5 ms·

I'm a psychiatrist, and I prescribe lithium quite a bit. It really is the gold standard for treating Bipolar I Disorder. Aside: If you are a person who uses th

I'm a psychiatrist, and I prescribe lithium quite a bit. It really is the gold standard for treating Bipolar I Disorder. Aside: If you are a person who uses the word "bipolar" as a synonym for moody or indecisive, I hope reading this will help you understand what actual bipolar mania looks like.

octatoan 11y ago
"OCD", too, is sadly overused.
MichaelGG 11y ago
Yet is it any wonder patients end up going off it so much? Her description sounds fucking awesome. What sane person wouldn't want to experience that kind of thing? Limitless energy, godlike feeling? In fact, apart from the depression and life-threatening stuff, why wouldn't you mostly wanna be like that? I suppose if you have to hold down a job an "be an adult", meh, OK you've got no choice. But if you're otherwise set? Bring it on. Depakote, yuck. Gain weight, feel like shit. Or others that remove all desire (except hunger). It's sad that medicine currently has no attractive offers for strong mental disorders like this.
- phren0logy 11y ago
  It is not a wonder they stop taking medication - at least at first. The second or third time they wake up in a psych ward and realize they have done serious damage to their relationships and career, medication may not look so bad... You are right that many of the medications have serious side effects. There are certainly better choices now than in the past, but there's plenty of room for improvement.
- michaelochurch 11y ago
  I think of the manic side of the spectrum like drinking: at mild doses, pleasant; at high doses, difficult and usually undesirable; at extreme doses, you don't know who you are. Actual mania (not hypomania) is usually more unpleasant, from what I've seen. (I know quite a few people who've had it.) The stereotype is that the happy mania is the "normal" mania, but the anxious, angry, or psychotic versions are more common. I also think (although phren0logy is going to know a lot more about this than I do) that it's very rare for a person to have only the "happy" mania, unless you're talking about mild hypomania that might not even be classified as bipolar (I tend to think of BP as a spectrum and think that 10-20% of people are "on the spectrum", but that's not the same thing as having BP1 or BP2). I've only had one actual manic episode (almost a decade ago) and my current doctor's pretty confident that I wouldn't be classified as bipolar based on recent and current state... but the one manic episode that I had was awful and I'll never forget it. There were flashes of the "happy" mania, but it was mostly anger and anxiety, with not a small number of panic attacks.
- lotharbot 11y ago
  > "Limitless energy, godlike feeling? ... why wouldn't you mostly wanna be like that?" Impaired judgment. The 'godlike feeling' results in thinking you cannot fail, and therefore in making decisions that are not even remotely prudent. For example, I know someone who, during a manic episode, tried to buy a limo off of ebay. From what I understand, the deep depression isn't actually all that dangerous -- you don't care enough to do any active harm. The climb out of depression, where the emotional funk is still present and there's sudden volition, is most dangerous from a suicide perspective. The peak of mania, where you're unstoppable and fearless and possibly thrill-seeking, is almost as dangerous.
  - pests 11y ago
    As someone who has experienced true mania, and the swing from depressed to manic, this entire comment is 100% correct.
- deleted 11y ago
  [deleted]
vezzy-fnord 11y ago
On the other hand, a non-negligible reason for this confusion is that the standard nomenclature for many psychiatric conditions is simply quite ambiguous. Bipolar? Borderline? The former implies there's two fixed states that are evenly transitioned to and from, where the latter implies... nothing immediately discernible.
- DanBC 11y ago
  We constantly learn more about mental illness and refine definitions and criteria and diagnoses. Borderline Personality Disorder is probably going to change to Emotionally Unstable PD. It's a controversial diagnosis which results in a bunch of stigma. (Not just from the wider population but also MH professionals too.) the document "meeting the challenge, making a difference" from UK NHS describes modern best practice for personality disorder, and the problems the illness, and the diagnosis, cause. The old name borderline comes because it was thought to be sub-threshold psychosis style illness. We know now that's wrong. The bi in bi polar just means "more than one" - so someone does not have just mania or just depression. I agree that the jargon being similar to everyday words is problematic. There are very many examples. (Recovery, in England "low secure unit" (which actually have higher levels of security than most MH units) etc etc).
  - reagency 11y ago
    Really? I thought bi=2 and multi=>1 Polar=extreme, So bipolar means "two extremes", and the question is how does one transition between them-- continuously varying across the gamut, or discretely jumping.
rhgraysonii 11y ago
As a developer who has been prescribed this after a fit of what could only be described as 'true mania' in my college years, I consider this statement somewhat disturbing from a personal perspective. I quite literally functioned as a zombie while on this nightmare of a substance. I ended up opting to spend double digit hours a week in therapy and implementing a system of Cognitive Behavioural Therapy over living my life in a cloud of misery after over 4 months on it. I'd rather feel and have to keep myself in check over function as a zombie barely capable of running a cash register or reading a real book. For reference: I've never had a mania or true low since working with it this way, and if I did I would immediately seek a medicated solution knowing the severity of the situation. But, I've managed to hold a full time job, excel my career more than I thought possible, and generally be quite well physically professionally and mentally without it.
- phren0logy 11y ago
  Some people feel that way on lithium, and should probably take something else. I'm sorry it had that effect on you, but it would be a bad idea to assume that's true for everyone. Many people feel much better when they take lithium. Further, your ability to manage your illness without medication is also not typical. I hope it continues to be true for you, as it's certainly true that many of the medications have problematic side-effects.
  - rhgraysonii 11y ago
    As I said to the other comment I replied to, I didn't mean to indicate this was a fact for all. Simply my experience.
- deleted 11y ago
  [deleted]
- alsetmusic 11y ago
  Your experiences in life are not indicative of the whole of the populace and it would be shortsighted to assume that they are. Many people cycle through life both with and without a given medication and find that the world is more manageable when substance X, Y, or Z is in play. Classifying Lithium as a "nightmare of a substance" is a sweeping judgement that, whether intentionally or not, also casts a negative reflection on those who intelligently and rationally choose to employ it daily to improve their quality of life. What works for you is not what works for everyone.
schoen 11y ago
Any other favorite examples of disorders whose names get misused as metaphors? (I guess "OCD" is a common one -- and indeed "depressed" and "schizophrenic" too.)
- DanBC 11y ago
  I quite like the word "schizophrenic" to refer to someone "in two minds" (but not with multiple personalities), and I prefer "psychosis" (or other more accurate terms) to "schizophrenia". But I don't ever user schizophrenia this way because a lot of people strongly dislike it. People use "psycho" to mean "violent". Psycho is close to psychotic, and you sometimes see people use psychotic to mean violent. This ignores the fact that people with psychosis are overwhelmingly not a danger to other people. The psycho there refers to psychopath, which is now rolled into the list of different personality disorders. I think that this is harmful. When people see someone having a psychotic episode in public they'll call the police. If they saw someone having a cardiac arrest or epileptic fit they'd call an ambulance. The police are probably not trained to deal with people who have a mental illness, which results in some police shootings of people with mental illness. (About half the people shot and killed by police each year are people with a mental illness. Since we know that violence is not more prevalent in people with a diagnosis this demonstrates huge over-representation).
- SolaceQuantum 11y ago
  Schizophrenic, psychotic, psychopathic (antisocial), autistic, ADHD.
- sramsay 11y ago
  When I was younger (I'm 45), lithium itself was synonymous with "really crazy." It no longer seems to be regarded quite so negatively. I had a bad reaction to it ("zombification," as we call it), but it has clearly helped so many. Over my lifetime, depression has become something you can talk about without too much stigma (though perhaps not completely), but these other illnesses have a long way to go. "My boss is bipolar." "The weather is bipolar." OCD is similarly treated like a big joke, and not the devastating illness it can be. I wish I could explain to people what it's like to be bipolar. The biggest problem you have is that the feelings of hopelessness, exhaustion, and despair seem to you to be caused by a lack of hope, laziness, and the fact that everything is dark. The feelings of elation, invincibility, the thought that you've "figured it all out, and all the energy just mean that things are going really well -- maybe that you're not bipolar at all! And if you're experiencing "negative mania" (angry, irritable, etc.), well, then it's whatever in front of you that's causing that, not your brain. And this is coming from someone who knows they have this illness. You just can't see it while you're having it. It's only when it's over that you finally see how screwed up you were, and for many people, there are jobs, relationships, and finances left in ruins for you to sort through. What's worst of all is that even the people closest to you can have a lot of trouble understanding it. Why can't you just snap out of it? Get out of bed? Why can't you see that that project is, um, a little nuts? But we just can't. And then even when the medication works, we live in constant fear that it's going to come around again. A lot of us are deeply traumatized by manic episodes (it only takes one). It's like we're watching and waiting for it to happen again. "I feel fine now (or do I)?" The end of that article really gets to the heart of that last bit. Totally heartbreaking.
tsotha 11y ago
I worked with someone who is bipolar. There's no way you could confuse her problem with that of a healthy person who's just too emotional. She needed lithium to have the semblance of a normal life, and even then when she started to get too bubbly we knew someone was going to have to cover her job for a week or two.

octatoan 11y ago

"OCD", too, is sadly overused.

MichaelGG 11y ago

Yet is it any wonder patients end up going off it so much? Her description sounds fucking awesome. What sane person wouldn't want to experience that kind of thing? Limitless energy, godlike feeling? In fact, apart from the depression and life-threatening stuff, why wouldn't you mostly wanna be like that? I suppose if you have to hold down a job an "be an adult", meh, OK you've got no choice. But if you're otherwise set? Bring it on. Depakote, yuck. Gain weight, feel like shit. Or others that remove all desire (except hunger). It's sad that medicine currently has no attractive offers for strong mental disorders like this.

phren0logy 11y ago
It is not a wonder they stop taking medication - at least at first. The second or third time they wake up in a psych ward and realize they have done serious damage to their relationships and career, medication may not look so bad... You are right that many of the medications have serious side effects. There are certainly better choices now than in the past, but there's plenty of room for improvement.
michaelochurch 11y ago
I think of the manic side of the spectrum like drinking: at mild doses, pleasant; at high doses, difficult and usually undesirable; at extreme doses, you don't know who you are. Actual mania (not hypomania) is usually more unpleasant, from what I've seen. (I know quite a few people who've had it.) The stereotype is that the happy mania is the "normal" mania, but the anxious, angry, or psychotic versions are more common. I also think (although phren0logy is going to know a lot more about this than I do) that it's very rare for a person to have only the "happy" mania, unless you're talking about mild hypomania that might not even be classified as bipolar (I tend to think of BP as a spectrum and think that 10-20% of people are "on the spectrum", but that's not the same thing as having BP1 or BP2). I've only had one actual manic episode (almost a decade ago) and my current doctor's pretty confident that I wouldn't be classified as bipolar based on recent and current state... but the one manic episode that I had was awful and I'll never forget it. There were flashes of the "happy" mania, but it was mostly anger and anxiety, with not a small number of panic attacks.
lotharbot 11y ago
> "Limitless energy, godlike feeling? ... why wouldn't you mostly wanna be like that?" Impaired judgment. The 'godlike feeling' results in thinking you cannot fail, and therefore in making decisions that are not even remotely prudent. For example, I know someone who, during a manic episode, tried to buy a limo off of ebay. From what I understand, the deep depression isn't actually all that dangerous -- you don't care enough to do any active harm. The climb out of depression, where the emotional funk is still present and there's sudden volition, is most dangerous from a suicide perspective. The peak of mania, where you're unstoppable and fearless and possibly thrill-seeking, is almost as dangerous.
- pests 11y ago
  As someone who has experienced true mania, and the swing from depressed to manic, this entire comment is 100% correct.
deleted 11y ago
[deleted]

vezzy-fnord 11y ago

On the other hand, a non-negligible reason for this confusion is that the standard nomenclature for many psychiatric conditions is simply quite ambiguous. Bipolar? Borderline? The former implies there's two fixed states that are evenly transitioned to and from, where the latter implies... nothing immediately discernible.

DanBC 11y ago
We constantly learn more about mental illness and refine definitions and criteria and diagnoses. Borderline Personality Disorder is probably going to change to Emotionally Unstable PD. It's a controversial diagnosis which results in a bunch of stigma. (Not just from the wider population but also MH professionals too.) the document "meeting the challenge, making a difference" from UK NHS describes modern best practice for personality disorder, and the problems the illness, and the diagnosis, cause. The old name borderline comes because it was thought to be sub-threshold psychosis style illness. We know now that's wrong. The bi in bi polar just means "more than one" - so someone does not have just mania or just depression. I agree that the jargon being similar to everyday words is problematic. There are very many examples. (Recovery, in England "low secure unit" (which actually have higher levels of security than most MH units) etc etc).
- reagency 11y ago
  Really? I thought bi=2 and multi=>1 Polar=extreme, So bipolar means "two extremes", and the question is how does one transition between them-- continuously varying across the gamut, or discretely jumping.

rhgraysonii 11y ago

As a developer who has been prescribed this after a fit of what could only be described as 'true mania' in my college years, I consider this statement somewhat disturbing from a personal perspective. I quite literally functioned as a zombie while on this nightmare of a substance. I ended up opting to spend double digit hours a week in therapy and implementing a system of Cognitive Behavioural Therapy over living my life in a cloud of misery after over 4 months on it. I'd rather feel and have to keep myself in check over function as a zombie barely capable of running a cash register or reading a real book. For reference: I've never had a mania or true low since working with it this way, and if I did I would immediately seek a medicated solution knowing the severity of the situation. But, I've managed to hold a full time job, excel my career more than I thought possible, and generally be quite well physically professionally and mentally without it.

phren0logy 11y ago
Some people feel that way on lithium, and should probably take something else. I'm sorry it had that effect on you, but it would be a bad idea to assume that's true for everyone. Many people feel much better when they take lithium. Further, your ability to manage your illness without medication is also not typical. I hope it continues to be true for you, as it's certainly true that many of the medications have problematic side-effects.
- rhgraysonii 11y ago
  As I said to the other comment I replied to, I didn't mean to indicate this was a fact for all. Simply my experience.
deleted 11y ago
[deleted]
alsetmusic 11y ago
Your experiences in life are not indicative of the whole of the populace and it would be shortsighted to assume that they are. Many people cycle through life both with and without a given medication and find that the world is more manageable when substance X, Y, or Z is in play. Classifying Lithium as a "nightmare of a substance" is a sweeping judgement that, whether intentionally or not, also casts a negative reflection on those who intelligently and rationally choose to employ it daily to improve their quality of life. What works for you is not what works for everyone.

schoen 11y ago

Any other favorite examples of disorders whose names get misused as metaphors? (I guess "OCD" is a common one -- and indeed "depressed" and "schizophrenic" too.)

DanBC 11y ago
I quite like the word "schizophrenic" to refer to someone "in two minds" (but not with multiple personalities), and I prefer "psychosis" (or other more accurate terms) to "schizophrenia". But I don't ever user schizophrenia this way because a lot of people strongly dislike it. People use "psycho" to mean "violent". Psycho is close to psychotic, and you sometimes see people use psychotic to mean violent. This ignores the fact that people with psychosis are overwhelmingly not a danger to other people. The psycho there refers to psychopath, which is now rolled into the list of different personality disorders. I think that this is harmful. When people see someone having a psychotic episode in public they'll call the police. If they saw someone having a cardiac arrest or epileptic fit they'd call an ambulance. The police are probably not trained to deal with people who have a mental illness, which results in some police shootings of people with mental illness. (About half the people shot and killed by police each year are people with a mental illness. Since we know that violence is not more prevalent in people with a diagnosis this demonstrates huge over-representation).
SolaceQuantum 11y ago
Schizophrenic, psychotic, psychopathic (antisocial), autistic, ADHD.
sramsay 11y ago
When I was younger (I'm 45), lithium itself was synonymous with "really crazy." It no longer seems to be regarded quite so negatively. I had a bad reaction to it ("zombification," as we call it), but it has clearly helped so many. Over my lifetime, depression has become something you can talk about without too much stigma (though perhaps not completely), but these other illnesses have a long way to go. "My boss is bipolar." "The weather is bipolar." OCD is similarly treated like a big joke, and not the devastating illness it can be. I wish I could explain to people what it's like to be bipolar. The biggest problem you have is that the feelings of hopelessness, exhaustion, and despair seem to you to be caused by a lack of hope, laziness, and the fact that everything is dark. The feelings of elation, invincibility, the thought that you've "figured it all out, and all the energy just mean that things are going really well -- maybe that you're not bipolar at all! And if you're experiencing "negative mania" (angry, irritable, etc.), well, then it's whatever in front of you that's causing that, not your brain. And this is coming from someone who knows they have this illness. You just can't see it while you're having it. It's only when it's over that you finally see how screwed up you were, and for many people, there are jobs, relationships, and finances left in ruins for you to sort through. What's worst of all is that even the people closest to you can have a lot of trouble understanding it. Why can't you just snap out of it? Get out of bed? Why can't you see that that project is, um, a little nuts? But we just can't. And then even when the medication works, we live in constant fear that it's going to come around again. A lot of us are deeply traumatized by manic episodes (it only takes one). It's like we're watching and waiting for it to happen again. "I feel fine now (or do I)?" The end of that article really gets to the heart of that last bit. Totally heartbreaking.

tsotha 11y ago

I worked with someone who is bipolar. There's no way you could confuse her problem with that of a healthy person who's just too emotional. She needed lithium to have the semblance of a normal life, and even then when she started to get too bubbly we knew someone was going to have to cover her job for a week or two.