Wow -- I've always wondered if medicated mothers might have something to do with the exponential rise in autism. This is a clue that certainly points in that direction. Seven times more likely to have a kid with autism -- that's huge.

Yes, but I believe I've seen studies showing genetic links between bipolar and autism, so that should be ruled out as a factor.

Still, for some of us Depakote is a godsend. I can't tolerate Lithium, so Depakote is the mainstay of my meds. It really works. And the side effects? Given the choice between Depakote's side effects and the unmedicated me, I'll take the side effects any day of the week, thanks.

Just to clarify a few things in the study from Neurology [2008; 71(23):1923-1924] that Philip cited:

First, the women taking the anticonvulsants did not have bipolar disorder. They were taking them for epilepsy.

Second, the study found an increased risk for autism SPECTRUM disorders (ASD; i.e. autism, Asperger's), and not just for autism alone.

Third, as Philip mentioned, the same sizes are small, 40-75 subjects per treatment group, and so these remain preliminary findings that require additional confirmation.

Fourth, 4 children developed ASD in 64 mothers on vaproate compared to 3 children developing ASD in 336 mothers not on valproate. Comparing a group of 64 to a group of 336 really skews the results. Maybe if the valproate group was also in the hundreds, then the results would be different. More ASD? Less ASD? The same level of ASD? Who knows? Until that study is done, it is all speculation.

Regardless, an interesting preliminary result that should lead to larger trials to clarify the issue. However, if valproate and other anticonvulsants contribute to autism and Asperger's, then that should definitely modify clinical practice.

dguller:

What's laughable and frightening all at the same time is that you say:

"However, if valproate and other anticonvulsants contribute to autism and Asperger's, then that should definitely modify clinical practice."

Meanwhile, a study published last year by Kimford Meador at the University of Florida, and presented at the American Academy of Neurology's annual meeting in Boston, MA, showed that 24% of children born to the valproate-consuming expectant mother had IQ levels at or below the IQ threshold of RETARDATION! Bunch of retarded babies because of an over-touted drug with a crappy safety profile, used negligently as a first-line treatment (for epilepsy in this case).

Neurologists already have "modified" their clinical practice. It is no surprise such a toxic compound is associated with all manner of birth defects. It teratogenic potential has been known for a long time. Yet it is still prescribed to bipolar woman of child-bearing potential as if they are immune to its chemistry.

Also, you know very well the literature is replete with reports of pseudoatrophy of several brain structures as a result of this medicine. You also know that cognitive deficits are one of the most prominent and common side-effect for this particular medication.

It isn't even a safe medicine for people who aren't pregnant. Balancing the risks and benefits is a totally different subject, but that compound is not compatible with long-term good health.

JC:

You are absolutely correct that Valproate is the riskiest anticonvulsant for pregnant women for a whole host of congenital and cognitive abnormaliies. I was actually unaware of many of those risks, and have to thank you for bringing them to my attention.

I was just commenting on that single study and the relationship between Valproate and ASD's.

And you are equally correct that it is ultimately a risk-benefit analysis between a clinician and his/her patient to decide what course of action is appropriate.

However, if a patient must remain on Valproate, then they should be kept at a dose under 1,000 mg daily, which apparently puts them at the same congenital risk as the other anticonvulsants.

my daughter took 1500mg per day from 1999 to 2005 at age 11 to 17.5 yrs old and now has Polycystic ovary syndrome confirmed by specialists that is a direct result of Depakote use. Depakote has a black box warning now for use in women under 20 years old. As a result of the use of that drug she cannot have children, and has increased cervical cancer risk.

re: using it per 1000mg per day? Depakote is efficacious at blood level 100-125 depending on the patient and how they feel. It's monitored by blood level not dosage, and for a clean reading 12-14 hours in the morning after the last dose taken.

My daughter's experience is what I base my comment on, I am not a professional, and my comment is not open for discussion. It's merely anecdotal.

Oh, and it was after 6 years of Depakote use that doctors also "announced" she is Aspergers/Autistic and is currently disabled from a decade of psych med use that occurred as a result from a misdiagnosis of Pediatric Bipolar Disorder. By age 17 she told her psychiatrist she felt extreme agitation on Depakote, and she also gained weight on it.

Dear Stephany,

I really admire your advocacy for your daughter and the fact that you are never afraid to speak up about this stuff.

I'm a guy, but I've read papers about how common PCOS is in girls and women using Depakote and my heart wrenches for you and your daughter. I think it is somewhere over 30%. I know I don't have to ask if you can imagine how effects like that can crush a young woman. You see that in your daughter I'm sure. But I feel doctors too often don't care and often view their patients as asexual. That's aside from destroying the person's ability to actually have children which is a step above and beyond the pale. It's medical abuse. Period. It's distorted and betrayed trust brought about by physicians themselves. (I'm speaking only of psychiatrists.)

I strongly believe that if the fertility of long-term users ( male or female) of psychotropic drugs (atypicals especially) were systematically investigated, I believe you would find high rates of infertility in young men and women.

Neurologists know anticonvulsants, Depakote included, can cause PCOS and aberrant hormone profiles in women and reduced testicular size, axillary hair loss, and aberrant hormone profiles in men. Neurologists got the memo a long time ago, psychiatrist unfortunately haven't. And to treat misdiagnosed kids such as myself and your daughter for all their developing years, and then hold themselves out as professionals, physicians, scientists, healers. A joke.

Personally, and I don't mean to be graphic or paint any pictures here, as a teen on and off Depakote several times, it became clear to me that Depakote caused my pubic hair to fall out. Sadly, I never realized there was anything especially wrong with that until my late teens. I would bet everything I have, that if questioned explicity or examined, of 300 male or female teen depakote users, a significant proportion would display that particular symptom I mentioned.

This compound is terribly toxic and has not one RCT ( whatever they're worth?) to it's name demonstrating its unequivocal efficacy. It's all marketing and prescribing off-label.

Man, woman, pregnant, not pregnant, child, dog -- valproate is not a safe compound and not compatible with long-term good health. You can take it and cross your fingers that you won't develop health problems stemming from it's use, but personally, I'd wager on a comet hitting the earth in the next 5 minutes before I wager on that. Psychiatrists as a whole often deny the damage they do up and down, until the evidence is so overwhelming, that law-suits start pouring in. Then the treatment is forgotten. Repackaged. Re-indicated, etc and then sold off on the public at some future time.

Vaproate has very dangerous chemistry, and shouldn't be a first-line treatment for anything. Most atypicals are actually safer than it.

And to dguller, who according to Google and a guess, is a psychiatrist, or psychiatrist-in-training, and yet is not fully aware of its many and varied adverse-effects.

To your list you can add mitochondrial-myopathy-like syndromes. Everyone knows valproate causes mitochondrial dysfunction, but it does so severe enough in some people to cause actual clinical symptoms.

Misdiagnosed by one of Biederman's colleagues at MGH, and put on valproate and risperdone at age 12, I developed those types of symptoms, which 2 MGH neurology consults and 5 MRIs and a million chemistry panels could not attribute to anything. Uh... the valproate jack-asses!?. To their credit, I believe the neurologists were trying to cover the psychiatrist's wimpy ass, but nonetheless, I was told I might die or my brain might continue to degenerate to the point where I'm a vegetable. Thanks Dr. Biederman! Tough decisions Judith Warner! Looking back on these medical records one doesn't know whether to laugh or cry -- often I do both.

I even had an IQ test done 3 times. One immediately prior to being medicated, one about 3 months after and one after about a year on depakote. Verbal IQ age 12: start. 137, 3mo. 126, 1yr. 116. That decline is almost in exact proportion temporally and quantitatively with whats reported in the literature of patients taking valproate, developing pseudoatrophy of the brain, and then being tested for IQ.

Scary shit. Biederman is going to hell -- sorry to say -- and his "brilliance" as Carlat unfortunately put it the other day, will be buried under the rubble of his quickly toppling career. And all the world's children will be safer for it.

Stephany, I'm always inspired and encouraged when you speak up here and elsewhere. I think you're a great person. I'm gonna pray for you and your daughter.

Take care,

JC

JC,

Thank you.

I think I have said this before, but it needs to be said again: I admire you speaking up as a representive of sort for kids (who are now adults)like my daughter and yourself, who had this tragedy happen. And, again I say I am grateful that you (how else to say this?) made it out alive and able to speak out.

Bravo to you, and hugs too.

Stephany

JC:

You are certainly correct that Valproate does have significant side effects that must be carefully considered whenever it is prescribed. I certainly was unaware of many of them, and have been looking into correcting my ignorance.

Before I respond to some of your important points above, I would like to apologize for the difficulties you went through due to the medications you were on. I wish cases like yours never occurred as they are extremely tragic. Again, I am sorry.

Now, regarding your ponts:

First, Valproate does have an increased risk of causing PCOS in women. A recent review article in Current Medicinal Chemistry (2007; 14(26):2799-2812) reports that the rates of PCOS in bipolar women who use Valproate range from 6-42%, but generally cluster around 9-15% (p. 2806). The studies that they cite were all small and involve 25 to 238 subjects and used different definitions of PCOS (p. 2807), and so larger studies with more uniform definitions are needed to clarify the rate.

Also, they mention that it is unclear what the baseline rate of PCOS is in the bipolar population independent of medications. They cite some studies that found high rates of menstrual abnormalities in bipolar women before they were diagnosed and treated. One found 50% of 80 bipolar women reported menstrual problems before diagnosis and treatment (Bipolar Disord. 2005; 7(3):246-59).

A similar situation occurs in women with epilepsy, and so it is hypothesized that the neurobiological underpinnings of epilepsy and bipolar disorder can influence the hypothalamus and pituitary gland, which could affect reproductive hormone levels. There are still many questions, but it is good practice to regularly monitor patients on Valproate for reproductive changes.

Second, you claim that there is not one RCT that shows that Valproate is unequivocally beneficial in the treatment of bipolar disorder. I am afraid that you are incorrect. Here are a few RCT’s that show that it is superior to placebo for acute mania in bipolar patients:

-- Arch Gen Psychiatry. 1991; 48(1):62-8.
-- JAMA. 1994; 271(12):918-24.
-- J Clin Psychiatry. 2006; 67(10):1501-10.

Third, regarding your comments about the effects of Valproate on mitochondrial function, I have pulled a few articles on the subject, and you are absolutely correct. In some individuals who are have inborn errors of metabolism in their mitochondria, then Valproate can exacerbate the defect and trigger a toxic syndrome (J Inherit Metab Dis. 2008 Apr 4). However, these are extremely rare occurrences.

Again, thank you for your comments. I have certainly learned from them.

JC,

I also forgot to add that my daughter lost hair and once off of Depakote her hair grew back. If she would get her haircut, the hairdresser was always shocked at her hair coming out in clumps.

Again, I'm glad you are here sharing this important story of yours.

This compound is terribly toxic and has not one RCT ( whatever they're worth?) to it's name demonstrating its unequivocal efficacy. It's all marketing and prescribing off-label.

This just flat-out isn't true. Follow the links below to read about randomized trials demonstrating Depakote's efficacy.

• A 12-week, open, randomized trial comparing sodium valproate to lithium in patients with bipolar I disorder suffering from a manic episode
• Divalproex in the treatment of acute bipolar depression: a preliminary double-blind, randomized, placebo-controlled pilot study
• A randomized, placebo-controlled, multicenter study of divalpoex sodium extended release in the treatment of acute mania

To your list you can add mitochondrial-myopathy-like syndromes. Everyone knows valproate causes mitochondrial dysfunction, but it does so severe enough in some people to cause actual clinical symptoms.

Could you point me to your source on this? My search didn't turn up evidence to support it. I did find a couple of articles about people with a previously existing mutation in their mitochondrial DNA having very bad reactions to Depakote, but nothing saying Depakote caused the mitochondrial mutation.

Ok, first of all:

lkhllywd: I'm not going to answer any of your questions, because you have posted here before and you are too ignorant of the available facts, that even if I did waste my time directing you to them, I'm certain you would disagree with everything that is published, because I know we disagree on nearly everything already. And historically, it seems facts are of no consequence to your rigid positions.

dguller:

I don't have enough time to respond completely, but I'll do my best right now.

First, thank you for directing me to those 3 papers concerning valproate's efficacy for acute mania. I made a mistake in not specifying what there is no evidence for, and by that, I meant without typing it, there is no evidence as far as I know supporting Valproate's use for bipolar maintenance, which is with few exceptions, the only way its used in practice by psychiatrists, it would appear. That also says nothing about its safety as we all know. LastPsychiatrist posted about this earlier this year, you might want to check over there for a lot more details.

Secondly, I appreciate your apology concerning the results of my mistreatment, although I would like to point out that 1) It is a very common and 2) that it is both COMMON and NEGLIGENT! It is definitely not tragic either. Being physically abused by a family member is tragic. Honestly, though, I do appreciate your profession-al (?) apology.

About valproate and PCOS. First of all, I have not read that review. Second of all, I did read a review some time back that placed the number where I said it was. I don't have the paper and will try to look though. However, more importantly, you are wrong in trying to draw a connection between epilepsy/bipolar disease and fertility and menstrual abnormalities in these patients. First of all, that is characteristic of psychiatrists and physicians in general to "blame the patient " for untoward or inexplicable effects from treatment. In effect though, the "disease" is "blamed", not the patient per se. This phenomenon is at it's worst when psychiatrists try to speculate between metabolic abnormalities in schizophrenia unrelated to medication, smoking, and sedentary lifestyle. There are a few reviews that call this speculating out on its ridiculous face. There is NO physiologic evidence of this, and thus is just a politically expedient explanation to deflect responsibility. I have actually read a lot about epilepsy and this controversy, it's my understanding the field is moving away from the speculation that epileptics have something inherently aberrant in their physiology that causes fertility, most especially, considering this would be rather easy to disprove, and I believe has been.

I have not read the paper you talk about that asserts a wildly high rate of "menstrual problems" and how that relates to PCOS in untreated bipolar women. But I would like to point out that the analogy of epilepsy's pathophysiology being related to bipolar disease is worn out, and most importantly unproven! You people talk about kindling and other minutiae happenstances in the brain without any coherent evidence or context.

Psychiatrists (some) because they regularly don't treat actual bona fide diseases make a lot of mistakes in interpreting sparse and inconsistent, sometimes incoherent, evidence of this or that as supporting a particular theory floating around. Unlike most medical specialties, they don't stop there, but then go one step further in promulgating the unproven theorizing as a neat fact and treating the condition accordingly with disappointing results.

The fact is, we don't know much at all about bipolar disorder's pathophysiology and a little humility would go a long way in this discussion.

There is no rational reason to think either, that bipolar young women (Biederman et al definition), who actually do not have bipolar disease, but trauma/attachment/ tempermant / and developmental issues PP;), have anything inherently aberrant in their physiology that would cause these devastating abnormalities. Such an assertion would also be very easy to investigate, but to my knowledge, and unsurprisingly has not been. Yet we know and assume PCOS develops in them at the same rate. In fact, in case you didn't notice one such person's mother regularly posts here. I personally know 2 young women from my unfortunate travails. Similar situation, both have PCOS. Listen, blaming the patient or disease in psychiatry, seems generally to be a horrible strategy in the long term, always. And while you tried to pawn off the devastating disorder pathetically, to the reproductive organs of previously healthy women, I'm afraid you have no way around my last point about fake-bipolar young women. Unfortunately here in the US, we have such awful experiments going on like business as usual everyday. I guess what I'm trying to say is I find the position taken by many physicians including yourself that their is any coherent, proven explanation for this obvious issue is as unsurprising as it is irrational.

Mitochondrial dysfunction -- first of all, you might want to "pull-up" some more articles, because some report the syndrome stemming from valproate without the inborn errors of metabolism you're speaking of. Again, a little humility.

And I know you ARE a doctor, but a little advice: -- testing you're patients with imprecise tests may make you feel better about youre hope that this or that compound isn't causing biological detriment, but in fact that's all it does, is make you feel better ( and hopefully the patient). That says nothing to the unfortunate reality that you or I, or the rest of the world have no way of accurately discerning in many instances.

Again, a little humility please.

lkhllywd: I'm not going to answer any of your questions, because you have posted here before and you are too ignorant of the available facts, that even if I did waste my time directing you to them, I'm certain you would disagree with everything that is published, because I know we disagree on nearly everything already. And historically, it seems facts are of no consequence to your rigid positions.

That's interesting, because what I've posted here in the past have been either links to published studies and information, accounts of my own experiences with certain medications and the mental health system, or my own opinions regarding the rather savage nature of some of the commenting that goes on here. In which of these areas am I "ignorant of the available facts?"

What exactly are these "rigid positions" I hold, and how can you possibly come to the conclusion that "facts are of no consequence" to them, whatever they are? And why do you presume that I would "disagree with everything that is published?" Maybe because you presume that I'm ignorant and heedless of facts anyway?

You're wrong there. You'll rarely find anyone more interested in facts and more willing to dig until they're found.

And now this from your reply to dguller:

Mitochondrial dysfunction -- first of all, you might want to "pull-up" some more articles, because some report the syndrome stemming from valproate without the inborn errors of metabolism you're speaking of. Again, a little humility.

No...YOU pull up some more articles about the above. YOU'RE the one making the claim, so you should provide the supporting evidence. I'm fully willing to accept that such articles exist if I can just see them.

lkhllywood:

First of all everything I said to dguller still stands.

But most importantly, I would like to apologize to you, for being too harsh. I apologize for insulting you and presuming what I can't know. I apologize deeply. I'm truly sorry for offending you.

I wrote that response in haste at a public computer. I lost my universities subscription service, so I can't readily or efficiently search for the articles I mentioned. I plan on it. I need to borrow my brothers password.

My larger point and one that is an established fact is that valproate is toxic and can even be toxic when used in what is considered the therapeutic range. I have been prescribed the drug. I've experienced all its effects and I also understand that it helps some people and that it is a fine balance of risks and benefits, like a lot of medications. My assertion which no one has to agree to, is that with regard to it's toxic effects, I believe they are vastly overlooked or obscured by blood-level monitoring and liver enzyme tests, for instance. I think it lulls some prescribers into a sense that it can be used long-term with no ill effects. It is also my understanding that there is no evidence for its efficacy in maintenance of bipolar disorder.

Valproate is a toxic compound, it inhibits beta oxidation of fatty acids in mitochondria and inhibits mitochondrial urea cycle enzymes. It generally rieks havoc on the cell respiration cycle, and may or may not cause clinical symptoms. That doesn't mean there isn't harmful processes going on.

Because it affects such basic processes in cell respiration the effects of valproate are multi-system. Some cases of mitochondrial myopathy from valproate have been related to a point mutation A3243G in the mitochondrial DNA. Still it's mere speculation to insist that this particular mutation is the cause of the susceptibility in metabolism that was simply worsened by valproate. To my knowledge that hasn't been investigated. It's at the least very misleading to simply attribute the syndrome to the susceptibility that the mutation imparts, because unfortunately we have no direct way of knowing whether that is a necessary factor, and even if so, to what degree or in what way it brings about the dysfunction There is additionally no reason to believe there are inborn, negative gene mutations that precipitate or are needed to explain every adverse event in an organ system as a result of taking the drug. For instance, it isn't proven that VPA liver failure is due to a genetic susceptibility, but its been speculated so.

I can remember in retrospect one funny (or sad?) incident in a hospitalization where the doctor was "stabilizing" my VPA level. Several days before I was approved to leave, the staff mentioned my breath. It had fruity odor. I was expelling ketone bodies, which is one obvious sign of mitochondrial dysfunction, yet I had no other overt symtoms (aside from really bad sedation). The day I left the doctor told me the levels were too high and to cut the dose. Wow.

That Valproate causes mitochondrial dysfunction, is an established fact. Sometimes its bad enough to causes clincial symptoms, sometimes it isn't, sometimes it causes a metabolic armageddon.

Stephany: I can't imagine what that was like for your daughter to have her hair fall out. I can guess it must have been awful. I had a male friend whose body hair fell off. Don't worry though. Aren't you a little optimistic though that Biederman's work is gonna come crashing down sooner than we all hoped? I know I am. Over the past 2 years I felt generally pessimistic about this particular subject though. Don't worry, he'll get his. And you always have your story, like me, to speak power to truth. Hang in there. We'll make it. And thanks as always for sharing your voice.

lkhllywd: Again, I apologize immensely. I shouldn't have wrote what I did. And I apologize for making those untruthful assumptions.

Take care.

JC,
Yes, we have our stories, and sad though that we have them. I wish you all the best, and thank you for your kindness.

JC:

First, Valproate does have some evidence to support its use in the prevention of depressive relapses in bipolar disorder. Please see Neuropsychopharmacology. 2003; 28(7):1374-82.

Second, you claim that I am incorrect regarding the relationship between epilepsy, bipolar disorder and menstrual problems. I merely mentioned a hypothesis described in the review article that I cited in my post in the journal, Current Medicinal Chemistry (2007; 14(26):2799-2812). Other articles that support the notion that epilepsy inherently causes menstrual problems in some women include:

-- Neurology. 2006; 66(6 Suppl 3):S23-8.
-- Neurology. 2003; 61(6 Suppl 2):S27-34.
-- Seizure. 2008; 17(2):111-9.

I could keep going, but I’ll stop here. Perhaps if you would cite the articles that argue against this hypothesis, then that would be helpful.

Third, you are correct that we do not know much about the pathophysiology of bipolar disorder, but we are learning more and more with passing time. We do have a long way to go, however, and acknowledging that fact should result in humility, as you rightly pointed out.

Fourth, you comment that women who do not have bipolar disorder, but have developmental issues secondary to attachment problems and trauma, have PCOS rates identical to women who do have bipolar disorder. Could you please cite studies in support of this?

Fifth, an increased baseline rate of menstrual abnormalities in women with epilepsy and bipolar disorder compared to the general population is not inconsistent with Valproate increasing the rate further for menstrual problems. My only point was that the actual rate is controversial, because we do not have a good grasp yet of the baseline rates.

Sixth, I agree with lkhllywd that the onus is upon you to cite articles in support of your contention that Valproate results in clinically significant mitochondrial dysfunction in individuals without genetic vulnerabilities in the form of inborn errors of metabolism in their mitochondria. I cited an article that contained case reports of a toxic syndrome secondary to Valproate exacerbating inborn errors of metabolism to support my position. Please cite your supportive evidence.

Another anecdotal comment:
After 19 months tapering Effexor and 3 months being in hell with withdrawal symptoms I had to go back to Effexor.
I was feeling so bad that my psychiatrist prescribed Depakote.
I took it for 6 months. When I felt that Effexor has made the withdrawal hell go away I've noticed that I was feeling some symptoms that I never felt before.
I remember of cramps and terrible pain on my back among others.
I've read the leaflet and found all side effects I was feeling there.
I've stop taking Depakote and recovered.

Dguller,

You write:"Third, you are correct that we do not know much about the pathophysiology of bipolar disorder, but we are learning more and more with passing time."

What exactly is it you mean by the vague term "bipolar disorder," and could you give us a bit of the "more and more" we (who is that precisely) are learning.

Bipolar disorder is not a specific disease but a vague term.

lkhllywd: Again, I apologize immensely. I shouldn't have wrote what I did. And I apologize for making those untruthful assumptions.

Take care.

Thank you, and you take care as well. I'm very sorry you've had such terrible experiences with Depakote. I'm currently having some Depakote-induced hair loss troubles myself, and am trying to lower my dosage to a point where I can benefit from the drug and keep my hair at the same time.

Depakote works better for me as a mood stabilizer than anything else I've tried, by far. I intend to give it every opportunity to keep working. The side effects that relate to child bearing don't concern me, as I won't be having any children. The PCOS is a bit more troubling, but it's a bridge I'll cross if and when I get to it.

Is Depakote a toxic compound? I guess in the strictest sense you could call it that. But many drugs are toxic compounds. Lithium, for example, was far more toxic to me than Depakote, even at supposedly non-toxic levels.

I've said this before, but here it is again: for me, it's all about weighing the benefits of a medication against any side effects it may have. And for now, Depakote's benefits far outweigh its side effects for me.

Sally:

By "bipolar disorder", I am actually referring to the DSM-IV criteria for it.

The "more and more" can be found in the following intriguing review articles:

-- For the various neurocognitive and brain imaging studies in bipolar, see Dialogues Clin Neurosci. 2008;10(2):153-63.
-- For the interesting idea that neuroresilience is compromised due to problems with BDNF in bipolar, see Expert Rev Neurother. 2008 Jul;8(7):1101-13.
-- For the specific neuroendocrine, neurotransmitter and intracellular signaling systems that are hypothesized to be compromised in bipolar disorder, see Expert Rev Neurother. 2008 Jan;8(1):93-110.

Have a look, and tell me what you think. But there is excited research looking into the various underpinnings of bipolar disorder.

Pancreatitus is another black box warning to watch for with Depakote use

Bipolar disorder is not a specific disease but a vague term.

On what do you base this assumption?

I don't want to speak for Stephany, but she could base her "assumption" on the fact there is no identifiable pathology by which to recognize the "disease".

Well, Sally wrote the comment that is in question above, but I can safely say if bipolar was a disease my daughter sure has not found the cure for it via medications, and most people are not prescribed potent chemicals such as over a dozen psych meds and ALL antipsychotics available for a wrong diagnosis which was childhood bipolar disorder.

It's not too often I hear of a patient of any kind being treated with medication for a decade for an abstract idea, which is what bipolar is in essence.

IF she in fact had a disease that was identified, she either would be well, healed, cured or something other than brain damaged and left with a body that has been battered by a life time of meds based on a psychiatrist's DSM version of pharma-funded-and-induced-by-greed-crap.

Wait until the DSM-V comes out where ALL human behaviours will be found and most all will be treated with antipsychotics!

dguller:

You tell sally to look at these papers. I have not looked at them and I maybe will, soon, maybe. Having said that, they've all been published this year. At the risk of sounding naive, I'm gonna have to go ahead and say that these are all hypotheses. We don't know what "underpins" bipolar disorder. And you even "slipped" and directed to her a paper that hypothesizes something. In science hypotheses are continually refined. I know, but you people too often mistake hypotheses for facts, and then go and treat them accordingly. Science unfortunately hasn't come that far. For instance, we still don't know what causes cancer. Some good ideas. Sadly though the gene mutation theory looks pretty bunk right now. So when you come to bipolar disorder and most mental illnesses in general, there is a double standard for the kind of science accepted. All theories about any mental illness currently have no explanatory power. In any other field people would quickly disregard a hypothesis that can't predict anything. Not in mental health research. No ones calling them out on it. And I also have to add that the human genome being mapped is probably the worst thing that could have ever happened to psychiatric geneticists. They now have to disregard all their theories. We have to accept that their are no single gene psychiatric disorder's and probably none caused by even a number of genes. And certainly none caused by multiple "tiny contributions", which at this point couldn't even be considered wishing. There are few overwhelmingly genetic diseases and isn't the cancer field figuring that out now? But psychiatrists go on and on making over-inflated and usually delusional claims. They have an excuse for every failed theory, it has to be genetic or microbial. Because a boot in a baby's mouth doesn't count for anything -- plus Dr. White Bald Middlegage just doesn't see any of those patients.

and lkhllywd: I want to mention because I forgot to. What I said is a completely different subject than recognizing suffering and impairment and treating it in a way that is comfortable to the person in question. I still believe what I said. But what I just said in this comment is just as true and completely aside from its status as a disease in the strictest sense.

JC:

What is the "identifiable pathology" identified with every case of delirium, dementia and autism? And if there isn't one, then would you conclude that these are not diseases? What are they, then?

JC:

Sorry, I didn't see your post above, and so I am only responding to it now.

You claim that I stated that it is a FACT that the underlying neurobiology behind bipolar disorder and epilepsy DOES affect the reproductive hormones. Here is what I actually wrote:

"A similar situation occurs in women with epilepsy, and so it is hypothesized that the neurobiological underpinnings of epilepsy and bipolar disorder can influence the hypothalamus and pituitary gland, which could affect reproductive hormone levels. There are still many questions ..."

"Hypothesized ... can influence ... could affect ... still many questions ..." Does that sound definitive to you?

You write: "A boot in a baby's mouth doesn't count for anything." If you implying that psychiatric theories of the etiology of mental illness is exclusively genetic or infectious, then you are wrong. The environment plays a huge role, including early childhood experiences. I am unaware of anyone who claims otherwise, except from various congenital diseases, such as Down's syndrome or Turner's syndrome, for example.

Other than that, I agree with much of what you say about scientific hypotheses. :)

Depaokote surely is toxic, especially at high doses and when used for a long time frame. I have a friend who was on Depakote for years to control his epilepsy. He switched doctors and the new doctor said he was way overmedicated on the Depakote. This doctor also found out that his brain had shrunk significantly. She decided to wean him off of depakote. When he was coming off of the Depakote, he was nervous, agitated, and his emotions were all over the place. Finally, he discovered from his new doctor, that the Depakote was what made his brain shrink. He's 42 and has the brain mass of a 70 year old. So now they think they can stop his brain from shrinking any further, but he'll never get back what he lost.