People often have a different idea of what “recovery” means in relation to bipolar disorder.

Some think of it as no longer needing to take medication or see a doctor or therapist. Others may think of it as regaining control of their lives with medication, therapy, lifestyle changes, and/or other approaches. Some people don’t view bipolar as an illness (they may even view it as a gift) and seek lifestyle changes as a way of accommodating their extreme highs and lows.

What does “recovery” mean to you?

If you’re taking a selective serotonin reuptake inhibitor (an SSRI antidepressant) that doesn’t seem to be working very well and you take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, to relieve pain, that NSAID may be the reason why your SSRI isn’t working.

Recently Paul Greengard PhD published a report in an online journal that strongly suggests that treatment with NSAIDs may reduce the antidepressant activity of SSRIs. Their research is based on the theory that depression is at least partially related to the body’s inflammatory responses. This is called the cytokine hypothesis and is based on observations that some chemicals released as part of inflammation – cytokines – are involved in regulating neurotransmitters such as serotonin.

NAMI Indiana has some very valuable information about what to do in a psychiatric crisis in Indiana. It actually publishes a small book called What To Do in a Psychiatric Crisis in Indiana.

Along with that, you can go online at namiindiana.org, click What to do in a crisis, and click your county to find out which Community Mental Health Center (CMHC) to contact, the number to call for police, whether the police have Crisis Intervention Team (CIT) officers who are trained to respond to people experiencing a mental health crisis, and additional helpful information.

Basically, what you do is contact people who can help:

When you’re experiencing a major mood episode, having key information available is essential to ensure that everyone on your treatment team is brought into the loop and the doctor on call has detailed information about your medications.

If everything’s on an even keel right now, you probably don’t want to think about the possibility of a future crisis, but a period of relative calm is the best time to prepare.

Prepare an information sheet that contains all of the following information:

Cathi asks…

My friend’s 9 year old has had severe behavioral problems and several alternating diagnoses. The Dr. has prescribed Focalin, Trileptal, Lamictal, and Seroquel. She has no concentration, violent outbursts, hallucinations, etc. She has been diagnosed, at present, with ADHD, Bipolar, ODD, and PDD. She will not do work at school; instead, she sits and picks at her skin. She has been violent and tried to choke other individuals. Mam says she can’t even leave the house with her.

My friend has no money. The state has removed an older child due to DMH reasons. She is afraid of the state agencies, but has nowhere to turn. Court appointed attorney said to call if she won the lottery. What happens to these children? These medications seem excessive and risky considering her age, the possibility of adverse interaction, and off label usage. Any advice or help. We are desperate. Thank you.

Dr. Fink answers…

This is an all too common situation in children with multiple levels of developmental, emotional , and behavioral symptoms, especially when the family’s resources are limited. The first place to start is with the current doctor to get a clearer picture of the reasons for the current medications and to express clearly the ongoing symptoms that are not being addressed.

A new report from the British Psychological Society entitled “Understanding Bipolar Disorder” suggests that viewing bipolar disorder solely as an illness with a biological basis may not be the most effective approach. The report seeks to re-establish a balance of biological and behavioral. Here’s a summary:

This report provides an overview of the current state of knowledge about why some people tend to experience periods of extreme mood and what can help. Much has been written about the biological aspects of bipolar disorders: this report aims to redress the balance by concentrating on the psychological aspects, both in terms of how we understand the problems and also approaches to help and treatment. We hope this report will influence the way in which services are delivered, so that more people have access to psychological treatments and that services will no longer insist that users accept one particular view of their problem.

Please check out the report and let us know what you think.

Added later: Although the report is free, you must register for a free account, login, add the report to your basket, and then proceed through the checkout process, but you won’t be prompted to enter a credit card number or anything like that.

After checking out, you’ll see a receipt showing that you’ve been charged nothing and providing a link you can click to download the report in PDF format. The report is 88 pages long.

Photo by DeepBluC, available under a Creative Commons attribution license.

Chris asks…

Can long term (decade+) acute pain from an artery joining a vein directly in the spine that causes legs to not work very well lead to bipolar? Person has master degree in Mech Engineering and a MBA. Started to make poorer decisions which led to job loss, went on disability, divorce, severe ruminating, depression, possible suicidal thoughts, inability to think things through, sense of being lost and blaming one’s self for all that has gone wrong, fear or what is going to happen and impulsive behavior that cost his life savings.

He knew what to do but didn’t do it to prevent such a large loss of savings. He is seeing a therapist for mental health reasons and a regular doctor for his physical impairments. A lot of his symptoms I’ve seen in several bipolar individuals who I am familiar with. He asked me if he could be bipolar. Therapist thinks pain.

Dr. Fink Answers…

According the NPR health blog “Shots,” three psychiatrists at Harvard University who were leaders in research on bipolar disorder in children were punished over not disclosing payments from drug companies for research and other activities totaling more than $4.2 million dollars. (See “Harvard Punishes 3 Psychiatrists Over Undisclosed Industry Pay,” by Richard Knox.) The psychiatrists cannot accept any payments from industry for one year and must seek approval for any such payments after that period. Additionally they will suffer a “delay of consideration” for promotions and advancements in their institutions.

The doctors’ public response to this suggests that they felt that they operated in good faith and that they now realize they should have paid more attention to the details regarding disclosure.