BP II vs BP I: diagnosis, treatment, prognosis
OutOnALimb
interesting; some of you might also:
http://www.mhsource.com/bipolar/bp9708explore.html
--
Kath
From here on my branch I can choose to plunge or soar.
I think I shall sit a while longer.
James D. Milton
On 3 Mar 1999 16:10:35 GMT, "OutOnALimb"
<OutOn...@REMOVEtoREPLYexcite.com> wrote:
>I found this page while looking for something else and found it pretty
>interesting; some of you might also:
>http://www.mhsource.com/bipolar/bp9708explore.html
Indeed I did; I found it to be most refreshing! Someone who goes against
the current thinking about diagnosing and treating BP II patients can't
be all bad. <G>
I have taken the liberty of quoting from portions of the article and
adding my comments.
... antidepressants usually are not enough and can make the illness
worse in many patients with bipolar II disorder. A likely scenario is
that when the physician treats the depression with an antidepressant,
it doesn't respond or it over responds, and the patient develops
hypomania or an irritable "depressive" mixed state. When the patient
doesn't respond to the first antidepressant, the physician tries other
antidepressants; unfortunately, when bipolar II patients receive a
series of antidepressants, they can become very refractory to
treatment. It is important at the front end to be conservative with
antidepressant use. Yet not all antidepressants are the same. ...
That is why it is SO VERY IMPORTANT to determine if a patient has EVER
displayed any prior hypomanic symptoms! Perhaps the refractory (hard to
treat) nature of our illness has been INDUCED in us by pdocs trying to
treat only our more obvious depressive symptoms??? IMO a very detailed
background and family history are ABSOLUTELY REQUIRED prior to
prescribing ANY psychoaffective meds!
For treating bipolar II, it is important to use mood stabilizers. There
is sufficient data to show that lithium augmentation works. But lithium
causes thyroid problems, especially in women. Thyroid replacement
hormones cause another set of side effects. Lithium itself causes some
mental dulling, something that the temperamental bipolar II patients
often resent.
NO JOKE!!!
More recently, and this is from clinical rather than controlled data,
we have been using divalproex (Depakote) in augmenting antidepressants
in bipolar II with fairly good results, without creating significant
problems in cognition. Divalproex is better tolerated than lithium. It
is also being used in combination with lithium, so as to lower the
lithium dose. The patients get the benefit of drugs with different
mechanisms of actions, without a high dose of lithium or divalproex
causing unacceptable side effects.
It seems to me that I have heard someone make similar statements. <G>
The down side with divalproex is primarily the weight gain.
You forgot hair loss! I bet this guy is bald!
Carbamazepine (Tegretol) does not have weight gain as a side effect,
but it is a difficult drug to use. You have to monitor the dosage and
blood levels, so it is not as widely used clinically for bipolar II
patients. There is also the grave problem with agranulocytosis. Right
now, the choices are one of the antidepressants with lithium or
divalproex augmentation or lithium and divalproex together without an
antidepressant.
Other newer mood stabilizers being successfully used in the US include:
Neurontin (gabapentin), Lamictal (lamotrigine), Topamax (topiramate),
Gabatril (tiagabine), and Isoptin (verapamil). In general they have a
more benign adverse side effect profile than the older mood stabilizers.
There are also some bipolar II patients where we just treat the
depressive episode. We call them "sunny" bipolar II patients. Their
course is seasonal. We know that they are going to be sick three or
four months a year, and we treat them with an antidepressant just
during that period. You may also consider augmentation with
phototherapy or sleep deprivation. (Many patients said to have seasonal
affective disorder may be viewed as bipolar IIs - Ed.)
I am aware of phototherapy (light box) for people with SAD. However I
have not heard of sleep deprivation being used. Perhaps someone could
enlighten me on that subject? TIA!
To me, the best treatment is the one the patient will accept. To help
the patient accept the treatment, you really have to understand the
patient's temperament. Bipolar II patients are often married many
times, because they are very colorful, very flamboyant, and very
unstable, which can make marital vows difficult. They go into
businesses and professions which require energy and intense
concentration, which they can do very well over a period of time and
then they crash. They are like yo-yos in their performance, but if you
add up their overall performance, it is usually very high.
IMO a good summary.
When you give bipolar II patients antidepressants, mood stabilizers,
and the like, you really have to give medications in doses that they
are willing to accept to bring some stabilization. But they don't like
total stabilization. If the medications bring total stabilization, the
patients won't take them, they will say, "It's not me."
I was totally stabilized on lithium. But unfortunately I became a super
depressed zombie. Is it any wonder that I insisted (and got) a change in
my mood stabilizer?
So administering medications is an art. Most of the studies on blood
levels have not included bipolar II patients. The key is not what the
literature says.
I think this particular statement is CRUCIAL! If the "therapeutic" values
for certain mood stabilizers have been developed using only patients with
BP I, they should NOT necessarily be used for BP II patients!!! If true
-- then it is no wonder why some of us are being so severely over
medicated! QED!
The patient should have some say in their treatment, with considerable
give-and-take between doctor and patient.
You got that right! But how many pdocs would feel comfortable with such
an innovative and potentially liberating process???
Temperament is a relatively neglected construct in American psychiatry.
Temperament is the bridge between the genotype and phenotype of
affective disorders. I predict temperament will dominate the psychiatry
of the next millennium.
That is QUITE a prediction! But who knows? Stranger things have come to
pass. Frankly I personally favor viral agents over temperament. But I
certainly could be wrong. Stay tuned for my latest installment on Borna
...
More opinion and commentary from the so-called mind of,
James
keith hardwick
James D. Milton
On 7 Mar 1999 22:30:52 GMT, jande...@aol.com (JAnde78972) wrote:
>James,
>I am new to this site and had found a message from someone that I think might
>have been you. It was an article about 5 pages long about manic depression and
>BP and I didn't have a chance to copy it.
Do you have the title or can you describe the content? I have posted literally
thousands of articles on the subject of BP (as well as other illnesses) -- so I
would need a little more to go on.
>I recently had a close friend that committed suicide that had this and I am
>trying to understand it better.
I'm so sorry to learn of your friend's passing! I feel for you and the loved
ones who must be asking themselves "Why?", "Couldn't I have seen this coming?",
and "Couldn't I have done something to prevent this tragedy?".
Suicide is an ever present reality with each of us. The mental pain oftentimes
becomes unbearable and the chemically-induced depression clouds our faculties to
such an extent that we cannot see that there is eventually a way out of the Pit
of Despair. Please don't judge your friend (or yourself) too harshly for this
final act of desperation.
>Please let me know if you can help me or if you happen to have the address of
>who might have sent it.
I will be glad to do whatever I can to be of assistance. I do feel for you. I
have had three friends to commit suicide. Though it may not seem so at the
present, time does heal all wounds -- although some scars may remain.
>Thanks,
>Teresa Birk
Thinking of you in this time of sorrow ...
James
James D. Milton
On 7 Mar 1999 22:38:06 GMT, jande...@aol.com (JAnde78972) wrote:
>James,
>Oh, by the way, I should probably tell you that I saw this message on Thurs.,
>Mar. 4.
The only long article I posted on March 4, 1999 was:
"More on the Borna Virus Hypothesis as a Possible Cause for BP". It was intended
to be a speculative article and a potential cause for optimism for an eventual
cure of mental illnesses.
>I really appreciate any help you can give me on this!
I'll be glad to email you a copy of this post if you like.
>Thanks again!
>Teresa Birk
Best regards from,
James
Debra Dawn Hysell
response by james.
KF
blues...@altavista.net (and yes, I'm on Tegretol)
Charles L. Perrin
Hysell) wrote:
>What is agranulocytosis? It was mentioned in the BP I & II article
>response by james.
It's a reduction of the number of granulocytes (one of the types of
white blood cell).
Agranulocytosis typically leads to increased subsceptibility to
bacterial and fungal infections.
It sometimes happens in response to anticonvulsant drugs, but it is by
no means a universal reaction (as it is to many forms of cancer
chemotherapy).
>blues...@altavista.net (and yes, I'm on Tegretol)
---
IMPORTANT: Remove the edible part of
the E-mail address before replying.
Lynda
> What is agranulocytosis? It was mentioned in the BP I & II article
> response by james.
> KF
> blues...@altavista.net (and yes, I'm on Tegretol)
Hi Debra,
Welcome to ASDM.
Agranulocytosis is a reduction of blood neutrophile count
(granulocytes0leading to susceptible bacterial and fungal infections.
Characteristics include:
Fever
fatigue
sore throat
buccal ulcers (in the mucosa of the mouth)
rapid heart rate
difficulty breathing
Causes:
ionizing radiation
benzene
antimetabolites
nitorgen mustards
aminopyrine
phenothiazines
sulfonamides
chloram
influenza
measles
cachexia
septicemia
lyphoid
paralyphoid
Treatment:
eliminate causative agent
antibiotics
supportive measures
There is an infantile form which is treated with bone marrow
transplantation and antibiotics.
Peace,
Lynda (Lyn...@bigfoot.com)
Reach beyond your grasp!