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    Joseph Goldberg, MD posted:
    Hello all! I am delighted to inaugurate this website and hope that it will provide a useful, lively and engaging forum for both consumers and practitioners to discuss issues related to bipolar disorder. I am both a researcher and clinician and for nearly 30 years have been involved in studying the treatment, course, neurobiology and clinical features of bipolar disorder -- including suicide, alcohol and drug abuse comorbidity, cognition, genetics, and effects on work and social functioning. Much has been learned in the span of a generation -- about both what may be helpful as well as not so helpful. This forum can provide an opportunity for exchange of ideas and information about the myths and realities of bipolar illness and its diagnosis and treatment. Let me get the ball rolling here by posting this discussion topic: if a medicine is begun, intended to treat symptoms of bipolar disorder, how can you tell if it is really having an effect -- whether good, bad or indifferent -- or if a subsequent improvement or decline in symptoms merely reflects the natural course of the illness? How confident are we about cause and effect when it comes to psychopharmacology?
    hisdestiny63 responded:
    Hi Dr Goldberg:
    Are you going to be reading questions and such submitted by the wonderful people of this board? I take Levothyroxine 150mcg, Gabapentin 400mg tid, Paxil 20mg qhs and Seroquel 300mg qhs. These are the meds my pdoc started me on. He substituted Seroquel for Saphris but I couldn't take the Saphris, it made me literally sick to my stomach. On some days yes I feel my meds work, but yet on other days, no I don't feel they are working at all. I have applied for SSDI but was denied initially, that really threw me into a deep depression. I am now appealing for reconsideration and have attained Binder and Binder (I actually attained them 1 week after I applied initally). My 7 yr old son gets SSI for Asperger's Syndrome. He was approved less than 1 month after I applied (same date for him and I). It is very hard right now for me and the family. I am not working and my husband is not working either. I need disability because I cannot keep a job. I have had 15 jobs in the last 10 years. I don't understand social security at all and what they are looking for. My atty said that according to my medical records, the evidence of mental illness in overwhelming. Maybe as a clinician you can shed some light on what they are looking for?
    shawnwest1 responded:
    Could you please tell me if you have a support group on this site for people that are "with" people that have Bipolar...?
    I can't seem to find it..
    Thank you
    snowyowl33 responded:
    Hey Doc,

    Welcome to our crazy board! Great to have you here and it will be fabulous having a real professional here to answer all our questions and steer us along the pathways to health. Absolutely awesome!

    maddie8415 responded:
    Hey Doc!

    I think it's awesome you're asking us this, it's something I've thought of a whole lot. I think that it must have to do with patterns of symptoms in the past and how the medication works over an extended period of time. I think it's too hard to ever know for sure if it's doing anything in the short term due to the natural course of the illness...and even hard to know if it's making a difference in the long term unless the patient has a pattern of symptoms typical to them.
    hope7951 responded:
    Welcome Dr. Goldberg,
    We had a very tight community with a complete mixed bag od new people coming here daily asking if they are bipolar or not. Many get diagnosis from their primary care practictioner who puts them on meds that don't seem to work and come here with symptoms that sound much more like borderline than bipolar. I was diagnosed in 1980 and have been on lithium and an anti-depressant since and stable. I think meds work if you have the illness they were intended for. I beleive bipolar is currently overdiagnosed and then people are given meds as a magic bullet whne normally people only do well with meds, therapy and on-going self-care for life. We've hac many a disccusion here if meds are the problem or the cure. Some here beleive only in supplements strongly There are people here in many stages of recovery.Some have been hear 6 years or more. Some deny their illnes, others don't sccept their illness, and other find their complete identity with this illness..

    When I was diagnosis, it was easier, it was manic depression, there was only one med and you either accepted it or know you'd be in a state hospital for life. Now everything seems to be called bipolars and there ar lots of meds. Many people end you not doing well on atyipcal anti-psychotics they were given on a bad day when they were reacting to some event and saw their Primary Care Psychian for 15 minutes.

    I beleive meds work but only if they are the right illness for the illness you have and only when conbimed with therapy and on-goning lifestyle changes that support wellness. Joye
    Chris_WebMD_Staff responded:
    Welcome Dr. Goldberg! So glad to see you here. I look forward to working with you and this great community!
    robbie2shoes responded:
    Welcome Dr. Goldberg!!!

    maddie8415 replied to hope7951's response:
    I think that PCPs should not be trying to diagnose and certainly not treat bipolar themselves. When I had my first terrible episode my PCP did "diagnose" me as bipolar spectrum but referred me to a pdoc for an emergency appointment (either that or I'd be going to the hospital). I got squeezed in with a pdoc the next day luckily and this pdoc actually waited until he'd seen me twice to use the "b" word. With all the medication out there for bipolar symptms I find it hard to fathom that a PCP would try to prescribe for such a condition. I also agree about people tagged as "bipolar" really having other less common disorders such as borderline personality disorder.

    My point: Pdocs are VERY important!
    bprobin responded:
    Hey Doc and welcome.
    I am going to answer on what i think your asking.
    I am like a roller coster without any meds and have spent many years self medicating off and on. my head never never slowed down must less stop. my head would move so fast that i couldnt think or comprohend anything. would be in the middle of a conversation and have to stop talking brcause i couldnt remember what i was talking about. anyway, I have tried 22 differents meds over the years and nothing seem to work right and just a couple weeks ago i started gettings injections of invege sustenna 234mlgs and I am like a new person. my friends that i am living with are thankful that im on them. they say i am like a new happy go lucky person. I myself feel like a brand new person. I can think and omg its just so wonderful. I can tell that the new meds are working because i can carry on a conversation without having to ask what I was talking about. I can even do a wordserch now. it use to take me a week to do just one and now i can do a couple in a days times. oh my gosh its so wonderful. and as far as the cause of being bipolar1 (very rapid cycling) manic depressions....I blame in on my really really really bad childhood. it was so bad that I dont even remember it. i dont remember who i was till i was 14 and i just remember bits and pieces of my life up to now. The person that gave birth to me was the same except she was and is a really mean person. I refer to her as satin. We do not speak.
    well thats all i go for now! Thank You robin
    robbie2shoes responded:
    if a medicine is begun, intended to treat symptoms of bipolar disorder, how can you tell if it is really having an effect -- whether good, bad or indifferent -- or if a subsequent improvement or decline in symptoms merely reflects the natural course of the illness? How confident are we about cause and effect when it comes to psychopharmacology?

    I started a new medication about 3 months ago and I started a mood chart. The medication has helped but then something happened that was tramatic to me and I know it's not BP II related and I know medication can't fix all problems. The medication is a mood stabilizer called Abilify 5 mg at night along with klonopin a.m. & p.m and amritriptyline (sp) p.m. and 20 mg of lexapro a.m............So I am at the point though that I say I can't do anything ( I don't want to do anything) I feel too down. So now I have taken my meds, I have journaled, I have done my mood chart and I still don't feel any better. Just wait it out and this shal pass.......I just don't know......I do know I am getting tired of everything in my life so much so where it makes me want to isolate and with my car broke down I have nothing else I desire to do.

    Joseph Goldberg, MD replied to hope7951's response:
    Dear hope7951,
    Your point about the extent to which bipolar disorder is under- or over-diagnosed is an interesting and important one. An accurate diagnosis is hard to make on the fly, or with imcomplete information, and there are many other types of mental health problems that can mimic bipolar disorder -- we would call this its "differential diagnosis." Let me cite a link to an online article I had done on this topic for MedScape Mental health about a year ago, which may be of interest:

    Perhaps this is a Discussion thread that this website might want to pursue further -- under- versus over-diagnosis, and reasons for both. Sometimes medicines for bipolar disorder don't work because that isn't the correct diagnosis, or because there are additional problems (like drug and alcohol abuse, or personality disorders) which require other types of treatment than medicines for bipolar disorder. My tip here is that the diagnosis of ANY mental health condition -- and its differentiation from other mental health conditions -- requires time, expertise, and a knowledge of the features that the illness in question does and does not involve. Accurate treatment(s) can only occur after a thorough and rigorous diagnosis...or diagnoses...gets made with reasonable confidence. - Dr. G.
    Joseph Goldberg, MD replied to bprobin's response:
    Dear bprobin,
    Well, nobody knows what causes bipolar disorder -- or any other mental health conditions, for the most part -- though difficult early life experiences with caregivers certainly can be associated with an array of problems with mood, relationships, and functioning. I'm glad that you've found something you identify as being helpful. It would seem to me that one crucial piece of knowing whether or not a medicine is truly helpful is if its apparent effect is persistent and consistent, and not fleeting. In research studies, sometimes patients are given a placebo "lead in" for the first week just to find out if a sudden "flight into health" signals a placebo response -- before the actual drug is even begun. A real response is one that is durable and sustained. I hope this proves to be the case for you. - Dr. G.
    Joseph Goldberg, MD replied to hisdestiny63's response:
    Dear hisdestiny63,
    Bipolar disorder is ranked by the World Health Organization as one of the leading causes of disability world-wide. Many, many things can go into work problems -- ongoing mood symptoms, problems with cognition, or behavior, anxiety, psychosis, and over time, what some people refer to as a "downward drift" -- meaning it can become harder and harder to get back on one's feet after time goes by and patterns of disability become ingrained. Sometimes occupational therapy or vocational rehab can be helpful in identifying areas of strengths and weaknesses that can help someone who struggles with a chronic and hard-to-treat illness find a middle ground; having structure in the day is important to recovery, even if that means volunteer work or attending a day program. Good luck. - Dr. G.
    Joseph Goldberg, MD replied to snowyowl33's response:
    Thanks! - Dr. G.

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