Wednesday, January 12, 2011

Your Bipolar - Not Your Grandfather's Bipolar

As you know, I'm trashing most of the articles in the Treatment section to mcmanweb and writing entirely new ones. Yesterday, I presented a sneak preview to one, The Problem with Bipolar Meds. Today, I managed to come up with a satisfactory introduction to it. Without further ado ...

When I was first diagnosed with bipolar at age 49 in 1999 (after a lifetime of denial), I was told by numerous clinicians and well-meaning lay people that my illness was highly treatable, a message reinforced by just about everything I read. I'm not saying these individuals lied to me, but the reality is rather different. Two explanations are in play:

First, doctors and researchers have a very different idea of successful treatment than patients. Clinical trials are based on the artificial criteria of symptom-reduction rather than return to function. Meanwhile, doctors are content to leave us in a state of over-medicated limbo - stable but not well, out of crisis but going nowhere.

 The other explanation is that your bipolar is not your father's bipolar or your grandfather's bipolar. "The illness has been altered," Frederick Goodwin MD, former head of the NIMH, informed a session at the American Psychiatric Meeting in 2008, with more rapid-cycling, mixed states, and other complications since the first edition to his classic "Manic-Depressive Illness" came out in 1990. We have no definitive answer, but the best guess by far (which Dr Goodwin advances) has been the indiscriminate use of antidepressants, which he declared a "disaster" for one-third of us.

This may account for the disconnect between the memoirs of Kay Jamison and Patty Duke, writing about their experiences at least two decades before SSRIs came on the scene, and the accounts you hear today walking into support groups. Lithium was the miracle med for both authors. Today, lithium has only half the success rate it had back when Dr Jamison and Ms Duke were put on the med.

The harsh reality is that despite spectacular advances in our understanding of the brain and mental illness, our doctors appear at a loss in how to treat us. Your best chance of success is coming to terms with this grim fact of life so you can make intelligent choices.

1 comment:

Natasha Papousek said...

My husband read an article in a magazine (Wired, or New Scientist or one of the other science magazines we have around the house)...and now he doesn't believe that bipolar exists.

I, on the other hand, just got diagnosed with bipolar II... which seems to make sense to me.

It seems that mental health is not an exact's not even really science because people aren't necessarily quantifiable and what works some of the time might not work all of the time. Whereas, penicillin always works to kill certain bacteria. But that's only because we understand bacteria. Cancer treatment isn't as exact either, and yet, I'm not sure anyone would doubt its existence because one of the authors of a definitive text decided it was suddenly not valid.

I struggle with worries about stigma... and know that I did experience discrimination when my diagnosis was only depression. I am concerned about the stigma of the diagnosis bipolar (in any degree)...but I'd like some help... and I realize that medicine may not have all the answers, if any...