Saturday, May 02, 2015

Bipolar craziness

Much of Edward Shorter's recent book, What psychiatry left out of the DSM-5: Historical mental disorders today, is, to my mind, speculative nonsense. However, there is a chapter on 'Bipolar craziness', which I think has some useful references. I've mentioned before (eg. see previous post) how the concept of bipolar spectrum has extended during my working lifetime to a notion whose meaning must be questioned. As Shorter says at the end of his chapter:-
Unlike in previous editions, when DSM- 5 was launched in 2013 the discussion of bipolar disorder was no longer merely a section of an "affective disorders" chapter but had a chapter of its own, as though the previous hundred years of world psychiatry had never existed.

Unipolar and bipolar disorders are now seen as separate disorders whereas they used to be seen as two subcategories of manic-depressive illness. I am not necessarily saying that the previous way of looking at this diagnostic issue was better, but it is clear that at least some of the motivation for the change has been to promote mood stabilisers for bipolar disorder (see eg. previous post).


It's suggested antidepressants should be avoided in treating patients with bipolar disorder in favour of mood stabilisers. However, I've also mentioned before that the risk of manic switch when using antidepressants has been exaggerated. NIMH has endorsed the use of the diagnosis bipolar disorder not otherwise specified to categorise bipolar disorder as on a spectrum (see press release). It affirmed that such patients were being inappropriately treated by giving antidepressants or other psychotropic medication in the absence of mood stabilisers. However, systematic reviews have not found evidence that switching to mania is a complication of antidepressant treatment (Gijsman et al 2004, Visser & Van Der Mast 2005). In a placebo-controlled trial, use of adjunctive, standard antidepressant medication, as compared with the use of mood stabilisers, was not associated with an increased risk of treatment-emergent affective switch (Sachs et al 2007). Moreover, there was no difference in efficacy.

The limitation of medication, whether antidepressants or mood stabilisers, needs to be recognised. Just because antidepressants are not always effective does not necessarily mean that even mood stabilisers will be helpful in so-called bipolar spectrum.

4 comments:

Chrys Muirhead said...

I agree with you that the "limitation of medication ... needs to be recognised". However I would go further and say that antipsychotic medication in particular causes bipolar disorder and that is why we have such an astronomical rise in the condition. I speak from personal experience of family members who have been medicated over a period of years with different antipsychotics.

The drugs can and do cause havoc with a person's moods, the tapering, the shifting, the switching and the adding of other neuroleptics to the mix. For me the Chlorporomazine in 1978 then in 1984, and the Risperidone in 2002, gave me clinical depression. Fortunately in the earlier decades I did not get prescribed any antidepressants so eventually I was able, within the year, to taper the antipsychotic and make a full recovery. The psychotic episodes were puerperal, after painful, induced childbirths. Bite on a bullet experiences.

However in 2002 I voluntarily entered a psychiatric ward for "treatment" and was made to swallow Risperidone. I did resist and so was detained for 72hrs until I would agree to swallow the pills. I did swallow them because the ward was very risky. Mixed gender. Dodgy male patients. I feared for my safety. Within a week I got discharged, the antipsychotic as usual working very quickly on me, taking me out of a psychosis within a few hours, right back down to earth.

Depressed within a few weeks on the drug. Then I was prescribed Venlafaxine. It depressed me more, I got suicidal impulse, swallowed a bottle of them, was rushed into Ninewells Hospital, on oxygen in ambulance. Released and put on maximum doses of Venlafaxine. Asked for a different antidepressant, wasn't allowed. Flat as a pancake, demotivated, depressed, no joy, couldn't sing.

So the psychiatrist put me on Lithium, he said to "augment" the antidepressant. No difference. Flat mood. So I decided to do something about it myself. For I didn't like being on a cocktail of toxic drugs. So I began to do volunteering, in a charity shop, in a mental health project, did training in how to be a befriender etc. Got active even though I felt flat. The more I did the less lethargic I felt.

By this time I was off the antipsychotic because the psychiatrist had taken me off it. So I told him I wanted to taper the Venlafaxine and would do it in small amounts monthly. And so I did, which left the Lithium. I now had a different psychiatrist for I'd been passed on, in the community. I told him I was going to taper the Lithium (800mgs daily) by 200mgs a month. It was now 2004. The psychiatrist didn't want me to come off the Lithium, said I had a lifelong mental illness, wanted to show me the DSM chart. I said I didn't believe any of it.

I had googled the internet in 2004 but couldn't see anything about coming off Lithium so I just came off it as planned. And did so without any bother. By 2005 I got a PT job in a library, by 2006 I got a FT job in a college, got another postgrad qualification, in FE lecturing, 2008. The schizoaffective disorder label still sits in my notes. In perpetuity says the psychiatrist who originally put me on the drug cocktail in 2002.

PJ A said...

Sense:
"The limitation of medication...needs to be recognised."

Antipsychotics completely unexpectedly as I did not think would happen in this era actually destroyed my health from healthy happy bit OCD to stone man with the next to 0 emotion intact only hopeless and sorrowig with all the remaining functioning emotion over the loss of the life I had, and thinking there is no reason to live it's logical for me to prefer to die.

If you would sign this petition and read some of peoples comments I would feel more hopeful:
https://www.change.org/p/the-un-committee-on-human-rights-we-demand-to-recognize-psychiatric-coercion-as-the-crime-against-humanity-and-on-this-basis-to-exclude-it-from-acceptable-in-the-human-community-measures?just_created=true

Here is a particularly powerful comment most toward the end: "I was destroyed by psychiatry. They forced haloperidol on me. This caused brain damage. I can no longer feel positive emotions - no love, not even love for my young son, no faith, no joy, no empathy. I feel as if i have lost my soul. This so called cure is worse than every illness. I am a mother of a 4 year old son and all i want is to die. I lost my life and my son lost his mother and psychiatry still believes they cured me."

If you posted it to your blog or sent it to a few friends I would feel very hopeful. I believe in people being good people and humanity prevailing as I've never met a bad person before, I think it's just the small butterfly effect actions which end up adversely affectig people, and I think psychiatry is one such resultant example of many little hurt inducing actions building a bad large force and it is quite well explained how generally as a force it can often dehumanize people and unexpectedly to everyone strongly adversely affect them in the petition. I also think money/profit is often the root of these little acts which lead to hurting the ecosystem and species including our own, here is a beautiful documetary to further that: https://www.youtube.com/watch?v=KphWsnhZ4Ag

Anonymous said...

Bipolar disorder is grossly overdiagnosed when the origin is often attachment trauma AKA borderline personality disorder. Read Bessel van der Kolk and Judith Herman.

Nicole.lascurain@healthline.com said...

Hi Duncan,

First off, I came across your site and wanted to say thanks for providing a great resource to the mental health community.

I thought you might find this bipolar disorder fact sheet helpful for your readers, as it shows symptoms, treatment and stats about the disorder: http://www.healthline.com/health/bipolar-disorder/fact-sheet

Naturally, I’d be delighted if you share this embeddable graphic on http://criticalpsychiatry.blogspot.com/2015/05/bipolar-craziness.html , and/or share it with your followers on social. Either way, keep up the great work Duncan!

All the best,

Nicole Lascurain | Assistant Marketing Manager
p: 415-281-3100 | e: nicole.lascurain@healthline.com

Healthline
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