Right on! I agree 100%. You should add in the new Bipolar 3. Supposedly, no SSRI/SSNRIs for them, but atypicals seem to work :)

As in any good business model, the atypical makers will not meet their goals for 2010 unless they have an increase in rate of "serious disorders" among the groups "so hard to bring in", such as whistle blowers (cause distress to others), animals (big NEW market potential), reptiles (full of negative symptoms), teenagers (we KNOW they are crazy), the elderly (sad, lonely?), pregnant women (very moody), those under 1 year old (i actually heard this talk, Phillip) AND of course, anyone, who is experiencing human tragedy or drama, and are distressed or in adjustment disorder (myself).
I have even heard talk of indications for those with more than 4 serious life events in a short time. This just blows.
With all these NEW indications, they can then meet their shareholder's intrinsic expectations for growth. I wish you freedom from pain in the near future.

Love and Peace,

BK

This is really excellent commentary and thank you for making it. The only thing I'd like to add is that in addition to stretching the diagnosis to include a whole lot of decent creative folks who get a buzz of extra energy from time to time there's something even more insidious going on and that is, drug-induced mania and bipolar disorder. First the industry "sells" depression (easy to do) and gets a whole lot of people on antidepressants and then a certain percentage of them become manic, even psychotic, as a RESULT of the drug, and this opens up a whole new market for even stronger drugs. This is definitely part of what's going on -- manufacturing the sickness in a number of different ways. It's great for business.

thank you Philip! I'm linking to this from my blog. I've been wanting to write something of this nature, but have not been well. I'm so glad you did it for me (and much better then I would've done it anyway!)

This is a great post.

It makes me think about how in the "old days" people were classified as good ol' Type A personalities, hot heads, or eccentric creative artists, etc. Now we are manic, O.D.D., O.C.D, M.D.D and hypersexual; all symtomatic of the new SBD spectrum, and officially being slammed down on hardcore chemicals.
The world without music, art, literature, theatre, or fights on a baseball field or hockey game---can we imagine such a place?
My psych asked me if I drank wine with dinner as a way to self-medicate. I told him I liked wine with cheese, and as far as classifying it as self-medicating--what's worse? that --or the all day stupor Seroquel was leaving me in, unable to function--and basically legally bombed.

This Pharma attack on society is unbelievable. We will be a changed country. Once everyone is on a medication of some sort---and more are than admit---we will most likely never see another Van Gogh or Pete Rose come out of the crowd.

Just wanted to note that BP-III is "created" from taking antidepressants.


and...

http://www.psychiatrictimes.com/psychiatryNews/showArticle.jhtml?articleID=199400206&cid=BreakingNews


The criteria for subthreshold bipolar disorder were:
Recurrent subthreshold hypomania (at least two criterion B symptoms and all other criteria for hypomania) in the presence of major depression.

At least two episodes of hypomania in the absence of recurrent major depression.

Recurrent subthreshold hypomania in the absence of major depression.

Sounds like just someone who has been happy once or twice in his/her life.

Hi Phillip,

Hmmmmmm . . . I have mixed feelings about this posting. I have just been diagnosed as bipolar and I have just been prescribed Seroquel. A twofer. Frankly I don't know what to think.

For the past several years, I have been on a cycle with antidepressants where they work for a while and then diminish. I work my way to the upper end of the dosage level and when that stops working I get changed to another. I've burned through Prozac, Paxil, Effexor, Lexapro, and now Wellbutrin. It was after my latest response to the increase in Wellbutrin, shooting my anxiety levels through the roof and causing my moods to change directions faster than a fighter jet in an air show, that my doctor decided that I may be suffering from something other than chronic depression and GAD. Thus the Seroquel. At this point I don't care about the label; I just want my brain back.

For the past week I've been reading everything I can find on the net about living with bipolar disorder. That is how I found this blog. For that I would like to offer a "Thank You" for the information you provide.

They'll just say, "Oh, I'm SBD."

In general, people always have an excuse for their behavior. It was alcohol, it was drugs, it was the stress, people are mean, people don't understand, it was physical pain, my mother/father/wife/husband/partner/God didn't love me enough. And then there are the multitude of psych dxs and people using those dxs as excuses even tho they have not been diagnosed as such. I hear all the time from people how they're a little OCD or a little manic.

The majority of people want to take a pill to feel better. Psychotherapy of some flavor works about as well (at least from the studies I've seen), but it takes time and it takes energy and it will involve looking at the bad bits of your life. People in general don't want to change their diet or exercise more if it would mean that they would feel better. Taking a pill is easier and plus adverse side-effects give you something else to blame/use as an excuse. Because that's what people do. A lot of people get mad because they want a better pill. Really, we all just want a cure. We don't want unruly kids and we don't want to feel sad and we don't want to be a lot of things. We want to change and we want to embrace easy pre-packaged solutions (see current Oprah fad).

I am so not interested in living in this normed world--the one without weirdness of any kind.

And what about those who are weird but don't want to have to deal with despair? A lot of weird folks who fall within the bipolar spectrum do medicate themselves, with drugs/alcohol/sex/codependence. Which is the better approach; psych meds or the others? All of the above will fuck you up if you're not in control of how you are medicating yourself. Then again, it's hard to have control when you're crazy.

A diagnosis is a label. A category used to bucket together like observations of behaviors. Everyone is looking for some demarcation in psychiatry. Yes you are crazy or no you are not. Human being are just unique enough so that will probably never happen. A million things make us who we are (genetics, environmental, biological, etc.) and maybe a spectrum approach to mental illness will be the correct paradigm. Maybe 4% of the population is bipolar. Maybe we should only worry about it if you are BPD I or when someone needs help. That's pretty arbitrary too. I've had 5 or 6 dxs in my time.

I wonder if SBD is really going to cause all that many more psychiatric dxs. How many people go a dr (psych or gp) and complain of emotional issues and don't get prescribed and rx? How many people then defer on treatment until they have more info? How many get a second opinion? So now people will be told they have SBD instead of depression. Is there really a difference?

This could backfire. Letting 5 or more percent of the population in on the dirty little secret that there is no "bipolar specific medication" only cast-off crap that does nothing more than produce side effects could be a bad thing for them in the long run.
*gasp* they may have to resort to actual research and development.
On a lighter note (or not)this is not as funny now, my pdoc and I actually joked about "what next, BP-IX for people who are a little down a couple of times a year and get excited at Christmas?"

@Craig

You said "I just want my brain back." I have to honestly say that you may not get it back following the "throw stuff at the wall and see what sticks" approach to prescriptions.

For example, I just saw my doctor for a problem with excess mucus. Yeah, pretty gross, tell me all about it. Nobody has been able to help me. None of the specialists, and not this doctor. He told me that I was out of his realm and that perhaps I should see another bunch of specialists over at the University of Utah. Then he gave me a bag full of Nexium samples because maybe I was having acid reflux problems which could cause hyper mucus production. I wasn't complaining about acid reflux, but there I was with a shiny, new bag of meds.

Doctors are too casual in their willingness to experiment with their patients' minds. You need to be proactive and less trusting. I'm with Philip on this one. "Side-effects" is too kind a word. I was treated for ADHD and Depression with Desoxyn and Zoloft and became neurologically damaged after only three weeks on the drugs. Which one did the damage? Both have been linked to inducing chronic motor tic disorder. Now I have it for life. I was better off before treatment.

I, too, used to move from antidepressant to antidepressant. Each med lost its efficacy rather quickly for me. The dosages went up, the side-effects went up. I gave it all up and worked on my own theories of thinking positive and forcing myself to be optimistic instead. Much better results. I now know that what I did was discover Cognitive Behavior Therapy on my own. I saw a CBT for a while and it was very helpful. I highly recommend it. Try to see one who can help you with medications as well. He'll want you to become more independent and will help you ween yourself off of them over time, but until you learn how to change your thinking patterns it will help to have them as a crutch, assuming they aren't damaging you. If they are damaging you get off them immediately. You might want to at least consider getting a second opinion before letting your current doctor use you like a lab beaker. And I hope you'll take my intensity for what it is - one depressive trying to help out another depressive before he is damaged by meds. I live with Depression but I can control it. It will take time but I'm willing to bet that you can learn to control it, too.

Philip, excellent article. Thanks for posting it.

~Douglas
-=-
The Splintered Mind - Overcoming Neurological Disabilities With Lots Of Humor And Attitude

I think this posting has generated a very interesting discussion. Thank you again, Phillip.

I would like to keep harping on my belief that people who have the tendency to hypomanic, should be very careful what drugs they take, even if they are prescribed.

I think that if a drug like Wellbutrin, makes you anxious, then they usually give you a benzo. Then if you get sleepy they give you aderall; then if you still feel racey they recommend Seroquel....

My impression is that primary care MDs DO NOT want to deal with psychiatric problems, so they try to push drugs which makes the MDs feel better, but not the patient.

I asked 3 MD psychiatrists if I should taper Neurotin (gabapentin) or could I quit cold turkey. They all said just stop. I was sick as a dog from doing that rapid tapering.

Thanks again.

---I asked 3 MD psychiatrists if I should taper Neurotin (gabapentin) or could I quit cold turkey. They all said just stop. I was sick as a dog from doing that rapid tapering.---

Not to mention it's an anticonvulsant, and therefore stopping cold-turkey is a good way to court seizures.

Too many MDs are trying to be psychiatrists and the flooding of our society with this new diagnonsense doesn't make it any easier.

Yes, many are all too willing to assign a pill to whatever problem you come in with, whether they are actually qualified to or not.

The poor fellow with the mucus problem had a doctor simultaneously telling him he was NOT qualified and yet giving him medications anyway.

And now we are doubling the "afflicted".
Oh we got trouble.

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