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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by linkadge on April 27, 2007, at 9:07:10
I have been reading an article at:
http://www.mcmanweb.com/depressionorbipolar.htm
It kind of got me angry.
Apparently antidepressant poop out is now seen (by some) as a symptom of bipolar disorder.
"Says who?", I say. Why is it that the failures of psychiatry are always forcably reframed as a fault of the patient?
In any other illness, if a treatment fails, this does not mean that the diagnosis was wrong.
If a Parkinsons medication poops out, it doesn't mean the patient has M.S. instead. Its called pharmachological tollerance. It happens in with all sorts of other meds.
I wish doctors would stop using bipolar to fill in every blank.
Any comments?
Linkadge
Posted by Klavot on April 27, 2007, at 9:41:50
In reply to Using Bipolar as a 'fill in the blanks', posted by linkadge on April 27, 2007, at 9:07:10
The human brain is a moving target. Brain chemistry constantly adapts to one's circumstances. I would actually expect that all psychoactive substances will, as a result, vary in effectiveness over time. AD poop-out is really just the distant cousin of benzodiazepine tolerance.
Klavot
Posted by polarbear206 on April 27, 2007, at 10:00:35
In reply to Using Bipolar as a 'fill in the blanks', posted by linkadge on April 27, 2007, at 9:07:10
Over 355 published studies involving Dr. Isop Akiskal for anyone interested. Decide for yourself. Go to www.pubmed.gov and do a search for Akiskal.
Posted by Phillipa on April 27, 2007, at 11:23:32
In reply to Re: Using Bipolar as a 'fill in the blanks', posted by polarbear206 on April 27, 2007, at 10:00:35
Well my mood does not alter at all. I'm always on the verge of worry and anxiety. I become somewhat depressed when I feel I can't do what other people my age do and the energy they have. My pdoc says well you ride 7.5 miles on your bike I couldn't do that. I say to her well you can get up at a decent hour I am like a zombie as I worked 3-ll for most of my life and my kids slept from ll at night to 9am in the am from 2 weeks of age. As a child I slept in till noon on weekends. So if people didn't operate on different time schedules where would the world be? So my disorder is more self imposed than biological . What do you think? Love Phillipa
Posted by Johann on April 28, 2007, at 0:04:16
In reply to Using Bipolar as a 'fill in the blanks', posted by linkadge on April 27, 2007, at 9:07:10
AD "poop out" plus some other information helped me to realize that my ferocious depressions were actually part of Bipolar Spectrum Disorder. After almost 30 years, my depressions abated due to beginning lithium.
It's a real thing and not just a scapegoat for psychiatry. You could say they deserve some props for making sense of this phenomenon.
Posted by greywolf on April 28, 2007, at 0:58:44
In reply to Using Bipolar as a 'fill in the blanks', posted by linkadge on April 27, 2007, at 9:07:10
I am really, really bothered by articles like this. Frankly, instead of reverting to some obscure "mood spectrum" because it is allegedly too difficult to distinguish true bipolar from recurrent depression punctuated occasionally by a sense of normalcy or happiness, maybe pyschiatrists need to be stricter about diagnosing bipolar to begin with. It certainly is a lot easier from a professional perspective to call treatment resistant recurrent depression a form of bipolar rather than what it really is--depression--because throwing depression into bipolar at that point relieves the psychiatrist of the obligation to admit that he doesn't have an effective treatment for your depression.
My case is a perfect example. I have treated with 3 psychiatrists and 3 therapists over the past 12 years. All are unanimous that I am bipolar II--not "soft bipolar", not "bipolar spectrum", not "somewhere near something like bipolar on the 'mood spectrum'." Simply and unequivocally bipolar II. These professionals recognize that hypomania isn't something as generic as "putting real butter on your bread" for excitement; that hypomania is not wholly relative in the sense that its baseline is proportional in some linear fashion to severity of depression.
I mention the "real butter" scenario because the article notes that hypomania may be difficult to discern in people with recurrent depression because for many of them doing something mundane like using real butter is "a walk on the wild side." In my opinion, any mental health professional who thinks this way has no real understanding of hypomania. Hypomania is simply not just a mood surge that can easily be confused with a momentary lifting of crushing depression. It is something completely different, and to suggest otherwise is a complete disservice to both patients who suffer from severe unipolar depression and those who are bipolar II.
Sure, I have learned and believe that bipolar II tends to be weighted toward depression in terms of the dominant feature. I wouldn't expect otherwise. But anyone who has recurrent experiences with hypomania understands that it's a lot more significant than a mood enhancement that appears to be a "walk on the wild side" merely because it's measured against the the person's typical depressed state.
In other words, you can suffer from long-term recurrent depression and have good days, even great days, without being hypomanic. So can people who are bipolar II when they're dealing with long-term depression between hypomanic episodes. But that doesn't mean that recurrent depression sits on the same mood scale as bipolar II.
For instance, both my current psychiatrist and my therapist have seen me in a hypomanic state on a few occasions during regularly scheduled appointments (meaning I didn't call in advance for help with hypomania, so they were expecting the depressed aspect that usually dominates my personality). Both of them have made a point of commenting on my abrupt, significant mood change and how different my presentation is during those times (extremely voluble and talkative; bursting with energy to the point where I look like I'm about to explode; speech mimicking racing thought patterns; much, much stronger personality projection than usual, etc.). Their observations and my affect are always complemented by clearly risk-oriented behavior (spending large sums of money on unnecessary impulse purchases; repeated instances of being "the life of the party"--to the extent that when I'm not hypomanic at social events--which is usually the case--people are actually waiting for the wild 'n crazy Greywolf to appear (like it's something I can turn on and off at will)). This isn't just popping out of a long-term depression for a day to do something "wild" like use real butter, and it diminishes the meaningfulness of the pain experienced by both bipolar II and unipolar depression sufferers to suggest something so flippant.
In my view, bipolar II is bandied about way too indiscriminately, both as a diagnosis and as a self-description. I can't tell you how many people I know claim to be bipolar, but they clearly have no clue what they're talking about. They've never been diagnosed, they've never been in treatment, and, typically, they think being moody means they're bipolar. NOOOOOO--you're not bipolar if you're generally happy, but turn into a complete bastard once in a while. You know what you are? A generally happy person who can be a real bastard at times, and bipolar isn't a handy explanation for rude or bad behavior (likewise, the person who's a complete jerk most of the time, but who occasionally has flashes of decency, is very probably just a jerk who's occasionally nice, and not bipolar).
Blurring the boundary between recurrent/long-term depression and bipolar II just camouflages a professional inability to figure out what's really going on or a simple unwillingness to do the hard work it often takes to make the correct diagnosis. Unfortunately, bipolar II often cannot be diagnosed in one or five or ten 15-minute appointments. In many instances it takes serious interaction with a patient over a long period of time to make a reliable diagnosis, and that just doesn't mesh with the typical "stop in for a few minutes, tell me how you feel today, and I'll send you on your way with a scrip" methodology.
Bipolar II should not be reduced to a euphemism. Those of us who have struggled with it for years know that hypomania's not just a cute "walk on the wild side"; it's a disturbing, destructive phase of the illness that cannot be responsibly equated with a minor mood elevation.
Greywolf
Posted by med_empowered on April 28, 2007, at 4:07:46
In reply to That article is fundamentally wrong » linkadge, posted by greywolf on April 28, 2007, at 0:58:44
In the 50s-70s (into the 80s, really), schizophrenia was **the** diagnosis. I mean, yes, they used other diagnoses, but schizophrenia dominated (at least in the US, not so much elsewhere). Then, shrinks decided that ,hey, maybe not everyone needs Mellaril, afterall.
Now Bipolar is the "it" diagnosis. It covers up for treatment failures, explains adverse effects (stimulant induced mania? AD induced mania? Bipolar!), and brings in loads of $$$ for new drugs (seroquel, zyprexa, lamictal, etc.) for this "often misunderstood" and/or "misdiagnosed" condition. Just as the Prozac years turned your blues into depression, the coming years will turn pretty much anything (happiness, sadness, insomnia, hypersomnia, etc.) into "bipolar." Like the old schizophrenia label, ANYTHING can be pushed into the "bipolar" category. Since polypharmacy is the rule in bipolar, it could actually work, and the potential profits are ENORMOUS--a mood-stabilizer, then something to move the mood up or down, something for sleep, maybe something for anxiety and/or inattentiveness...bipolar is a mental illness where EVERYBODY wins, b/c any and every part of the "bipolar experience" can be medicated.
I'm not anti-meds--I mean, take what works, whether its Prozac or Percocet--but I am against this practice psychiatrists have of disguising *trends* in prescribing as being somehow scientifically based. They're not. For instance: shrinks act as if the use of low dose antipsychotics for sleep, bipolar, depression, agitation, etc. is something novel. Its not. Read the old ads for trilafon, etc.: alot of them were aimed squarely at the non-psychotic market. All that's happening is the market is being flooded with heavily promoted tranquilizers, just like in the 50s and 60s, so docs are changing their prescribing habits accordingly. Maybe, if patients are lucky, drug companies will do something that *patients* will appreciate, like bring back Quaaludes. (Fingers crossed)
Posted by linkadge on April 28, 2007, at 14:04:15
In reply to Re: Using Bipolar as a 'fill in the blanks', posted by Johann on April 28, 2007, at 0:04:16
I know its easy to believe the diagnosis that is associated with any pill that works.
But what happens when lithium poops out?
Lithium helped my depression for about 1.5 years, then I was hit by by on of the worst.
Linkadge
Posted by Johann on April 28, 2007, at 18:56:10
In reply to Re: Using Bipolar as a 'fill in the blanks' » Johann, posted by linkadge on April 28, 2007, at 14:04:15
Lithium has worked for years now for me.
You seem to have a lot of anger and cynicism, what can you say that is constructive?
Posted by Quintal on April 28, 2007, at 21:38:06
In reply to Using Bipolar as a 'fill in the blanks', posted by linkadge on April 27, 2007, at 9:07:10
I had this problem myself with pdocs, but here in the UK they seem to look on most of the fads and trends in the US with scepticism. I have been diagnosed with bipolar II and treated with mood stabilizers. They worked because one of my major problems is stormy emotions, which they calm. So am I bipolar afterall? No, according to my last pdoc who overturned the diagnosis made by his predecessors - because a person who can take nearly every class of antidepressant in the pharmacopoeia without a mood stabilizer and not suffer a single manic episode is very unlikely to have bipolar disorder. Conversely, in people for whom the main problem is stormy emotion (people with strong *Borderline Personality Disorder* traits) SSRIs are probably among the most effective mood stabilizers due to their flattening and blunting effects on emotion. Stormy emotion is not bipolar disorder.
Q
Posted by linkadge on April 29, 2007, at 9:46:02
In reply to Re: Using Bipolar as a 'fill in the blanks', posted by Johann on April 28, 2007, at 18:56:10
Overall I am not angry. I am just angry (I use that word loosly) at certain directions that psychiatry seems to be going in.
I am glad that lithium has worked for you this long. I hope it continues.
I am just saying that there are probably a number of people who may be depressed, and who simply do not respond to serotonin/norepinephrine manipulations.
If you only have two types of tools, and one doesn't work, doesn't mean the other one necessarily will.
Sure its logical to try the otehr path, but I hate to see people beat themeselves up when neither current unipolar meds nor bipolar meds do anything.
I would just like it if doctors said, "we don't know whats wrong. We can try such and such a med and see what happens".
Linkadge
Posted by Johann on April 30, 2007, at 1:31:27
In reply to Re: Using Bipolar as a 'fill in the blanks' » Johann, posted by linkadge on April 29, 2007, at 9:46:02
Linkadge,
I appreciate your comments and find myself agreeing with you. It's a lot easier to hear what you're saying when you're not so hot under the collar.
Sounds like you've had some unfortunate experiences with psychiatrists. Being a psychologist, I work with a lot of shrinks and none of the ones I refer to would use BPD as a fallback position.
In my case, AD "poop out" was *one* of the indicators that I might be dealing with some form of BPD. Then, after having a manic depression, near suicidal, in response to disiprimine, it became pretty clear. I have almost no mania, though; however, a lot of anxiety.
I don't think that MDD and BPD are dichotomous. I see them more as a gradient or matrix field--but that's another story for another day.
Regardless, I hope you are doing well,
Johann
Posted by linkadge on April 30, 2007, at 18:26:31
In reply to Re: Using Bipolar as a 'fill in the blanks', posted by Johann on April 30, 2007, at 1:31:27
>I appreciate your comments and find myself >agreeing with you. It's a lot easier to hear >what you're saying when you're not so hot under >the collar.
I'm sorry that you got that impression. I am not angry as much as I am frustrated (about my own situation)
>In my case, AD "poop out" was *one* of the >indicators that I might be dealing with some >form of BPD. Then, after having a manic >depression, near suicidal, in response to >disiprimine, it became pretty clear. I have >almost no mania, though; however, a lot of >anxiety.
While this is for a separate topic, I do not believe that antidepressant induced mania is indicative of bipolar.
Here are some of the logical fallacies I see constructed by psychiatrists. While the following may be true some of the time, they are not rules.
1) Antidepressant poop out indicates bipolar
2) Antidepressant induced mania indicates bipolar
3) Response to mood stabilizers indicates bipolar.I believe these are logical fallacies for the following reasons (respectivly)
1) Drugs poop out all the time regardless of diagnosis.
2) There are millions of dollers of reaserch currently being undertaken to research animal models of antidepressant induced mania. Some researchers believe that antidepressants can induce mania in individuals who don't have bipolar disorder. Just as they can induce permanant seizure disorders in some individuals without epilepsy. Antidepressants can activate many genes that are activated in mania, namely PKC, GRK3, CLOCK2, and others. The noradrenergic antidepressants in particular, can significantly reduce rem sleep, which can reduce seizure threshold.
3) There are GABAergic and glutamatergic theories of major depression. Certain depressive disorder may respond to mood stabilizers due to their ability to increase GABAergic neurotransmission and or reduce glutamatergic neurotransmission.
My mother never ever had a manic episode before she was exposed to tricyclic antidepressants. She was just an anxious depressive. She was called bipolar, after high doses of doxapin sent her into a extreme mixed state. Because of this she is now called bipolar (which I do not agree with) and has been placed on lithium.
While lithium has been of some use, she has clearly deteriorated over the last 30 years. Her kidneys are shot, and her memory is gone.
While I hope this doesn't happen to you, I'd just hate to think you were another casualty lead down the garden path.
Again, I don't mean to come across like a a-hole. It is just hard to accept the kind of logic that has changed my mother from a loving caring person to a brain dammaged near vegatable. (I don't say that in a disrespective way at all).
Linkadge
Posted by Johann on May 1, 2007, at 1:08:16
In reply to Re: Using Bipolar as a 'fill in the blanks', posted by linkadge on April 30, 2007, at 18:26:31
Linkadge,
I posted a long, thoughtful reply to your most recent post, expressing also my sadness for what you and your mother have had to endure--and then the damn computer lost everything because it couldn't access this site. I'm sure it was caused by evil psychiatrists ;-)
When I get over my frustration and find the time, I will try to recapture my sterling comments.
Take care,
Johann
Posted by linkadge on May 1, 2007, at 6:24:58
In reply to Re: Using Bipolar as a 'fill in the blanks', posted by Johann on May 1, 2007, at 1:08:16
I am sorry for the error, and thanks for the gesture.
I don't think all psychiatry is evil, I just think there can be a propensity for some psychiatrists (and other humans) to make big mistakes and to try and to blame it on something else.
Linkadge
Posted by Johann on May 1, 2007, at 12:32:46
In reply to Re: Using Bipolar as a 'fill in the blanks', posted by linkadge on May 1, 2007, at 6:24:58
Can't argue with that.
> I am sorry for the error, and thanks for the gesture.
>
> I don't think all psychiatry is evil, I just think there can be a propensity for some psychiatrists (and other humans) to make big mistakes and to try and to blame it on something else.
>
> Linkadge
This is the end of the thread.
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