But there are some other qualities. They take up too much space. When you’re in the room with a Manic person, that’s all there is. When I ran the emergency room at our City/County hospital, the major source of our Manic patients was the airport. For one thing, Manic people are on the move. But once on the plane, they become loud, boisterous, disruptive, walk the aisles. Many times, planes added a stop in Atlanta to off-load such people, or turned around to bring them back.
Another example of their space occupying problems has to do with jails and civil commitment. In order to involuntarily confine a mental patient, there are two criteria – mental illness and dangerousness. You can’t deprive a person of their civil rights just for being mentally ill. They have to be imminently dangerous to self or others. With Manic patients, the first criteria is easy, but the second is much less clear. After a few years it gets easier because you’ve allowed Manic people to leave only to have them returned having been beaten to a pulp because they’ve wandered into a bar and agitated the wrong kind of people. New psychiatry residents don’t have a feel for that, so they send them back to jail where they’ve been incarcerated for causing disturbances. And if you’re in charge of the emergency room, you get a call at home from an experienced jailer who says, "you’ve got a new resident on call tonight, right?" And then you’re in a department store and run into that patient you saw in a full manic splendor last year, and they say, "Hi doc," exchange a few niceties, and go on with their shopping – and you get it about periodicity.
With the coming of the DSM-III and its progeny, a whole lot more patients fell into the pot – "rapid cyclers," depressive people, bipolar II. A lot of the new arrivals didn’t have periodicity. They were always disturbed or frequently disturbed. I never totally bought their inclusion. They didn’t seem to fit clinically, didn’t have they same response to treatment, and I never ran into them in the store normal. I assumed they had something else, though I wouldn’t know how to describe them as a group. All I know is that they didn’t fit.
What I’m getting at is Biederman’s comment, "…who can be explosively angry, irritable, frantically active, suicidal, or even homicidal." An adult with these symptoms would very likely be diagnosed with bipolar disorder…" Not by me. Manic people can be "explosively angry, irritable, frantically active" if you challenge their grandiosity or try to stop them, but that’s not their nascent state. So I’m wondering if Biederman is following the over-inclusive lead of the adult psychiatrists who came before him that [in my opinion] were way too loose with this diagnosis since being Spitzer-ized [Wash-U-ized] with the DSM-III. There is a classic Manic Depressive Illness. Then there’s a new extra-crispy bipolar disorder that’s only about thirty years old. I’m not impressed that expanding the diagnostic net for the adults has been much more successful than it has been with the kids.
–adj
of unknown cause, as a disease.
This is intriguing. When you saw these irritable squared folks back when they weren’t included in the bipolar labels, how were they treated and what was thought to be a factor? How did they respond to treatment?
If this population sort of “appeared” about 30 years ago, that would correlate with big national food and nutrition trends, such as the rise of fast food outlets/increased # fast food meals, higher subsidies to corn, soy, wheat, and oats, and the introduction and explosive use of high fructose corn oil.
Just out of curiosity, were therapeutic diets ever employed? Thinking along the lines of light ketogenic, whole foods, high protein types of diets.
The metabolic, immune and nutrition literature is showing positive effects on inflammation and immune responses with these types of diets on neuropsych and neurodegenerative disorders, so it might be time to take a closer look….
Oops – meant to say high fructose corn syrup and industrial seed oils.
The increased medicating of behaviors of all sorts has increased the chances of never knowing what’s wrong with the kids in the first place (environment, allergies, organic reasons, etc) because the drugs have their own side effects and some are behavior side effects and psychiatric side effects that most doctors refuse to acknowledge (pills being the reason for recent behaviors) therefore there is no longer a true baseline of a med-free child for any doctor for that child in the future.
Until the mass marketing of drugs (like Saphris!) stops in kids, the kids will be lost to the bipolar child medication based treatment paradigm forever.
Biederman has a place in the discussion due to the fact he was behind this explosion, but yes he is now a rent-check at Harvard with a desk and plenty of ppl he has influenced along the way continuing his regime, and Janet Wozniak is one of them.
Schools also play a big part in the pressure to medicate kids, I’ve worked in the school system over a decade and overheard many a discussion where teachers dx kids ADHD and break protocol and tell the parents their kid needs ‘help’. Once the child has meds and a label, the school then pressures the parent when the child acts up, that’s an entire story in itself. Many facets to the medicating of children in America, it’s a mess and it won’t stop with things in place such as teen screen, NAMI promoted (NAMI 75%funding from pharma)programs, CABF pushing their agenda (Biederman’s) and entrenched doctors such as Koplewicz
http://investing.businessweek.com/businessweek/research/stocks/people/person.asp?personId=29428126&ticker=DCTH:US&previousCapId=264691&previousTitle=CORTEX%20PHARMACEUTICALS%20INC
He’s prominently featured in the NTY often for his ‘expert’ opinion on ADHD, he’s a high end Park Ave doc… plenty of ppl fueling the Pharma Medicate the Kids paradigm in America!
Now here is Harold Koplewicz again
http://www.biosign.com/company.htm
Director of Biosign Company, along with ex Senator Alfonse D’Amato
Suppose the biomarker discussion on where the KOLs end up re-creating designer dx’s using the same old meds to treat the kids is up again?
The KOLs w big bucks are great at reinventing themselves and increasing paychecks, one thing noted with all this talk lately is how Nemeroff and Biederman and ones like Koplewicz never want for income! no matter what sordid past….
I would debate the FDA is just doing it’s job; in fact they are just as corrupted and manipulated by corporate pharmaceutical influence as any other entity. The whole fast track system and deregulation of the 70’s under the Reagan administration basically sold the FDA (and public safety) to the pharmaceutical industry.
As far as the bipolar child; they approved the drugs first to validate a new non-disease…as complex as all this is to unravel and dissect; it’s really comes down to simply money, egos, power, and greed at every level from government to advocacy groups…they are all getting well compensated to keep the lie alive & going forward….
The diagnostic criteria or the “science” (if you even wish to call it that) is just a side note to be kept muddled in the grey until the “obvious” becomes too public & evidenced to ignore in the horrible toll of human carnage it has left behind….
I started medical school in 1963, the year after the Kefaufer Hatch amendment. Prior to that, the only requirement was safety. Kefaufer’s ammendment added efficacy, and something else important, requiring the listing of side effects. I recall a lecture in a second year pharmacology course on the amendment, seen at the time as a dramatic change. It followed the Thalidomide tragedy.
I don’t recall when “approved for” became important. I never really heard the term until the more recent [25 years] use in the drug ads. “Drug X has been approved for Disease Y.” It effects what the drug can be advertised for by the manufacturer. I’m not aware that practitioners think much about what the FDA says, but instead rely on the medical literature. That’s why I, for one, am so up in arms about the pharmaceutical invasion of our journals. They’ve contaminated hallowed ground, and so one has to find one’s own way, usually by waiting until general usage provides a usable answer. I almost never prescribe “new drugs” and rant uncontrollably when a patient asks about a drug they’ve seen on television ads or news.
So I wasn’t defending the FDA. I was chiding Dr. Biederman for using FDA approval to bolster his argument. It does and should take a lot more than FDA approval to say that a drug is safe and effective. That used to be the job of drug trials done by academic centers, but they’re now so contaminated by industry financing that they’re routinely suspect [except in the rarefied situation of a non-PHARMA financed trial by a reputable investigator]. For that reason, some of us rarely if ever prescribe drugs that are “in patent.” I wrote my first Zyprexa prescription ever several weeks ago – a 19 y/o suicidal schizophrenic boy who is very skinny and had failed attempts at treatment with first generation neuroleptics and Risperdal – now refusing to take them. I worry about him every day, but so far, he’s alive, is becoming less disturbed, and hasn’t gained weight.
I don’t see the FDA as a problem because I never counted on the FDA in the first place. I see the loss of a trustworthy medical literature, however, as a national tragedy…
“There is a classic Manic Depressive Illness. Then there’s a new extra-crispy bipolar disorder that’s only about thirty years old. I’m not impressed”
I’m not impressed with your use of the derisive term “extra crispy”
Mickey is right. The FDA was chartered by Congress to regulate the commercial behavior and claims of drug companies. It was not originally intended to regulate the practice of medicine – that is the responsibility of State Medical Boards. The risk now is that the corruption of medicine and of the medical literature by commercial conflict of interest will lead to federal government intrusion into the practice of medicine. That would be yet another proof of the adage that if we do not regulate ourselves then government will do it for us.
RH
… or with anything else that comes from me, I might add.
“RH
… or with anything else that comes from me, I might add.”
I do disagree with a lot that you said this week because my perspective and experiences are different from yours on the subject of early-onset bipolar. But I thought I had expressed myself in a respectful manner, as befitting a visitor to your blog.
Whoa, I am wondering, are my current problems REALLY due to bipolar disorder? I had classic bipolar I when I was in my 20’s and 30’s, but sometime in my late 30’s I haven’t had mania. Instead, I am depressed all the time without relief, cycling between severe and moderate depression, the pattern tracking the seasons closely. Treatment doesn’t work (helped by MANY doctors).. Because I am sick ALL the time now, for several years, does this mean it is likely there is something ELSE besides bipolar causing the problem? I have pretty much bought into Robert Whitaker’s argument, that the meds themselves made me chronically depressed. I really did used to cycle in the classic way when I was younger.
Perhaps what happened to me is a known course of bipolar, and I took the example too literally. I should really look for a psychiatrist who is retirement age and can take the long view.
Pat,
I don’t know about antidepressants, but I have a friend with schizophrenia and in retrospective it was exactly like Robert Whitaker’s analyzed it. Before I read Anatomy of an Epidemic, I had already the feeling that something is not right with her treatment and that the meds are helping her less and less. Whenever she had a psychotic episode and went to the clinic they tried some new meds. Like the treatment guides Mickey posted on this blog. Combine everything with everything and up the dosage until it works, but there was no improvement in the last years, only more and more side effects.
Are you still taking meds and have you thought about going off meds? I’m just asking out of interest, I’m no doctor and don’t want to suggest any advice regarding meds.
What possibly helps against depression: aerobic exercise, mindfulness meditation, yoga, friends who are warm and emphatic. I have the feeling that dual n-back training could help too.
I did go off meds about a year ago and several months later (several months) the agitation from hell went away. In hindsight, it looks like I had akathisia for many years. My behavior also improved – I was kicking holes in the walls, picking fights (arguments, not hitting) etc and in the hospital every year. I think the meds were either disinhibiting me like alcohol does, or else they were causing cognitive problems and so I couldn’t control my behavior when I was overwhelmed. I eat a good diet and exercise and have lots of coping skills, but nonetheless, the depression will not go away anymore.
It did take about 6 months for the differences in my behavior to become obvious (that agitation went away after much more quickly though). I dunno if that is drug withdrawal, or me having to learn to control my behavior again, now that it was possible. I think maybe both – I don’t rise to rage hardly ever now.
I don’t know what to say about your friend – serious mental illnesses are such a life and death matter, and involuntary commitment is a risk and who wants to be put in an FBI database when they never harmed a fly? A person also needs to be able to assert themselves with the doctor. A lot of people with mental problems seem to have learned helplessness, due to the system being so coercive, and they have trouble even telling the doc that the meds don’t work or are intolerable etc. If your friend has a social worker, perhaps the social worker knows of a doc who always tries to minimize dosing, instead of over medicating all the time.
In my area, peer recovery services (not sure what it is called) have been helping people a LOT. We also have drop in centers for socializing. The non medical part of mental illnesses has been completely ignored for years, and I think a lot of the problems come from isolation.
Pat,
I should have written “I had a friend…”. She died a couple of month ago at age 30. Her heart stopped beating as a side affect of some or the cocktail of several antipsychotics.
Isolation is indeed a huge problem. She was very reluctant to go out and meet (“normal”) people. “I’ll see friends, when I’ll feel better.” It’s a vicious cycle, because you need good relationships to feel better.
I feel that antipsychotics can reduce the brain’s capability to recover or integrate psychotic experiences. Prescribing kids antipsychotics seems crazy to me (also unethical and unscientific). Maybe there are some rare cases where it makes sense, but the serious side effects of atypical antipsychotics shouldn’t be ignored.
I’ll hope your depression will get better. I guess nobody can tell you for sure if your depression is caused by the meds and how likely it is that it gets better?
Oli, I am very sorry about your friend. I agree with you that it is a vicious circle on the friends issue. I have to keep seeing a psychiatrist anyhow, so I guess as my experiment off meds keeps going, at least one psychiatrist around here will know about it.
I was never warned about ANY side effects of antipsychotics or any other med. Not ONCE. I didn’t always have internet to look this stuff up either. One time at the hospital, they gave me a printout when I asked for it, but they wouldn’t have if I hadn’t thought to ask. While I was doped up heavily on risperdal.
It really really upsets me to see those abilify and seroquel ads for depression, given how awful antipsychotics are for your health.
Your blog is really fine. I am thoroughly hooked on the Biederman mystery. I am a retired psychiatric social worker who worked in a community clinic with adults and adolescents. At one point (now maybe 15 years ago) we had a psychiatrist who thought every teenager she saw was bipolar. She put them all on lithium and other drugs. Side effects and no successful treatment. The freedom of psychiatrists even in those days to prescribe all sorts of powerful stuff to kids as well as adults with little oversight and on the basis of snap decisions made during fifteen minute monthly (at best) sessons was appalling. The corruption of the field as evidenced in industry-driven research and literature is, as someone put it, indeed tragic. No wonder people can’t see why alternative medicine isn’t just as good. What a shame, what a disaster.
Please keep up your investigative work! And your writing is very engaging.
Pat,
Since you have Whitaker’s book, you might want to take another look at pages 177-179 (“Bipolar Before Lithium”). Whitaker describes the conclusion of Winokur’s 1969 retrospective analysis of of the long term outcomes for bipolar patients thusly: there “was no basis to consider that manic depressive psychosis permanently affected those who suffered from it”. It seems that before psychiatrists began toying with “prophylactic” or “maintenance” drug “therapies”, the majority of patients fully and permanently recovered after (at most) two or three episodes.
the psychiatrist who writes this blog practiced in the age of lithium, and he states that bipolar patients recovered between episodes during the time he practiced. My former father in law took lithium for bipolar, and was able to maintain a great career and didn’t have problems between episodes. So this makes me think that maybe OTHER meds, or other problems, keep me depressed so much. Because I used to be just like my former father in law, recover completely between episodes. Maybe he mostly only got mania, though. I didn’t talk to him about it because he was a jerk and my husband didn’t get along with him either.
So anyway, if what is wrong with me NOW isn’t bipolar (or is something new in addition to bipolar) then it would be good to know that, because maybe there is something that I can do about it. I don’t have any more bipolar treatments to try anyhow, so I just gave up finally and see a therapist and my doctor just does my paperwork for me and tells me to hire a housekeeper (that sounds snotty, my docs have mostly been nice).
I liked Whitaker’s book very much, and I do think there is a lot of truth in it. Many issues that are raised, there is not enough evidence to say either way. I have nothing to lose being off the meds, anyhow, because practically the only options left are stuff like Saphris. No reason to think that would do anything good.
I think it might behoove me to find a psychiatrist near retirement, because they practiced before all this antipsychotic treatment for bipolar etc and they learned how to treat patients before the mindless checklists. I wasn’t being silly about that when i put that in one of my comments.
Pat,
Whitaker is not suggesting that lithium ( a CNS depressant) therapy prevents recovery between episodes; rather, he is affirming that it is not the prophylactic it was touted to be. A more complete analysis of the various (and poorly designed) lithium clinical trials can be found in Joanna Moncrieff’s book “The Myth of the Chemical Cure”. Moncrieff draws attention to the phenomenon of “lithium rebound” – the rapid development of mania in patients who abruptly terminate lithium therapy. Lithium rebound mania may develop in patients who have never had a full blown manic episode – hence her conclusion (and that of other psychiatrists) that lithium therapy may produce a very bad outcome in non-compliant patients. As to the question of whether lithium produces a good outcome in compliant patients, Moncrieff asserts that it is no better than a particularly toxic placebo.
It has been many months since I read Whitaker’s book. I will have to go back and re-read that. I haven’t been on lithium in a long time, so I read more about those horrible antipsychotics that gave me so much trouble. I haven’t read that other book you refer to, so I guess I have to put that on my summer reading list. It still doesn’t help me with what to do NOW. The answer to that is, nobody knows., I think. Thank you for your heads up!
Did 1 Boring Old Man read this? More info from yet another well-reimbursed psychiatrist talking about childhood bipolar disorder.http://www.cmeinstitute.com/psychs-talk/
I read this article on Psychology Today
http://www.psychologytoday.com/blog/do-the-right-thing/201106/children-bipolar-disorder-really
There is a comment from “Mama Bear” which a link to this Blog
http://mysonhas2brains.blogspot.com/
My gut feeling tells me that it is fabricated and that this is not the only fake blog.