Bipolar 2 From Inside and Out

Posts tagged ‘drug side effects’

Bipolar Conversation

This morning a podcast called Bi-Polar Girl was uploaded, and I was the interviewee. (You can find it on Apple, Amazon, and other podcast sources.) Here’s a look at what was like.

  • Prepping. Before we recorded the podcast, my anxiety kicked in, and I tried to overprepare. I bombarded the hosts with emails asking what I should be prepared to talk about or what questions they were going to ask me. Basically, they told me we were going to “wing it” and have me tell my story.
  • History. The thing we talked about most was when I started showing signs of bipolar and when I was diagnosed. I explained that I was showing signs of it as early as my high school years, how I decided to seek treatment after college, and how I was mistakenly diagnosed with major depression for years before receiving the proper diagnosis and medication.
  • Meds. We discussed medication in some detail – pill-shaming, how every person reacts to meds differently (so it’s useless to “recommend” a particular drug to friends or support group members). We talked about the side effects of various medications, including the fact that the most-feared one seems to be weight gain. One particular point of discussion was how many people are afraid that taking medications to treat their disorder will stunt their creativity or turn them into “zombies.” Snowflake (one of the hosts) and I agreed that our creativity and ability to work were actually improved while on medication, because it enabled us to focus and do more creative work.
  • Family. We also talked about the fact that I have no children and my reasons for that. (We also introduced some of our pets during the Zoom call, or they introduced themselves. Just try to keep an animal out of a Zoom call.) I shared that I felt it would be unfair to a child to have a nonfunctional mother, that I was afraid of going off antidepressants while pregnant, and postpartum depression afterward. Snowflake shared her story of medications, potential side effects, pregnancy, and postpartum depression.
  • My publications. I talked about my blog and my books, Bipolar Me and Bipolar Us. In particular, we discussed gaslighting, which features in my second book, and how people with bipolar are more susceptible to it. Both Snowflake and I shared how we had encountered gaslighters in our own lives.
  • Groups. Chacoman, the other host, questioned me about whether I was involved in any local or regional support groups, and I had to admit that I’m not. Now, during the pandemic, group meetings are problematic at best, but I don’t react well to groups at any time, due to my anxiety (which is how my hypomania manifests). In my case, outreach is limited to my blogs and books, and membership in online support groups.
  • Miscellaneous. We got off topic a number of times. I don’t want to make it sound like the interview was all serious or grim. We also talked about our pets, positive relationships, college memories, and even politics.
  • Plans. I talked about how my next book will be a mystery, with a bipolar main character, and received positive feedback on the idea.

All in all, it was a good experience, worth overcoming my anxiety for. I had only participated in a podcast once before, a not-altogether-successful interview about my first book with an interviewer who had obviously not read it and was more interested in whether any of my family members were also creative. (It was supposed to be a podcast about first-time authors.)

This was not the same sort of thing at all. I told my story, as the hosts had recommended, and we had a genuine, far-ranging conversation about not just my own experiences with bipolar disorder, but with how others cope with it as well. Actually, I learned a lot about myself, from how much my anxiety – and especially social anxiety – still affect me, to how much my teen years illustrated my journey into depression.

So, here’s a big thank you to Snowflake and Chacoman for the opportunity to share with them and their audience. I would absolutely do it again. It helped me step out of my comfort zone and, I hope, will help the listeners as well. It’s a form of outreach that I had never considered, but one that I found valuable – and just plain fun!

 

 

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My Hypothetical Baby

By pololia / adobestock.com

Having bipolar disorder was one of the reasons I decided not to have children. Really, it was having major depression, which was what I was diagnosed with at the time.

I wasn’t so much concerned with passing my condition on to any potential offspring, since, at the time when I was contemplating motherhood, the genetic links were not yet that firmly established. Now that I know more about it, I think that might have been another deterrent. My parents had no idea what to do with me when bipolar symptoms started happening, and there’s no guarantee that I would have done any better. I’d like to think I would, but there’s no telling, really.

No, what I feared was having to go off my medication while pregnant (and breastfeeding, should it come to that). I was terrified of being unmedicated and I knew that psychotropic drugs were not good for pregnant women or their developing babies. Once I had discovered the benefits of Prozac and other mood-regulating meds, I knew I never wanted to be without them again. I never wanted to again fall into the pit that I had clawed my way out of. (In truth, that pit was waiting for me anyway, when I experienced a major depressive episode many years later.) 

Postpartum depression scared me too. I had heard the horror stories of women killing their children and/or themselves while suffering from the illness. I knew how out of control I could get with just plain ol’ garden-variety depression and anxiety. Adding postpartum hormones to the mix could be a really bad thing.

But the main reason that I decided my bipolar disorder made it unwise to have a child was that it would be unfair to the child. How to explain to a toddler that mama couldn’t get out of bed today or that she burst into tears for no apparent reason? How to explain weeks or months like that? How to deal with a child jazzed up on mama’s sudden hypomanic jag, who would then be let down when she crashed? How to soothe a child’s anxieties when mine were making me jump out of my skin? How to take care of a child’s essential needs, when I suck at taking care of my own?

Is that selfish? I know there are people who would say it is. That when the time came, I would suck it up and do the best I could. And I might. But would that “best I could” be good enough? I’ve heard it phrased that I was too involved with giving birth to myself – a relatively stable, reasonably happy, mostly functioning self – to give birth to someone else. And I think there’s some truth in that. It’s been a struggle, filled with despair, misery, hard work, setbacks, immobilization, dangerous thoughts, and living too much in my own head. To do the work of bringing myself to some baseline of functioning while trying to nurture and bring up another person daunts me.

I do understand that there are women with bipolar disorder and even postpartum depression who have children and that those children can be happy, healthy, and as well-adjusted as any modern child ever is. I don’t know how they do it, though. I was fortunate that I had a choice of whether or not to have children. I know that not all women do, and that many are delighted with their choice – whichever way they decide. I know that there are those who desperately want children and are unable to have them. I was fortunate that my husband didn’t push the issue, despite the fact that he would have welcomed a child.

I also had irrational thoughts about that potential child. I imagined that if the child were a boy (which run in my husband’s family), Dan (whose inner child is, shall we say, close to the surface) and the little boy would be natural allies and I the odd one out. He would be the fun dad and I the not-fun mama. And while that’s somewhat irrational, it also might be partly true. It took a long time for me to learn how to relax and have fun and share it with another person.

The one time I was open to having a child was when my father was dying a slow death. I thought that if he was going to see his grandchild, I’d better produce one promptly. Fortunately, it didn’t happen. I later realized that that was a really poor reason to bring a new life into the world.

What I’m saying is that the decision is not – was not – an easy one. Having a mental disorder makes it even more difficult.

 

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New Diagnosis, New Drug

Photo Sesaon/adobestock.com

While never leaving the category of persons with a serious mental illness, I seem to have also become a person with an autoimmune condition. Here’s what happened.

About two months ago, I noticed a hard lump growing on my forehead and another developing underneath my eye. Then one night, I rolled over in bed to feel a strange sensation in my right forearm – an area of thickened, hardening flesh under the skin about the size and shape of a cuttlefish bone. This seemed sudden and alarming compared to the forehead lump, so off I went to the emergency room. They diagnosed cellulitis and gave me a scrip for antibiotics.

A follow-up visit to my PCP revealed no change in my arm, but again a provisional diagnosis of cellulitis and another course of antibiotics.

When that failed to clear matters up, the doctor decided to biopsy the lump on my forehead and send me for an ultrasound and MRI on the arm. The biopsy revealed the lump to be a sarcoid, which immediately changed the thinking about my arm and cellulitis. It now seemed likely that that was sarcoidosis too.

Sarcoidosis is, according to the Mayo Clinic, “a disease characterized by the growth of tiny collections of inflammatory cells (granulomas) in any part of your body — most commonly the lungs and lymph nodes. But it can also affect the eyes, skin, heart and other organs.” I’m lucky that in my case, only the skin appears to be affected. Having my lungs affected would be pretty scary right about now. (The Mayo Clinic adds, “The cause of sarcoidosis is unknown, but experts think it results from the body’s immune system responding to an unknown substance.”)

Then the real fun began. The treatment my doctor prescribed was steroids (cream for the forehead, pills for the arm), which makes sense, but didn’t play well with my bipolar condition or meds. “Mood changes” appears on the Mayo Clinic’s list of potential side effects, along with agitation, irritability, and a host of other physical and psychological difficulties.

After a few days on the steroids, I began experiencing chills, raging headaches, insomnia, and the dry heaves. A tele-consultation with my doctor later and my dosage was reduced, which seems to have helped (and the steroids seem to be helping reduce my mysterious cuttlefish).

“Steroids are a bipolar sort of medication,” my doctor told me.

“Appropriate,” I said. (My PCP knows about my bipolar disorder. He’s read my books.)

Dr. S. continued, “One time steroids can make you feel terrific and another time they can make you feel miserable.”

“I’m gonna say miserable,” I replied. “I haven’t slept or eaten in three days.”

“Well, they can get you so revved up that you can’t sleep.”

“Actually, it was the dry heaves that kept me up,” I explained.

A mutually agreeable course of action was decided on. I would lay off the steroids for a day, then resume with a lower dose. That’s just what I have done, and my symptoms are better. At least I’m no longer retching.

What does the future hold for me? It’s hard to tell. Potentially steroid injections in my arm, and having the lump on my forehead removed if the steroids don’t resolve them. Potentially mood swings that I won’t know whether to attribute to my bipolar condition or to the steroids.

I hate the thought that this is an autoimmune disorder – that my body is attacking itself. Of course, my brain has been attacking me for so long, I really ought to be used to it by now.

 

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The Worst Side Effect of Psychotropic Drugs

I’ll admit that I’ve had a lot of side effects from the various psych meds I’ve taken over the years, and some of them were bad enough to make me ask for something different. There’s been insomnia, sleeping too much, twitchiness, vivid nightmares, and others. But as far as I can see, there are only two side effects that would make me completely quit taking a prescribed medication, even before I could ask my doctor about it.

The first is Stevens-Johnson Syndrome. It’s what they mean when they say on TV commercials, “a fatal rash may occur” (I didn’t even know rashes could be fatal). Indeed, your skin starts to come off. I think it’s always a bad sign when your insides suddenly become your outsides, like in that Simpsons episode where everyone turned inside out. Among the medications that can cause SJS are anticonvulsants, antipsychotics, and other psychotropic drugs, at least two of which I take daily. When he prescribed them, my psychiatrist told me to stop taking the meds instantly if I got a rash around my mouth and nose, and go to the emergency room. It’s that serious.

Apparently, the anti-smoking drug Chantix and maybe some others can also cause SJS, which I guessed from the “fatal rash” warnings on the commercials and later confirmed. I idly wonder if the rate of Stevens-Johnson has increased now that more of these drugs are being used.

The other side effect that I truly fear is tardive dyskinesia. Tardive dyskinesia means involuntary, repeated muscle movements, which can affect the face (tics, twitches, grimaces) and other parts of the body (legs, arms, torso, and fingers). Think John Nash in A Beautiful Mind. These movements appear after taking medications such as antipsychotics. Worst of all, the movements may become permanent and a number of people are disabled because of them. There are now medications that treat tardive dyskinesia, but I still wouldn’t want to have it.

Yet, what is the most feared, the most despised side effect of psychotropic medications?

Weight gain.

I see countless comments in online support groups asking about weight gain on particular medications and posts that say such-and-such a drug caused weight gain. A number of people post that they will not take these medications, or will stop taking them, because they can cause weight gain.

Admittedly, weight gain is not often a good thing. It can certainly lead to other health problems. But my point is that many people are more concerned about their appearance than their mental health. 

I’ve struggled with my weight too over the years, and I have written about it (https://wp.me/p4e9Hv-7o). But I’ve struggled more with my mental health, which could kill me just as surely as obesity.

There is vast stigma in our society surrounding fat people. That’s undeniable. Fat people are stereotyped as lazy, sloppy, unattractive, unhealthy, and more. Despite recent body-positivity messages and a few clothing commercials that now feature more plus-size women (I haven’t seen plus-size men), this stigma continues virtually unabated.

Of course, there is stigma around mental illness, too. Those with mental disorders are stereotyped as out of control, violent, dangerous, suicidal, and a burden on society. I can see that people are reluctant to add the two stigmas together.

But honestly, is weight gain so very bad compared with the chance to alleviate the misery and suffering that accompany serious mental illness (SMI)? Personally, I prefer to weigh more and not live my life in despair and hopelessness.

Some of the medications I’m on can cause weight gain. Some of them can cause Stevens-Johnson Syndrome or tardive dyskinesia. Fortunately, weight gain is the only side effect I’ve had, and I can live with that. Stevens-Johnson is potentially deadly and tardive dyskinesia is potentially permanent. There are things I can do about my weight if it really concerns me, or I can chalk it up to a side effect of being content, stable, and productive.

Frankly, of the possible side effects, I fear weight gain the least.

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The Compliant Patient

My mother was not a compliant patient. She would have side effects from medication and just stop taking them: The meds gave her sores in her mouth or nauseated her.  And that’s valid. We’ve all had medications that we couldn’t tolerate because of the side effects. But Mom stopped taking them without telling her doctor. Once she went to the emergency room, where they had a list of the meds she was supposedly still on and I had to tell intake, “No, she stopped taking that one. And that one too, I think.” (She was not mentally ill, but that’s where I’m going with this.)

There is only one psychotropic medication I know of (though there may be others by now that I haven’t heard about), where the potential side effects are so horrible – potentially lethal – that patients are advised to stop taking them immediately and get medical help right away.  The side effect is called Stevens-Johnson Syndrome and it is a potentially fatal rash.  I wrote about it a few years ago, (https://wp.me/p4e9Hv-1g)

Other than that one instance, psychotropic medications should never be discontinued unless you have consulted your physician. You never know what withdrawal symptoms lie in wait for you, but they’re bound to be unpleasant, even if they don’t cause you to relapse, which could easily happen. Withdrawal from any drug is not fun; it’s to be avoided.

Nonetheless, I read posts in support groups all the time which say that people have decided by themselves to stop taking a medication, or even all their medications on their own. I have friends who have taken their treatment into their own hands this way.

There are several reasons they sometimes give for giving up medications. One is that the meds aren’t working. What they really mean is that the meds aren’t working yet. Many psychotropics don’t show positive effects until they have built up in your bloodstream, which can easily take four to six weeks. Expecting results in a day or two is unreasonable.

Others stop taking their meds because they “feel better” and think they no longer need the pills. This is just ridiculous. The meds are the reason that you feel better. Your psychiatric condition does not just go away, like the flu, when you feel better. Your disorder may soon come roaring back (or creeping back). And the thing is, when you restart a medication, it sometimes no longer works as effectively. Then you have to start all over with a new prescription and have another four to six weeks of symptoms while you wait to find out if it works or doesn’t.

Still other people simply don’t like taking medications.  This I don’t understand.  People take meds for flu and infections and such conditions and never seem to resent them. Maybe it’s the idea that you could well be – will likely be – on psychotropics for the rest of your life. But lots of people have meds they need for life – insulin, cholesterol meds, anti-inflammatories, asthma meds, thyroid meds, and others. People don’t quit taking those just because they don’t like to take pills or injections.

I think the real reason people don’t like to take their psychiatric meds is that they’re psychiatric meds. There is still massive stigma around the subject of mental illness. Taking medication for a mental illness means admitting you have one, which some people are reluctant to do.

Or they may be giving in to “pill-shaming.” There are plenty of people, perhaps in your own family – and certainly across the Internet – who will tell you that all you need is self-love or affirmations or sunshine or exercise or vitamins or meditation or willpower to banish your mental illness. Funny how they never tell people that sunshine will cure their broken leg or that exercise will cure their breast cancer.

I hesitate to say that I love my psychotropics, but in a way I do. They have brought me out of states of mind that were harmful to me. They have made it possible for me to function and create and communicate. They probably have saved my life.

Occasionally I let my psychiatrist know that I may need a change in dosage or that one of meds is no longer working. I’ve even reviewed with him whether there are any meds I could quit taking (there aren’t at the moment). But I keep taking them faithfully, every day, morning and night.

I need the psychotropics. So I am a compliant patient.

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Drug Therapy: The Short Form

From what I’ve read in Facebook support groups – and noticed from my own experience – the effects of antidepressants don’t always last as long as we might want.

My first psychotropic medication was, as nearly as I can remember, imipramine (Tofranil). At the time I was only diagnosed with unipolar depression, so it seemed like a good choice. Imipramine is what is called a “tricyclic” antidepressant because of its chemical structure. Many people complained of the side effects.

Tricyclics were about all the medical community had to offer until 1987, when Prozac hit the market, followed by its cousins Zoloft and Paxil. All of these were classified as SSRI drugs, ones that selectively acted on the neurochemical serotonin in the brain, rather than a wide variety of brain chemicals as the tricyclics had.

Since then we have listened to Prozac, talked back to Prozac, and been referred to as a Prozac Nation. Prozac has been hailed as a miracle drug, damned as a gateway to violence or suicide, and prescribed in phenomenal amounts.

And Prozac has helped me. After about six weeks on it, when the drug started to kick in, I was on a sailing trip. One of the crew said I was the passenger most at peace with myself that he knew. It was a revelation to me and a new way of thinking of myself.

Prozac changed my life – possibly saved it. And then, not so much. I moved on to other medications.

“Major Study Finds Antidepressants Work, But May Have Limitations,” by Brigit Katz, published on The Smithsonian.com, validates my perception.

Her article states, “A meta-analysis [or study of studies] of existing trials suggests that the drugs are mostly effective on a short-term basis for patients suffering from acute depression.” Katz’s article also cites articles in the New York Times and The Lancet that report similar findings.

The Lancet study “analyzed 522 double-blind studies that included 116,477 patients and 21 commonly prescribed antidepressants. The results of the study showed that all 21 of the antidepressants were more effective than placebos in reducing depressive symptoms during the first eight weeks of treatment.”

“The new analysis suggests, however, that the efficacy of the drugs may be limited,” Katz reports. “For one thing, the benefits applied in the short term, and only to patients who are suffering from acute major depression.” [emphasis added]

The Smithsonian.com article and the studies conclude that “while the new study suggests that antidepressants are more effective than a placebo, at least in some cases, media reports claiming [as an article in Newsweek did] that the research shows ‘antidepressants do work, and many more people should take them’ are not entirely accurate.”

(This hearkens back to a pet peeve of mine: that headline writers (who are almost never the authors of the articles) do a poor job of summarizing articles in favor of more definitive or appealing descriptions of the text. https://wp.me/p4e9Hv-Br)

At any rate, the meta-analysis bears out my experience. Although I was bipolar 2, my disorder first manifested as major depression. I got relief from Prozac, results that later diminished. Since my proper diagnosis I have found more relief from a combination of an SSRI, an anticonvulsant medication often used for bipolar disorder, and an atypical antipsychotic also useful for bipolar as well as schizophrenia. Even though I do not have seizures or schizophrenia, these medications work for me and have not worn off for several years now.

So, what’s the takeaway from all this? I think it is that, if your medication for bipolar or depression seems to be “wearing off,” your perception may indeed be valid. But that’s no reason to give up on psychotropics altogether. People and their disorders differ in ways we just don’t know. You can ask your doctor to try a different medication or combination of medications that may work better for you.

The benefits of medication for psychiatric disorders do not simply go away just because the effect of one does.

Read more: https://www.smithsonianmag.com/smart-news/major-study-finds-antidepressants-work-may-have-limitations-180968452/#vjLKOqe2JdKEWOe3.99

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“Lock Up the Crazies Before They Hurt Someone”

Mass shootings and the public reactions to them are pretty predictable among the mental illness community.

One thing you hear after every mass shooting – and after many smaller ones – is that the mentally ill should not have access to guns.

Fine. But I have bipolar disorder, as well as some guns that I inherited from my father. I occasionally go to a gun range and fire them, but not often since I’m not the gun aficionado my father was.

So what am I supposed to do? Sell the guns? Give them away? Turn them in to the police? My therapist? I was taught gun safety from a young age by two certified pistol and rifle instructors (my parents) long before I received my diagnosis.

The further you go into the debate about guns and the mentally ill, or about whether the mentally ill are a danger, the deeper you get into fundamental constitutional, legal, and medical issues, as well as considerations of simple practicality.

Some advocate locking up the mentally ill. This is irrational. What the proponents really mean is “Lock up the dangerous mentally ill before they become mass shooters.” And that is impossible.

First, there’s the matter of due process, which is as much a part of the Bill of Rights as the vaunted Second Amendment is. You can’t just lock people up without a trial or at least a hearing.

Second, there’s no way to determine whether a mentally ill person is likely to become a mass shooter or any other kind of danger. The only generally known predictor of violent behavior is past violent behavior. In fact, there’s no way to tell whether any given individual is going to become a mass shooter. That’s because it’s really hard to predict the future.

Third, there’s the consideration of medical decisions and the right to privacy. HIPPAA has gone a long way toward protecting the privacy of patients – including the mentally ill. At the moment, a mentally ill person can only be held for 72 hrs., and then only if the person goes to the hospital voluntarily or is determined to be a danger to self and others. That’s a high standard, and it should be.

Fourth, the mental health system is already understaffed, underfunded, and overwhelmed. There are long waiting lists for beds in hospitals and treatment facilities. Are we to build new asylums to accommodate all these supposedly dangerous persons? Train more counselors to treat them? Or just lock them up and get them out of sight, out of mind?

Fifth, the idea that mentally ill persons can be forced to accept treatment and take their medication as prescribed violates several basic rights. My mother, who was not mentally ill, hardly ever took her medications as prescribed. She would quit taking one after a few days “because it wasn’t helping” or “it caused sores in her mouth” – without telling her doctor. Should she have had a caregiver to monitor her compliance? Who would monitor all those potentially noncompliant mentally ill persons as they take their psychotropic drugs? I see, we’re back to putting them in asylums.

Besides, refusing treatment is a right that patients have – even mental patients. Physically ill patients, for example, can choose to forgo chemotherapy or dialysis or medications that cause side effects worse than the condition they’re prescribed for. And mental patients have the same right. They can stop taking a medication because they fear side effects like tardive dyskinesia or even weight gain, though we hope they consult their doctors first.

But forced treatment and forced medication, as some have suggested, brings us back to the question of who, how, and where. Asylums? Court-ordered treatment? Medications that must be taken in the presence of a doctor or a therapist (who is not qualified or licensed to dispense medication)?

Take all those arguments against forced treatment of the mentally ill and add the fact that the mentally ill are far more likely to be victims of violence than perpetrators of it, and where are we? Admittedly, the mental health “system” is broken, or at least badly fractured. But is the answer really to take away the civil rights of people who have broken no laws?

The press and the public are quick to focus on the mentally ill as the culprits in mass shootings. But even if they were correct, taking away fundamental rights would not only be no real solution, but would chip away at the rights of other disenfranchised or minority populations – the homeless, for example.

If there’s a solution to this problem, I don’t know it, but locking up the “crazies” isn’t it.

 

If you want to read more on both sides of the issue, see the L.A. Times article by Paloma Esquivel at http://www.latimes.com/local/la-me-adv-lauras-law-20140310-story.html.

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The Latest Headlines on Mental Illness

There’s a wonderful article, originally in The Telegraph, with the title “Can Depression Be Treated With Anti-Inflammatory Drugs?” Snopes.com, the preeminent debunker of all things dubious, proceeded to do what they do best – debunk. In their analysis, they find several factors common to many widely reported studies that illustrate why we shouldn’t take these announcements of causes or cures at face value or at least without a grain of salt.

They break down their reasons for not jumping on the study’s bandwagon into three major categories.

No Credible Scientists Have Argued that All Depression is Caused by Inflammation. The article in The Telegraph was talking about patients with Major Depressive Disorder (MDD) who were not responding to current medication, or who also had other inflammatory-related conditions such as rheumatoid arthritis (RA). And the information came from just one talk by just one scientist,

Association is Not Evidence of Causation. I’ve written on the subject before (http://wp.me/p4e9Hv-7Z, http://wp.me/p4e9Hv-9L), and included a link to a short video that explains the scientific process, from original study up to the time when a new drug or treatment hits the market (http://www.vocativ.com/culture/junk-science/). Briefly, it means that just because two things are correlated (or happened one after the other) does not prove that one caused the other. Inflammation may have caused depression, or depression may have caused inflammation, or other factors may have influenced one or the other, or both, or neither.

The Anti-Inflammatories Discussed Are Specific, Powerful Drugs with Side Effects. You can’t just go down to the corner drugstore and pick up a bottle of ibuprofen and think you’ve solved your depression problem. And it turns out that the anti-inflammatories they’re talking about increase the risk of infections and cancers, and are wildly expensive.

Snopes concludes:

While the science discussed by the Telegraph in this article is real, it omits seriously important context and misrepresents decades-old research as a breaking development in a way that could provide false hope to those suffering from depression. The interplay between the immune system and the mind is increasingly well established, but that doesn’t mean that science has established anything close to a new treatment for depression as a result of this understanding.

“False hope.” That’s what a lot of these headlines regarding causes and treatments for depression offer. Shall we look at another recent example?

This one, I’m sorry to say, comes from bp magazine (bphope.com). The headline is “Underlying Molecular Mechanism of Bipolar Disorder Revealed.” The tagline reads, “Findings inform development of potential diagnostic test and improved therapies.”

But that’s not exactly true. The first paragraph says nothing about the underlying mechanism of bipolar disorder. Instead, it talks about the mechanism “behind lithium’s effectiveness in treating bipolar disorder patients,” something very different. But that doesn’t make as snazzy a headline. The article also says the results “may support the development of a diagnostic test” and “may also provide the basis to discover new drugs that are safer and more effective than lithium.” May. Might. Or might not. Too soon to get your hopes up.

The conclusion? [T]he study demonstrated that bipolar disorder can be rooted in physiological—not necessarily genetic—mechanisms.” Well, I’m a word nerd, not a science geek, but “can be” is a far cry from “is.”

Now for my favorite, reported by the BBC: “Magic mushrooms can ‘reset’ depressed brain.” Again, the tagline says “raising hopes of a future treatment,” which is a pretty far stretch. The study was performed on 19 subjects, each given one dose of psilocybin. The article reports that “Half of patients ceased to be depressed and experienced changes in their brain activity that lasted about five weeks.”

So. Tiny sample. No control group. And flip a coin on the results. Personally, I don’t see that raising much hope.

Bottom line for this one: junk science. Eye-catching headline. They won’t be handing out magic mushrooms at the local mental health clinic anytime soon. (The article does warn not to self-medicate.)

We’ve been hearing for years about tests to diagnose depression and bipolar, and stunning new treatments. Well, the studies take years to do properly; the tests need to be proved accurate and better than current psychological testing; and the treatments must go through years and years of studies, animal testing, and human testing, complete with control groups and sufficient numbers of subjects to make them scientifically significant.

I just wish these people would quit reporting “results” until they have some to show.

 

Resources

http://www.snopes.com/2017/09/19/can-depression-treated-anti-inflammatory-drugs/

https://www.bphope.com/underlying-molecular-mechanism-of-bipolar-disorder-revealed/

http://www.bbc.com/news/health-41608984?utm_source=dlvr.it&utm_medium=facebook

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Bipolar and Growing Older

I was a bipolar child. I was a bipolar college student. I was a bipolar adult. And now that I am about to be able to get the senior discount card, I am a bipolar – what? – mature adult.

First, let me say that aging sucks. Except that the alternative sucks more. The problem is, I can’t always tell whether anything that happens to me is due to my bipolar disorder or due to aging. I fear that, since my bipolar is fairly well in check at the moment, what are left of my problems may be due to something else.

My hands shake, for example. This has been true for years, though. The neurologist called it “essential tremor,” which I think means it just happens and they don’t know why. But some medications have made the tremor worse, and one of the medications I’m taking now could be increasing the shaking. And the shaking gets worse when I have anxiety. So I think we can chalk that one up to bipolar disorder, mostly.

I forget words. Sometimes, when I’m talking, I forget the word that comes next and have to pause or talk around it until it comes back to me. Sometimes my husband fills in the blank, which is helpful, but really annoying. For a writer, losing words is scary, but the memory difficulties seem to happen more when I talk than when I write.

I know I’ve had memory lapses before that can be attributed to my medication, and those memories are gone forever. I’ve written about that phenomenon: http://wp.me/p4e9Hv-6k. But these seem to be single words that escape me, and that I can usually get back within a few seconds. It doesn’t feel like anything I’ve had associated with bipolar, so I suppose this one is aging. If it’s the onset of Alzheimer’s, I’m going to be so pissed.

I isolate. This I’m pretty sure is bipolar in nature, since I’ve been doing it for years, especially when I’m depressed. I’m also reasonably sure that I am getting less isolated as my bipolar disorder has eased. I still don’t get out much, though I did go to a fabulous (and large) party last Sunday. But I am active on Facebook and Messenger, and I write these blogs, and I talk on the phone.

On the other hand, I seldom leave the house, and that I think is an effect of aging. I have mobility and balance problems because of a bad back and some nerve damage in one foot. But bipolar is involved, since weight gain from medications also affects my mobility, and an aversion to crowds and noise is likely associated with my anxiety.

Side effects of bipolar disorder and bipolar medications are to be expected. So, for that matter, are side effects of aging. Teasing out which is which may seem futile, and perhaps it is. I just want to know which I have some degree of control over and whether some, especially the cognitive symptoms, are likely to fade, stay the same, or get worse.

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Mental Health

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What I Learned About Ketamine and Depression

Trigger Warning – Meds

Note that I’m not a doctor or a pharmacist or any kind of medical personnel. Do not consider this post to be advice on what you should do. If the subject interests you, ask a licensed physician for more information.

What did I know about ketamine before I started doing some research?

Not much.

I knew that as a street and “club” drug it was known as “Special K.”

Then I heard that it was being used for treatment-resistant depression. Here’s what I found.

First, you can’t just go down to Brown Street and buy a few pills. That’s illegal. And what you get may include other substances that you didn’t intend to take.

So, you need a prescription for it. Once you get that prescription, usually after a consult with a psychiatrist, you need to find a treatment center that will administer the drug. Clinic operators may be anesthesiologists, as ketamine is primarily used as an anesthetic.

The treatment is delivered via IV or injections. No simple pills to take. It’s a course of treatments, each lasting 45 minutes to an hour, with a rest of an hour afterward. The treatment may be delivered for as many as six doses over the course of 12 days. (There may also be a nasal spray option, but the IV version seems more typical.)

You have to have someone who can drive you. The possible side effects include confusion and blurry vision. You can’t drive for 24 hours after the treatment, which basically means you can’t drive for two weeks, since the treatments are roughly every other day.

They don’t know how it works. I don’t find this surprising, since every time I’ve asked my psychiatrist how a medication works, I’ve been told, “They don’t really know, blah blah blah, neurotransmitters, blah blah blah, serotonin, blah blah blah.”

It’s expensive. The initial treatment may cost $500–$1,000, and a full course of treatments may cost as much as $3,800, which insurance won’t cover. These are estimated costs, based on treatment in various regions of the country. (The wholesale cost is approximately $.32 per dose, by the way.)

The results don’t last. They give relief for as little as a few hours to as much as nine months, after which a $600 booster shot is required.

You may still need regular antidepressants and psychotherapy. Ketamine may get you “over the hump” until your regular antidepressant kicks in, but is not a stand-alone treatment.

There are side effects. Confusion, hallucinations, and high blood pressure are among them, along with something called “lucid daydreaming.”

More research is needed. Duh.

The FDA has also approved trials of MDMA (Ecstasy) for treating PTSD. It is also being researched for effects on OCD, depression, and other conditions.

So, assuming that I could afford it, would I try ketamine? There’s not one easy answer to that.

Back in the days when my depression was drug-resistant, when I had spent years trying different combinations of psychotropics, when I was considering electroshock, I might well have seen ketamine as something to consider before I took that step. It should be noted that, at the time, my psychiatrist did not recommend or even mention it, so it might not have been appropriate for me whether I wanted to try it or not. And anyway, a combination of meds and therapy finally kicked in and made the subject moot.

Nowadays, I would not try ketamine (or MDMA, for that matter). My bipolar depression has moved from drug-resistant to drug-alleviated, at least for the most part. And that “most part” is enough for me. I have no need to be driven 45 minutes to the nearest clinic or to try to find a psychiatrist and anesthesiologist willing to go off-label. I am satisfied as I am.

As always, Your Mileage May Vary.

Sources

http://www.webmd.com/depression/news/20140923/ketamine-depression#1

http://www.ketaminetherapy.com/Depression.html

http://uchealth.com/intranasal-ketamine-infusion/

https://psychcentral.com/blog/archives/2012/12/01/should-you-try-ketamine-for-depression/

https://en.wikipedia.org/wiki/Ketamine

http://www.webmd.com/depression/news/20161130/fda-ecstasy-ptsd-treatment#1

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