Drug Information

Medication noncompliance in bipolar disorder is generally considered a bad thing -- and it generally is -- but can medication noncompliance ever be a good thing? I would say so, in very limited situations. Read on to see why medication noncompliance in bipolar disorder can occasionally be a good thing.
Sometimes it feels as if your body isn’t yours because of bipolar medication. It feels like the medication takes over your very being. It feels like you no longer have a human body but, rather, a collection of drug-related effects. This particularly happens when you’re getting on medications or tapering off medications, but really, bipolar medication can make you feel like your body is not your own at any time.
When you’re changing medications, it becomes very clear how much bipolar medication changes suck. Being on the first one(s) sucks and changing to the next one(s) sucks, too. And people not on medication may not get this. They may not get what it’s like to have to take medication for bipolar and they certainly may not get why bipolar medication changes suck.
I had dental surgery last Thursday and as fun as that was, managing the pain since has been ever more so. It got me to thinking that mixing bipolar and codeine likely isn’t the best idea.
As many of you have heard by now, the drug ketamine is being investigated as an antidepressant. Yes, the drug known on the street as “Special K” causing it’s users to fall into a “k-hole” is being researched for clinical, antidepressant use. Ketamine has shown promise both in unipolar and bipolar depression. There are many problems with ketamine, though, not the least of which being that it’s a scheduled substance in the United States and thus very hard to get your hands on. It can be done but it’s awfully pricey. There are also substantial side effects like hallucinations to worry about. (Ketamine is typically used as an anaesthetic in medicine.) Luckily, there is a chemical cousin of ketamine on the horizon that appears to work in a similar way to ketamine but without all the unfortunate side effects.
Today I tuned into a webcast on managing bipolar depression. I wasn’t sure what to expect although I was aware the webcast was designed for doctors so I knew the level of discourse would be high. And I must say it was a great hour. Granted, I knew the vast majority of what was being presented but the nuggets of new items here and there definitely made it worthwhile. What’s more is that this view on managing bipolar depression is evidence-based and they present the numbers behind what’s recommended. They make clear which studies are drug company-funded and which are not. It’s the kind of information that I wish every doctor knew. And, if you have bipolar, especially bipolar depression, it’s the kind of information you should know too.
Two nights ago, I was privileged to attend the National Council’s Awards of Excellence dinner. This is a dinner during which we honor and hear the stories of those who won the awards. I was there because the Bipolar Babe won a Reintegration Award in mentorship, and believe me, no one deserves it more. Being a winner, the Bipolar Babe gets $10,000 for her charity. But what you might notice about these awards is that they are a partnership between the National Council for Community Behavioral Healthcare (mental and addiction illnesses) and Eli Lilly and Company. Now, The National Council, . . . advocates for policies that ensure that people who are ill can access comprehensive healthcare services. We also offer state-of-the-science education and practice improvement resources so that services are efficient and effective. Whereas Eli Lilly is a drug company designed to make money. But what I learned while I was at the awards is that the Eli Lilly folks had neither horns nor tails.
Recently I went through a nasty bipolar medication change. I stopped one antipsychotic in favour of another. Of course, this was to improve my overall treatment. And as I’ve said before, if you change nothing then nothing changes, and in this case, I had to change medications in the hopes of changing my mental wellness. It did not go well. What ended up happening was a gradual slide into horrific suicidality. The new med was not effective for me. But I learned something from this experience. Before changing bipolar medications, it’s a good idea to put into place a medication change safety plan.
I am a very difficult case of bipolar to treat. Believe me. I have been on more bipolar medications than anyone I know and finding an effective cocktail is akin to walking on water. It’s possible, but it’s pretty darn rare. And recently I made a medication change from one antipsychotic to another. It went very badly in a whole host of ways. In fact, I terminated the medication trial early and went back to my previous medication. I see my doctor this afternoon and now I have to tell him the bad news about how it went. And I feel guilty about failing another bipolar medication. I know he will be disappointed and I feel bad about it.
Recently, our blogger Natalie Jeanne Champagne wrote a post: Mental Illness: Understanding Rational and Irrational Fears and this got me thinking about the fears I, and others, have had about bipolar medication. Some of the bipolar medication fears are completely justified and rational while some really are not. Some are fears that stem from real possibilities while others are often propagated by fear-mongering groups online or our own internal catastrophizing.