Patient Treatment for Bipolar Disorder Varies Depending on Doctor...

After 40 years of various treatments for BPD "Treatment Algorithms" have never been mentioned by any of the many doctors I have seen. here is a brief summary of the latest medicatyion switch. This information may be of use to others:
__________
10.3.4 Who knows what lies ahead in my dealing with BPD? At the age of 63 I would like to put this story permanently to bed--forever, never to return to another, yet another, chapter in the long tale, the longue duree, to use a French expression. But I have my suspicions that the story is far from over. I am able to work at reading and writing for at least 8 hours in total per day in a series of small time periods most days even after all this experience of bipolar disability. I am still a functioning member of society, but only in certain quite defined and limited ways.
10.3.5 The pattern of behaviour that has become apparent after four months on this new medication package now in September 2007 is:(a) alternating periods of fatigue and sleepiness on the one hand; and energy and enthusiasm on the other—sometimes all within a few minutes; (b) staying up to quite irregular hours, very often until 3 and 4 a.m. and sleeping until 9 or 10 with an hour of sleep in the evening after dinner; (c) a certain excessiveness/speed in speech patterns, a lack of moderation, a lack of control; an overly, overtly emotional state and over-the-topness, so to speak, which is more problematic when I am in groups that I associate with from time to time; (e) a speeding in situations that do not require speeding like: washing dishes, making a cup of coffee, and other domestic and daily activities; (f) OCD, obsessive-compulsive behaviour: straightening & squaring bits of paper, magazines & newspapers on tables and desks and other forms of tidiness much more than in previous years; (g) urinating on average every 80 minutes,(h) a general unpredictability in and fatigue with my reactions to others; and (i) a nightly dream pattern that is more extensive than ever before in my life.

Ron Price
Third Edition May 2007
Draft No.16.
Updated: 6/10/’07.
Age 63
No of Words: 15,400

I'll just add the following to provide a relevant perspective to the above.-Ron Price,Australia

10.1.2 Depending on what study you read some one to five per cent of the population suffers from this illness. The extremes of this illness as I had experienced them before 1980 were largely treated by lithium carbonate from 1980 to 2007. The prescription of lithium(1980) and the addition of fluvoxamine(2003); the changeover to sodium valproate(2007) and venlafaxine(2007) in April/May 2007 each had its own story and problematic for periods of time in the main for less than two months each. By June/July 2007, after 7 consultations with my psychiatrist in the January to July period of 2007 it was obvious that the new medication package was giving good results. My psychiatrist and I agreed that, unless some problems arose, I would not come for any follow-up visits for at least one year, until at least July 2008. This is, then, my latest medication package, my most recent cocktail, as it is sometimes called in the vernacular. There are, as I have said, other packages of medication available and many alternative treatments that people try. I tried many alternatives in my efforts to obtain healing in the years from 1962 to 1980. But in 1980 I settled on the lithium, just the other day, it seems, although it was over 27 years ago. And in the last three months I have worked out—thanks to my psychiatrist--a new and quite satisfactory alternative package.

Some people think of the acronym "BPD" as referring to Borderline Personality Disorder, which admittedly is closely related to Bipolar. Just thinking that some clarification might help avoid some confusion here, unless I'm the one who's confused, lol.

Effexor tends to lead to rapid cycling in those with bipolar disorder. It should be a last resort if used at all in bipolar treatment or in treatment of those with a strong family history of bipolar disorder and or ADHD( often misdiagnosed form of bipolar disorder). I just thought people should be aware.

Thanks, Iamo and Brigid. You raise good points. I'd never thought of BPD as being an acronym for another disorder...and rapid cycling, yes, I think you are right...I'll check that out.-With appreciation.-Ron Price, Tasmania

RonPrice wrote:

Thanks, Iamo and Brigid. You raise good points. I'd never thought of BPD as being an acronym for another disorder...and rapid cycling, yes, I think you are right...I'll check that out.-With appreciation.-Ron Price, Tasmania

Ron I am a Price as well. Good to know I'm not the only Price with BP.

Ron Price wrote:

I'll just add the following to provide a relevant perspective to the above.-Ron Price,Australia
10.1.2 Depending on what study you read some one to five per cent of the population suffers from this illness. The extremes of this illness as I had experienced them before 1980 were largely treated by lithium carbonate from 1980 to 2007. The prescription of lithium(1980) and the addition of fluvoxamine(2003); the changeover to sodium valproate(2007) and venlafaxine(2007) in April/May 2007 each had its own story and problematic for periods of time in the main for less than two months each. By June/July 2007, after 7 consultations with my psychiatrist in the
January to July period of 2007 it was obvious that the new medication package was giving good results. My psychiatrist and I agreed that, unless some problems arose, I would not come for any follow-up visits for at least one year, until at least July 2008. This is, then, my latest medication package, my most recent cocktail, as it is sometimes called in the vernacular. There are, as I have said, other packages of medication available and many alternative treatments that people try. I tried many alternatives in my efforts to obtain healing in the years from 1962 to 1980. But in 1980 I settled on the lithium, just the other day, it seems, although it was over 27 years ago. And in the last three months I have worked out—thanks to my psychiatrist--a new and quite satisfactory alternative package.

Thank you for the information.

My son has not had an official diagnosis of BP. He is a very high functioning autistic individual that was a pistol as a kid, rages, always on the move, sleep disorders, tics etc.

Last year just past his 17 th. birthday he injured his knee had surgery and was off the high school soccer team and on crutches.

During a loose time frame of March to June he experienced a psychotic episode of course I learned of after he was coming out. My experience was the explosive anger and some paranoia but as I sat at UCLA during evaluations I learned of voices, shadows and kids in his math class that could read his thoughts. I was sick my son when through such horror.

He took Depakote from early August 16 until 2 weeks ago when the psychiatrist allowed him to quit but with the agreement he would begin Lamictal this coming Monday. He is refusing to take the medication.

I 'm upset, NAMI and others state that to have the best prognosis you do not want another psychotic episode for 8 months and beyond, the longer the better.

How can I approach a 17 year old with oppositional defiant disorder? HELP.

Pat

He is at a very hard age to deal with. It is natural to want to rebel at his age, and, of course, if he has paranoid tendencies this will be much worse. You can't force him to take his meds. You can only keep encouraging him and remind him of how bad things got before. Remind him of the paranoia and psychosis. It would probably help him quite a bit to find a peer support group in the area. Kids around his own age who are dealing with the same kinds of issues. He will probably take advice from peers much more readily than from you. DBSA has a website where you can look for local support groups in your area. NAMI and NMHA are also good sources of info. You could also ask his psychiatrist or therapist for referral to local support groups. The local Psychiatric hospitals should also be able to provide you with some info re: peer support.

Definitely call his Psychiatrist to let him know that your son is not complying. If he gets symptomatic again, he may need to be hospitalized for his own protection or he may be eligible for intensive outpatient therapy if he is not a threat to self.

I wish you luck.

Thank you.

Thanks for your feedback, folks...let me add a little on childhood and adolescent BPD...it may be useful to some on this thread and others who come upon it in their reading.-Ron Price, Australia
----------
2.6 Comments on My Ante-Natal, Neo-Natal,
Childhood and Adolescence Life: 1943-1963
2.6.1 As I refer to above, I had some experience of what may well have been BPD in childhood as far back as infancy and at the toddler stage, all of the pre-school years, 0-5, of early childhood development. My mother nearly died in the first month after my birth, the implications of which it is not my intention to go into here. If there are any significant implications and events at all in the ante-natal and neo-natal phases of my life I do not examine here. I am inclined to think, though, they may be important in the aetiology of this illness. Before the age of five there is evidence that my behaviour had some of the features of what is now called Attention-Deficit/Hyperactivit y Disorder (ADHD). Perhaps in a later edition of this essay I will attempt a more detailed outline of what I recall from these years of early childhood, but my recollections are minimal and it is not my intention to comment further on these early years.
2.6.2 Through middle and late childhood into the puberty cusp of 12/13 in 1956/7 I did exhibit personality features, behaviours or symptoms that had features of BPD, at least to a limited degree, or so it could be argued if not proved:(a) a lack of control of my emotions, impetuosity, lack of emotional restraint and (b) a far too intense activity threshold what is now called hyperactivity, mild mania or hypomania. I recall at the age of 12/13, at the onset of puberty, exhibiting inappropriate or precocious sexual behaviour, although the particular manifestations only involved one episode which constiuted groping and an attempt to kiss a girl who did not want to be kissed. Adolescent BPD presented me with an accentuation of puberty and teen-turbulence caused by hormonal shifts. Society value shifts in the 1960s accentuated my tensions and behavioural problems more, or so it seems to me, as I look back from the perspective of half a century. My mother’s understanding, commitment, perseverance and patience even though she did not know that I even had BPD is now in my memory bank.
2.6.3 Keeping sexual stimuli under control has always been a struggle to regulate so as not to have it claim too great a share of my attention. With the years, the half century since 1960, the opportunities to go over the top and to let physical/sexual temptations assume too great an importance have increased. My mother took a liberal attitude to my sexual frustrations and this liberal attitude became part of my own attitude to the battles I had to face in this domain of life’s tests.

2.6.4 It was not until much later in life, though, that I began to see my aberrant childhood behaviours and my aberrations at puberty and then adolescence as possibly having a link with my future mental illness. It was not until I was 19 in 1963 that any characteristics of this illness became quite clearly apparent, pathological and, in retrospect, could be called part of a BPD and given that medical diagnosis. At the time, though, in 1963 no doctor would have given, or at least gave me, that diagnosis. Looking back to the age of 19 in October of 1963, I recall feeling a depression so deep it was like ‘a sickness unto death’ that I had never before experienced. It was a sadness so pathological that it made me feel suicidal, like death not warmed over, as one could say colloquially.

2.6.5 One can read about this intensity of depression in many fields of literature and of mental health. The desire to die at the time was overwhelming, but little talked about to anyone, except perhaps my mother, although I honestly can not now recall the extent of my openness with her. She knew I was depressed but neither she nor I really understood the dynamics or the intensity of the depression. I think it was assumed that I would grow out of it. And I did. By December 1963 the depression began to lift. I wrote my December exams and I continued with my first year university studies.

2.6.6 These behaviours, this depression, at the age of 19 or any of my behaviour before that last year of my teenage life(1963-1964), did not result in my receiving any medical attention. The first formal diagnosis of my illness was labelled a schizo-affective disorder(SAD) in 1968. In retrospect, I now see the autumn of 1968 as the first formal mis-diagnosis of my BPD. At the age of 19, though, I was given lots of advice from religious to common-sensical: diet, exercise, prayer, vitamins, interesting leisure distractions/interests like horse-riding, watching TV, music, et cetera. After several months to several years, 1963 to 1968, the emotional aberrations disappeared or could be said to be sub-threshold at least for a time. My episodes over those years and in the years December 1977 to June 1980 seemed to exhibit quite separate and distinct tendencies and patterns.

2.6.7 Hypomania(H) was always characterized by elation and D was always characterized by varying degrees of very low moods. Such an observation seems now to be so obvious as hardly requiring a mention, but at the core of my experience of this problem was either D or H and the impact of their various symptoms. Within those five years 1963 to 1968, though, the permutations and combinations of emotional variation were enough to being tears to the eyes of a brass monkey, as my mother used to say and, as I say, looking back in retrospect. It was a miracle I ever got my degree and my teaching qualifications labouring under such emotional chaos from time to time and often, week after continuous week in a variegated pattern.

2.6.8 Sometimes there was a return of incapacitating symptoms; sometimes I simply exhibited impetuosity or lack of emotional restraint; at other times my moods were expansive, quasi-manic. Perhaps, as some of the BPD literature suggests, I was affected sporadically by the extremes of a psychomotor retardation and agitation which is characteristic of this illness. Combinatory, lateral, uneven, unusually sensitized thinking, particular sensitivity to energy levels and a state of increased awareness were all part of my experience in these five years. It is difficult to describe these five years in retrospect given the bizarre and chaotic nature of the experience. Given, too, a general context of a degree of normality and the inevitable routine and quotidian nature of life that went on inspite of everything, inspite of the emotional problems makes the description, after forty years, difficult.