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Dr. Bob is Robert Hsiung, MD,
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Posted by ttee on May 10, 2007, at 15:46:01
In reply to Re: NIMH on Bipolar Spectrum Disorder » polarbear206, posted by MaddieB on May 10, 2007, at 14:48:51
Now I would be on of the last people to give kudo's to any of the drug companies or research psychiatrists. But, I do think there is such a thing as soft bipolor (less severe) that gets misdiagnoised as MDD along with anxiety disorders. I think it is important to remember that none of the psycho drugs cure anybody of any pycho problem. At their best, they reduce symptoms for a small subset of patients. We don't have a cure for cancer yet either, but we still try with the best drugs we have available. There is no cure for a mood disorder, but we try the best we can to reduce symptoms with psycho meds. I would say that the mood stabilizers are less toxic than most cancer drugs, but they still use them. Just as AD's don't work for everyone with MDD, the same problem happens with all the types of bipolar. Just because somebody didn't do well on Zyprexa, doesn't mean that rules out some for of bipolar.
Posted by MaddieB on May 10, 2007, at 15:53:38
In reply to Re: NIMH on Bipolar Spectrum Disorder, posted by polarbear206 on May 10, 2007, at 15:37:37
> I don't appreciate your harsh attitude against me because I work in the field. There are many things I don't agree with!! As far as I'm concerned they can throw the DSM out the window. That should of been revampt years ago, and maybe people wouldn't have to walk around for years not knowing what is wrong with them. I acutually diagnosed myself with mild bipolar. I come here offer help and advice and stress to people to educate themselves.
Yes, my attitude was harsh in disagreement but not intended to be harsh toward you personally.
For that I do apologize sincerely. I am happy to agree to disagree. I support you in your struggles and I hope you can do likewise. I've been diagnosed with many labels all across depression the spectrum but no one has yet to be successful in medicating me (even the bright minds at Mclean and MGH.) This has been since 1992. My next trial is by MAOI.More work needs to be done. We are on the cusp of great change and if the study helps to enlighten some then where is the harm? But there is much more to the story yet to be oncovered. I am obviously frustrated. I know you are too.
Best wishes to you and to us all. Maddie
Posted by polarbear206 on May 10, 2007, at 16:07:53
In reply to Re: NIMH on Bipolar Spectrum Disorder, posted by ttee on May 10, 2007, at 15:46:01
> Now I would be on of the last people to give kudo's to any of the drug companies or research psychiatrists. But, I do think there is such a thing as soft bipolor (less severe) that gets misdiagnoised as MDD along with anxiety disorders. I think it is important to remember that none of the psycho drugs cure anybody of any pycho problem. At their best, they reduce symptoms for a small subset of patients. We don't have a cure for cancer yet either, but we still try with the best drugs we have available. There is no cure for a mood disorder, but we try the best we can to reduce symptoms with psycho meds. I would say that the mood stabilizers are less toxic than most cancer drugs, but they still use them. Just as AD's don't work for everyone with MDD, the same problem happens with all the types of bipolar. Just because somebody didn't do well on Zyprexa, doesn't mean that rules out some for of bipolar.
Thank you for your post. I totally agree with you.Polarbear
Posted by linkadge on May 10, 2007, at 16:54:05
In reply to Re: NIMH on Bipolar Spectrum Disorder, posted by polarbear206 on May 10, 2007, at 14:36:44
>The average person will not get a proper diagnosis for about 10 years
I don't know how those types of statistics are arrived at.
I just see it as the latest trend. Its a trend to try and compensate for both the lack of efficacy and outpourings of adverse reactions to antidepressants.
Back in the day, bipolar meant *BIPOLAR*. Now we've got all this inbetween fluff, where everybody and their monkey's uncle can fit into the bipolar diagnosis. It all fits nicely with a trend towards the latest trendy meds abilify, seroquel, lamictal etc.
Symptoms that *used* to fit under the umbrella of depression (irritability, anxiety, racing mind) are being thrown into bipolar now, just for the sake of it. (or because current antidepressants often exasperate things like agitation etc.)
Linkadge
Posted by linkadge on May 10, 2007, at 17:01:04
In reply to Re: NIMH on Bipolar Spectrum Disorder » polarbear206, posted by MaddieB on May 10, 2007, at 14:48:51
>Why is that PolarBear?? Because the first thing >out of the gate is an SSRI Which Increases >Cycling (and there is evidence that w/o >introduction of an SSRI, there is less cycling >later on. Read: you're only a virgin once.)
Exactly. Things like rapid cycling are much more prevalant since the widespread use of antidepressants. These drugs are very much like street drugs.
Check this out. Its an entire page devoted to the research of *why* these meds are increasing incidence of mania, rapid cycling etc. Antidepressants activate some of the same genes as do cocaine, amhpetamines etc. PKC, CREB, GSK, GRK, Clock, etc.
http://www.neurotransmitter.net/admania.html
The bottom line is "drugs are drugs". If you start with the incorrect assumption that a bunch of scientists cannot create drugs that do harm, you're in for a lesson.
It wasn't that long ago that methamphetamine was prescribed for depression. So when people had psychotic reactions to that, I wonder what they tried to blame it on?
Just a few months back, permax, and cabergoline were presumed perfectly safe, untill we find out that they were severly dammaging peoples hearts.
What makes people think that they cannot make mistakes about psychiatric drugs?
Linkadge
Posted by linkadge on May 10, 2007, at 17:07:49
In reply to Re: EMSAM vs. Manerix )) Maddie B » MaddieB, posted by polarbear206 on May 10, 2007, at 15:12:26
Research is FLAWED.
The single greatest predictive factor in the outcome of any published antidepressant clincial trial is the identity of the funding body.
That means, the greates predictive factor in the sucess or failure of a drug created by Pfizer, for instance, is wheather or not Pfizer sponsors the clinical trial.
How can we reason with that kind of bias?
The NIMH, for instance, endorses ECT information that was gathered and compiled by individuals who have shares in the companys that built ECT machines.
Its a terrable web of lies that ammounts to nothing meaning anything.
Linkadge
Posted by Phillipa on May 10, 2007, at 19:29:31
In reply to Re: EMSAM vs. Manerix )) Maddie B, posted by linkadge on May 10, 2007, at 17:07:49
When I worked in psych bipolar was two poles one high the other low with a great resemblence to schizophenia. Funny a lot of the ones that ended up diagnosed as bipolar were abusing street meds. Love Phillipa ps we had one doc two that said everyone was misdiagnosed and was bipolar and lithium would cure them. So all his patients got lithium. Come to find out he was truly bipolar. So I don't buy the new diagnoses of bipolar. Also don't think that many meds work for depression. Love Phillipa
Posted by Johann on May 10, 2007, at 23:23:45
In reply to NIMH on Bipolar Spectrum Disorder, posted by ttee on May 9, 2007, at 16:52:24
Seems to me that the article states the situation well. Some researchers are genuinely attempting to help people.
After almost 30 years of ferocious depression and strong anxiety, it wasn't until my psychiatrist and I realized that I had Bipolar Spectrum Disorder that I was prescribed the correct medication, lithium, and the depression ceased. One validation of this, aside from all the AD "poop outs," was my mixed bipolar response to Disiprimine, a TCA, which are known for causing cycling.
I believe many people could make better sense of their experience and get more effective help if Bipolar Spectrum Disorder were taken more seriously.--Johann
Posted by Johann on May 10, 2007, at 23:25:46
In reply to Re: NIMH on Bipolar Spectrum Disorder, posted by polarbear206 on May 10, 2007, at 14:36:44
Posted by polarbear206 on May 11, 2007, at 8:22:16
In reply to I agree with Polarbear (nm), posted by Johann on May 10, 2007, at 23:25:46
Posted by polarbear206 on May 11, 2007, at 8:34:03
In reply to Re: I agree with Polarbear (nm), posted by polarbear206 on May 11, 2007, at 8:22:16
Posted by polarbear206 on May 11, 2007, at 8:54:47
In reply to Re: NIMH on Bipolar Spectrum Disorder--YES, posted by Johann on May 10, 2007, at 23:23:45
> Seems to me that the article states the situation well. Some researchers are genuinely attempting to help people.
>
> After almost 30 years of ferocious depression and strong anxiety, it wasn't until my psychiatrist and I realized that I had Bipolar Spectrum Disorder that I was prescribed the correct medication, lithium, and the depression ceased. One validation of this, aside from all the AD "poop outs," was my mixed bipolar response to Disiprimine, a TCA, which are known for causing cycling.
>
> I believe many people could make better sense of their experience and get more effective help if Bipolar Spectrum Disorder were taken more seriously.--Johann
Yes, I agree we need to take this more seriously so people like you get a proper diagnosis and treatment, not 5,10,20 or 30 years down the road.
Thank you for your valuable input.Polarbear
Posted by MaddieB on May 11, 2007, at 10:20:38
In reply to Re: NIMH on Bipolar Spectrum Disorder--YES » Johann, posted by polarbear206 on May 11, 2007, at 8:54:47
> > I believe many people could make better sense of their experience and get more effective help if Bipolar Spectrum Disorder were taken more seriously.--Johann
>
>
> Yes, I agree we need to take this more seriously so people like you get a proper diagnosis and treatment, not 5,10,20 or 30 years down the road.
> Thank you for your valuable input.
>
> PolarbearAh, yes, I see. "Valuable input" is one that agrees with your take on things. Also see that you are too full of your own self-image of correctness to accept an apology. That's OK, I support you anyway because I believe that your heart (and perhaps even your science) is in the right place. I tried to make a point. I'm sure that I went about it in a way that didn't communicate what I wanted to say such that it could be understood by you and refuted in a way that was at least educative to me, if not one that acheived consensus. I tried to explain that but was ignored by you. I guess that you are just too angry about this issue. I just wanted to say that I suffer too because the diagnosis and treatment of mental illness isn't as precise as I know it will be one day. Regardless of what you think of me, I do know your pain. Maybe one day we can be on the same page. I hope for that day. Best Regards.
Posted by polarbear206 on May 11, 2007, at 10:22:49
In reply to Re: NIMH on Bipolar Spectrum Disorder » polarbear206, posted by MaddieB on May 10, 2007, at 15:53:38
> > I don't appreciate your harsh attitude against me because I work in the field. There are many things I don't agree with!! As far as I'm concerned they can throw the DSM out the window. That should of been revampt years ago, and maybe people wouldn't have to walk around for years not knowing what is wrong with them. I acutually diagnosed myself with mild bipolar. I come here offer help and advice and stress to people to educate themselves.
>
> Yes, my attitude was harsh in disagreement but not intended to be harsh toward you personally.
> For that I do apologize sincerely. I am happy to agree to disagree. I support you in your struggles and I hope you can do likewise. I've been diagnosed with many labels all across depression the spectrum but no one has yet to be successful in medicating me (even the bright minds at Mclean and MGH.) This has been since 1992. My next trial is by MAOI.
>
> More work needs to be done. We are on the cusp of great change and if the study helps to enlighten some then where is the harm? But there is much more to the story yet to be oncovered. I am obviously frustrated. I know you are too.
> Best wishes to you and to us all. Maddie
>
>
>
>Thank you Maddie. If you don't mind, I would like to know about your about your history and course of your illness. Maybe I can offer some insight.
As you can see, I am very passionate about helping others, I don't want ANYONE to go through what I did to get to this point. My symptoms erupted after the birth of my son 18 years ago. The anxiety and depression was overwhelming and consumed me. I was diagnosed with severe PPD and was hospitalized for 3 days. I was put on imipramine and klonopin, which I had an immediate therapeutic response. This was prior to Prozac coming on the market. The doctors couldn't get over how well I improved. I was well enough to go home. Well, that was short-lived, then 2 weeks later the merri-go-round started. My cycling was not classic BP-2. It was more subtle and I was still functional. I cycled with periods of bursts in energy, getting so many things done. It was a good energy!! Nothing that looked like classic hypomania. I mostly had a mixture of anxiety, agitation, atypical depression, esp. in the winter. I threw myself into researching about mood disorders. I diagnosed myself and it took a while to get the right cocktail of medication. I thank God for the newer drugs, esp. Lamictal, which has given me my life back. I wonder how different my life would of turned out, if I had the opportunity to take these newer meds back then. I would of had more children and not feel guilty about not being there 100% for my son. I still require and AD because my bipolar is depression dominated. Effexor is the only AD that has worked well for me. So as you can see, as Johann said in the above post, the public and medical profession need to take this spectrum more seriously. So through research studies and clinical trials, the word is getting out there. I just wish it would of been sooner.
PolarbearPoarbear
Posted by polarbear206 on May 11, 2007, at 10:38:46
In reply to Re: NIMH on Bipolar Spectrum Disorder--YES » polarbear206, posted by MaddieB on May 11, 2007, at 10:20:38
>
> > > I believe many people could make better sense of their experience and get more effective help if Bipolar Spectrum Disorder were taken more seriously.--Johann
> >
> >
> > Yes, I agree we need to take this more seriously so people like you get a proper diagnosis and treatment, not 5,10,20 or 30 years down the road.
> > Thank you for your valuable input.
> >
> > Polarbear
>
> Ah, yes, I see. "Valuable input" is one that agrees with your take on things. Also see that you are too full of your own self-image of correctness to accept an apology. That's OK, I support you anyway because I believe that your heart (and perhaps even your science) is in the right place. I tried to make a point. I'm sure that I went about it in a way that didn't communicate what I wanted to say such that it could be understood by you and refuted in a way that was at least educative to me, if not one that acheived consensus. I tried to explain that but was ignored by you. I guess that you are just too angry about this issue. I just wanted to say that I suffer too because the diagnosis and treatment of mental illness isn't as precise as I know it will be one day. Regardless of what you think of me, I do know your pain. Maybe one day we can be on the same page. I hope for that day. Best Regards.
Maddie,I think we are getting our signals crossed. I did reply yesterday and thanked you for your apology, but I must of forgot to submit my post and anyway, I said I had to leave babble to go to a baseball game. So please don't assume that if I don't respond righ away, I am being "full of myself". Please give me a little more respect. I don't ever want to come across like that. I have said in prior post, that I agree there are many people out there that are that are treatment resistant, which I assume you are from you above post in your above post. I TRUELY sympathize with you and all the others who are going through this.
Polarbear
Posted by MaddieB on May 11, 2007, at 11:14:12
In reply to Re: NIMH on Bipolar Spectrum Disorder--YES » MaddieB, posted by polarbear206 on May 11, 2007, at 10:38:46
OMG...YES Signals Crossed!!!
You message came across RIGHT after I hit the send button. Thank you for your reply. Again, I am sorry. Mea Culpa. Would be happy to give you details of my history. Is this the right forum?
Don't want to bore anyone as I believe by now I'm "off message" on this thread. Please advise.
Maddie
Posted by polarbear206 on May 11, 2007, at 11:20:10
In reply to Re: NIMH on Bipolar Spectrum Disorder » polarbear206, posted by linkadge on May 10, 2007, at 16:54:05
> >The average person will not get a proper diagnosis for about 10 years
>
> I don't know how those types of statistics are arrived at.
>
> I just see it as the latest trend. Its a trend to try and compensate for both the lack of efficacy and outpourings of adverse reactions to antidepressants.
>
> Back in the day, bipolar meant *BIPOLAR*. Now we've got all this inbetween fluff, where everybody and their monkey's uncle can fit into the bipolar diagnosis. It all fits nicely with a trend towards the latest trendy meds abilify, seroquel, lamictal etc.
>
> Symptoms that *used* to fit under the umbrella of depression (irritability, anxiety, racing mind) are being thrown into bipolar now, just for the sake of it. (or because current antidepressants often exasperate things like agitation etc.)
>
>
> Linkadge
>
>
>Link,
If you do a search at pub/med on Akiskal, there is an abundant amount of literature about past time spans with undiagnosed bipolar disorders. There are also books written by highly respected psychiatrist in the field who recognize this occurs. Akiskal and others have been doing research on broading the boundaries of bipolar disorders for years, and finally the word is getting out there. I'm not arguing with you that there isn't any validity in what you are saying. For many people, drugs just don't work, and they shouldn't be lumped into the bipolar mix. Hopefully you an others will benefit from future drugs to come, which is not soon enough.
Polarbear
Posted by polarbear206 on May 11, 2007, at 11:27:07
In reply to Re: NIMH on Bipolar Spectrum Disorder--YES, posted by MaddieB on May 11, 2007, at 11:14:12
> OMG...YES Signals Crossed!!!
> You message came across RIGHT after I hit the send button. Thank you for your reply. Again, I am sorry. Mea Culpa. Would be happy to give you details of my history. Is this the right forum?
> Don't want to bore anyone as I believe by now I'm "off message" on this thread. Please advise.
> Maddie
>Maddie,
You can babble mail me. If your not signed up, there are instructions to do so. I will get back to you sometime today if you do so. I will be off for now, I need to study for an exam.
Cheers,
Polarbear
Posted by linkadge on May 11, 2007, at 11:30:26
In reply to Re: NIMH on Bipolar Spectrum Disorder--YES » MaddieB, posted by polarbear206 on May 11, 2007, at 10:38:46
I contend that the meds predict the diagnosis more than the diagnosis predicts the meds.
When a medication works, it is easy to think that one has the disease that it treats.
I have some questions though:
If coffee makes you anxious, does that mean you have an anxiety disorder?
If l-dopa gives you hallucinations, do you have psychosis?
If stimulants keep you up at night, are you an insomniac?
Of course not, because these are documented and established drug *side effects*
What bothers me about all of this bipolar spectrum stuff, is that it is a response to a lot of the *side effects* of psychiatric medications.
Many of the people who are being diagnosed as bipolar *do not normally have significant mood swings* prior to taking medications.Dr. Manjii, a very highly respected cellular biologist who is currently working for the NIMH,
on cellular targets for mood stabilizers said this (in response to the question of wheather antidepressants can make normal people manic)"it seems that given the right conditions, just about anybody can have a manic episode".
You're taking a group of people. You're feeding them powerful drugs, which can do all sorts of strange things include inducing manic episodes. And then you're telling them they have a more significant illness requiring harsher medications which pose significantly more long term risk.
That is what I call the garden path.
IMO, nobody, without a clear cut history of significant non-drug induced life impairing mood swings should have to endure mood stabilizer therapy.
Linkadge
Posted by Johann on May 11, 2007, at 11:35:15
In reply to Re: NIMH on Bipolar Spectrum Disorder » linkadge, posted by polarbear206 on May 11, 2007, at 11:20:10
> If you do a search at pub/med on Akiskal, there is an abundant amount of literature about past time spans with undiagnosed bipolar disorders. There are also books written by highly respected psychiatrist in the field who recognize this occurs. Akiskal and others have been doing research on broading the boundaries of bipolar disorders for years, and finally the word is getting out there. I'm not arguing with you that there isn't any validity in what you are saying. For many people, drugs just don't work, and they shouldn't be lumped into the bipolar mix. Hopefully you an others will benefit from future drugs to come, which is not soon enough.
>
> Polarbear
>
>
Posted by Johann on May 11, 2007, at 12:35:37
In reply to Re: NIMH on Bipolar Spectrum Disorder--YES, posted by linkadge on May 11, 2007, at 11:30:26
> Many of the people who are being diagnosed as bipolar *do not normally have significant mood swings* prior to taking medications.
The Spectrum Disorder doesn't require mood swings other than going from depression to what can be called euthymic, or particularly enthusiastic, states: "Bipolar without the mania."
> IMO, nobody, without a clear cut history of significant non-drug induced life impairing mood swings should have to endure mood stabilizer therapy.>I haven't found mood stabilizers (lithium and Lamictal) to be onerous; bothersome yes, but worth it, and no more than many ADs.
Posted by linkadge on May 11, 2007, at 13:29:59
In reply to Re: NIMH on Bipolar Spectrum Disorder » linkadge, posted by polarbear206 on May 11, 2007, at 11:20:10
>If you do a search at pub/med on Akiskal, there >is an abundant amount of literature about past >time spans with undiagnosed bipolar disorders.
All of this is in the stage of theory. There are obviously a number of controversies in the field. For instance there is a *strong* devide on the issue of wheather or not antidepressants can induce mania in non-bipolar individuals. Things like this are going to remain contoversial for a while. I don't see any large scale reformations of the DSM happening over night.
>There are also books written by highly respected >psychiatrist in the field who recognize this >occurs.
There are books written by people who have this particular oppinion. There simply is insufficiant data to conclude things like, "bipolar is vasly underdiagnosed". Sure you can conclude this based on certain samples, and certain populations, but there is no guarentee that this extends to the general population.
>Akiskal and others have been doing research on >broading the boundaries of bipolar disorders for >years, and finally the word is getting out >there.What good will it do? You honestly think that more people are going to get well on mood stabilizers? You're going to get more diabetes, more burnt out thyroids, more liver dammage, more zombies, more sapped creativity. A large portion of bipolar individuals are disabled. More bipolar diagnoses, means more impairing drugs. I know a number of people who find their previous jobs to be too difficult under the weight of theraputic doses of lithium etc. There are even authors who suspect that the high rate of disability within the bipolar population is *because* of the treatments, and not inspite of the treatments.
I'm sorry. I just don't really see the bipolar diagnosis as helping people who are only mildly bipolar, or "soft" bipolar (whatever that is).What are you going to take for *soft* bipolar? Soft lithium? Soft zyprexa?
Linakdge
Posted by linkadge on May 11, 2007, at 13:40:09
In reply to Re: NIMH on Bipolar Spectrum Disorder--YES, posted by Johann on May 11, 2007, at 12:35:37
>The Spectrum Disorder doesn't require mood >swings other than going from depression to what >can be called euthymic, or particularly >enthusiastic, states: "Bipolar without the >mania."
But what does that mean? You have a person who is periodically depressed? What depressive doesn't have better days and worse days? Many diseases follow patterns of changes in sevarity. Parkinsons disease, for instance, has periods of reduced symtpoms. MS is another example. It has periods of remission followed by periods of periods of normalacy. I really don't see how depression is any different. So now you have to be ill *all the time* in order to have depression? Nobody would say, oh you were feeling better last summer therefore you don't have MS. Lithium, (and more so depakote) have very limited antidepressant potential. We're finding out that the antidepressant effect of lamotrigine has also been greatly hyped. I really don't see why an individual whos depression periodically remits needs to endure heavy meds like lithium. Both are better antimanic agents than antidepressants. Depression is a documented side effect of treatment with depakote or tegretol in epilepsy.
My mother will shortly need dialysis because of kidney damamge from lithium. These aren't walk in the park drugs.
>I haven't found mood stabilizers (lithium and >Lamictal) to be onerous; bothersome yes, but >worth it, and no more than many ADs.Count yourself lucky. Not everyone can tollerate the side effects from lithium. My grades dopped from an A- to a D in the semester that I was on a theraputic lithium dose. They went back up after I stopped. It took me twice as long to do simple tasks.
Linkadge
Posted by Johann on May 11, 2007, at 13:59:47
In reply to Re: NIMH on Bipolar Spectrum Disorder--YES, posted by linkadge on May 11, 2007, at 13:40:09
So how would you classify people whose chronic depression (and minor mood swings) is only effectively treated with mood stabilizers (after trying many ADs over many years)?
Posted by MaddieB on May 11, 2007, at 14:33:21
In reply to Re: NIMH on Bipolar Spectrum Disorder--YES, posted by linkadge on May 11, 2007, at 13:40:09
Thanks Link. These are legitimate questions that I am seeking answers to as well. I was on many AD's and I have suffered greatly (and have chronic problems)as a result. I am lucky that my pdoc is not pushing for more mood stabs. On a tiny dose of lithium I had a severe reaction. On Depakote, I slept all the time. I was asleep more than I was awake. I am overjoyed that some people are getting help that were misdiagnosed but I do wonder how many 'misdiagnosed' bipolar cases were created by the cycling that AD can cause. There is a very nice discourse in a book by Jim Phelps on this. He's definitely on the 'spectrum' side but he has been brave enough to pose this very question.
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