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March 26, 2013

BehindTheMedspeak: 9 drugs for bipolar disorder means none of them are much good


It's an iron axiom of medicine that if there are many treatments for something, none of them is very effective.

Consider hiccups, for which tens, scores, hundreds of remedies exist, none of which always or even often work.

Bipolar disorder is in the same boat: there are innumerable drugs used by millions around the world to try and control this devastating and tragically oftimes fatal disease, yet none of them is a cure.

The graphic up top, from an excellent piece by Bethany Halford in the latest Chemical and Engineering News, demonstrates this quite nicely.

March 26, 2013 at 12:01 AM | Permalink


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Perhaps if we knew the cause of the disease, and/or why some drugs seem to help (I am unaware of a true "cure" as opposed to non-chemical coping mechanisms) the number might come down. Or go up...

I compare it to people who are apalled that I do not eat many common vegetables and insist "Peas are good for you!" Thankfully, there are lots of alternatives because I happen to be allergic to green veggies*, the greener the worse my reaction. Why I am allergic is unknown. And if peas were the only vegetable, well, I'd probably have died long ago.

* But apparently not to green fruits, such as limes or Granny Smith apples. Again, WHY is unknown.

Posted by: John A | Mar 27, 2013 1:53:18 AM

A teaspoon of sugar seems to cure my kids of hiccups.

Posted by: Fred | Mar 26, 2013 11:53:52 PM

In about 99% of the cases, drugs are a cure of the symptom not the cause. And without curing the cause, nothing is going to change for very long.

The one thing almost all shrinks and psychiatrists are taught is that drugs will only wear off quickly, but patients never seem to want to hear this, and more importantly, neither do the insurance companies.

Drugs are SUPPOSED to be used to start off a patient into intense therapy to change the root causes so that they can see real change, and then move them out of the drug treatment almost as quickly as they start. You find the treatment works in about 80% of the cases when administered in this fashion. However, most people will tell you that they are the rare 1% of the cases that therapy doesn't work, and only a simple lazy take a pill every day works. Even though a year or two later, they've upped the dosage a number of times and now of their 6th new med and the cocktail just keeps expanding. 100% of the people I've spoken to when I was pretending to be a therapist were in that very 1%.

Ain't no one got time for nutthin' but a pill.

Posted by: clifyt | Mar 26, 2013 5:11:13 PM

notpollyanna: Well put. Though I will tell you that EVERY single drug used for general anesthesia will work 100% of the time on EVERY patient. The trick is to be able to wake them up. Heh.

Posted by: bookofjoe | Mar 26, 2013 3:02:10 PM

Not very effective overall doesn't mean that none of these are effective for individuals. If, say, Geodon works for you, that is fantastic, but I wouldn't call it "very effective" when it fails so many other people. With psychiatry, it seems more like a process of finding the needle in the haystack; there are lots of pills that won't work and a very few that will, on an individual level. For anesthesia, according to Joe (who I am trusting because I know nothing of it), it is more like avoiding the hay in a needle-stack; there are only a couple that won't work and lots that will.

Also, in my experience, Geodon is like swallowing Satan himself. So. So. Bad.

Posted by: notpollyanna | Mar 26, 2013 1:51:32 PM

There are many different drugs for the same ailment because there is no one drug right for everyone. We all respond differently to medication. If you are dying from a disease and your deathly allergic to the one and only cure. You would want a variety at hand to cure you. One pill does not fit all.

Posted by: nellouise | Mar 26, 2013 11:23:25 AM

Marianne, your point is insightful and appreciated by this gas passer. Anesthesia is another kettle of fish entirely, though: a million different drugs are used and work well—general anesthesia works 100% of the time. Trust me on this.

Posted by: bookofjoe | Mar 26, 2013 8:34:16 AM

Thanks for this Joe, your depressingly pragmatic take seems to be exactly right in my experience, but the nasty side effects of available treatments, and the euphoria and mild to severe delusions associated with manic episodes further compounds the problem, resulting in strong temptations to be non-compliant with any treatment regime.

My sister has extremely severe bipolar disorder, and sadly, is also acutely sensitive to the side effects of any and all treatment cocktails tried to date. The result is that she constantly skates at the edge of dosages required to control manic episodes, and lives a life deeply compromised by both the medication and the problems associated with partly uncontrolled bipolar disorder.

Posted by: Don | Mar 26, 2013 6:34:52 AM

From personal experience, I have to disagree. I have worked with my psychiatrist to find the right 'cocktail' of drugs that controls my bipolar disorder. It would take up far too much space and too much of the reader's time but it boils down to this: The life I'm living now is far superior to the life I was leading three years ago.

I'm taking two of the drugs mentioned and several others, besides. I don't think I've ever before known such calmness within myself. There were too many days when I sat on the couch, on my hands, watching the minutes tick off the clock and saying, "There. I didn't kill myself that minute. Let's see if we can make it one more."

Posted by: Becs | Mar 26, 2013 5:47:59 AM

Not like anesthesia, where one size fits all?

Posted by: Marianne Kandel PMHNP | Mar 26, 2013 12:43:02 AM

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