What Do Underperforming Meds Mean for Bipolars

In a prior post, I pointed to research data showing that atypical antipsychotics work well for schizophrenics about 30 percent of the time. Seventy percent of the time, patients switch off whatever med they are taking to yet another atypical, often within a year of taking the first med. This leads to an endless cycle of med switching.

This same phenomenon exist with bipolars, although it remains unstudied with the kind of scientific precision I'd prefer. We are taking tons of atypicals, too, and are half the $10 billion market for atypicals. What I've gleaned from interviewing numerous bipolars, as well as researchers and clinicians who work with bipolars, is that patients switch from atypical to atypical the majority of the time. These meds come with profound side effects--collectively known as the metabolic syndrome--for those who take them.

So why are docs pushing atypicals on bipolars so aggressively when their performance is so weak? Sadly, atypicals are the only meds that work at all for schizophrenia, so I understand why they are used there, as problematic as that use may be. (I don't say that lightly, by the way.) But for bipolars there are far more options than there are for schziophrenics--mood stabilizers and anti-depressants. There are performance issues with these meds as well, but the side effects simply aren't as severe as with atypicals. So why prescribe atypicals so aggressively? Where's the logic in forcing bipolars into an endless cycle of med switching with such powerful meds?

Advocates and clinicians and researchers typically respond that "that's the way it is." Med switching is just something patients have to accept, and if they keep bouncing from med to med, then they will eventually find something that works well. That's a lame, evasive stance to take, one that suits the needs of advocates and clinicians and researchers. But it ignores the reality patients live with. Med switching is a nasty, risky business--ask any bipolar--and often leaves patients more screwed up than they were before.

I am tired of a mental health system that expects patients to accept this state of affairs. The system ignores patients at their peril. The question: When do we push back on the system? When do we, in effect, say fuck this shit? When do demand, not ask for, something else?