I often recommend The Bipolar Disorder Survival Guide by my friend Dr David Miklowitz. You can also find general information about lithium and other treatments for bipolar disorder on the Mayo Clinic website or on some of the webmd links. Your doctor also should be fully explaining to you any drug he or she prescribes and answering your questions about your own unique treatment.
Dr GView Thread
Dear Dori, WebMD can't give you specific treatment advice or recommendations -- only a doctor who is evaluating and treating you can do that -- but generally speaking, if someone has bipolar disorder and is currently having (hypo)manic symptoms (or hypomanic symptoms during depression -- so-called mixed depression), antidepressants could make current mania symptoms worse and the standard of care would rather routinely be to eliminate antidepressants and focus solely on mood stabilizing drugs that have both antimanic and antidepressant properties, such as the ones I mentioned in my prior post. Dr. G.View Thread
Dear dori5011, Bipolar II disorder would mean that you experience periods when you feel neither depressed nor like your usual self, but instead have high energy, less need for sleep, fast thoughts, overconfidence, and overproductiveness -- but those symptoms don't cause trouble for you or get in the way of your finishing projects (which would be bipolar II disorder). People with bipolar disorder who have 4 or more distinct episodes over the course of a year are said to have rapid cycling during the past year. When there have been 4 or more episodes in a year, antidepressants have been shown not to be helpful and may in fact lead to more episodes, especially more depressions. Generally speaking, antidepressants can cause mood changes to go from depression to mania in about 10-20% of people with bipolar disorder, especially people with bipolar I disorder -- so the risk is fairly small. The bigger risk than antidepressants making things worse is that they mainly have been shown to be neither helpful nor harmful for most people with bipolar depression. Seroquel, Symbyax and Latuda are the "standard" treatments for bipolar depression. There is no evidence that antidepressants increase the chances of developing suicidal thoughts in people with bipolar disorder and more or less than in unipolar disorder, and in fact a recent study from the NIMH Collaborative Depression group found that antidepressants did a better job in preventing suicidal behaviors in bipolar than unipolar patients. So, antidepressants tend to get a bad rap in bipolar disorder but much of the bad rap may be due to the illness itself, and not treatment with antidepressants. Dr. G.View Thread
I may have missed something in the exchange of posts...but, while it is normal and human for both a therapist and a patient to attach importance to a relationship that has emotional depth, there isn't particular value in a therapist telling a patient that they loved them, which can be a confusing and boundary-bending statement. It's certainly appropriate and "human" to tell a patient that the work they've accomplished together feels meaningful and gratifying to the treater (with a reciprocal hope the same is true for the patient)...but as a rule of thumb a therapist doesn't say things to a patient unless they are clearly relevant to the treatment.
With respect to gifts, the American Medical Association's code of ethics states that "There are no definitive rules to determine when a physician should or should not accept a gift" and advises that decisions to accept gifts be made carefully on an individual basis. General rule of thumb here as well is that modest gifts which are clear expressions of gratitude (e.g., a patient paints a picture, writes a poem, or bakes a batch of cookies at the holidays) are entirely appropriate, and that rejecting such offerings can damage a therapeutic relationship. Expensive or otherwise extravagant gifts, gifts intended to curry favor or alter treatment/services, inappropriate (eg, sexual) gifts, or inappropriate gifts that attempt to blur boundaries (e.g., theatre tickets for us to go together) are a no-no and need to be explored for their meaning.
I must confess I too am not sure I understand what you're asking in terms of the "ethics and psychological mechanisms". Sounds like emotional depth gets reflected in a 20 year relationship with someone who may well have been a confidante and trusted individual. Genuine attachments form and evoke a normal array of feelings when a relationship of depth has ended, or changed.
Transference is still called transference and becomes a focal point of psychoanalytic therapies, where an analyst together explores the unconscious meaning behind emotions and reactions to the therapist, particularly as they may reflect unconscious feelings about early caregivers. That type of psychotherapy is mainly useful when the problems leading to problems in relationships as the main issue of treatment...rather than a psychotherapy directed more toward other types of problems, like coping with depression or mania or psychosis.
Dr GView Thread
Dear shrinkingnightmare, A formal second opinion from a good psychiatrist with expertise in both substance use disorders and bipolar disorder may make sense, since you describe a complex history and the impact of genetics, medicines, street drugs, attention problems, and mood problems can intersect in ways that demand careful and detailed assessment. I wouldn't rely on medication recommendations over the internet; you want a doctor who has personally examined you and evaluated your unique circumstances. The quotient test is an experimental approach for helping to diagnose ADHD in children using geometric shapes on a computer. ADHD persists from childhood into adulthood in about half of cases. There isn't an established test for ADHD, it remains a "clinical" diagnosis, meaning it's based on an interview to review symptoms.
Dear Ashrinkingnightmare, Tough, important issues and questions you ask. The extent of drug abuse that you describe can certainly mess with mood and cause mood swings, psychosis (sounds like you had alcohol withdrawal delirium, more accurately than psychosis) and overall chaos. "Textbooks" say that no mood disorder (bipolar or otherwise) can be diagnosed when someone is actively using, unless there is a clear chronology that the mood symptoms started before the substance use. In any case, drug treatment has to get "prioritized" over mood treatment if there's any hope for the chaos to resolve and diagnostic clarity to emerge. If someone has psychosis only in the setting of drug withdrawal, that wouldn't get called psychosis in the sense of a psychiatric diagnosis. Rapid cycling means that over the course of a year, there have been at least 4 distinct and separate mood episodes which represent changes from your usual self -- be sure your doctor isn't confusing "rapid cycling" with just mood instability or lability (which is, basically, moods all over the place, up and down, moment to moment or day to day or within a day -- that isn't rapid cycling, as the field defines it). If you have been clean and sober for at least a few months, I think it would be quite reasonable to revisit the diagnosis question based on any symptoms you may be having (e.g., needing less sleep to feel rested, too much energy, expansive or grandiose thinking, etc.). If none are present, then a very slow and careful reduction of medicines may be entirely appropriate; if this is bipolar disorder, the symptoms would likely start to return off medicines assuming you remain free of alcohol or street drugs; if it's all drug-induced effects, then presumably if you are drug-free, you would not have mania symptoms. While many people with bipolar disorder do also have drug abuse, studies have shown that about half the time it is impossible to make a clear diagnosis of bipolar disorder because the drug use mimics it or otherwise confuses the picture. Good luck with ongoing recovery!! Dr. G.View Thread
Dear Resiliancy, If someone is experiencing a primary or secondary gain from the sick role, it's called malingering if it is consciously done and factitious if it's conscious. If someone's sense of identity is overly tied to an illness, that probably reflects more on their overall sense of identity than on an unconscious gain. Not sure there's a particular name for that kind of dynamic.