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.
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.”
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:
- Opioid-Induced Mood Disorder
Yes, pain meds can make you look like a bipolar.
- Neuroleptic-Induced Acute Akathisia
He’s agitated, let’s give him more neuroleptic. Neuroleptics are old-fashioned antipsychotics such as Haldol.
- 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?
- 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.
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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How to identify mania:
One way is to make a rough calculation of the percentage of support list email that is yours. Is half the email yours? That’s the support list equivalent of being at a party and running around in a frenzy trying to keep tabs on every conversation.
My personal favorite way to tell is to read my own posts and count how many times I begin a paragraph with the word “I”. If I write a post and every goddam sentence is about me, me, me, then I know that I should be talking to a therapist instead of taking energy from people whose boundaries are too soft for them to say or even think “no” or “you are a boring, self-involved twit.” When folks talk talk talk, it’s because there’s something that they want to say. Not the mush that comes tumbling out in idle chit-chat, but something important and maybe life-changing. OMFG, no, keep talking loud and fast so that you can’t hear it.
In case you aren’t aware of yourself enough to gauge when your thoughts are racing, you are emotionally labile, or you are feeling overly optimistic, grandiose, charitable, attractive, psychotic or whatever else might be part of your mania, then you have to focus on your behavior. Or more specifically to others’ reactions to your behavior.
I realize that gaining some awareness is the first step in being able to reduce your meds, get out and make new friends, do volunteer work or maybe even get job training, and eventually even stop hating yourself and your bipolar disorder. In a way, allowing yourself to be competent and independent is like sawing off the branch you’re sitting on if your continued access to medical care requires that you be sick enough to qualify for it.
Can you imagine being paid to stay sick?
A reminder: I’m an engineer. This is all my opinion based on readings in a field that is not my own. I request that as you read my posts, you also check my references.
Cigarettes are powerful anti-anxiety drugs. It’s my opinion that may smokers are self-medicating an anxiety disorder.
“Exposure to moderate stress significantly increased ratings of anxiety, discontent and aggression and nicotine blocked these mood changes in females, but enhanced them in males. This suggests that young women may start regular smoking as a form of stress self-medication, which implies that preventative and smoking cessation programmes would be more successful in women if they addressed issues of stress and anxiety, which may be core factors underlying initiation and maintenance of regular smoking.”
A bipolar most certainly will get a high score on an ADD screening test like the Copeland symptom checklist. The symptoms of ADD overlap with the symptoms of bipolar. A bipolar child scores higher on the ADD screening test that a child with ADD. Your GP isn’t qualified to make a differential diagnosis, and in fact is likely to misdiagnose you and make your illness worse.
I’m going to quote from articles about children because misdiagnosis kills so many of them. It applies to adults too, but we don’t have parents to FORCE us to continue taking ritalin when it is obviously tearing us to pieces.
“There is concern that ADHD is being overdiagnosed and bipolar disorder underdiagnosed in the population of children.”
That being said, yes, I have ADHD combined type. My psychiatrist diagnosed it after I’d been seeing him for 10 years and after an evaluation that DIDN’T included taking an ADD screening test. Screening tests are useless for bipolars. You have to be cautious.
I have been through the entire pharmacopia, or it seems that way. Every ADD med I’ve taken makes me hypomanic within a week. So how I work it is that on days I really REALLY need to focus I take it. I have tried:
Ritalin (methyphenidate) – this is the one they give our children. Somebody please explain to me why 40% of American children need psych meds?
Strattera – this was the absolute worst for me. It interferes with metabolism in the liver of SSRIs, resulting in a huge buildup of both drugs. I was up there in 3 days and in a nasty mixed state in a week.
Provigil – similar to Strattera, but takes longer to build up. YMMV! 🙂
Adderall – amphetamine. SPEED FREAK! Three days in a row and I’m have “racoon eyes” and am well on my way to psychosis.
Strattera Risks May Widen
FDA,s warning about Eli Lilly’s drug Strattera causing suicidal thinking in children used for ADHD caught many parents and doctors by surprise.
“Dr. Laughren says the agency also plans to ask Lilly to include a stronger caution on Strattera’s label about its risk of inducing mania and similar mood destabilization, along with the new “black box” warning out this week. The new warning will focus on the drug’s risks for kids with undiagnosed bipolar illness, according to Dr. Laughren. In fact, “very often bipolar illness is not recognized until you [give] patients a drug like Strattera,” he says.”
“Now understanding that early-onset bipolar disorder is frequently co-morbid with other childhood psychiatric conditions, doctors and parents should be concerned that a medication used to treat these other conditions may “flush out” a previously quiescent bipolar gene that can significantly worsen the course of illness and potentially wreak havoc with that child’s life. It is therefore vitally important that parents learn everything they can about their family histories, and if mood disorders (depression or manic-depression), suicide, or alcoholism come to light, treatment should proceed very cautiously. Mood stabilizers should perhaps be the first line of treatment (and it may take two such medications to stabilize the child), and attentional, obsessional, or depressive symptoms be treated only after a therapeutic dose of the mood stabilizer is achieved.”
Perhaps the greatest source of diagnostic confusion in childhood bipolar disorder is that its symptoms overlap with many of the symptoms of attention-deficit disorder with hyperactivity. At first glance, any child who can’t sit still, who is fidgety, impulsive, easily distracted or emotionally labile is more likely to receive a diagnosis of ADHD than bipolar disorder. However, since over 80 percent of children with a bipolar disorder will meet full criteria for attention-deficit disorder with hyperactivity, ADHD should be diagnosed only after bipolar disorder is ruled out. While these two conditions seem highly co-morbid, stimulants unopposed by a mood stabilizer can have an adverse effect on the bipolar condition. 65 percent of the children in our study had hypomanic, manic and aggressive reactions to stimulant medications. Parents wrote to us and described some of their children’s reactions to stimulants. They said things like: “He got sky-high on Ritalin and then violent”; “Ritalin caused physical aggression”; “She got psychotic on stimulants”; “He got suicidal and tried to get run over by a car”; “He went bonkers…”
Don’t let a GP play with screening tests. See a psychiatrist.
The long awaited Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression, Second Edition, by Frederick K. Goodwin and Kay Redfield Jamison is finally in stores.
Hopefully you have the first edition. It is *the* reference book for bipolar disorder. Over the years many of the hypotheses set forth in the first edition have been proven out. It’s all there. Phototherapy, circadian rhythms, bipolar creativity. The effects of lithium on the suicide rate. Why we must avoid unopposed antidepressants. And that’s what I saw just riffling the pages! I can’t wait to sit down and read the medical roadmap that Drs. Goodwin and Jamison set out for the next 15 years.
A sample chapter is available for download from the Oxford University Press.
If you apply for the Amazon.com Visa when you make the purchase you can get a hefty rebate. Yippee!