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Expectations of meds?


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Just some random thoughts,

Are we expecting too much too soon from meds?

I do not have BP. I am coming at this from the perspective of someone who has helped a loved one through this from both extremes of the disorder. While I may not be able to offer first hand experience I can offer a perspective that may be equally important (you know that lack of insight and all). 

BP is not good for the brain. There are many studies that demonstrate areas of atrophy in the brain that are related to BP. In this sense it should be fair to note that I share Dr. Manji's assertion that BP should be conceptualized as a neurodegenerative disorder. So, with regards to the original question, seeing that there is some trauma to the brain from episodes and during an acute episode in which one would seek a pharmacological intervention what should the expectation be? Should one expect to feel better (IE. normal) within a few weeks?

My own feelings and observations are that the primary expectation should be to find the medication that ends the acute episode, without the expectation to feel normal right away. After the acute episode is over the goal should be to find the minimum effective dose required. IMHO, it is to much to ask to feel as sharp as a tack and as quick as a whip so shortly proceeding an episode. Referring to the interview with Dr. Manji, lithium and depakote have been shown help the brain reverse the neuronal atrophy, which is great  but it takes time. Even after regenerating these neuron, would it not seem reasonable that they would require some time to rehabilitate and habituate? Especially so when referring to the frontal cortex which would be, in a evolutionary model, the area of the brain which would require the most plasticity.

In the end would it not be better to have a clear cut expectation, albeit lower, of what to expect from medication? Should we expect potential and not solutions, meaning that the meds give us the potential to become reasonable and logical again but do not do it for us? Could this be the reason that psychotherapy is shown to be equally effective as pharmacology when used in conjunction but not in isolation?

My own observations with my loved one is that 900mg of lithium was effective in ending a mixed episode in about 10 days. It took about six months to fully recover though. The dose was lowered to 600mg after three months and there were many times when she complained that she did not feel like her old self but perseverance paid off and she is much better today.

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Who is the 'we' that you refer to? Do you mean 'you people here'?

Meds make things possible.  For me that's equivalent to meds making me reasonable and logical.  I damn straight do expect solutions from my meds, and often get them. 

Most of my changes have indeed happened within a few days, except for lamictal which has a long titration schedule. 

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There are a lot of VERY EXPENSIVE, VERY ADVERITISED new treatments for BP/psychosis. Just like anything else, if I'm going to pay for it, then I'm going to have high expectations. As a consumer I think these expectations are necessary.

I do know that more studies have been done on the brain-healing effects of older mood stabilizers, and the new meds are still being researched. Scientists aren't sure why they work, but they do. No one is even sure why our old standby, Lithium, works its magic. It just does.

I've had full-blown manias that were ended with a couple of shots of Zyprexa, and the symptoms of BP/psychosis remit very soon after with these powerful AAP drugs. As I said, they are still being researched to discover their full potential, but for the money and hype, I do and should have high expectations.

I think that the opinion that we should expect to suffer from the physical aftermath of an episode is one from the stone-ages of lifetime inpatient care. Maybe *some* people do need this and experience physical aftermaths for longer,

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Who is the 'we' that you refer to? Do you mean 'you people here'?

<{POST_SNAPBACK}>

Everyone, sufferers, family, freinds and doctors.

I am afraid that some may misconstrue the question(s) that I've asked. Of course it is right to expect efficacy from medication. The question is do you think that some people (that means everyone I listed above) expect near total remission from meds alone and in short order. 

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Unless scientists dissect the brain of a living person, they will not be able to know what actually is going on, for absolute sure, concerning any psychiatric disease or medication in action. We have to accept, at least for now, that our fixes will help our bodies cope with imbalance issues, and there is no cure for it.

It sucks that many cancer patients do not achieve remission or total remission, and die. It sucks that we cannot do anything for HIV/AIDS sufferers short of pill cocktails. It is kinda like BP, and most other psychiatric disorders.

I think I'm in total remission. My last hospitalization was exactly one month ago. That's short order!

There is no cure for diabetes, HIV/AIDS, MS, Lupus...!!! There is no cure for BP. I'm happy I have the drugs I have and am not in a hospital forever.

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i get the feeling many here are resigned to being a bit sub-par thanks to meds, the alternative--unchecked bp--being so much worse.

some, especially the newbies, do seem to expect too much too soon.  i personally did find that the more lith and time on it i had, the more it helped.

7

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I expected that once the docs knew what was wrong they could fix it.  However, I

had been suffering since my teens and been misdiagnosed more than once.  I now

know not to expect miracles. I have resigned myself to a life filled with remissions

and periods of complete madness.

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I can't speak for anyone else, of course, but I don't think I expect too much from my meds. I count on them to keep me safe. That's about all.

Maybe I'm alone in this but, even when well controlled with meds, I don't feel like I think or see things as other people do.

Even when my BP  is under control I still feel different. Medication isn't going to change that. Depakote is not going to allow me to think exactly like a NT.

That, IMO, would be expecting too much from meds.

InfoNut

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seven,

Is this resignation to being sub-par really due to the meds though? Removing the issues with physiological side effects and and focusing on the pure cognitive and behavioural ones is this feeling of being sub-par the effects of meds or a period of time in the healing process? Furthermore, especially for those naturally hyperthymic BP'ers, is the comparison being made to a symptomatic or sub symptomatic period? Again this question is in the context of the model that I shared in my original post.

<{POST_SNAPBACK}>

Many here do seem to feel they were somewhat sharper cognitively/behaviorally pre-meds. I personally couldn't say how much of my dullness is attributable to residual bp/substance abuse brain-damage. My little joke to myself regarding neuro-protective properties: brain cells that aren't being used don't fry (cuz lith won't let you near them). On the other hand, don't cells need stimulation or they shrivel (exhibit a: alzheimers).

I think some of us are labeled bp because hyperthymia is sometimes called hypomania. So it can be hard to say whether the comparison is to an episode or not. Behaviorally, there is a Darwnian reason I need to be effervescent; that's the source of my social ease, motivation, optimism. I consider it a part of the normal range of mood swings. Hypomania by itself has no DSM whereas mania does (bpI).

Do I think I'd recapture the spontaneous hyperthymia with 6 months of healing on lithium? Not without a positive environment; and while therapy can help you deal with the life you have, it can't show you how to get the one you want. If you don't have a life, it would be cheaper to join a monastery. Now, instead, I question bipolar theory. I have the chemistry that makes me so bp-like. That much, I think, has been proven. But I wonder if it can't be controlled through sheer will combined with a great life. But I'll never work for or chase that great life without my hyperthymia. Catch-22.

7

p.s. i believe lamictal has some neuro-protective amygdala-repairing properties as well...

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meds keep me in control of myself so i can do things like a normal person.  i am of course still crazy and most likely will be for a very long time.  i don't expect a cure.  just treatment so i can go on living my life.

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Okay, my two cents:

I read Glen's post to say that we expect too much too soon from meds.  I tend to agree, mostly because my pdoc cites studies about executive functioning being reduced after prolonged manic episodes.  I think, in my case, it's going to be a good long while before I'm back to being "me" again, and even though that frustrates me, I'm not going to give up.

I don't think Glen is against medication, just that he thinks that we should give it time to work.  I agree.

*Edited to add:  I don't think this means that we should have to live with these symptoms.  The team I have is teaching me to differentiate between the symptoms of my disorder and the cognitive effects of it.  Even though it will take a while for the cognitive effects to disappear, they fully expect to be able to help make me symptom-free as soon as possible.  For me, that translates to the right medication, the right education regarding signs, symptoms, triggers, etc. and the right behavior on my part in response to these things.

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Yep, that's how I saw it as well.

I didn't add much in my previous post because Glen seemed to be getting at more of the long term effects of BPI episodes, as opposed BPII (or even to MDD, etc.) Not being BPI, I couldn't speak to it. But I do think Glen's questions/premise still hold water for other types of BP and other disorders.

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Thanks for the insight everyone.  ;)

No I am not anti - meds at all. Quite the opposite. I just feel that there are more ingredients to getting well than just meds and that they are all equally important. This attitude of impatiens's holds true for a lot of people regardless of condition (even non MI ones). I raised the issue because some of the protracted effects of BP episodes are also similar to to side effects of the meds given to treat and could could affect the issue of compliance.

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