Dr. Kevin Most: Bipolar Disorder and Depression medication news

Dr. Kevin Most on the Steve Cochran Show

We often take a story in the news to discuss a health issue, sometimes the awareness has an amazing impact. It may help identify a patient who needs early treatment, or help us all understand a little better what some people are going thru with an illness. Last week Mariah Carey had the strength to share with the world her stuggles with bipolar disorder. We all have seen her perform with more energy than we could ever imagine, we have seen interviews where she is magnetic and charismatic. How could she be bipolar? She would not believe the diagnosis for many years, and now that she has and is receiving treatment, she wants to share her story. In order to understand this we need to know what she has been going thru and the struggles she will continue to have.

She shared that she has been diagnosed and is being treated for Bipolar Disorder II. Lets take a minute and understand a little bit about Bipolar Disorder. Individuals with Bipolar have episodes have periods of time when they are depressed and other times when they are felling manic, thus the highs and lows, so it is considered bipolar, hitting extreme mood swings. There are 2 types of Bipolar Disorder, Ms Carey has the type that is less acute, often this type has depressive episodes but the manic phases are less severe.

We don’t know what causes Bipolar Disorder, there are some that have a genetic component, but others do not. Some have a stressful incident that appears to have triggered some cases, but overall it is still unclear as to why it occurs.

For patients with bipolar they will find themselves with changing symptoms, we will share some of those so you may understand and know what to look for.

When in the manic portion of the illness patients may find them with the symptoms below

A feeling of excessive energy, often not even able to sleep

Feeling wired, often unable to control emotions

Displaying inappropriate social behavior and risky behaviors

Rapid talking, loud talking

Disconnected and racing thoughts

When in the depressive portion of the disorder patients will may have the following symptoms

Feeling sad or hopeless

Have no energy, feel exhauasted

Have excessive sleeping patterns

Finding no enjoyment in activities you normal enjoy, including social isolation

Poor appetite/ weight loss

If you know people who you notice have these mood swings, encouraging an evaluation may make a huge impact on their lives.

Treatment for bipolar is often coupled with therapy as well as medication. The medications chosen by your physician will be tailored to your symptoms. They may use antidepressants or antipsychotic medications. One of the biggest issues with this illness is the importance of continued medication until discussing stopping them with the physician. Some whn in their manic pahse feel they no longer need the medication and they stop. This is not good as the mood swing will occur and the antidepressant medication do not work quickly. Often they take up to a month to show the full effects. Physicians may need to try a few medications before finding the one that works the best.

There is a wide spectrum for this illness, some is major depression and some have people just feeling the blues at times. Anyone on the spectrum knows that it impacts not only your quality of life but the quality of life of those around you

As we start to come into some warmer weather and more sunlight, our moods seem to improve. We enjoy getting outside and having some sun and warm weather, it appears to help us get out of our winter funk. This year is no different and in fact may be pushed further into the spring as we have had snow going into mid-April. One thing we need to understand is the winter doldrums are not true depression, Seasonal Affective Disorder is a well-known cause of winter blues. This can be treated with the use of sun lamps, essentially giving the body an exposure to the daylight they so miss in the winter.

Depression however is not about the seasons and lack of light in most people. There has been a lot of research on depression over the past 20 years, many advancements have occurred. We know now that there is a chemical imbalance in many patients with depression, and we now have medication to help correct that. The days of “just shake it off” or “go out and have fun” as possible cures for depression are known not to work.

We must get beyond the social stigma that once was out there for patients with depression. This is not a weakness, it is not something a patient can just shrug off. In many cases it is a life threatening condition, remember there are over 45,000 suicides a year. This number is actually higher as some suicides are not captured as a suicide, and many suicide attempts are actually thwarted with medical care. It remains the 10thleading cause of death in the US.

Forget about going to the extreme of suicide, depression impacts close to 20 million US adults, over 7 % of the overall population. Even this statistic is under reported as the stigma with depression has some suffering silently afraid to go to the doctor to discuss their symptoms. The impact on the individual is sad, the impact on the community is staggering. Think of the quality of life for the patient who is embarrassed to discuss this with their family or their physician.

We need to be able to identify the symptoms of depression and act on them. If it is you personally, you need to discuss this with your doctor. Remember some experts estimates the rate of depression in the US is well over 10%. Knowing that you should be reassured that your doctor has had to treat this and is not judging you, the doctor is there to help you to wellness, both physical and mental. He can’t treat or diagnosis if he doesn’t know the symptoms you are having. There is no blood test for depression. What is more important is if you see someone exhibiting symptoms, encourage them to seek care. We must get past the social stigma, as the treatment can be life changing as well as life saving.

We also need to push for better coverage from an insurance view as well as a clinician view. We have counties in this state that do not have a psychiatrist in the entire county. To help with this we can now allow for technology to help as using telehealth is now allowed for treatment. This allows many who have no opportunity for care to receive care and start treatment, something they had no chance for in the past.

Recent news on Treatment for depression

Treatment for depression is wide ranged. It may be as simple as conversations with a mental health provider, it may be medications and in some cases it may be hospitalization. The largely vast majority are treated with therapy and medication. The success of treatment has risen dramatically as the science behind depression has advanced. Medications have advanced from some meds needing to be taken many times a day and with terrible side effects to once a day medications with minimal side effects. This is good news, however the impact of those improvements now has over 13% of all Americans taking them daily It is very important that you have discussions with your physicians around the use of medications. For some patients the meds may only be needed for a short period of time, sometimes to get thru a life changing event. Others may need medications long term to continue to get the full effect and prevent a depressive relapse.

An article in the NY Times last week highlighted a concern with many patients on these medications for long terms. Some recent studies show a large percentage of patients on the medications for over 2 years. For many this is good news as they have improved their quality of life. For others the thought of stopping the medication is met with some concern. That concern is the difficulty quitting the medications after being on them for a long time. There may be significant side effects in some individuals and in order to get off of them it may require a weaning process. All patients should discuss with their doctors before stopping any medication but this is very true with antidepressants. The reason to discuss is to make sure it is the right thing to do, understand that a weaning period may be needed to prevent side effects and to understand that stopping and starting medications is not successful