Looking For: A Little Good News, If I Can Remember It

You know what I like? A little good news. It doesn’t really seem like all that much to ask. You know, just not the constant drumbeat of gloom and doom.

But apparently ever since T.S. Eliot had the brilliant insight that April was the cruelest month, with all those lilacs breeding out of the dead land, or whatever the lilacs were up to, things just haven’t gone right come springtime, and that, apparently, is as true for those with bipolar disorder as it is for mystics, poets and fools.

One April publication after another on bipolar disorder (BD). . .well, failed to spread cheer, shall we say?

The feeling that this wasn’t going to be an ‘all hail the luck of those with BD’ started on a personal note, with my visit to the doc. He happens to be a truly lovely person, one of these sweetie pies, so very kind that he can’t get his four-year-old to sleep through the night.  The type (you may remember this from the old days of medicine) who gives his personal cell number to his patients. (I’m sensing skepticism but I’m totally for real.)

I was complaining to him– yet again – about how ECT had really taken a toll on my intellect, and, in case he had suffered any memory loss from going through the process with me, I was reviewing my academic pedigree for him one more time. Probably tired of hearing about my Ivy League graduation or the honors I had accrued (how, I ask you, could one tire of this conversation?), he reminded me – nicely, of course ––that I was not just suffering cognitive damage from ECT alone. Oh, no. No no no.
Bipolar disorder itself -– which I had known, but had–of course–forgotten–takes a very real cognitive toll on its  sufferers.
And lest you think that impairment improves during euthymic episodes, the April issue of the Journal of Affective Disorders published a piece entitled “Longitudinal course of cognitive deficits in bipolar disorder: A meta-analytic study,” letting me know that the cognitive impairment one experiences during a manic or depressive episode is apparently one and the same during the entire course of the illness.  I do find this a hard one to swallow: am I really as totally hopeless on a day-to-day basis as I am when profoundly depressed? If he believes this, it’s no wonder the doctor responded as he did, apparently thinking that little art projects might be the wave of my future.
Just to finish off that interaction: It was time, the doctor informed me, to forget about returning to my life as it was before, and rather to start imagining new avenues for myself.
He seemed to think they might involve what I do to pass time now–for example, making no-sewing fleece blankets, which, it is true, does challenge me to cut fabric in a straight line, and then actually tie a knot. You know, like you learned in pre-school?
In an article with a title that bodes no good, “The Case for Polypharmacy in the Treatment of Bipolar Disorder” [in the interest of full disclosure, this is an older article from the Psychiatric Times, published on May 1–but it’s close enough to April to fit our the cruelest month theme] it’s bad enough that author Robert Post argues for more and more and more drugs for the BD patient (he must have an ‘in’ with my doctor).  But still worse, Post states right out in the first paragraph: “Recent evidence suggests that the illness is not as benign as originally considered and in some . . . settings, patients remain symptomatic almost half of their lives despite . . . treatment in the community. Bipolar disorder has considerable morbidity and mortality, both from suicide and medically related premature death.”
At least, my thinking might go, if I take all these meds my doctor has thunk up for me, along the lines of Post and his ‘case for polypharmacy,’ well, things ought to go well then, right?
Perhaps not. While it’s true that at times relapse can be correlated with med changes, another (April) study made it clear that taking gobs and gobs of medicine is not actually enough to keep you out of the hospital.
The April issue of Psychiatry Research found that a shockingly high one-third of bipolar patients admitted to the psych ward were taking at least four psychotropic medications when admitted.
Author Lauren M. Weinstock and her colleagues point out that the these findings are a bit, well, problematic (you’ve just got to appreciate her use of the adjective ‘enormous’).  Says the doctor, the results “reflect the enormous challenge of symptom management” in bipolar I disorder and the “fine line between help and harm that clinicians face” because monotherapies for [bipolar disorder] often are ineffective.
So I hear what you’re telling me–those eight different meds I take, six times a day–they do precious little to guarantee I won’t have to go back to the booby hatch.
But that really isn’t where the bad news about taking these meds ends. I mean, we all know the obvious: the antipsychotics put weight on you, often enough to cause serious metabolic problems, a number of the drugs interfere with your white blood count, which doesn’t work to your advantage, I assure you. We all know about drowsiness, headaches, dry mouth, constipation, sexual dysfunction blah blah blah.
But of course nothing cheers one up quite like finding out that medications for their BD are wreaking havoc elsewhere in the body.
For example, on April 26, Dr. Keith Roach, from the Detroit News (where I get all my most sophisticated psychiatric information, of course) informed us of some lovely new facts about lithium, an old standby for many bipolar people.
He cheerily responds to a question from a parent:
“Dear B.V.: Lithium, an effective treatment for bipolar disorder, can have many effects on the thyroid. Lithium can cause a goiter, an enlargement of the thyroid gland, in 40 percent to 50 percent of people who take it. Lithium also inhibits the thyroid’s ability to make thyroid hormone, so the TSH level (a signal from the pituitary gland to make more thyroid) goes up. In addition, lithium may cause excess thyroid release and autoimmune thyroid disease.”
Goiters, huh? Well, there you have it then.
I’m about to have pity on you and you can thank me later. I’m not going to address the (April) article in Clinical Psychiatry News whose upbeat title really says it all: “Speech comprehension worse in bipolar mania.” As if the poor manic person didn’t have enough to worry about without some random researcher assessing his speech comprehension as his thoughts take off.
And I won’t talk about the poor pregnant woman, who really has enough to worry about as it is–but surely was cheered by Futurity’s promise that BD symptoms can get worse around pregnancy. [In fact, the authors took no pity on those poor souls, but rather wrote that symptoms could be exacerbated during pregnancy and. . well, look, the title really does my work for me: “BIPOLAR SYMPTOMS CAN GET WORSE DURING (AND AFTER) PREGNANCY.” Written in caps like that.]
Nice.  Really. Makes you just want to stand up and cheer. And then there was the study published April 9 in the Journal of Clinical Psychiatry which found that two-thirds – that is correct, if you are standing in the middle of two people, and you look to the left and you look to the right, you better be praying your head off, for only one of you is going to come out unscathed  – of those with bipolar – and that can be bipolar I or bipolar II –will relapse within the mean time of 208 days.
I mean, is a year of peace – or a (sizeable) bit little less than two-thirds of year of peace–so much to ask for?
April truly is the cruelest month.
And there’s just this one paltry day left, thank goodness.
It gives new meaning to American’s favorite goodbye:  Have a nice day.

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