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March 7, 2004 2:07 PM   Subscribe

Are You Bipolar? Mild bipolar disorder may be to this decade what depression was to the nineties, thanks to a new drug and an expanding definition. But when do ordinary peaks and valleys become pathological?
posted by konolia (59 comments total) 3 users marked this as a favorite

 
Very interesting read and it goes along with my belief that many Doctors are far too quick to prescribe 'easy fixes' for problems. I recall a period about four years ago when I felt I was having severe anxiety troubles. I went to speak with my doctor about it and within a matter of 20 minutes he had prescribed Paxil to me which I began to use and continued to do so for about six months before I realized that it was more of a psychological issue rather than medical. Furthermore, I hated feeling so "neutral" to the world. There ain't no easy fixes, but we're a society obsessed with finding them and believing them.
posted by tgrundke at 2:55 PM on March 7, 2004 [1 favorite]


It's a brave new world, and getting braver every day.
posted by PigAlien at 3:00 PM on March 7, 2004


And I was just diagnosed as depressed less than six months ago. Dammit. I never get to be in with the cool kids. (I blame those doctors at that County Hospital; the ones at the Catholic Hospital always came up with cooler diagnoses)

Then again, in nearly six months of taking Prozac and not hearing it talk to me, I have yet to feel "smarter, funnier, cooler, prettier, better than I had before." I still don't have "fabulous concentration", be "undistracted by any edge of competition or envy", or find "that I could function easily on five or six hours of sleep". But going into my twentieth week without suicidal thoughts makes me almost giddy. And that part about "excessive involvement in pleasurable activities with a lack of concern for painful consequences,” sounds like my eating habits for most of my life, and the "inappropriate laughing and joking, and, as one set of diagnostic criteria had it, “inappropriate punning,”" is backed up by my MeFi posting history. Does it matter that I don't like Ted Turner and Jim Carrey, but have had a crush on Carrie Fisher since the first "Star Wars"? So, I may never become a "Romantic poet, a bullfight-obsessed writer, [or] an artist who cut off his ear," but I'll admit Id much rather be an 'artistic-type' like Berke Breathed or Alton Brown.

I seem at a strange advantage over most people regarding psychopharmacology: since my ex "went crazy" many years before I officially did, I've seen nearly all the medications in the article in action (and mostly before they became 'trendy'). And if they do as much 'good' for the new generation of bipolars as they did for her, in ten years, there are gonna be a lot of people in psychiatric hospitals.

Maybe there are just some things in our Modern Society that tend to make us "crazy". What do you want to blame this time? Television, marijuana, McDonalds or the Internet?

On a personal note, I don't think konolia is bipolar; she seems perfectly normal except for that delusion she has about the existence of God... (yep, I'm doing that inappropriate joking again). And when they discovered that third variation of the disease, why didn't they do like the movie sequels and call it "bipolar 3D"? (inappropriate punning) And up until today, I thought MetaFilter was a Mood Disorders Support Group... (okay, I wasn't so sure about the "Support" part.) But maybe that's the MetaMania talking.
posted by wendell at 3:26 PM on March 7, 2004


Within our lifetimes, most of us, there will be federal classifications for people on various substances. Opiate duplicates for the junkies, amphetamines for the crystal methodists, and outrage blockers for just about everyone. People living "off the grid" will be viewed with suspicion. And, in that world, perhaps rightly.

I have no deeper sympathy than my sympathy for the depressed. Any depressant knows the slow-motion horror of watching all value drop out of the world. It's a disability like any other, depression sucks. Bipolar may even be worse, but I wouldn't know first hand. I have it very close in my family, and it seems worse than depression. At least with depression you can set up a schedule for yourself, and like it or not, you can keep going through it. A bipolar disorder can continually bust you out of your life into a terrifying alien world. Of course, it can also lead you to the gates of heaven on earth. Some of our greatest artists have been bipolar, but I don't think I'd take the deal.

On preview: wendel, you're right on.
posted by squirrel at 3:29 PM on March 7, 2004


MeFi seems to be one place where the discussion of psychopharmaeutical culture isn't so--polarized. It's cool to get perspectives that differ from my own (minor depression, no medication "needed") but don't evangelize the wonders, or the horrors, of anti-depressants and whatnot.

Thanks, wendell, for the comment.
posted by Ignatius J. Reilly at 3:40 PM on March 7, 2004


The form of bipolar described in the article is the form I have been diagnosed with. Like the person in the article, I am not on meds right now (the insurance ran out over a month ago.) I'm now wondering why being superproductive and very happy is a problem.

Here's the thing. With this type of bipolar the highs are something anybody would want. It's the depressions that are a problem. To treat them with just antidepressants is very problematic, and until Lamictal came along there weren't a lot of good options that didn't risk hypomania/mania.

What I would like to see is a followup article about six or nine months from now. From my experience the gal in the article really is bipolar, and like me the denial is easy to live in for about half the year. The other half it bites you and it bites you bad.

Wendell, praise God that you haven't gotten a bipolar diagnosis. It still carries a stigma. It's much better to be a formerly depressed person who is the life of the party. (But on the other hand all the other bipolar people I know on or offline are just about as cool as they get.)
posted by konolia at 4:01 PM on March 7, 2004


The "sky has been falling" or "we're in a brave new world" since about valium became available in the 60s. As usual the horror stories of medication get more play than the success stories. I feel sorry for people who just buy the sensationalized media generalizations and because of a preconcieved notion of depression or any mental illness decide to "work it out myself" and "not see a quack who will make a zombie."

Or worse, jump on the herbal huxster bandwagon. I'd be intersted to see how many suicides have a bottle of St. John's Wort in their bathroom cabinet or some other form of self-medication.
posted by skallas at 4:17 PM on March 7, 2004 [1 favorite]


Hey, if it weren't for my ginkgo biloba, I wouldn't be able to remember my MeFi password...
posted by wendell at 4:21 PM on March 7, 2004


konolia: You're right about the highs - but I won't trade them for avoiding the lows (I made the decision 20 years ago), but both seem to be less extreme as I get older.

It would be nice to think that the medical profession will eventually work out what causes these problems, rather than just prescribing drugs to mask the symptoms.

On preview: skallas - St John's Wort is one of the things that helps flatten out my lows, without fucking me up some other way.
posted by daveg at 4:25 PM on March 7, 2004


The article's focus basically describes a close relative of mine who has Bipolar Type II and has been on the Lithium/former-epilectic-drugs-very-recently-approved-for-bipolar-disorder-such-as-Lamictal combo. It's worked wonders (thank God!), and as the article mentions, seems to have few side effects.

Personally, I think if you're going to be stuck being Bipolar, it must stink to only get the Type II variation: instead of fabulous highs and horrible lows, you only get minor highs and horrible lows. And for my relative, the minor highs (hypomania) weren't even highs or creative periods, just extreme irritability and inability to sit still/deal with annoying stimuli. One of the first signs that we knew the drug combo was working was that Relative's grades went way up, because all of a sudden, Relative could actually read more than a paragraph without getting distracted/irritiable (during hypomania) or getting zoned-out (during depression).

God bless pharmaceuticals.
posted by Asparagirl at 4:26 PM on March 7, 2004 [1 favorite]


And I can't take ginkgo biloba because it makes me feel weirder than crap.

Skallas is right about the herbs. Self-medication of any sort is playing with fire. But if one refuses meds on whatever grounds, I can say with some authority that exercise does work as a mood elevator. I spend a LOT of time at the gym for that reason.
posted by konolia at 4:29 PM on March 7, 2004


Asparagirl, you are so right. It would stink to be a Bipolar type I, but at least with that people KNOW you are ill. With type two people expect you to act normal, and many times that is like climbing Mount Everest without a sherpa.
posted by konolia at 4:33 PM on March 7, 2004


IF YOURE NOT HAPPY ALL THE TIME YOURE BIPOLAR.
posted by Satapher at 4:37 PM on March 7, 2004


Or worse, jump on the herbal huxster bandwagon

I wouldn't mind the herbal-remedy people so much if they didn't present them as an alternative to drugs, when they are, plain and simple, drugs. St. John's Wort is just as much a drug as Taxol or THC.

That and the "natural=safe" idiocy... yes, St. John's Wort is natural, just like cobra venom, botulinum, and chlorine.

All this stuff will get very interesting when mental states become largely an object of choice. Pushing to get your dissertation done? Time for a bit of hypomania and Asperger's. Going on a trip to the desert southwest to see the natural wonders? Upload a more meditative, contemplative attitude into yourself, along with some skill at composition for photography.

ObSF: "Axiomatic," Greg Egan, in the collection Axiomatic, and Focus in A Deepness in the Sky, Vernor Vinge.
posted by ROU_Xenophobe at 4:37 PM on March 7, 2004


have a gramme and relax. we'll take care of the rest.
posted by Satapher at 4:38 PM on March 7, 2004


perhaps some Victory Gin is in order?
posted by Satapher at 4:39 PM on March 7, 2004


do you have a boring ass job and and television withdrawls? You may have Adult ADD.
posted by Satapher at 4:40 PM on March 7, 2004


IF YOURE NOT HAPPY ALL THE TIME YOURE BIPOLAR.

Typing in all caps is a sign of trauma during toilet traing, you know.
posted by jonmc at 4:49 PM on March 7, 2004


> I'm now wondering why being superproductive and very happy is a problem.

Answer: Because other people who have to live with the bipolar person can't deal with it. I causes huge social problems and breaks up relationships, which can be a trigger for a depressive episode. Bipolar sufferers experiencing depressive episodes have an appalling suicide rate (of around 15%1). It looks like somewhere between 25 and 50 percent try to suicide at least once. That level is approximately the same as, if not higher than the suicide rate for schizophrenia (10-13%2).
__________________
1. Goodwin FK and Jamison KR. Manic-Depressive Illness. New York: Oxford University Press, 1990, p. 230.
2. Caldwell C and Gottesman I. Schizophrenics kill themselves too: a review of risk factors for suicide. Schizophrenia Bulletin 16:571-589, 1990.

posted by snarfodox at 4:50 PM on March 7, 2004 [1 favorite]


...along with some skill at composition for photography.

You had me until there, ROU. The sensation of intelligence and bliss are easy to synthesize in the short run, but talent will always take body work.

Here's a crackpot theory: the middle classes are wigging out because they're beginning to spend 90% of their lives in disembodied abstraction. The working classes get it less because they can't afford to. Exceptions abound, of course. Just a thought.

On preview: footnotes! We're classin' up the joint now!
posted by squirrel at 4:57 PM on March 7, 2004


IF YOURE NOT HAPPY ALL THE TIME YOURE BIPOLAR.

If you were happy every day of your life, you wouldn't be a human being; you'd be a game show host.
posted by weston at 5:03 PM on March 7, 2004


If you're happy and you know it, clap your hands!
::clap clap::
If you're happy and you know it, clap your hands!
::clap clap::
If you're happy and you know it,
and now you're not... you're bipolar!


::clap::
posted by wendell at 5:28 PM on March 7, 2004


The reason St. John's wort doesn't "fuck you up" is because it doesn't DO much of anything - it's no more effective than a placebo in treating moderate/severe depression. Strong drugs usually have strong side effects - that's how you know they're actually doing something.
posted by Veritron at 6:03 PM on March 7, 2004


MetaFilter: you're bipolar!

Heh- good one wendell ^_^/~
posted by gen at 6:07 PM on March 7, 2004


"But when do ordinary peaks and valleys become pathological?" - well they don't if they are ordinary.

Here's a seat of the pants definition - when the peaks and valleys become so intense as to prevent achievement of one's life goals and/or effect personal relationships and quality of family life : mood volatility as a handicap and a curse. That's pathological.

I have to do a little mild eye rolling about the linked story ....it's what I would call "bipolar lite". There is a world of difference between this and the reality of moving through extended soul-crushing depressions which prevent almost all purposeful activity - all social activity, most cleaning, even very minor tasks - and which tend to obliterate most life plans - to manic highs of constant work and initiation which leave chaos and disorder in their wake for all the projects initiated which fall by the wayside when the lows hit again.

Not that I would know anything about that personally.
posted by troutfishing at 6:46 PM on March 7, 2004


trout just about summed it up.
posted by precocious at 7:01 PM on March 7, 2004


Wendell, I'm making you an honorary member of the beeper club* regardless of your label. You would fit right in. Please take it as a compliment, as I am referring to your wit and vivacity.

*all the perks, none of the dues.
posted by konolia at 7:41 PM on March 7, 2004


Troutfishing, the depressions are the same. We type IIs just don't go as far up the high end. But granted, a lot of life damage is done on the high end, so in that sense point taken.

Did you know that studies supposedly show that type IIs are MORE likely to kill themselves than type Is? That little statistic surprised me, but not much.
posted by konolia at 7:47 PM on March 7, 2004


You had me until there, ROU. The sensation of intelligence and bliss are easy to synthesize in the short run, but talent will always take body work

Yeah, but. All of that body work and practice is going into building a set of connections in your brain, or otherwise doing real, physical work to your real, physical brain.

If I give you a pill full of nanobes that go into your brain and give it the appropriate connections in the appropriate places (or otherwise cause the same physical changes that body work and practice do), then you go to sleep a tyro and wake up with all of the skill and talent of an experienced master.
posted by ROU_Xenophobe at 7:48 PM on March 7, 2004


About the whole "talent pill" business:

I think it was the Oliver Sacks books An Anthropologist on Mars that had accounts of artistic savants who automatically had a high level of artistic skill, being able to draw gallery-ready work from the age of four or something ludicrous. The kicker, though, is that they didn't quite have all of the skill and talent of an experienced master, and they were never able to improve.

I also suspect a "talent pill" would be unable to produce generic talent - high-level talent is wildly idiosyncratic, which is good, but you'd wind up with a Cezanne pill and a Rembrandt pill, for example.
posted by furiousthought at 8:42 PM on March 7, 2004


The thing about sadness is that everyone has a relationship to it. And like so much of the world, this issue is managed by the extroverts, who have pronounced sadness a choice. "You don't have to act on it," is the message. And not acting on it, it will dissolve into the real world everyone else lives in.

The highs are the only ticket in. As much of a problem as they are, I'd kill to get past the sadness to the high, no matter how limited. The alternative can be deadly.

Once in a great while, I get to own the sadness. For a couple of minutes, it becomes a choice. Next morning, I'm back to square one.
posted by divrsional at 9:09 PM on March 7, 2004


I'm now wondering why being superproductive and very happy is a problem.

Answer: Because other people who have to live with the bipolar person can't deal with it.


True, awful as it sounds. I have a close friend who is undiagnosed but probably has some form of rapid-cycling bipolarity. I actually dread the mornings he calls talking a mile a minute to tell me he's finally figured out his place in the world. It's hard to see him (quite literally) bouncing off the walls, writing page after page of poetry and philosophy, rhapsodizing about new friends and making grand plans for saving the universe when I know that two days later he'll be curled up on his bed, lonely, overwhelmed and sure that everything he's written is worthless.

Of course I'm always glad to see him happy and productive--I wish he could always feel that good. Every time, though, he's sure he's got it all worked out and will never be down again. What takes a toll is knowing that's not true.
posted by hippugeek at 9:38 PM on March 7, 2004


Ouch.

It's obviously no fun being fully bipolar, but perhaps being just a little bit bipolar has cachet for some as a tactic for gaining authenticity? As the wealthy dilettente painter attempts to wear a bit of that sexy starving-artist edginess made so exotically enticing when one merely visits but does not live there ?
posted by troutfishing at 9:48 PM on March 7, 2004


It's obviously no fun being fully bipolar, but perhaps being just a little bit bipolar has cachet for some as a tactic for gaining authenticity?

There's something like that. In Touched With Fire, Jamison argues that people who are bipolar often have family who are "merely" very creative and active without hitting pathological levels (however one might define those).

I can't remember whether it's her analogy or not, but sort of like sickle-cell, where having one copy of the gene protects against malaria, but two copies makes you sick.
posted by ROU_Xenophobe at 10:15 PM on March 7, 2004


All of that body work and practice is going into building a set of connections in your brain, or otherwise doing real, physical work to your real, physical brain.

This is a side point, but I think the brain's role in the life of the mind is overstated. The mind is distributed throughout the body's nervous system, may exist in magnetic relationships around the body, and possibly extend beyond that. Who knows, maybe to forever.

I reject the notion that the "I" of an artist (or a manic depressive or religious fanatic) lives and operates only within the cranium, and that the entirety of difference between that mind and all others is a tiny bit of electrochemical sizzle. Thought isn't meaning; physical action is meaning.
posted by squirrel at 10:23 PM on March 7, 2004


One is fascinated by the world, and sometimes it seems that the world falls in love with you, too, turning all the lights up Sixth Avenue green, sending the subway rushing into the station a moment after you’ve swiped a MetroCard. This can seem to be your best self, the state of self-actualization that one prays to get to with self-exploration, therapy, and medication, but for many remains just out of reach.

Ding, ding, ding!

Exactly what my hypomanic states are like. I spent much of my life thinking that was how I was supposed to be, that that was how everybody else felt all the time, everybody but me, cursed with chronic depression, only able to be "normal" for a very brief time.

As I've got older and got feedback from peers - for example, a co-worker at the half-way house told me she could always tell if a client was going through a severe crisis by how cheerful and energetic I seemed when she relieved me from my shift (emotionally intense, stressful situations seem to set me off), another friend, who was bi-polar herself, told me that she thought I was having a manic episode at one point - it became clear that something was going on. After a doc suggested the diagnosis of Bi-Polar II might be more accurate than Clinical Depression, I read up on it and it seemed to fit.

Still, I didn't see any reason to do anything about it - I felt so pessimistic and gloomy most the time that I figured that the Universe owed me a little up time here and there. Besides, I never got in trouble with the law, lost a job, went on a huge shopping spree, or became delusional like many individuals with classic bi-polar disorder do, so I figured I should just enjoy the up periods while they lasted. I also wasn't connecting the dots on another, more frightening, phenomena - the Mixed Episode, that always seemed to show up at the peak of the most severe, deep depressions. So while I intellectually knew that I fit the criteria, it didn't seem like something I needed medication for.

This last year though, it became all too clear that I was paying a big price for those all-too-brief infrequent periods of hyper-clarity, uber-confident, super-motivated, and feeling like the most dead sexy, lucky person in the world. The pattern of feeling like a demi-goddess, partying like a would-be rock star, engaging in some "Jackass"-type antics, and then spiraling down into a suicidal thought-inducing morass of self loathing and dread was becoming more dramatic and obvious, although still relatively infrequent.

The fact that I showed up for an intake appointment at a mental health clinic chattering like a capuchin monkey on "E" sort of made it painfully clear - I'd accompanied and interacted with the same clinic staff several times on behalf of severely mentally ill friend in my usual somewhat depressed, slightly anxious state only weeks before, so they had some context by which to measure my behaviour. They suggested I take mood-stablizers, which I swore to them I'd never do. A couple of months later, while in the midst of a suicidally depressed black hole, I decided that it just wasn't worth having having brief periods of super-bliss if it meant having to spiral down so far. I decided to try a mood stablizing medication, just to see if it made any difference.

I've been taking Lamical for about 3 months now. I feel much calmer, more clear-headed and steady. It's good.
posted by echolalia67 at 11:26 PM on March 7, 2004 [1 favorite]


I'd interacted with...

My editing skills are rather poor today
posted by echolalia67 at 11:38 PM on March 7, 2004


I reject the notion that the "I" of an artist (or a manic depressive or religious fanatic) lives and operates only within the cranium, and that the entirety of difference between that mind and all others is a tiny bit of electrochemical sizzle

And I accept it. If you don't accept an "I" that results from physical processes in the human body, you more-or-less* have to appeal to some manner of supernatural entity that's possessing your body, jerking it around on puppet strings through some sort of supernatural connecting force we don't know of. Heck, I'm a Christian and I wouldn't accept that. I'm me, in my meat. I am my flesh.

At one level, it's very unromantic to think that you consist entirely of a bunch of stupid atoms and cells. But unromantic is not the opposite of true.

And think of the different ways you can build a human mind -- if you go all out, there are easily more ways to connect your neurons with each other than there are atoms in the universe. Of course, most of those wouldn't build a functioning mind. Even from within the range of possible functioning human minds, I'd be willing to bet a dinner that you could go through the universe, assigning each planet or star to one possible person, and you'd run out of stars and planets before you exhausted the wells of human possibility. Each of these individual possible people are whole interior universes, whole magnificent and tragic and glorious stories, each contains models of the universe around them, and models of the people around them, and models of the way that these people see the universe, nested near to infinity. And there are more of these interior human universes than there is dumb matter in the entire universe. And we're just one species in it.

Thought isn't meaning; physical action is meaning.

I'm not sure what you mean there. Thought is physical action anyway. Do you mean that thoughts not acted upon either don't count or count less? But the difference between a thought that gets acted on and one that doesn't is largely a matter of thought itself.

*I suppose you could appeal to some manner of quantum-entanglement jiggery-pokery, but that seems even more work, and you have to explain what in the hell you're entangled with and what organs you use to entangle. If there were EM fields around the body that were sufficiently complex to support mentation, I think we'd have noticed them by now -- and our thinking would go blooey every time you walked by a big magnet.
posted by ROU_Xenophobe at 11:53 PM on March 7, 2004


Interesting that peoples' descriptions of bipolarity (is there any other kind of polarity? [/safire]) sound to me a heck of a lot like a coke/speed binge and the crash afterwards.

Not that I've ever done that, of course.
posted by stavrosthewonderchicken at 12:43 AM on March 8, 2004


I had a bit too much of ____ and was hospitalized briefly and as a spat obscenities at the doctors before they calmed me with introvenous ativan -- they called me bipolar
posted by RubberHen at 1:00 AM on March 8, 2004


Stavros, from what I understand, it IS very similar. I know that when I am in a social setting and a bit hypomanic, I constantly have to keep telling myself to chill so I don't look like I'm high.
posted by konolia at 3:46 AM on March 8, 2004


is there any other kind of polarity?

You haven't lived until you've tried tripolarity.
posted by spazzm at 4:04 AM on March 8, 2004


From the link: "...I called time-out. I began to see a new therapist, who saw drugs as a last resort and had no faith in my diagnosis... and the depression scared into corners by antidepressants seemed to lift in a more organic fashion, bit by bit."

The spouse of a friend has been taking medication for BP for years without getting therapy or making life changes. A friend recently got of antidepressants for depression. A relative recently got diagnosed with Bipolar 2. The relative told me, "BP travels in families, you know, so if you ever want to talk about it with me, you can."

I replied that my solution, given my obviously eccentric life style and clearly extravagant personal presentation, was obsessive reliance on rules and relationships. I must exercise. I must ask the people I trust about what is appropriate and what is not. I must plan and think things through and be accountable to my plans and friends.

Could I get someone to diagnose me with BP2? Betcha I could. My relative lived life by destructive rules for a long time until it became change or die. My depressed friend got out of the job that was destroying him and got help. My friend's wife? Not getting any better. Not doing anything about it. Neither are her friends.

When our appetites for life do not match our constitutions we must admit that we don't have the same freedoms as normal people. We have to take more care, drink less, sleep more, choose healthier friends. We must create our own little AA circle of accountability. We have to get therapy when we find ourselves in sweats for a second week. And we have to have rules we follow about not buying sweats if we can't accept the responsibility, which sounds silly, but isn't.
posted by ewkpates at 5:25 AM on March 8, 2004


"I reject the notion that the "I" of an artist (or a manic depressive or religious fanatic) lives and operates only within the cranium, and that the entirety of difference between that mind and all others is a tiny bit of electrochemical sizzle" - Squirrel

"And I accept it." -ROU_Xenophobe

I'll take a little of "A" and a little of "B". I know most find that an indigestible menu. but I like it just fine.

I know quite well which branch of my family is "touched". It's pitifully obvious. But I can easily accept the fact of a biological basis for the condition without demanding a completely reductionist universe. That's the beauty of the inherent definition of "divine" - it's that which transcends our understanding! By definition! ( ho ho ho ) S0 - by means of this sly trick, I can keep my spiritualism and yet also retain my belief in scientific explanations. There's even room for personal responsibility. Amazing!
posted by troutfishing at 5:51 AM on March 8, 2004


You might want to Google on (lamictal rash fatal) after your prescribing physician tells you about it and compare his tone with what you see.
posted by bukvich at 7:24 AM on March 8, 2004


You might want to Google on (lamictal rash fatal) after your prescribing physician tells you about it and compare his tone with what you see.

Yes, Stevens-Johnson Syndrome, I know. Although uncommon (.08% for people treated for Bipolar, 0.03% for people being treated for Epilepsy) it can be fatal, which is why there is a standard protocol for prescribing the medication - the likelyhood of developing the rash is much higher if you start out at a high dose. The correct protocol for prescribing is for the dose to be titrated up slowly - 25 mgs the first week, 50 mgs for 2 weeks, 100 mgs for a week, 150 mgs for a weeks, topping out at 200 mgs. My prescribing doc went even slower keeping me a 100 mgs for a month, 150 mgs for a month, and finally 200 mgs.

It's definitely important to do some research before taking any medication - you need to make sure that your doctor is prescribing correctly, that you are doing any blood work needed to monitor how it is affecting your liver, etc.
posted by echolalia67 at 8:51 AM on March 8, 2004


A gramme is better than a damn
posted by Satapher at 8:54 AM on March 8, 2004


Thank you for your thoughtful replies, ROU. I sense that we are more closely aligned than our apparently polarized (hey, pun!) positions would suggest. I say only "apparently" polarized because (as I think you would agree) the body-contained mind vs. body-independent mind is a false dilemma, as I infer from troutfishing.

If you don't accept an "I" that results from physical processes in the human body, you more-or-less* have to appeal to some manner of supernatural entity that's possessing your body

This seems like a false dilemma, too. To clarify the gist of my original position, I argued that the mind exists throughout the body, not just the cranium. You seem amenable to this notion.

As for my speculation that the mind may extend beyond the body, I think there are several alternatives to your supernatural "possession" scenario. For example, we (our minds) all may be interconnected. This doesn't require supernatural forces in the way I infer you meaning. Current research in communication builds a credible model of meaning creation (the site of reality generation) as a fully social process. (See e.g. Pierce, Cronen's Coordinated Management of Meaning theory).

I suspect that popular understanding will eventually move beyond the model of humanity as a landscape of discrete mind containers that mechanically transmit meaning over networks. A new model of mind as distributed process may emerge. I see this happening in tandem with our development of computer network technologies. In a way, the machines are a modeling system that is enabling us to explore the way interconnective processes operate.

To ground all this in the bipolar issue, I suspect that the apparent rise in destructive neurosis relates to the end of an outmoded mind conception. I believe that one day we will understand "mental illness" as a truly social phenomenon, existing throughout social systems, rather than as a collection of localized individual brain chemistry imbalances.
posted by squirrel at 10:05 AM on March 8, 2004


This seems like a false dilemma, too. To clarify the gist of my original position, I argued that the mind exists throughout the body, not just the cranium. You seem amenable to this notion.

Sure. If nothing else, hormone flux obviously affects thought and might be considered part of the mind, even though an awful lot of that happens in the Naughty Regions.

For example, we (our minds) all may be interconnected. This doesn't require supernatural forces in the way I infer you meaning. Current research in communication builds a credible model of meaning creation (the site of reality generation) as a fully social process.

I don't disagree exactly. But I think that's not going to be usefully distinguishable from a case where the mind is entirely within one person, but our internal models are influenced by what other people tell us about their internal models.

I believe that one day we will understand "mental illness" as a truly social phenomenon, existing throughout social systems, rather than as a collection of localized individual brain chemistry imbalances.

I think I could express the same idea in a simple-reductionist single-cranium mind by talking about patterns of stressors, and how stressed individuals apply new stressors to those around them in a feedback cycle, and the like.

I suspect we could have fun talking right past each other for a good long time!
posted by ROU_Xenophobe at 10:43 AM on March 8, 2004


Lamictal is not the only drug that has a possible risk of Stevens-Johnson Syndrome.

I have been on enough of a variety of things to know that any chemical you stick in your mouth has effects in addition to what you are actually taking it for. If I had to go back on meds tomorrow Lamictal would be what I would take.

Meanwhile,

I replied that my solution, given my obviously eccentric life style and clearly extravagant personal presentation, was obsessive reliance on rules and relationships. I must exercise. I must ask the people I trust about what is appropriate and what is not. I must plan and think things through and be accountable to my plans and friends.

ewkpates has the idea.
posted by konolia at 12:12 PM on March 8, 2004


squirrel: how is psychosis a social phenomenon and not a brain chemistry imbalance?
posted by swerve at 1:24 PM on March 8, 2004


I have been on enough of a variety of things to know that any chemical you stick in your mouth has effects in addition to what you are actually taking it for. If I had to go back on meds tomorrow Lamictal would be what I would take.

Word. I also have noticed that amost all of the scare-mongering "Look out!! That medication can kill you!" around prescription medication is focused at people taking psychiatric medications.

Somehow, it's okay that people with other serious medical conditions take medications with rare but serious side-effects, but if someone takes it for a mental health condition, people feel free to tell you that your life is in danger. I mean, when was the last time you heard people warning folks with epilepsy against taking Lamical, or Depakote, or Tegretol? Or telling smokers to stay away from Zyban, for that matter (Wellbutrin sold under a different name, in case you don't know).

I think it speaks to the all-too-common belief that mental illness aren't "real" medical conditions and that people with psychiatric disorders need to buck up and quit being such a baby.
posted by echolalia67 at 1:29 PM on March 8, 2004 [2 favorites]


Yeah. I think people's attitudes are a heavier burden to bear than the disease itself. Pity the next individual who says in my presence that depression is a choice.
posted by konolia at 1:52 PM on March 8, 2004


squirrel: how is psychosis a social phenomenon and not a brain chemistry imbalance?

Psychosis need not be seen as either totally an individually-contained or socially-distributed phenomenon. (Disclaimer: I'm not a doctor, and mine are communication theories, not biological theories.) Do you see psychosis as socially independent, swerve?
posted by squirrel at 5:07 PM on March 8, 2004


"squirrel: how is psychosis a social phenomenon and not a brain chemistry imbalance?" - Well, the rise of Fascism in Nazi Germany may be one excellent case to buttress squirrel's claim :

Peter Loewenberg has some very important things to say about this : "The Psychohistorical Origins of the Nazi Youth Cohort," perhaps Loewenberg's great masterpiece, is a carefully reasoned, carefully argued, beautifully written essay which unfolds with logical precision and surprises again and again with telling facts and examples. The hypothesis is simple: youth was the key to Nazi success, and much of Hitler's support came from those who had suffered massive physical and emotional deprivation as children in the last years of World War I. The first years of The Great Depression recalled the earlier trauma, and Hitler came to unconsciously represent the absent fathers and mothers of the war years. "French and British families undoubtedly experienced the sense of fatherlessness and desertion by mother as much as did German and Austrian families." But two additional factors made a crucial difference: for central European children, "extreme and persistent hunger bordering in the cities on starvation," was the first; the second was the fact that German and Austrian fathers returned in defeat and were unable to protect their children in the tumultuous post-war years. It was reinforced by the sociopolitical order being overturned: "The Kaiser of Germany had fled and the Kaiser of Austria had been deposed." Naturally, fathers and father figures were both wanted and idealized. Loewenberg dips into literary sources to help prove his points that Hitler offered himself as a fantasy object."
posted by troutfishing at 6:52 PM on March 8, 2004


Behavioral disorders and physical illness are very different, and where one is caused by a combination of environmental factors, genetic predisposition and behavioral patterns, the other can be traced to viral, bacteriological, or similar cause.

But it may be that diabetes can offer an insight: You don't choose to have it. But if you live a high risk lifestyle, you may very well end up with it as a result of your choices. If we look at some of the data on treatment, it appears that depression and other mental disorders are very much the same way.

Treatment for diabetes often involves changing behavior. It may become so severe that you need regular insulin injections, but nevertheless... choices got you there.
posted by ewkpates at 8:22 AM on March 9, 2004


You don't choose to have it. But if you live a high risk lifestyle, you may very well end up with it as a result of your choices.

Well, that may be true but the problem with mental illness is often a case of not seeing the forest for the trees. The very thing you use to determine reality, your mind, is not interpreting it correctly. It often takes the assistance of medication to get to the point where you can think about making the lifestyle changes needed to stave off further breakdowns.
posted by echolalia67 at 11:04 PM on March 11, 2004


definitely true to a degree, but this doesn't address the significance of the analogy. Certainly people experiencing significant blood sugar fluctuations are "hungrier", and this makes it hard for them to think. Try a Coke and Snickers diet for a week or two and you'll see what I mean.

Again, the problem we have is that in both cases people are more likely to seek medical treatment instead of making changes to their behavior and environment.

So, insulin/ssri drugs aren't "treatment", and we need more prevention education for patients with family histories.
posted by ewkpates at 4:12 AM on March 12, 2004


Well, insulin is prefereable to death for a diabetic, I would think. Medication gave me a period of time that my emotions could rest, my adrenal gland could rest, and everyone around me could rest.

I'm now unmedicated and using lifestyle strategies that do work for now. Perhaps one day I will have to go back to meds. It's nice to know they are available if needed.
posted by konolia at 11:32 AM on March 12, 2004


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