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    Dr. G. What do you think?
    ddnos posted:
    Dear Dr. G

    I've long been curious about something that I have noticed in many people with bipolar type 1 or 2 (I think more often, type 1). Granted, they likely have other diagnosis accompanying, but their primary diag is bipolar.

    I have witnessed a lot of people who though they are on meds, they are still experiencing frequent mood swings (lack of stability in their moods) or become either significantly manic or depressed. Not just "Oh, I'm a bit manic today" but I mean really manic and even psychotic with it sometimes, and likewise, not just having a bad day, but very depressed often.

    When I see someone with that experience whether it's here on the boards or with people I've seen in person, one of my first thoughts is that 1) they aren't on meds or 2) they aren't on the right meds for them or the right amount, and 3) they aren't or haven't been in therapy along with taking meds.

    My question then, is there any truth to the possibility that those in question probably aren't on the right med or combo of meds and in therapy (and doing the work) because if they were, they wouldn't still be having such difficulty to the same degree?

    I mean, I believe very strongly that therapy has to be part of the treatment - meds are to treat the physical aspect of the disorder and therapy is used to treat the psychological aspect of of it; so I can totally see that if a person is utilizing only one part of the treatment, then there will continue to be major problems for that person.

    I realize that you can't make a blanket statement and say that either yes that's true or no it's not because there are many variables; but generally speaking - and even in many of the cases, would you say there's any truth to the above? (I hope I'm making sense)

    I do think that many folks rely totally on medication too much to make them "better" and don't bother with therapy to help them make the changes that meds alone can't do; and so I wonder if that plays a big part of why the continued severity of symptoms. What do you think?

    Thanks for your time and input
    Forgiveness is letting go of the hope that the past could have been any different --Unknown
    ddnos responded:
    Forgiveness is letting go of the hope that the past could have been any different --Unknown
    Joseph F Goldberg, MD responded:
    Dear Debbie,

    All the possibilities you mention could be the case, along with the unfortunate reality that the medicines which today exist to treat bipolar disorder are not entirely effective, and some people simply do not improve despite taking appropriate medicines. This is why there is a compelling need for new treatments to be developed.

    - Dr. G.
    An_243880 responded:
    You might want to be a bit cautious about passing judgement on other people's therapeutic processes. Just because biochemical nervana hasn't been acheived yet for some patients doesn't automatically mean that the patient is non-compliant, the treatment team is incompetant, or that treatment hasn't gone on long enough. Readjusting brain biochemistry is a delicate and tricky process. Not everyone's neurology magically adjusts to the first elixir that gets prescribed. Also, biochemistry changes depending on stress levels, hormone levels, and other physiological factors. I know with myself, although my Bipolar Disorder is still not managed to the point where I don't have severe episodes, I am still alive and I am able to hold down a highly technical and complex job despite the illness. Both of these acheivements are huge and are a direct testament to the dedication and quality of my treatment team as well as own my unwavering willingness to follow their lead. I believe my psychiatrist will work out the correct pharmacological mix given time. I absolutley trust him. In the meantime, it's hard enough to live with the sense of shame and powerlessness this disorder causes without other people's judgements. Please be careful about that.
    ddnos replied to An_243880's response:
    An_ I wasn't passing judgment; I was curious. I am primarily a logic oriented person, and so my logic was saying one thing while I was seeing another - I wanted to know why. I have no doubt that there are tons of variables as to why for each person such as their diagnoses, meds, therapy, circumstances, severity of symptoms and length of time experiencing them, past abuse, physical health and the list goes on. I'm really not that naive to think there is such an easy fix for anyone. My only question and curiosity (just because I'm curious about something doens't mean I'm passing judgment) was that if someone were on the right meds for them, shouldn't that significantly reduce certain symptoms? If they're not, doesn't it logically mean that the meds they are on are not working well enough for them? I wasn't saying that is the way it is, I was ASKING the docs opinion and/or knowledge on the subject.

    I'm sorry that what I wrote came across to you as passing judgment, but I can assure you, I wasn't.

    Forgiveness is letting go of the hope that the past could have been any different --Unknown
    An_243880 replied to ddnos's response:
    I understand logic. I'm a medical researcher. However, as you well know, treating a complex brain chemical disorder is not straight forward. In medicine, if you have an infection, it's pretty easy to target the bacterium with the right antibiotic and be relatively (but not entirely) certain when the bacterium will cease to be infectious. Bipolar Disorder and medication do not have that simple of a cause and effect relationship. I do cancer research. There are many complex reasons why a "cure" for cancer is elusive despite the billions of dollars spent on research. The more complex the disease process the more elusive the cure. In Bipolar Disorder psychotherapy is invaluable in helping to deal with the emotional, social, and interpersonal fall out of the disorder. The ultimate solution however is a biochemical one. Neuroscience and brain chemisty are in their infancies as sciences and medical disciplines. That is not the fault of the patient. It's the reality of the current science.
    doxielover10 replied to An_243880's response:
    I was the International Director of Sales and Marketing for the third largest medical company in the world. I spent forever working with Pharmaceutical Companies regarding appropriate medication for all illnesses.

    My entire life I have had very strange reactions to medications. This past March I had surgery on a gland in my neck at MD Anderson Hospital. He gave me Salagen to produce saliva, it took 15 minutes and I was in anaphilactic shock , yet I had taken 1200 mg of Seroquel and 12 other drugs for years with no problems. I have a HUGE tolerance for medication as does my father.

    Why does one Bipolar spend all the money they have and another sleeps with everyone they meet.

    I am so miserable right now, I have to have surgery on the gland again and I've had migraines for 3 weeks and I'm in agony.
    jselleck replied to doxielover10's response:
    Doxielover, I hear your pain. I have a high tolerance to medication also, but had a scare a few years ago. I was in a Day Program at a very reputable clinic in Texas and they were messing with my meds. I also changed the type of deodorant I was using. Well first I went blind, then I developed tumor like pockets near my breasts. Now breast cancer runs in my family. My uncle had it, I've had a cousin die from it,, and two fight it into remission. I was freaking out. Luckily my vision returned once they got the right cocktail into me, and the tumors turned out to be cysts and I no longer use that brand of deodorant. I hope you find some relief from your pain. I'll be thinking of you.

    doxielover10 replied to Joseph F Goldberg, MD's response:
    I am now taking 16 different meds, some bipolar, seizure, depression, anxiety etc.

    I was forced to take the lithium and look what happened.
    doxielover10 replied to jselleck's response:
    Unfortunately the only drugs for the horror show migraines I have is that they are chronic.

    As much as I hate it, right now I'm taking Percoset or hydrocodone.
    which all it means is that when taken the pain subsides until the drug wears off.

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