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Does anyone here see a psychiatrist for bipolar disorder whom keeps them unmedicated?

S

Sage

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Does anyone here see a psychiatrist for bipolar disorder whom keeps them unmedicated?

Or minimally medicated?
 
Libra1

Libra1

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Hi Sage and :welcome: to MHF. Hope you make many new friends here. This is a friendly, helpful and supportive forum. (y)
 
D

Dollit

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If you have a degree of bipolar disorder that means medication wouldn't make a great deal of difference then perhaps a psychiatrist would call a judgement shot not to medicate. As for being minimally medicated, then I would hope that would be an aim for everyone. I certainly take the least amount of medication necessary with the blessing of both my GP & consultant and that gives me a great deal of flexibility for the times when I do need to increase or adjust.
 
S

Sage

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Could you clarify "a degree of bipolar disorder"?

I know the classifications have become very peculiar in terms of specificity, and various subtypes of the traditional type I, type II, and now type III, are the result. But what is this "degree" of bipolar you speak of? I know some people are in and out of hospitals all their life, while others don't have episodes for 10+ years at a time, and otherwise live normal lives.

But from my understanding, once diagnosed as bipolar, the medical practitioner is taking undue (professional) risk by providing care for the health of a patient without at least a mood stabilizer.

This is what my original question is about.

How often do you have a bipolar patient seeking ongoing medical care by a specialist and NOT have the specialist require some form of essential pharmaceutical intervention? Is it unheard of? Or do bipolar patients actually manage this?



And by minimally medicated, I mean treatment with something off-label or unconventional. My mother, for example, is prescribed 8mg of xanax per day, but receives no other meds at all. NONE. But I think she lies to her treating physician(s) about her history. Either that, or her docs are unqualified to treat her, because her degree of bipolar disorder is severe.

However, this thread is not about her. I ask for my own reasons.

Another off-label treatment would be tamoxifen:

http://www.ncbi.nlm.nih.gov/pubmed/...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Arch Gen Psychiatry. 2008 Mar;65(3):255-63.

Protein kinase C inhibition in the treatment of mania: a double-blind, placebo-controlled trial of tamoxifen.

Yildiz A, Guleryuz S, Ankerst DP, Ongür D, Renshaw PF.

Department of Psychiatry, Dokuz Eylül University, Huzur Mah, Saffet Baba Sok, No. 27/12 PK: 35320 Narlidere, Izmir, Turkey. [email protected]

CONTEXT: Findings that protein kinase C (PKC) activity may be altered in mania, and that both lithium carbonate and valproate sodium inhibit PKC-associated signaling in brain tissue, encourage development of PKC inhibitors as candidate antimanic agents. OBJECTIVE: To perform a controlled test of antimanic efficacy of the centrally active PKC inhibitor tamoxifen citrate. DESIGN: Three-week, randomized, double-blind, placebo-controlled, parallel-arms trial. SETTING: A university medical center inpatient psychiatric unit in Izmir, Turkey. PATIENTS: Sixty-six patients aged 18 to 60 years, diagnosed as having DSM-IV bipolar I disorder on the basis of the Structured Clinical Interview for DSM-IV, currently in a manic or mixed state, with or without psychotic features, with initial scores on the Young Mania Rating Scale (YMRS) greater than 20. INTERVENTION: Treatment with tamoxifen or identical placebo tablets for up to 3 weeks. Adjunctive lorazepam was allowed up to 5 mg/d. MAIN OUTCOME MEASURES: Primary: change in YMRS scores; secondary: change in Clinical Global Impressions-Mania scores, weekly ratings of depression and psychosis, and adjunctive use of lorazepam. RESULTS: The 21-day trial was completed by 29 of 35 subjects randomized to receive tamoxifen (83%) and 21 of 31 given placebo (68%) (P = .25). Intent-to-treat analysis of available measures on all 66 subjects indicated that tamoxifen treatment yielded mean decreases in scores on the YMRS and Clinical Global Impressions-Mania of 5.84 and 0.73 point per week, respectively, compared with mean increases of 1.50 and 0.10 point per week, respectively, with placebo; both drug-placebo contrasts differed significantly (P < .001). CONCLUSIONS: Tamoxifen demonstrated antimanic properties and was remarkably well tolerated. The findings encourage further clarification of the role of PKC in the pathophysiologic mechanism of bipolar I disorder and development of novel anti-PKC agents as potential antimanic or mood-stabilizing agents. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00411203 and isrctn.org Identifier: ISRCTN97160532.

Traditional tried and true treatments such as lithium and depakote are obsolete. Tamoxifen accomplishes exactly what they do, does it in a fraction of the time, and in a much more direct and elegant manner. Tamoxifen does not have ANY of the traditional treatment side effects. Tamoxifen is a considerably "cleaner" therapeutic.

However, the jury will remain hung for years because studies have not yet been conducted for long-term efficacy. Does it work as a long-term maintenance drug? The answer is most likely a solid "yes," but that's not how medicine works. Doc's need documented evidence to make patient care decisions on -- not neuroendocrine theory and proof of concept work.

BigPharma doesn't usually repackage old drugs for new uses. They will find a new selective compound that can cross the blood brain barrier to inhibit protein kinase C so they can patent it and make money.

So maybe you see where I'm headed with this.



What I want is a doctor that will work with me. I want to know what my odds are of finding the right guy without having to doctor shop for months.
 
daffy

daffy

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Can i ask why you want to know this. Is it for yourself, or a study, or for your mum. If it is for someone you are concerned about why dont you contact the MHT thats treating them.

People need differing medications and the lower the dose the better. Some on here are a large cocktail of meds and treatment whereas others manage without any and may use the facilities of the MHT instead.:tea:
 
D

Dollit

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Sage by degree of bipolarity I mean just that - how severe is it. Not everyone with bipolar disorder is medicated by any means. I take as little as possible and mine is severe enough to stop me working, probably for the rest of my life.

As to how often a person seeking medical intervention and not getting medication happens - I don't know and I'm not sure how you expect anyone here to answer that. This is a forum run by and for those who have mental health problems or who are related to or have some sort of personal relationship with those people. We get few professionals on here.

Your tamoxifen link is inconclusive. It charts a small study that doesn't seem to have been repeated and just because it's on pub med doesn't make it good science it just means it's science and it doesn't necessarily mean that's it a breakthrough drug. There is mention of anti manic properties but none of anti depression and any mood stabiliser has to work from both ends of the spectrum.

Lithium and SV aren't obsolete, they still have an effective place in management of bipolar disorder and will have until something with a proven record of established results supercedes them. And having said that there will never be one drug to cover all the bases.

It seems that you don't want lithium or SV and want someone to give you something different. Sorry but we can't do that here - we're not doctors or psychiatrists.
 
S

Sage

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Your tamoxifen link is inconclusive. It charts a small study that doesn't seem to have been repeated and just because it's on pub med doesn't make it good science it just means it's science and it doesn't necessarily mean that's it a breakthrough drug. There is mention of anti manic properties but none of anti depression and any mood stabiliser has to work from both ends of the spectrum.
Nope, the study I've posted is confirmation -- it IS a repeated study. The original pilot study was done in 2000. This is the original follow-up done by a prestigious, peer-reviewed journal that confirms proof of concept.

The first-in-human trial was in 2006 and was highly successful.

The second pilot last September (of 2007) reproduced the 2006 pilot with greater statistical power.

Way back in 2002, the psychiatric community reached a conclusive agreement that tamoxifen, lithium, and depakote have the same round-about end result, only tamoxifen is direct acting, whereas lithium and depakote are indirect:

http://www.nature.com/mp/journal/v7...l;jsessionid=C3E901739CDDB773E225C99D66D5C820

Mol Psychiatry. 2002;7 Suppl 1:S46-56.

PKC, MAP kinases and the bcl-2 family of proteins as long-term targets for mood stabilizers.

Manji HK, Chen G.

Laboratory of Molecular Pathophysiology, National Institute of Mental Health, Bethesda, MD 20892, USA. [email protected]

The complexity of the unique biology of bipolar disorder--which includes the predisposition to episodic, and often progressive, mood disturbance--and the dynamic nature of compensatory processes in the brain, coupled with limitations in experimental design, have hindered our ability to identify the underlying pathophysiology of this fascinating neuropsychiatric disorder. Although we have yet to identify the specific abnormal genes in mood disorders, recent studies have implicated critical signal transduction pathways as being integral to the pathophysiology and treatment of bipolar disorder. In particular, a converging body of preclinical data has shown that chronic lithium and valproate, at therapeutically relevant concentrations, regulate the protein kinase C signaling cascade. This has led to the investigation of the antimanic efficacy of tamoxifen (at doses sufficient to inhibit protein kinase C), with very encouraging preliminary results. A growing body of data also suggests that impairments of neuroplasticity and cellular resilience may also underlie the pathophysiology of bipolar disorder. It is thus noteworthy that mood stabilizers, such as lithium and valproate, indirectly regulate a number of factors involved in cell survival pathways--including cAMP response element binding protein, brain derived neurotrophic factor, bcl-2 and mitogen-activated protein kinases--and may thus bring about some of their delayed long-term beneficial effects via under-appreciated neurotrophic effects. The development of novel treatments, which more directly target molecules involved in critical central nervous system cell survival and cell death pathways, has the potential to enhance neuroplasticity and cellular resilience, thereby modulating the long-term course and trajectory of these devastating illnesses.

PMID: 11986995 [PubMed - indexed for MEDLINE]

There are other studies showing the same thing, and others discussing the meaning of these findings in greater depth. If you're interested I'd recommend heading to your university library to get a copy of the full texts.


Lithium and depakote are absolutely obsolete.

There will never be one great drug, that is correct. That is the flaw of the molecular, sub-cellular approach. But tamoxifen is a step in the right direction. It doesn't fix the root problem. No drug fixes the root problem. But tamoxifen caps the brain activity that goes wrong in bipolar patients more cleanly than lithium and depakote.

Lithium and depakote are a chainsaw, whereas tamoxifen, comparatively, is a surgical scalpel. Which would you prefer to be operated on by?


However, tamoxifen won't work alone in cases exhibiting psychotic features. In those cases, you need an adjunctive therapeutic specific to the needs of the patient.

Similar goes for depression. Tamoxifen doesn't replace SSRI's, MAOI's, or tricyclic's.




It seems that you don't want lithium or SV and want someone to give you something different. Sorry but we can't do that here - we're not doctors or psychiatrists.
No, actually. My original question still stands:

Does anyone here see a psychiatrist for bipolar disorder whom keeps them unmedicated?
 
D

Dollit

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Perhaps your question does still stand, perhaps you'll have to ask several forums before you get the answer you want on that one. To be quite honest I'm not into having a long and complicated "debate" on off label prescribing on something that hasn't been used in this country and so is a purely academic argument and one which you've seem to have decided you've won anyway. Perhaps someone else has the time and energy but not me at the moment.
 
S

Sage

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I'm sorry you've taken this personally, but the facts stand. They are irrefutable.

You could bring this information to your practitioner and I'm sure he would be very happy to let you try it. The drug is cheap and readily available. It's typically used for treating early and advanced stage breast cancer, and is also approved for use in treating patients at high risk for breast cancer. It is also used to treat female infertility, and in men is used to treat gynecomastia. Tamoxifen has as long of a safe track record as lithium and depakote. It is considered the best and safest SERM on the market. It is most definitely used in the U.S. The argument for its usage is ironclad unless you are female and currently on an oral contraceptive as a means of birth control.
 
D

Dollit

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I'm not taking it personally but perhaps I should make my feelings a little clearer? I'm not interested in a discussion and I am unconvinced unless I see a little more empirical evidence and some that has been carried out in this country. That's not taking it personally it's just a refusal to get into a discussion.
 
S

Sage

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I'm not taking it personally but perhaps I should make my feelings a little clearer? I'm not interested in a discussion and I am unconvinced unless I see a little more empirical evidence and some that has been carried out in this country. That's not taking it personally it's just a refusal to get into a discussion.
Did you even look at the studies I posted? 3 out of the last 4 were done in the United States. All 5 studies I posted qualify as empirical evidence.


By the way, the U.S. is considered tier III in terms of stringency of drug approval. We are not the most advanced nor most heavily regulated country in terms of medicine. Canada is tier I, the European Union represents tier II, and the U.S. follows them. Generally, drug use in the U.S. is considered FAR more liberal here in the U.S. than in Canada and Europe.

In terms of drug regulation, Turkey is a country more stringent than the U.S. They aren't part of the EU yet, but they are trying to become part of it. They are going the extra mile to appease everyone by conforming to everything imaginable. The quality of their research is excellent. Personally, I can't speak for Israel, but I wouldn't throw their work out the window quite like that.
 
Poopy Doll

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Hi Sage. I found your discussion quite interesting. But your question is odd because when people go to a psychiatrist they are going to be given a prescription whether they need it or not.
 
J

jackiesiomara

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Jun 15, 2015
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I see a good psychiatrist. She got me off lamictal. I don't see why they would under medicate anyone unless they're introducing a new medication to your treatment. Talk to your psychiatrist and tell him that combination or dosage is not helping you. Remember everytime you switch meds they often start you on a low dose. In anycase if you no longer feel comfortable with the treatment plan change psychiatrist. I feel keeping good communication with your psychiatrist is important for your treatment
 
G

glimmerofhope

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Mar 4, 2015
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I am diagnosed with Bipolar Disorder II and see a psychiatrist. We have tried MANY different medication combinations over the years but have discovered that I need to be heavily medicated. I don't function well on less medication/lower dosages and I would be inpatient if I were to take nothing.
 
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