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Do you think a lot of psychiatrist’s undermedicate?


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So on Facebook it’s constantly people being manic and saying they’ve tried everything. I’m wondering if a lot of doctors are undermedicating people or if persistent mania is common.

I’m able to keep my mania under control with abilify and others. Also Facebook groups don’t let you talk about meds like we can here. 

ETA or they don’t know they’re manic 

I’m just curious about this

Edited by iLove
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14 hours ago, iLove said:

So on Facebook it’s constantly people being manic and saying they’ve tried everything. I’m wondering if a lot of doctors are undermedicating people or if persistent mania is common.

I’m able to keep my mania under control with abilify and others. Also Facebook groups don’t let you talk about meds like we can here. 

ETA or they don’t know they’re manic 

I’m just curious about this

Personally, I wouldn't put a lot of value in what is said on Facebook, especially about mental illness.

No, I don't think "a lot of doctors are undermedicating people"......If you're able to control your own mania with what your doctor has prescribed, I think that's great.

Edited by CrazyRedhead
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14 hours ago, iLove said:

So on Facebook it’s constantly people being manic and saying they’ve tried everything. I’m wondering if a lot of doctors are undermedicating people or if persistent mania is common.

I’m able to keep my mania under control with abilify and others. Also Facebook groups don’t let you talk about meds like we can here. 

ETA or they don’t know they’re manic 

I’m just curious about this

I don't do Facebook for a lot of reasons- especially the misinformation perpetuated there.  Not a good place to go to if you are manic.  Not a good place to gauge whether people are chronically undermedicated

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iLove -

A quick search on the prevalence of chronic mania shows that findings from studies place the incidence of chronic (i.e. persistent) mania at between 6% and 12% of sufferers - a lower incidence rate than that for chronic unipolar depression. In other words, no, persistent mania is not all that common.

Do psychiatrists undertreat? I guess it depends on what lunatic corner of Facebook you decide to hang out in. I guarantee you that you can find other parts of Facebook where the people will swear up and down that their pdocs are shoving meds down their throats by the handful. Facebook is The Great Sharing Of Ignorance. It is the world's largest ongoing demonstration of the principle that opinions are like assholes and everyone is absolutely determined to show you theirs. Facebook is absolutely unreliable as a source of factual information on more or less anything at all.

Looked at logically, it is unlikely that psychiatrists routinely undertreat for mania. Mania is generally a more straightforward diagnosis, as its characteristics are rather in-your-face. A psychiatrist's work is to take a set of symptoms and apply measures to mitigate those symptoms. It is usually fairly clear whether a given treatment for mania is having the desired effect, and if not, the psychiatrist will attempt to either increase or decrease dosages, or try a different formulation altogether. But there's no rule-of-thumb that says "treat mania lightly". Mania can have devastating consequences on the manic, and must be handled seriously.

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On 12/10/2021 at 12:05 AM, iLove said:

Also Facebook groups don’t let you talk about meds like we can here. 

They don't? I didn't know that. Not sure about the rationale behind that. It's apparently OK to talk about how Bill Gates and a group of Satanic pedophiles met in a Pizza restaurant and decided to create the Covid pandemic in order to microchip everyone. I'm not if that's exactly what some people believe but it's some horseshit like that. But talking about meds, as opposed to Satanic pedophiles, can actually be helpful. When the information is reliable at least. Why restrict that of all things? I don't know much about Facebook. I'm not technologically illiterate just unsociable. The word "Facebook" always reminds me of the Necronimicon from The Evil Dead.

ED2Book.jpg

That's a facebook. But overmedicating is a problem I hear about more. I don't have bipolar or take anti-psychotics so things might be different here. I do know that these meds can have some nasty side-effects and that there can be a lot of trial and error involved in finding the right balance. I suppose you're more likely to see extremes online. People who are doing OK on their meds get less clicks than someone having a meltdown. The internets is a wonderful thing, bringing people together and all, but it can also be a fucking cesspool.

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On 12/10/2021 at 6:57 AM, CrazyRedhead said:

Personally, I wouldn't put a lot of value in what is said on Facebook, especially about mental illness.

No, I don't think "a lot of doctors are undermedicating people"......If you're able to control your own mania with what your doctor has prescribed, I think that's great.

^^^

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On 12/11/2021 at 10:50 AM, Cerberus said:

iLove -

A quick search on the prevalence of chronic mania shows that findings from studies place the incidence of chronic (i.e. persistent) mania at between 6% and 12% of sufferers - a lower incidence rate than that for chronic unipolar depression. In other words, no, persistent mania is not all that common.

Do psychiatrists undertreat? I guess it depends on what lunatic corner of Facebook you decide to hang out in. I guarantee you that you can find other parts of Facebook where the people will swear up and down that their pdocs are shoving meds down their throats by the handful. Facebook is The Great Sharing Of Ignorance. It is the world's largest ongoing demonstration of the principle that opinions are like assholes and everyone is absolutely determined to show you theirs. Facebook is absolutely unreliable as a source of factual information on more or less anything at all.

Looked at logically, it is unlikely that psychiatrists routinely undertreat for mania. Mania is generally a more straightforward diagnosis, as its characteristics are rather in-your-face. A psychiatrist's work is to take a set of symptoms and apply measures to mitigate those symptoms. It is usually fairly clear whether a given treatment for mania is having the desired effect, and if not, the psychiatrist will attempt to either increase or decrease dosages, or try a different formulation altogether. But there's no rule-of-thumb that says "treat mania lightly". Mania can have devastating consequences on the manic, and must be handled seriously.

Interesting figures. Most people I’ve run across with BP or SZA seem to spend most of their time mired in depression, not in mania. And not just by a small amount, either. There are exceptions, however. Many of these people also suffer from psychosis. At least the kinds of people you’re going to find on a place like this (i.e., a place where people are often more treatment-resistant). More often than not, even people with more severe symptoms are probably more likely to get their mania under control than their depression, or even their psychosis. Part of that is, perhaps, the fact that mood stabilizers and antipsychotics can both address mania in many instances, and a great many of us are on both.

But depression can be notoriously hard to treat. On average, my understanding is that pills for depression are maybe 40% effective, while TMS is closer to 65%, and ECT is closer to 90%. But even TMS and ECT only last so long (maybe 1-2 years). APs, even multiple APs can certainly helps with psychosis, but I think you’ll find plenty of people with breakthrough symptoms here, even if they are on multiple APs. 

As for pdocs undermedicating, I think most of them are trying to get you the best results possible with the minimum amount of yucky side effects. Some are, undoubtedly, going to be more conservative in their approach than others. And some are going to be more aggressive. That said, I think most pdocs will be more likely to be more aggressive when they see you exhibiting the symptoms first-hand. And since most BP types will show up in the office exhibiting depression more often than anything else, that’s probably what they’re going to target the most. Within limits, of course, because they don’t want to make you manic (or mixed).

Personally, I’ve been on everything from 1 psych med (now) to 8 plus an extra med to manage the side effects. But when I was on 8, I was a frickin’ mess. I’m now in full remission. During my last remission, I was on just two meds. So it all seems very symptom-based, along with finding out what works (and what doesn’t work) for you.

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