Do People Really Get Worse Over Time when Treated?
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Q:  Do People Really Get Worse Over Time when Treated?


I'm BP II. Over the 13 years I've been in treatment, I seem to be on a gradual decline. I initially responded to lamictal, and then stopped responding, and since then it's been cocktail after cocktail trying to find anything that works. Dramatic overreactions to stress, good or bad. Without even feeling stressed, I just get more depressed.

I'm almost always depressed. I've had Dr's throw everything at the wall including oodles of therapy, ECT, triple chronotherapy (seriously, I'm desperate), and VNS and nothing seems to stick.

And now I find myself in the unenviable position of having to face antipsychiatry and antipharmacology folks pretty much daily due to column I write. This is rather challenging due to my own lack of success.

So, what's a crazy person to do? I'm out of good ideas for my own treatment and in the wake of Anatomy of an epidemic, I'm having a hard time even explaining why people should take meds for a mental illness at all. Do people really get worse over  time when treated?

Please help me if for no other reason then so I can help someone else.

- Natasha


I can certainly understand your frustration and that you are feeling discouraged about the lack of response to treatment.  Usually when dealing with a problem of this nature,  I first recommend a thorough reevaluation of the diagnosis to ensure that Bipolar II is the correct one.  This may seem laborious but it is extremely important.  Next I would reconsider some of the prior medications you have tried.  Bipolar illness and its treatment are a dynamic process, so even if you did not respond to a particular medication in the past this does not rule out the possibility that you may respond to it now. Though I can't make treatment recommendations without a thorough assessment, a retrial of the lamotrigine could be useful as it has been helpful in the past.  Another idea to consider is rTMS, and there are some exciting new medications emerging such as the NMDA antagonists.  Though you have had a difficult course with bipolar illnes, I wouldn't lose hope as there are always treatment alternatives available.
Dr Plyler


 Published August, 2011


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