Newsgroups: bit.listserv.psycgrad
Date:         Thu, 13 Aug 1992 14:18:54 EDT
              <PSYCGRAD@UOTTAWA.BITNET>
From:         JCV@NIHCU.BITNET
Subject:      Manic-depression and medication issues

I work in the Biological Research Branch at
NIMH where we do research on medication for
people with unipolar and bipolar illness and
anxiety disorders.  The primary focus of our
studies is the drug carbamazepine, also known as
tegretol, an anti-epileptic drug.  Mood swings and
the connection in the brain seem to mimic epilepsy
in the sense that epileptic seizures often start
in response to an external stimulus, but then the
brain seems to be 'kindled' and takes over and
starts patterns of seizures that do not seem related
to an external stimulus, but rather to something
set in the brain.  This is true of bipolar illness, too.
Most manias or depressions seem to occur the first few
times in response to a life event, but eventually
it seems that the mood swings are not related to any
life event, but rather that the brain has 'taken
over'.  We have done a lot of research on this issue
of lithium and people going off the drug because it
is becoming fairly apparant that if you discontinue
lithium, have an episode and then start lithium again,
lithium will never be an effective treatment again.  If
you search through the literature, this is emerging in
a variety of research locales, here and abroad.

The reasons why people go off their medication include the
ones that people have already mentioned.  Here are some
other anecdotes:  Most people are feeling well after being
on lithium for years, don't like some of the side effects and
think, since I am doing so well, why don't I just go off
the medication.  Of course, they are doing well partly
because the medication has stabilized them, and partly
because stabilization gives them a chance to work on
the other problems in their life that get sidetracked
during repeated episodes.  Another reason is someone in
their life will say, how come you're taking that medication,.
or so many medications--you seem ok to me, why don't you
stop that drug.  And so they do.  We have a patient who
was on lithium and a friend of her's said, hey , you're doing
ok on that drug, why don't you stop it.  And she did, and
she had several episodes, and she lost her job and her
husband... and no doubt her very helpful 'friend'.  Another
patient here had a dermatologist say, why do you take all
those drugs, you seem fine, why don't you get off of them.
And they did, and they had episodes and now lithium doesn't
work for them.  (Moral: don't let a dermatologist under your skin!)
Basically, there is a tremendous amount of stigmatism in
this country about taking psychotropic meds.  It's ok to
take insulin if you have diabetes, but god forbid you take
lithium on a regular basis.  We have this attitude that
if you have a mental illness, you should pull yourself
up by your bootstraps, get a hold of yourself, exercise
eat right, stay fit and your mind will take care of itself.
I don't think you can medicate life events, but I don't think
people should be discouraged from taking medication if it
will help.

For all of you that know people on lithium, who are
doing ok on it, and are thinking of quitting because
they are feeling pretty good, remember, it may be that
they are feeling good in part because the drug is helping
them, and if they discontinue it, they may find that it
is not an alternative for them in the future.

Jennifer in D.C.
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