Posted by JohnL on November 1, 2000, at 4:41:15
In reply to If i've said it once, I've said it 1000 times, posted by pullmarine on October 31, 2000, at 21:54:46
> You really should not worry about psychiatric labels. they are very arbitrary (basically, the labels are a list of symptoms that are designated via consensus with little or no scientific validity.
> If your doctor is not giving you a diagnosis. Then he's probably a very knowledgeable man. Patients usually seek and cling to labels and let them define their lives. Please avoid this trap. Refuse the labels, and accept taht the things that you go through are just normal variances in human temperament.
> Personally, I have been on meds, and dealt with the labels for many years. I am currently off meds (except for dexadrine, but I'm working on that too). I have known people who were diagnosed with bi-polar, put on lithium and years later, are living med free and depression free (in no way am I suggesting that this is the right option for everyone.
> In my experience, I have come to accept that everything has cycles, be it the economy, or the seasons of the year. I am no different, I have my seasons and my cycles, but overall, I am functional (but the journey has been long and hard and I'm not entirely through the woods yet).
> Best of luck.
> PS. if you want to know about some non med ways of dealing with depression, just ask.
I am in favor of all the excellent points John made in his above responses. Making the link between diagnosis and medication is a pipedream in my opinion. I mean, sometimes it happens, sometimes it doesn't. If biplor is the diagnosis, then the drugs appropriate would be Lithium, Depakote, or Tegretol. So how do we explain that a bipolar person might not do well with any of these, but instead do extremely well with an antipsychotic instead? Or a stimulant? Or anything else with no clinical justification? The fact is, it happens. I know doctors are trained to make a diagnosis and then match drug treatment to that diagnosis. Sometimes that works. Sometimes it doesn't. Might as well flip a coin. The odds are about the same. Just my opinion based on what I've seen happen in the real world.
In the book "Dysthymia, The Spectrum of Chronic Depression", by renowned world researcher/psychiatrist Hagop Akiskal, he states that mental illness is an evolving condition. In other words, it doesn't stay the same forever. It's constantly in motion as we age, and it doesn't breed true from one generation to the next. It presents itself in various forms over time, and in various forms from one generation to the next. In general, he basically feels that there is a good deal of overlap between all the various psychiatric conditions. In the real world, I personally have found it best to use a preliminary diagnosis as a starting point in treatment. It is guidance tool to get started, but in the end may have no relevence to which drug actually works or not for the particular person. Brain chemistries are too complex and too unique from one person to the next to neatly categorize them into a diagnosis. Someone either feels better on a drug or they don't. The diagnosis may have nothing to do with it.
I know when someone has recovered from alcoholism, years later they will still say, "Hi, I'm So&So, I'm a recovering alcoholic." I don't like using that same approach to bipolar or whatever. I think it's counterproductive to include a diagnosis as part of our identity.
I like to use a chart of statistics as a guide. Let's say for example I am depressed and may be bipolar. I go to my chart and I see that the highest percentage of depressed people responded to a serotonin drug over other drugs. OK. So I'll start there. If I get worse, or get manic, then I would go down the list to the next highest percentage which happens to be Lithium. Closely following are Depakote and Tegretol. If treatment is still going lousy with these, which it often is, what use was that diagnosis in the first place? I continue down the list. Antipsychotics. Stimulants. Thyroid.
Just one real life example is me. One psychiatrist said I had double depression. Another diagnosed me as bipolar. A third diagnosed me as depressed with possible psychosis. Really? Who was right? What good were these diagnosis in actual treatment? One thing for sure was the depression component. Paxil, Zoloft, Serzone, Effexor, Luvox, Nortriptyline, Moclobemide, and more....hey, one of these should have worked, yeah? But no. In the end, it was a stimulant+antipsychotic combination that worked. In a way, all three pdocs were partially correct. There may have been overlapping components of each different diagnosis, but not one exactly correct. And the fact is that the drugs that actually worked were far removed from what normally should have worked with any of the diagnosis that were made.
I don't know. Diagnosis is helpful to get started. But in the end it is often fruitless. Sometimes. Sometimes not. It's just a guide that may or may not prove helpful. I like to keep an open mind, and know that anything's possible, any drug might work. Don't rule any out just because they aren't clinically justified. Sometimes the magic we're looking for is hiding in a place we don't suspect. A diagnosis might prevent us from finding it.