing with medication side effects. There is very little medication pain that I cannot tolerate. I have taken medications that have made me feel amazingly well and bipolar medications that have made me feel intolerably ill. I’ve seen treatment miracles and treatment devastations. And still, I feel nothing but terror when I think of taking new bipolar medication.

I have talked many times about how important a routine is in bipolar disorder (Limitations and Rules that Keep Us Safe). There are many reasons for this, but one of the main ones is because bipolar disorder is considered a circadian rhythm disorder by many medical professionals. Your circadian rhythm is critical to your functioning as a human as it tells your body when to sleep and when to be awake (among other things) and trying to go against it is like swimming upstream. Assuming bipolar disorder is, indeed, a circadian rhythm disorder, we should do everything we can to work to regulate our circadian rhythms in a healthy manner. Keeping a strict bipolar routine is one major way of doing that.

In one year I write over 100 blog articles for Breaking Bipolar. I’m honoured to say that many people have responded to this writing and it has spawned many great conversations. Popular topics this year ranged from self-harm to passing down of bipolar to your kids to the understanding of mental illness. Check out these popular articles you might have missed.

Some time ago, I wrote about generic medications. I explained that generic medications are bioequivalent to brand name medications within a given margin. Generic medications may use binding and other inactive agents that are different from the brand name medication. All of this can lead to a generic being less effective than the brand name drug in a small percentage of cases. Usually though, the generic works just fine for people and the switch is unnoticeable. And all that information was correct. But new information has arisen. And it’s alarming information to me. It’s information on exactly how bioequivalence is determined for medication and in the case of one generic medication, the generic of Wellbutrin XL 300 mg, it caused an ineffective drug to be allowed on the market for many years.

You’d let them take an ice pick to your brain if you thought it would help. Bipolar disorder impacts different people differently. For some people, bipolar disorder is immanently treatable. These people find doctors, therapy and medication and walk off into the sunset with few bipolar symptoms left with which to contend. These people lead the same lives as everyone else and besides (likely) controlling certain lifestyle factor that contribute to stability, they don’t have to think about bipolar disorder on a daily basis. Then there are the people who are more affected by the illness. These are people for whom treatment partially works. They likely find doctors, therapy and medication too, but in spite of best efforts, they live with bipolar symptoms every day. These people might live your ordinary life or might live a life that is more affected by the illness, such as one where they can only work part-time. And then there are the people that are severely affected by bipolar. Even with treatment these people tend to have intractable moods and likely can’t work because of them. These people do not live average lives. They live lives dictated by the illness and the treatment. These people are in pain every day. And it’s only chance that places you in one of those three groups.

As I’ve mentioned, recently I’ve started volunteering for a local bipolar organization and what I do is give presentations to others. One part of the presentation is my “bipolar story.” It’s the story of my life before diagnosis, the process of treatment and whatnot. It’s long and, well, not that happy. But one of the things that stands out is that treatments have turned me around, but then they stopped working and new treatments had to be found. And these new treatments were extremely hard to find. In fact, successful treatments have been found through guessing as often as through any type of clinical judgement. And there’s a reason for this: bipolar disorder and bipolar disorder treatment are moving targets and our responses have to move with them.

I wish someone had asked me before naming a class of drugs “antipsychotics.” I mean, I understand that to psychiatrists it might not be a big deal, but to the medication-taking public out here, let me just say that the stigma around medication is about 10-fold when you say you’re on something called an “antipsychotic.” Tell someone that you’re on “antipsychotics” sometime and watch them back away slowly. I’m not kidding. It’s like they think an axe is about to magically materialize and you’re about to use it to chop off their head.*

It should surprise no one that I consider mental healthcare an essential service for people. Now, I live in Canada and this means that I can get the care I need without paying for it, but people in the United States are not so lucky. I have to constantly hear about people who can’t get the care they need because of the limits placed on them by insurance companies. And this is wrong. Mental healthcare is as essential as any other kind of healthcare. If you have a broken leg, you expect treatment, and if you have a broken brain, you should expect the same thing.

One of the problems with psychotherapy (and, keep in mind, I like psychotherapy) is that psychotherapists try to look for a cause for every emotion. And this seems reasonable. Or at least it does, to a person without a mental illness.