Tuesday, June 05, 2007

Good News/Bad News

A church of Christ preacher made an announcement to his local congregation. He said, "I have some good news and some bad news. This last week, I baptized seven people in the river. The bad news is that I lost two of them in the swift current."

It's unfortunate that so much of the news today, even the good news, is mixed. Frankly, as a bipolar sufferer, I'm always a little hesitant to talk about the positive things that I have happening, for fear that I will in turn have to announce that the situation has changed. That's an issue that people who have BPD (or chronic depression) have to deal with. Is what I'm now experiencing a permanent condition, or will it prove to be temporary?

Over six weeks ago, I mentioned a recent study and consequent debate that challenged the historical approach to treating BPD. March 30, 2007-"According to the Systematic Treatment Enhancement Program for Bipolar Disorder, a large placebo-controlled trial of community-dwelling patients with bipolar depression who were receiving mood stabilizers, adjunctive antidepressant therapy did not reduce symptoms of depression, neither did it increase the risk for mania."

"One group of experts was saying, 'When you get depressed, you should add an antidepressant,' and another group of experts was saying, 'When you get depressed, if you do a really good job with a mood stabilizer, you don't need an antidepressant.'

"This study proved that the latter group (the anti-antidepressant group) was correct, and that it is perfectly reasonable to treat patients without the addition of an antidepressant, as long as you are doing a good job with mood stabilizers."

Studies and conferences of this nature sometimes only add to a BPD patient's confusion. We might say, "If the medical professionals can't agree, who can we turn to for advice about the proper treatment of our disease?" This question only serves to emphasize how important it is for us to play a proactive role in reaching a conclusion about how to best stabilize our condition.

Shortly after I read this article, I spoke with my psychiatrist and passed on this information. You might remember that I had been having an increasingly serious problem with rapid-cycling. My moods were beginning to make a radical change at least twice weekly. Each time I swung into the depressed part of the cycle, I became almost incapacitated. My depressions were horrible. Also, I was becoming terribly discouraged.

My psychiatrist and I decided that it was worth taking a chance on this new approach to BPD. Since I was taking Wellbutrin for depression, I was able to immediately discontinue its use, and increase the level of Lamictal, my mood stabilizer. We increased the Lamictal dosage from 300 mgs to 400.

Within two days my depression began to lift. When I say "lift," I do not mean that it ceased to exist. The most encouraging change was that I was no longer rapid-cycling. On a scale of 1-10, with 5 being a stabilized mood, I went from a depression level of 2 to a level of 4-5. The question is always "How long will this last?"

The caveat is that this treatment approach might work for me, but not for you. As you know, everyone has a metabolism and a brain unique to them. The biochemical structure of our brain changes over time, so that what is effective at one point in time, may not be effective at another point.

Because of these things, I want to temper this "good news," by warning you to seek the advice of your medical professional before making a change in your medications. This is always the wisest course to take.

You might wonder if I would ever go against my doctor's advice. At this stage in my illness, because of the historical problems I've had with treatment-resistant depression, I might take a risk that I would not advise others to take. From my personal point of view, I dont' have much to lose and possibly much to gain. I promise to periodically tell you how I'm doing.

May God bless you. I'll talk to you again, soon.

["I'm so low, I could do a ten minute free-fall off the edge of a dime."]

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