Psycho-Babble Medication Thread 269101

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how can you tell when your psych is over involved?

Posted by waterfall on October 13, 2003, at 19:07:03

Hi,
I have been with the same psychiatrist for 9 years. She admitted me to the hospital and diagnosed me bi-polar in under 5 minutes without looking at me. I was extremly depressed and had spent a couple of thousand dollars on credit. 12 admits, a dozen different drug combinations and 4 years later I was able to move on with my life. Now, I am happy, have a good marriage, a good job, a new car, yadda, yadda. Early this summer I decided I'd had enough of the drugs (Depakote, Wellbutrin, Remeron and Provigil) - I simply didn't think I needed them anymore. Perhaps I'll be back on something for another swing through hell's door at a different period in my life, but I've been stable and well for 3 years and I knew now was the time. I had come to the conclusion that to ever get away from my emotional dependence on this doctor I was going to have to leave the state. I mean that. When I told her what I wanted to do it was extremely difficult and she is still stalling me. Well, I'm off the Wellbutrin and Remeron and Provigil and feeling fine. Now, we're just left to battling it out over the Depakote. But we're really battling. She's not used to having her authority questioned, particularly by me, and the "I'm going to be making my own medical decisions now" line was NOT greeted with enthusiasm. Of course, she just says she thinks I'm bi-polar and is worried about me. How can you tell when your psych is simply over-involved and making bad decisions?

Thanks to anyone who has experience with this who might reply.

Waterfall

 

Re: how can you tell when your psych is over involved? » waterfall

Posted by David Smith on October 13, 2003, at 21:41:03

In reply to how can you tell when your psych is over involved?, posted by waterfall on October 13, 2003, at 19:07:03

"But we're really battling. She's not used to having her authority questioned, particularly by me, and the "I'm going to be making my own medical decisions now" line was NOT greeted with enthusiasm. Of course, she just says she thinks I'm bi-polar and is worried about me. How can you tell when your psych is simply over-involved and making bad decisions?"

I would gather other unbiased opinions to make such a determination. They might include your medical doctor, marriage partner, close friends and other family members.

Perhaps you might have someone intercede on your behalf? It could be a transition professional, such as a therapist. You may not need the drugs anymore (and boy am I happy for you!), but it might be a good idea to have someone else to fall back on.

IF you really are bi-polar then maintenance is crucial. Exercise, nutrition and emotional support must be securely in place before "flying solo."

Congratulations on achieving what many "normal" people have yet to attain.

May I ask why you wish to discontinue the Depakote?
(as if I could not hazard a guess)

dave

 

Re: how can you tell when your psych is over involved?

Posted by stjames on October 14, 2003, at 10:13:07

In reply to how can you tell when your psych is over involved?, posted by waterfall on October 13, 2003, at 19:07:03

Bipolar is a progressive disease that does not get better without traetment every day. The cycles tend the get worse to more of them you have. I think this is a issue about your health and not about your psych.

 

Re: how can you tell when your psych is over involved?

Posted by ratgrrl on October 14, 2003, at 16:54:39

In reply to Re: how can you tell when your psych is over involved?, posted by stjames on October 14, 2003, at 10:13:07

The theory to which stjames refers (that "the cycles get worse the more of them you have") is called the "kindling hypothesis" in the medical literature. I am by no means a dr or a professional but I am doing grad work in a scientific field and know my way around a medical library. In a recent paper on the APA treatment guidelines it was stated that the "kindling hypothesis" is debated, rather than an established fact. Some scientists were presenting evidence, not that bipolar goes away, but that it may not get progressively worse. I'll dig up my references at home tonight and post citations tomorrow.

Despite the fact that the "kindling hypothesis" may be debated, there does seem to be consensus that bipolar is chronic (and thus is most likely to require long term/permanent treatment)

With regard to the original Dr. situation posted by waterfall, keep in mind that it is very easy to go on meds and very hard to go off of them. Thus this isn't necessarily an unexpected conflict. Not knowing your original symptoms and not knowing your dr's point of view it is impossible for me to say whether I personally think it's a good idea or not to go off depakote. However, I think that if you really do decide to do it, try very very hard not to burn the bridge with your doctor. There is a not so small chance that you will run into trouble, either from withdrawal or an unmasking of symptoms that were treated by the depakote. You don't want to be caught high and dry without a doctor when you really need one. Perhaps you could suggest a VERY slow taper (over many many months) so that your doctor could be part of evaluating your functioning every step of the way. This way you will also lessen the risk of relapsing due to going off of the drug quickly.

Just my 2 (or 3 or 4...) cents. Good luck.

ratgrrl

 

references

Posted by ratgrrl on October 15, 2003, at 9:42:46

In reply to Re: how can you tell when your psych is over involved?, posted by ratgrrl on October 14, 2003, at 16:54:39

Here are the references re: the "kindling hypothesis" as promised

The article that I read in full is by Mark Hyman Rapaport, MD and Deborah J. Hales, M.D. and is called
"Relapse Prevention and Bipolar Disorder: a focus on Bipolar Depression" from the Journal FOCUS: the jounal of lifelong learning in psychiatry, in the Winter 2003, Vol 1, No. 1 issue, pages 15-31

I will quote the paragraphs that discuss the "kindling hypothesis"

Post et al. proposed that bipolar disorder may be subject to a kindling-like phenomenon (9). The kindling hypothesis postulates that the course of biplar disorder generally shows increasingly shorter periods of remission between episodes of illness, with later episodes more independent of environmental precipitation. This model postulates that patients become sensitized to very minor stressors, with play an increasing role in precipitating the onset of new episodes. For example, subsyndromal symptoms will increase the risk of disease recurrence (10). Post and colleagues suggested that treatment with mood stabilizers may favorably affect the course of the bipolar disorder by reducing the kindling phenomena.

However, not all studies are supportive of the kindling hypothesis; a 10-year naturalistic follow-up study by Winokur et al. found that some patients, even patients with rapid cycling, experienced less frequent mood episodes over time (11). A recent analysis of the longitudinal bipolar data set from Western Psychiatric Institute and Clinic did non show that sensitization occurred as the number of episodes increased, nor do these data support the observation that the interepisode time decreased significantly in patients with bipolar disorder (12). Although these studies do not support the kindling hypothesis, authors agree with the assertion that continuation of treatment is reasonable for most patients with bipolar disorder."

So what was all that mumbo jumbo? It was just saying that despite what most doctors (at least most of my doctors) present as fact: that if left untreated bipolar gets worse and worse and thus if you ever go off treatment, you will be worse than you were before, and might become untreatable, there is definitely not consensus on this fact. Note however, that even the people who don't support the kindling hypotheis, do support treatment with mood stabilizers. They are not saying the disease cures itself with time, they are only saying it may not get worse.

The numbers in the paragraphs referred to the actual studies discussed. They are as follows:

(9) Post RM, Rubinow DR, Ballenger JC; Conditioning, sensitizationand kindling: implications for the course of affective illness, in Neurobiology of Mood Disorders. Edited by Post RM, Ballenger JC, Baltimore, Williams and Wilkins, 1984; 56:5-13
(10) Solomon DA, Keitner GI, Miller IW, Shea MT, Keller MD; Course of illness and maintenance treatments for patients with bipolar disorder. J Clin Psychiatry 1995; 56:5-13
(11) Winokur G, coryell W, Akiskal HS, Endicott J, Keller M, Mueller T; Manic-depressive (bipolar) disorder: the course in light of a prospective ten-year follow-up of 131 patients. Acta Psychiatr Scand 1994: 89:102-110
(12) Hlastala SA, Frank E, Kowalski J, Sherrill JT, Tu XM, anderson B, Kupfer DJ; Stressful life events, bipolar disorder, and the "kindling model" J Abnorm Psychology 2000; 109:777-786

If anyone needs help deciphering the references, let me know.

--ratgrrl

 

Re: references

Posted by waterfall on October 15, 2003, at 18:37:48

In reply to references, posted by ratgrrl on October 15, 2003, at 9:42:46

Thanks so much for your references, I really appreciate it. I have been suspicious of my diagnosis for a long time. The depression part was blatantly obvious, but as for the manic part, I think I was diagnosed in haste by someone unwilling to revisit the situation. I spoke with my family doctor and the minister (and former counselor) who married me and my husband before I decided to go through with reducing the medication. I've taken it slow and am off of 3 of the 4 drugs reducing over a period of about 7 months. The Depakote is hardest for my shrink to agree to and I am being careful not to burn my bridges. But she's so controlling that she makes working with her as opposed to serving under her difficult. She said I was one of the most compliant patients she ever treated before this spring. Oh well. I fully accept that I may have recurring bouts of depression throughout my life, but I don't want to continue on maintenance drugs I don't think i need.

Thanks again for your info, I relaly appreciate the time you took.


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