Bipolar Planet on Facebook

The Bipolar Planet has made it to the 21st century. Social Networking is all the rage, and though The Bipolar Planet has provided a private email list for over ten years and a web page for 15 years as of May 2009, I’ve resisted wandering. Ok, here we go… Become a fan at the official Bipolar Planet Facebook page.

Medication and Reduced IQ

The Maudsley Bipolar Disorder Project: the effect of medication, family history, and duration of illness on IQ and memory in bipolar I disorder.

This article presents evidence that psych meds make us sicker.

“Patients on treatment with antipsychotic drugs had a lower current full scale IQ, lower general memory scores, and lower working memory scores. A family history of affective disorders was associated with a higher full scale IQ, but not with either general or working memory measures. Duration of illness was negatively associated with general memory scores, but had no effect on either IQ or working memory measures.”

The Power of Irrationality

If you haven’t read Kay Redfield Jamison’s “<a href="Touched with Fire: Manic-Depressive Illness and the Artistic Temperament“>Touched With Fire; Manic-Depressive Ilness and the Artistic Temperament” run out and get a copy. She is a psychiatrist at Johns Hopkins and is bipolar herself.

“I believe that curiosity, wonder and passion are defining qualities of imaginative minds and great teachers; that restlessness and discontent are vital things; and that intense experience and suffering instruct us in ways that less intense emotions can never do. I believe, in short, that we are equally beholden to heart and mind, and that those who have particularly passionate temperaments and questioning minds leave the world a different place for their having been there. It is important to value intellect and discipline, of course, but it is also important to recognize the power of irrationality, enthusiasm and vast energy. Intensity has its costs, of course — in pain, in hastily and poorly reckoned plans, in impetuousness — but it has its advantages as well.”
Dr. Kay Redfield Jamison, Author and Professor of Psychiatry and Behavioral Sciences at Johns Hopkins University
in “The Benefits of Restlessness and Jagged Edges”
NPR Morning Edition, June 6, 2005

There is a video of a speech she did about Exhuberance on YouTube that was quite inspiring. She wrote a great book about the love of life called Exuberance: The Passion for Life
.

The Neurology of Trauma

A few weeks ago there was a vehicle in front of me at the coffeeshop window with a phone number and link to The Evolutionary Brain. I called the number and got the guy in the truck, we waved at each other, and he gave me a DVD of the above video, Dr. Robert Scaer on Brain State Technologies and Trauma.

I had a theory about this 18 years ago when I worked for an EEG company and was getting into brainwave synchronization. Doesn’t it seem obvious that if you can “read” brainwaves, then you can also write them? It would be tricky. We’re not looking for ECT, which is more like an electromagnetic pulse (EMP) that wipes the whole thing clean. We just want to defrag the mind.

The main site for the technology, Brain State Technologies™ Brain State Conditioning™.

Imnsho, information like this is an absolute necessity if you don’t want to drown in your own drool. YMMV, of course.

Mental Health Rules Put in Bailout

http://www.house.gov/apps/list/press/financialsvcs_dem/essabill.pdf

The above link is to the full text of the bailout bill, and I suggest that everybody read this bill. It was pushed through with only a couple of days debate by lawyers who have little understanding of the workings of Wall Street or The Fed. And they tacked a lot of pork barrel spending onto it to BRIBE Congress to agree to it. Unfortunately, mental health parity verbiage was tacked onto the bill with the pork. NAMI, of course, is celebrating the bill for its own sake without regard to what effect it will have, or when. Having appeased the mental health lobby, congress is off the hook as far as enacting any further legislation. Way to go!
http://www.house.gov/apps/list/press/financialsvcs_dem/essabill.pdf

“To amend section 712 of the Employee Retirement Income
Security Act of 1974, section 2705 of the Public Health
Service Act, section 9812 of the Internal Revenue Code
of 1986 to require equity in the provision of mental
health and substance-related disorder benefits under
group health plans, to prohibit discrimination on the
basis of genetic information with respect to health insurance
and employment, and for other purposes.”

This means that you only get parity if your employer provides your insurance AND that insurance already has mental health coverage. It doesn’t seem to require them to cover it in the first place. It also doesn’t appear to apply to private health insurance.

There is a cost exemption so to limit mental health coverage if it increases costs by some undetermined amount. The insurance companies can still deny claims bases on their definition of “medical necessity” or by their definition of “reasonable and customary” services.

??(2) COST EXEMPTION.?
6 ??(A) IN GENERAL.?With respect to a
7 group health plan (or health insurance coverage
8 offered in connection with such a plan), if the
9 application of this section to such plan (or cov
10 erage) results in an increase for the plan year
11 involved of the actual total costs of coverage
12 with respect to medical and surgical benefits
13 and mental health and substance use disorder
14 benefits under the plan (as determined and cer
15 tified under subparagraph (C)) by an amount
16 that exceeds the applicable percentage described
17 in subparagraph (B) of the actual total plan
18 costs, the provisions of this section shall not
19 apply to such plan (or coverage) during the fol
20 lowing plan year, and such exemption shall
21 apply to the plan (or coverage) for 1 plan year.”

Discrimination on the basis of genetic information only affects illnesses for which genetic tests have been developed. This bill ignores a lot of of the provisions of the ADA, while modifying ERISA quite a bit. I am concerned that this will weaken the ADA by tightening the definitions to exclude non-genetic diseases.

Specific diagnoses this bill applies to will be determined by the GAO, which has 3 years to study it and present a report. Once the beancounters are through will this bill, we’ll have no more than we had the day before the bill passed.

(h) GAO STUDY ON COVERAGE AND EXCLUSION OF
4 MENTAL HEALTH AND SUBSTANCE USE DISORDER DIAG5
NOSES.?
6 (1) IN GENERAL.?The Comptroller General of
7 the United States shall conduct a study that ana8
lyzes the specific rates, patterns, and trends in cov9
erage and exclusion of specific mental health and
10 substance use disorder diagnoses by health plans
11 and health insurance.”

I doubt this will change anything in the near future.

A few years from now you’re going to hear Congressdroids bitching because they didn’t have enough time to collect the facts before enacting this bill.

Online list of DSM-IV diagnoses.

PSYweb DSM-IV Diagnoses and Codes.

PSYweb has a list of the DSM-IV Diagnosis Codes. Notice that there are a lot of psychiatric diagnoses caused by psych meds. This makes it totally clear that your meds can make you sicker, a good argument for doing the minimum meds to make you functional vs. medicating yourself into oblivion.

The following are a few examples of iatrogenic (physician-caused) psychiatric disorders:

292.84

Opioid-Induced Mood Disorder
Yes, pain meds can make you look like a bipolar.

333.99

Neuroleptic-Induced Acute Akathisia
He’s agitated, let’s give him more neuroleptic. Neuroleptics are old-fashioned antipsychotics such as Haldol.

292.12

Amphetamine-Induced Psychotic Disorder, With Hallucinations
Some of the ADHD meds they give to kids, including Ritalin and Adderall, are amphetamines. Can you imagine turning your kid into a Speed Freak?

292.89

Sedative-, Hypnotic-, or Anxiolytic-Induced Anxiety Disorder
Anxiety from anti-anxiety pills? Some of the benzodiazepines can even induce hypomania, however there doesn’t seem to be a diagnosis code for it. Maybe in the DSM-V. Or maybe not. I hear it’s being written by Big Pharma.

Another cool thing on psyweb is a Mood Disorder Flow Chart that is able to distinguish bipolar disorder from the other mood disorders. A real kick in the head is the question “Symptoms Psychotic in nature, occur at times other then during Manic or Mixed Episodes?”

This seems to imply that bipolars don’t have psychotic depressions, but other mood disorders do. Note that the only the 296 numbers are mood disorders, and only a few of those are called bipolar disorder. Been there, done that, bought the t-shirt.

A couple of years ago I did a decision tree for the bipolar disorders based on the DSM-III. It’s a little different from the DSM-IV-based version.

Psyweb also has a decision tree for differential diagnosis, and that’s a better choice than the mood disorders tree, even for diagnosed bipolars. This tree helps you figure out whether you have another psych diagnosis masquerading as bipolar, something that a 15-minute psych eval will definately miss. That would be truly disastrous, being treated for life for bipolar instead of dealing with something less severe. Have fun!

I think I’m going to invent Seroquel jimmies for ice cream.

Sleep and Bipolar

I found this in my drafts folder. I have no idea where I was going with it or who I was answering.

I hear that they are studying drug-induced coma as a treatment for mania. Granted, sleep is a good prophylactic for bipolar. It’s just too, too creepy. The end game will be to stack comatose mentally ill off in a warehouse somewhere. Didn’t Robin Cook write a chilling medical fiction about something like this?

How much sleep does it take? Are they researching conversion tables to translate hours of coma to days of sleep?

There’s a good section on sleep and bipolar in Dr. Fieve’s latest book, Bipolar II: Enhance Your Highs, Boost Your Creativity, and Escape the Cycles of Recurrent Depression.

There was also a chapter in the first edition of Goodwin and Jamison. Incidentally, Manic-Depressive Illness Second Edition is out.

It’s rather disheartening to hear that the researchers are repeating the same old studies over and over instead of exploring new treatment options that would enable us to go back to work instead of turning us into mental cripples by reducing our IQs and impairing our short-term memory. And then stigmatizing us for having cognitive deficits.

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The Invisible Plague

I’m not doing so well. I had a steroid-induced hypomania for about two weeks, and a subsequent crash. I was able to continue working through it, but I’m going to need a few days off to completely level out. Unfortunately I work for a company with only 5 people, and I do the testing so that we can ship product and bill the customers for all our hard work. It’s hard to get even one day off. I took off on Friday and had to take calls all day long. I might as well have gone in.

I really enjoy my work. Engineering is just as creative as any of the humanities. The main difference is that it attracts linear-sequential people and reductionists. That trait and that philosophy can be real creativity-killers.

Hypomania, or mild mania, can be socially and financially devastating. It’s the reason I sought treatment for the bipolar disorder. “Why do I get so stupid and unreasonably optimistic over and over again?” “Why do I keep making the same mistakes?” Hypomania by definition doesn’t include psychosis, so the impairment is completely due to over-optimism. As an engineer I have Mad Skilz at reality testing.

I usually avoid steroids for that reason, but my back is a mess from the accident last year and I got an epidural to have some relief from the pain. I also avoid painkillers because opioids are a guaranteed depression. There is a DSM-IV code for opioid-induced mood disorder.

Hypomania is exhilarating. Without an occasional hypomania, life is in shades of grey. Dorothy in Kansas. All bipolars have to accept that the price of avoiding hell is to give up heaven.

No meds stop mood swings completely but they make them tolerable and easier to manage. It takes a bit of effort to avoid triggers like lack of sleep, stress, etc. I do ok. A lot of folks on the list and the forum will never do ok. There but for the grace of God go I, eh?

I saw a book online while maintaining the forums this morning. I think you know the researcher EF Torrey? He has a new book called “The Invisible Plague: The Rise of Mental Illness from 1750 to the Present.”

I don’t feel like a deadly bacillus. Mental illness isn’t contagious! You can read everything I write, you can shake my hand and even drink from my glass, but you won’t catch get bipolar disorder from me. So why call it a plague? Why not focus on the triggers that cause a simple genetic propensity to become full-blown mental illness? Is that the point, to avoid implicating societal forces like the switch to strict industrial time constraints in the time frame Torrey’s book covers? Which, incidentally, was fueled by the shortage of workers in post-Plague Europe, but that’s another story. I’m a history buff and I really get into anthropology.

Refer to Edward T. Hall’s “The Dance of Life: The Other Side of Time” for a fascinating exploration of the perception of time as defined by our cultures.

And if you like rock, listen to Dire Straits “Industrial Disease.”

How does Torrey plan to eliminate mental illness? Does he want to go back to forced sterilization? Take biopsies of unborn children to identify and abort diseased DNA, thereby destroying even the unaffected siblings? Or is he content to make a good living calling us names? “Plague” indeed!

Remission in Bipolar Disorder

If someone figures out how to “cure” genetics, let me know. You can’t exactly pick up a bottle of Grecian Formula for Brain at the local pharmacy.

Remission is another thing altogether. That simply means that you are having an extended symptom-free period. Given that the DSM-IV bipolar criteria only require that the patient have ONE episode of mania or hypomania, some folks may remain in remission for the rest of their lives even without meds.

Science *is* empiricism. I would like to suggest that a large percentage doctors are not particularly careful in their application of the science of medicine. If they were scientific, they’d test and retest the bipolar patient’s continued need for meds instead of following the bizarre rule of thumb that once you’re on meds you need them forever. The killer is that as long as the illness is masked by drugs, it is impossible to practice “evidence-based medicine” as they disparagingly call it.

None of us on meds is being treated in an scientific manner. It isn’t scientifically valid to say that bipolar disorder causes cognitive deficits if a large percentage of the patients in the study were on meds. Antipsychotics have been *proven* to reduce the IQ by affecting the short-term memory. They aren’t the only drug to cause cognitive deficits. Lithium makes you feel as if your brain is wrapped in cotton wool.

I don’t believe that it is scientifically valid to say that bipolars must be on meds for life. If the patient stops the meds and experiences a return of symptoms… well, you’ve rewired the brain. The drugs themselves create a continued need for themselves by reconfiguring the brain’s neurons to need higher levels of serotonin in the synapses. The symptoms are bound to return, and much worse than before the drug did its damage.

Another thing about remission is that so many things besides bipolar disorder cause mood swings. Bipolar disorder has periods of remission. Things like the personality disorders, schizophrenia, schizoaffective disorder, PTSD and any of a hundred organic illness all cause mood swings. But they don’t necessarily have periods of remission, and in many cases remission just doesn’t occur.

Here – this is my particular manifestation of bipolar disorder. Three-year cycles. They come no matter what, but fortunately the meds attentuate the episodes. On the other hand, until I was on meds the cycles didn’t seriously impact my salary.

I think that it’s important, if a bipolar isn’t having remissions, to figure out why. Ultra-rapid cycling could be caused by an antidepressant, particularly in women. Newly-diagnosed bipolars often experience a great deal of fear or anxiety that might be better treated with therapy than with additional meds. Antipsychotics may ruin the patient’s ability to effectively manage the illness by dumbing them down. Sometimes it isn’t the illness, it is the meds that make bipolars disabled.

Are your drugs masking periods of remission?

Sometimes I get tired of the reverse stigma that I get for taking fewer meds so that I can continue to have a life. Isn’t that the purpose of treatment? If not, what is?

Most bipolars have the so-called milder varieties of the illness, and many of them are unfairly overmedicated and isolated from society for no good reason. It is unbearably sad to see that happening. So if I can tolerate psychosis instead of trying to medicate away every little nuance of mood or emotion, does that make me somehow inferior? I don’t f*cking think so. It isn’t pathological until it has a negative effect on my life.

Medifocus Guide

I just finished reading the Medifocus Guide to Bipolar Disorder.
The Medifocus Guide to Bipolar Disorder has articles on current and relevant research organized into categories for easy reading. Free updates are provided for one year. It also provides an international physician finder.
I believe this book will be a very useful resource for bipolars and their families, especially if recently diagnosed.