December 07, 2006

The Last Psychiatrist Strikes Again

It's not my standard practice to cop a bunch of someone else's text when linking to them, but when the subject is bipolar disorder and potential tolerance to anti-epileptic drugs (read: Depakote) and the blogger blogging is The Last Psychiatrist, well, I cannot help myself.

"If mania is a strictly biochemical dysfunction in the brain, shouldn't tolerance to its treatment occur? Don't we make patients worse by keeping them on the meds? Or at least harder to treat? And if it isn't strictly biochemical--if we're allowing that life happens--do we really believe that a fixed dose of an antieplieptic is going to prevent a negative response to a life event? And wait a second--doesn't mania spontaneously remit even without medication? Shouldn't we just, sort of, help nature along, or even get out of its way?

I'm not saying not to treat--I'm saying not to overtreat.

A guy is on 1500mg Depakote today. What do you do when the patient relapses? Increase to 2000mg? Then what? When does it stop? When does it not result in polypharmacy?

Any reason--biochemical or epidemiological--why we should not be treating symptomatically rather than prophylactically? Anti-manics when you're manic, then stop them when you're better?

I know everyone thinks Osler helped write the DSM after finding the gene for psychiatry and Hippocrates is jealous because he's balding junior faculty, but perhaps we should go reread The Epidemics and rethink our principles."

Posted by Philip Dawdy at December 7, 2006 12:03 AM
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Comments

I saw that post on TLP. I agree with him 110 percent. Where DOES it stop?

Posted by: Marissa Miller at December 7, 2006 06:05 AM

Here I am again with a comment. How about a 11 yr old kid on 1500mg of Depakote a day and 10 mg of Zyprexa a day, and I put the question out to the doc to remove the Zyprexa due to not being in a crisis state of mind after 5 years?
Doc agrees. Lowers the Zyprexa clear down to 2.5mg. All agree after 6 months on that dose should be fine to remove it totally.
2 months later, psychosis and catetonic.
The following Spring, same thing. Due to being on Lithobid also, it was time to question the Depakote. Nope, couldn't go off of that either.
I feel the same way. Over-medicating and leaving it as that is not the way to go.
Because, yes, where do you draw the line?
Once gone for 6 months to hospitals, they actually shot the old 10mg of Zyprexa up to a whopping 30mg a day, because that is all they could think to do...increase what wasn't working.
Looking at my daughter's case for one example, I think proves that over-medicating and leaving it that way, especially on a growing child's brain is dangerous, deadly, and quality of life removing.
Doctor's always treat life stress with medication, it appears in the Western belief system to be standard practice now.

My daughter by age 17 asked her doc if "this is the meds or me?"

Why not take them until we feel better? becaue I feel the brain becomes addicted to these medications and cannot go off of them once on them long term.

Posted by: Stephany at December 7, 2006 07:56 AM

Kinda off topic, but I cannot read (literally)"The Last Psych" site due to the color scheme. It triggers a blinding headache for me. As do many sites. Probably all related to the possible seizure activity we all have without knowing; thus the mystery solved as to why anti-seizure meds working for bipolar disorder.

Posted by: Stephany at December 9, 2006 09:49 AM

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