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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 48. This is the beginning of the thread.
Posted by ttee on May 9, 2007, at 16:52:24
The following article is from a NIMH source and not the bipolar med drug companies. Do you think there is any truth in this?
Bipolar Illness Widely Underdiagnosed
Study Shows More Than 4% of U.S. Adults Affected
By Salynn Boyles
WebMD Medical NewsReviewed by Louise Chang, MD
May 7, 2007 -- There appear to be almost twice as many Americans with bipolar disorder as previously thought, and many are not getting the treatments they need, researchers from the National Institute of Mental Health report.
Once thought of as a single mental illness, bipolar disorder is increasingly recognized as a spectrum disorder, with symptoms ranging from less severe to devastating.
The NIMH researchers found that people with the mildest form of the condition, often referred to as sub-threshold bipolar disorder, generally sought treatment for other mental health conditions such as depression or substance abuse.
NIMH senior investigator Kathleen R. Merikangas, PhD, says a large percentage of people diagnosed with major depression may actually have this form of bipolar disorder.
"Misdiagnosis is particularly troubling because the drugs used to treat depression can actually trigger bipolar symptoms," she tells WebMD.
What Is Bipolar Disorder?
There are two main types of bipolar disorder (once known as manic depression): bipolar disorder I and bipolar disorder II. Symptoms include dramatic moods swings between euphoria and severe depression; patients may have hallucinations or delusions.
Patients with bipolar I have the most severe symptoms; bipolar II patients have more moderate symptoms.
Study researchers say health professionals should recognize a third and milder category --sub-threshold bipolar disorder.
In 2006, the NIMH estimated that 2.6% of the U.S. population, or roughly 5.7 million American adults, suffered from bipolar disorder in any given year.
By including patients who met the diagnostic criteria for sub-threshold bipolar disorder in their latest analysis, Merikangas and NIMH colleagues concluded that about 4.4% of U.S. adults have some degree of bipolar illness during some point in their lives.
The researchers evaluated data from a nationwide mental disorders survey conducted between February 2001 and April 2003, involving 9,282 adults living in the U.S.
The lifetime incidence of bipolar I and bipolar II was roughly 1% each in the surveyed population and 2.4% for sub-threshold bipolar disorder.
"The [findings] reinforce the argument of other researchers that clinically significant sub-threshold bipolar disorder is at least as common as threshold bipolar disorder," Merikangas and colleagues wrote in the May issue of Archives of General Psychiatry.
Targeting Treatment
Most people who met the clinical definition of sub-threshold bipolar disorder (70%) were already receiving treatment when surveyed. Many were taking antidepressants, according to Merikangas.
Depression, substance abuse, and anxiety disorder are all conditions commonly seen in bipolar disorder patients, complicating the diagnosis of less severe bipolar illness.
As a result, mood-stabilizing drugs such as lithium, which are most effective for treating bipolar illness, are widely underprescribed while antidepressants are being prescribed far too often, Merikangas says.
The researchers conclude that clinicians who treat patients for depression, anxiety, or substance abuse must develop a higher suspicion of bipolar disorder.
"Bipolar disorder can manifest itself in several different ways. But regardless of type, the illness takes a huge toll," NIMH Director Thomas R. Insel, MD, says in a news release.
"The survey's findings reiterate the need for a more refined understanding of bipolar symptoms so we can better target treatment."
SOURCES: Merikangas, K.R. Archives of General Psychiatry, May 2007; vol 64: pp. 543-552. Kathleen R. Merikangas, PhD, senior investigator, intramural research program, National Institute of Mental Health, Bethesda, Md. Thomas R. Insel, MD, director, National Institute of Mental Health. "The Numbers Count: Mental Disorders in America," National Institute of Mental Health, 2006.
© 2007 WebMD, Inc. All rights reserved.
©2005-2007 WebMD, Inc. All rights reserved.
WebMD does not provide medical advice, diagnosis or treatment
Posted by Phillipa on May 9, 2007, at 22:01:28
In reply to NIMH on Bipolar Spectrum Disorder, posted by ttee on May 9, 2007, at 16:52:24
May not sound nice but I wonder if it's because ad's don't help that many people they are creating the new subtypes to put the responsibility on the patient? Could this be so? Love Phillipa
Posted by linkadge on May 10, 2007, at 6:38:57
In reply to NIMH on Bipolar Spectrum Disorder, posted by ttee on May 9, 2007, at 16:52:24
I always found it amusing how people like this were so gung ho to diagnosis bipolar, without accounting for the poor likelyhood that patients are going to want to take such toxic meds.
I mean there is no way 4% of the population is going to down some of the toxic meds that are currently used. It is hard enough to get those who really need the meds to take them dispite these subthreshold persons.
Nobody likes antipsychotics, and lithium/valproate are toxic.
Why don't they spend all the money that they are wasting by pushing the diagnosis to develop safer more effective meds?
Just my 2 cents
Linkadge
Posted by MaddieB on May 10, 2007, at 8:04:25
In reply to NIMH on Bipolar Spectrum Disorder, posted by ttee on May 9, 2007, at 16:52:24
No word also regarding the fact that some anti-depressant meds push people into cycling patterns. The current assumption is that they had underlying cases of BPD. Nice (and convenient hypothesis) but I would not be so quick to draw that
conclusion. Why does no one draw the conclusion that psycho-active medications are just not good for some people. Time and again cognitive therapy is demonstrated to be effective. It's just harder to keep up with. Lithium for sub-threshhold BPD???Please.
I agree with Phillipa and Link
Posted by linkadge on May 10, 2007, at 10:32:16
In reply to Re: EMSAM vs. Manerix )) Maddie B » ttee, posted by MaddieB on May 10, 2007, at 8:04:25
>No word also regarding the fact that some anti->depressant meds push people into cycling >patterns. The current assumption is that they >had underlying cases of BPD. Nice (and >convenient hypothesis) but I would not be so >quick to draw that conclusion.
Exactly. The problem is that people like the NIMH feel they have to accept and promote the efficacy of medications wheather or not they work or are safe.
For an organization like this to say, yeah these medications are making some people sicker, would be to significantly compromise their integrity. So they sweep it all under the carpet.
Some of the earliest investigators of the tricyclic antidepressants noted similarities to the amphetamines. If there was no connection between antidepressant use, and manic reactions, there wouldn't be millions of dollers poured into the research of animal models of antidepressant induced mania.
It is a big deal, as some peoples lives can be permanantly altered by such diagnosis.
Linkadge
Posted by polarbear206 on May 10, 2007, at 14:36:44
In reply to NIMH on Bipolar Spectrum Disorder, posted by ttee on May 9, 2007, at 16:52:24
Sorry, but I totally agree with NIMH on this topic. I'm in the psychiatric field and what I see is a HIGH percentage of undiagnosed bipolar disorders. The average person will not get a proper diagnosis for about 10 years. It's very sad this has to happen.
Polarbear
Posted by MaddieB on May 10, 2007, at 14:48:51
In reply to Re: NIMH on Bipolar Spectrum Disorder, posted by polarbear206 on May 10, 2007, at 14:36:44
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.)
Perhaps if the psych community didn't just a) imagine that people fit into neat diagnostic categories (Ah Yes...a "Spectrum" Disorder...Who Knew!!) and b) dive headlong into the AD/SSRI pool within 20 minutes of meeting a person, this 10 year lag you speak of would not happen. What is sad it the NIMH is just figuring this out. I'm not impressed.
> Sorry, but I totally agree with NIMH on this topic. I'm in the psychiatric field and what I see is a HIGH percentage of undiagnosed bipolar disorders. The average person will not get a proper diagnosis for about 10 years. It's very sad this has to happen.
>
> Polarbear
Posted by polarbear206 on May 10, 2007, at 15:12:26
In reply to Re: EMSAM vs. Manerix )) Maddie B » ttee, posted by MaddieB on May 10, 2007, at 8:04:25
i> No word also regarding the fact that some anti-depressant meds push people into cycling patterns. The current assumption is that they had underlying cases of BPD. Nice (and convenient hypothesis) but I would not be so quick to draw that
> conclusion. Why does no one draw the conclusion that psycho-active medications are just not good for some people. Time and again cognitive therapy is demonstrated to be effective. It's just harder to keep up with. Lithium for sub-threshhold BPD???Please.
> I agree with Phillipa and Link
How can you assume that that this is a convenient hypothesis, when the evidence of studies done on this topic is profound to support their theory. If you do some research at scholarly sites, you can locate studies done in this area. I would also like to see studies where cognitive therapy is more effective ALONE than medications. I believe that congnitive therapy is an important part of therapy in conjunction with medication. I have been researching this topic for 15 years, and the proof is out there, so lets just agree to disagree on this.Polarbear
Posted by polarbear206 on May 10, 2007, at 15:37:37
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.)
>
> Perhaps if the psych community didn't just a) imagine that people fit into neat diagnostic categories (Ah Yes...a "Spectrum" Disorder...Who Knew!!) and b) dive headlong into the AD/SSRI pool within 20 minutes of meeting a person, this 10 year lag you speak of would not happen. What is sad it the NIMH is just figuring this out. I'm not impressed.
>
> > Sorry, but I totally agree with NIMH on this topic. I'm in the psychiatric field and what I see is a HIGH percentage of undiagnosed bipolar disorders. The average person will not get a proper diagnosis for about 10 years. It's very sad this has to happen.
> >
> > Polarbear
>
>
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.
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
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