Monday, September 23, 2013

'Anti-Psychotic' Drugs and Bipolar Disorder

A few words on the odd seeming fact that all of the drugs for schizophrenia, all of the 'anti-psychotic drugs,' have been found useful for bipolar disorder. Schizophrenia is a disorder characterized by loosening of ego boundaries. As a recent cartoon in the New Yorker captioned 'I can't tell if that is an internal thought or something I already said.' Viewed in a topographic sense, these drugs tighten up those boundaries. I can recall walking down the hall of the ward with the Vice Chief of Psychiatry at the VA and a patient walked up to us and indicated some way in which he had been hostilely treated by Dr. Charles. Dr. Charles would respond passively and entering the nurse's station would take the man's chart and write in the orders 'Mellaril 100 mg three times a day.' The patient had indicated a psychotic transference toward Dr. Charles. The Rx would help the man not project on to Dr. Charles his negative feelings about himself.

Now depression can often be seen as a narcissistic problem; you know a problem of self esteem. The standard mythological portrayal of Narcissus is of a young good looking man looking at his reflection in a lake in ancient times. One might speculate he is having trouble holding a positive view of himself internally. The 'anti-psychotic medication' helps pull the feeling of 'I am beautiful' back into the person. So an adolescent who is both angry that others aren't affirming him sufficiently and depressed that he can't see himself as beautiful might be able to pull his self regard back and not have the depression or anger. And it may be that the fact that bipolar spectrum disorder responds in adolescence much more favorably to anti-psychotic drugs than to other drugs used for bipolar in adults may indicate that the disorder at that developmental age is more basically a narcissistic problem.

9 comments:

Anonymous said...

I feel kind of mixed on this issue. I take these medications as an adult and they have helped tremendously, but I don't think I would have wanted to take them as an adolescent despite my problems. As an adult, I went in knowing that I could end up obese and diabetic due to the drugs so I was able to take action to decrease the odds that that would happen (i.e. exercise, strict diet, etc). As a teen I don't know that I would have had that knowledge or been able to act on that knowledge to prevent some of the side effects. I really think being a fat, diabetic teen on top of everything else I was dealing with would have made my life considerably worse. Kids aren't too kind to fat kids.

I can't say my situation would be the same for someone else, though. For them, maybe it would be worth the risks. These are difficult decisions for sure.

a psychiatrist who learned from veterans said...

You are a much more likely to have benefit than have metabolic side effects. The worst of the bunch of the 2nd generation drugs is Zyprexa. Because if its lack of a restlessness side effect I was told once 'I could be someone's doctor' if I prescribed it. I didn't at that point like the drug but agreed if the person had follow up labs. His fasting blood sugar dropped from 95 to 84, cholesterol went from 110 to 130; so not too bad a deal.

Anonymous said...

Really the only side effect so far is probably the blow to the ego. I think my response to him when he suggested it was, "You want me to take WHAT?" I am going to hope my doctor is prescribing off label.

For all the bad press they get, when they work, they work well.

jesse said...

...That sounded really disturbing. The patient informed the doctor that he felt mistreated, and the doctor immediately decided it must be transference and requires antipsychotic meds. I am sure there is more to this than that, but it just sounded really creepy.

jesse said...

...That sounded really disturbing. The patient informed the doctor that he felt mistreated, and the doctor immediately decided it must be transference and requires antipsychotic meds. I am sure there is more to this than that, but it just sounded really creepy.

Himalee Abeya said...

Depression symptoms has been approved as a significant indication of misbalanced psychological wellness recognized by a feeling of dejection, low emotions and aversion towards all types of activities that begins to impact the individual's actions, thought styles, emotions as well as situation of his wellness.

Psychiatrist Sydney

Anonymous said...

There is tremendous overlap in the genetics of both schizophrenia & bipolar disorder. As a psychiatrist, you should know this.

When genes overlap, presumably pathophysiology does too. So what works for SZ also works for BP. This is borne out in the clinic as well.

Psychiatrist Post-residency Fellow

Anonymous said...

Tu nalga esta hedionda.

a psychiatrist who learned from veterans said...

In re the comment of 'post residency fellow,' thee are 3 classes of drugs which treat bipolar disorder, only 1 also treats schizophrenia.