One way to look at recovery is through the concept of connections. Everything that happens to you is a tool to either connect you with something you want or need, a tool to loosen a connection, or a tool that creates a problematic condition. Everything that happens the question is simple: Do I want to be connected like this or not. Tools are not true or false. They are useful of not. Use the tools that are useful.
- Medication is the rock and the hard place. If you have bipolar 1 you are unlikely to make it without meds. I have personally never met someone who has. Met a few who have tried. No one has made it. A psychiatrist I talked to yesterday told me he has seen a few BP2 people who do not have deep depression make it, but they are the rare exception. But yet meds- especially the atypical antipsychotics- have real risks and dependent on the health variables you bring to the table maybe verious serious risks. Meds ideally connect you to a cognitive capacity you dont have without them. A friend of mine told me going without meds is “like jumping off an ocean cliff and hoping it doesnt end with you getting all wet.”
- Therapy and counseling- I think a great tool, but one many go without it. I think it connects you to knowledge and insight. If it doesnt either you refuse to open your eyes or your counselor is not very good. A great tool but you must use it.
- Support- support groups connect you to people. I believe it might be the most important connection. People connected to people will usually try to stay stable on meds and therapy. And in the experience of others you will find hope for yourself.
There are many other tools: jobs, education, church, advocacy, recreation… the list is probably endless. But look for what works and what you need and grab hold tight.
Without connection you don’t have to be smart to see where the road ends: death, jail, suicide, or hospital.
What is connected to what for you?
August 3, 2009 at 11:15 am |
Dear Hopeworks Community,
I am posting a long response to this post on my own blog, Since I put some time and thought into my ‘essay’, and it might as well be my own post for today. I am appending my response here also. Feel free to leave the appendage off if you don’t want such a long comment. Interested readers can then just link to my site.
Thank you for a thought-provoking post.
Personally, I believe your overstate the value of medications, especially in bipolar II/depression. (They are indeed quite effective against manic escalation. It is not impossible for someone with Bipolar I to go without meds, but it is difficult and takes discipline.) However, the efficacy of antidepressants is regularly exaggerated by psychiatrists and pharmaceutical representatives. Are you aware of a single long term placebo-controlled study that demonstrates sustained benefit of any antidepressant over time frames longer than a few months? I’m not. Approval trials typically last six weeks. And even in that short time period, usually not much more than half the population benefits (compared to 30% that respond just to placebo). Yes, when people first start antidepressants, they often feel better. But if they are someone with longterm problems with low moods, and many recurrences, (which is the story for most bipolar II patients) if you look a year later they are usually back to fighting depression. Only now they are stuck on a medication that causes even worse moods and other symptoms if they try to stop it. Realistically, don’t you notice that mental health clinics are filled with clients in awful depression who also happen to be taking 3 or 4 or 5 medications? If the drugs work so well, why are there so many people like this? For acute depressions, especially prolonged situational depression, the pharmaceuticals can really help. They may also give those with more chronic problems a bit of relief while they learn better ways of dealing with their moods. But as a sustained strategy: it just does not work. If long term antidepressants were often effective, I would be in favor of them; I am not reflexively anti-medication. But they are not.
The psychiatrist who claims “he has seen a few BP2 people who do not have deep depression make it, but they are the rare exception” is a psychiatrist who loses his patients after they realize they can find ways to deal with recurrent depression and hypomania without drugs. The only ones he sees are those who come back asking to be put back on pharmaceuticals. Not only that, but once on long-term drug treatment, it is indeed exceedingly difficult to stop it. To say that bipolar II patients can’t come off drugs is very different from saying they are better off than if they had never been established on longterm treatment in the first place. And how hard does he work to very slowly taper his patients while providing behavioral means to manage their moods? A close family member required a 2-year taper off prozac, and she was just on the one drug. Imagine how much patience it would take for a psychiatrist to help patients get off 4 or 5 medications. Does he work that hard to achieve something he obviously does not believe in?
Therapy and counselling are indeed helpful. Not always those based on opening up (though for those coming from traumatic backgrounds, as many bipolar II patients have, it may be vital), but especially those that provide behavioral advice (including promoting exercise) and cognitive training, along with something like meditation or spiritual support. And peer interaction can be lifesaving. But meds? They are not a rock opposing a hard place. They are just an ineffective rock opposing a condition that can often be ameliorated without longterm drugs.
August 3, 2009 at 1:43 pm |
I think I probably said things poorly. I know of no evidence that says that antidepressants work well with bipolar anything. My wife has bipolar and was diagnosed as major depression. Two years of antidepressants left her in a living hell. Most people I know with serious depressive issues are the victim of a system that values pills above people and in my experience are rarely taught the kinds of things that you mention. As chemicals become more and more important less and less money goes to other services and that is a travesty.
The psychiatrist that I talked about does believe in meds. The tapering you talk about is part of his standard operating procedure. He typically has no one on 3 or 4 drugs. He recognizes the fallacy of giving drugs for drugs. He thinks the solution should not be worse than the problem.
Most of the people I know with bipolar believe that they can not make it without meds. They all back this up with tales of when they tryed to stop and the chaos that ensued. They have all had the experience of drugs that dont work and believe they know when meds are helping.
A large group of people that i know refuse to be part of the mental health system because they dont believe it works. They may think the meds work, but they hate the side effects. They think that therapy is useless. I talk about this in my last post.
I am not sure, but I think is substantial ways we agree. I am glad that you took the time to reply.
August 3, 2009 at 2:16 pm |
You are right. We mostly (maybe entirely) agree. You seem to be saying, as I tried to, that just because people can’t stop drugs once on them does not mean the drugs have actually helped.
I was on multiple medications for nearly ten years, terribly depressed the whole time, before I started to get better. It was not a new drug that made the difference. It was improving my lifestyle, challenging my negative thinking, meditating, and learning to accept. Unfortunately, I am now having a really hard time getting off the many pills I take. If I go too fast, all joy drains from my life, I get seriously suicidal, and I feel physically awful. So I keep swallowing the pharmaceuticals, chipping away at my chemical burden as much as I can without risking killing myself in withdrawal-induced despair.
I am convinced that if I had never started a single antidepressant, I would be exactly where I am today: pretty satisfied and stable. But I would not be dependent on chemicals that have caused a slew of adverse reactions, some horrible and permanent.
I do not claim objectivity. But I am well educated in the field (since I am a former surgeon and have devoted a lot of time to learning this stuff). My last few posts have covered this material exactly, so it was rather fortuitous to come across your discussion. The more the truth about medication treatment gets disseminated, the better.
Thank you for the valuable conversation.
September 4, 2009 at 11:03 am |
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