Use of medicine as needed when sensitive to becoming bipolar. My story.

On August 7, 2019 - I was a Guest blogger at the Dutch site Pyschosenet: https://www.psychosenet.nl/medicatie-alleen-wanneer-nodig/. 

I have translated the text to English for an old friend. See below: 

Bipolar Advantage in a nutshell

"In this blog, Ansgar wonders why there is no protocol for use of medicines "as needed" for people diagnosed with bipolar: “If medication is presented as a temporary treatment, such as a plaster cast on a broken leg, it may become a little more manageable for the patient.”

Why is there no protocol to taper drugs and use only prophylactically if necessary if the patient wishes?

This is also called 'if necessary', or 'p.r.n', drug use. p.r.n. deriving from Latin, it stands for either "when necessary" or "for an occasion that has arisen, according to the circumstances."

Background: Since 1997 I, Ansgar John Brenninkmeijer, have been diagnosed with Bipolar type 1. In 1997, in consultation with my then psychiatrist, I reduced valproic acid (Depakote) to zero, but kept it at home to occasionally use it prophylactically after the detection of prodromes and when implementing my emergency protocol. I believe there are several people who have or could have done this, but I am not aware of any research that has been done on this. Current practice seems to be very subjective and tied to the personal opinion of the treating physician. My current GP and I just do something.

For me, a handout/protocol would be desirable and give peace of mind. 

An additional advantage of a protocol from the VMDB, Kenbis or Psychosenet seems to me that it can help with the discussion with manic patients who refuse medication because they feel that they will have to be bound to ongoing treatment for the rest of their lives and view the use of medication as a kind of capitulation. If medication is presented as a temporary treatment, such as a plaster cast on a broken leg, it may become a little more manageable for the patient.

A doctor could then say on the basis of a guideline:

“Try it temporarily and we'll see how it goes in X units of time. If you are no longer manic according to the DSM checklist and you wish to do so, you can start tapering off the medication.”

Instead of what many manic people now think they hear:

“You, manic patient, who is experiencing something that is the most wonderful thing you have ever experienced, who is in direct contact with the almighty, will now have to get rid of this feeling immediately. You will have to spend the rest of your life drugged, like a zombie.”

Many things are unclear and confusing when you are manic and psychotic.

I think it is good to put clear agreements on paper that are recognizable somewhere for the patient when he comes to his senses again. Instead of freely interpretable things such as: 'sometimes,' 'some time', 'a certain time', 'in consultation with the doctor'. Too many people die of suicide because they are confronted by doctors with the above depressing outlook where feelings and emotions will be muted forever while refusing to accept it. It is great that initiatives, such as Psychosenet, offer a more realistic perspective for people with a diagnosis.

I myself have drawn up a protocol with my doctors whereby I start with sleeping pills if I cannot sleep (Temazepam) and then Zyprexa (Olanzapine) if I am hypomanic and/or in danger of becoming manic, in consultation with the GP. Often one pill is enough. If the GP says to me, “You have to take it longer”, the appointment is to evaluate how it is going after one week.

It is very important to be able to find a general practitioner and/or psychiatrist who is open to this way of thinking.

In addition to medication, I followed the Dutch Psycho-education course on bipolar disorder and also the Bipolar INorder course by Tom Wootton. You then make a distinction between your mental state and behavior. You learn to control yourself during mania so that you don't destroy things in your life.

There may be a difference between the signals in your head ("you're seeing things") and your behavior. You remain aware of what you actually wanted to do and what you had agreed with people. It can be compared to having a craving for something tasty and yet putting off eating. It is important to do this under the supervision of a doctor and with agreements about how long (so-called 'accounting for time').

I have benefited greatly from the Bipolar Advantage course.

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Ansgar John Brenninkmeijer has been diagnosed with Type 1 Bipolar Disorder. He grew up in London, New York, and Montreal. His biography can be found here.

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