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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by SalArmy4me on June 13, 2001, at 22:55:05
Pharmacologic treatment should last for a minimum of 6 months after an initial episode of depression or bipolar disorder. Most clinicians will continue treatment for at least 1 year for patients with a second episode. If the patient has responded, and symptoms are resolved, the decision can be made whether to taper the patient off of the drug or continue maintenance therapy. In a National Institute of Mental Health Collaborative Depression Study, one third of patients became ill again 1 year after recovery from an index episode of depression; almost one half became ill again by 2 years; and almost three quarters by 8 years. Maintenance therapy may be continued indefinitely for patients with a history of frequent or multiple episodes of depression, major depression with preexisting dysthymia (double depression), onset of depression after the age of 60 years, long duration of individual episodes, severe index episode, poor symptom control during continuation therapy, and comorbid anxiety disorder or substance abuse. A strong family history of affective disorder also increases the risk of recurrence. Maintenance therapy with full doses of antidepressants is highly correlated with preventing recurrences for up to 5 years.
Posted by AMenz on June 14, 2001, at 10:24:29
In reply to How long on meds?, posted by SalArmy4me on June 13, 2001, at 22:55:05
Although I only have a sample of one, myself, I question the merits of maintenance therapy, specially because it lumps together BPI, BPII's and unipolars. I had a long remission period during which I was symptomatic but functional, fifteen years and unmedicated. In retrospect and after seeing that withdrawal from lithium causes severe anxiety (in my case) I think avoidance of episodes, which may come anyway, by medication which can have devastating side effects should not be automatic.
> Pharmacologic treatment should last for a minimum of 6 months after an initial episode of depression or bipolar disorder. Most clinicians will continue treatment for at least 1 year for patients with a second episode. If the patient has responded, and symptoms are resolved, the decision can be made whether to taper the patient off of the drug or continue maintenance therapy. In a National Institute of Mental Health Collaborative Depression Study, one third of patients became ill again 1 year after recovery from an index episode of depression; almost one half became ill again by 2 years; and almost three quarters by 8 years. Maintenance therapy may be continued indefinitely for patients with a history of frequent or multiple episodes of depression, major depression with preexisting dysthymia (double depression), onset of depression after the age of 60 years, long duration of individual episodes, severe index episode, poor symptom control during continuation therapy, and comorbid anxiety disorder or substance abuse. A strong family history of affective disorder also increases the risk of recurrence. Maintenance therapy with full doses of antidepressants is highly correlated with preventing recurrences for up to 5 years.
Posted by Cam W. on June 14, 2001, at 13:25:36
In reply to Re: How long on meds?, posted by AMenz on June 14, 2001, at 10:24:29
A - One problem that I have with not staying on maintenance medication for bipolar disorder is the phenomenon of kindling. Cutler and Post, in 1980 (I believe) did a search of old hospital records of people with BiPD in the premedication era. They found that with every episode, the probability of having another episode increased and lasted longer than the episode before. Kraepelin, early in the 20th century, also noted this phenomenon. With longer and longer bouts of mania and depression often lead families to institutionalize their afflicted family member.
The kindling theory states that each episode of mania or depression seems to "kindle" the next episode. Periods of wellness become shorter and the episodes become more severe. Mood stabilizers seem to interupt this kindling by helping to prevent the next episode. Fewer episodes in a lifetime mean there is less opportunity for kindling to occur. Still, full compliance with medication therapy in bipolar disorder does not guarantee one will not have another episode. A vast majority of those with BiPD do have another episode, but the incidence of these episodes seems to decrease.
Some people with BiPD do not respond to mood stabilizers (or certain mood stabilizers) and this just emphasizes the point that BiPD is a collection of syndromes, with similar presenting symptoms.
- Cam
> Although I only have a sample of one, myself, I question the merits of maintenance therapy, specially because it lumps together BPI, BPII's and unipolars. I had a long remission period during which I was symptomatic but functional, fifteen years and unmedicated. In retrospect and after seeing that withdrawal from lithium causes severe anxiety (in my case) I think avoidance of episodes, which may come anyway, by medication which can have devastating side effects should not be automatic.
Posted by Zo on June 16, 2001, at 21:50:20
In reply to Re: How long on meds? » AMenz, posted by Cam W. on June 14, 2001, at 13:25:36
Interesting. Neurontin, in calming the GABA receptor sites, helps my TLE "kindling."
Posted by AMenz on June 17, 2001, at 14:11:38
In reply to Re: How long on meds? » AMenz, posted by Cam W. on June 14, 2001, at 13:25:36
Cam I understand the theory of kindling. What I don't understand is the elevation of theory to fact with scant data.
I think nobody at present knows what the different bipolar disorders are. Whereas people with severe manic episodes may not be able to afford to not be on maintenance all the time. This may not be true for all bipolars.
In my case the inability to adjust a rapid cycler has turned out to be more of a difficutly than living with rapid cycling itself. This is not to say that this statement applies to everybody. And that is my point. I think in the absence of hard date, psychiatrists are left with the option to extend every dictum from one case to all similar cases to err on the side of caution. I think this is really a matter for the individual patient to decide after sufficient information on the risks they are running.
> A - One problem that I have with not staying on maintenance medication for bipolar disorder is the phenomenon of kindling. Cutler and Post, in 1980 (I believe) did a search of old hospital records of people with BiPD in the premedication era. They found that with every episode, the probability of having another episode increased and lasted longer than the episode before. Kraepelin, early in the 20th century, also noted this phenomenon. With longer and longer bouts of mania and depression often lead families to institutionalize their afflicted family member.
>
> The kindling theory states that each episode of mania or depression seems to "kindle" the next episode. Periods of wellness become shorter and the episodes become more severe. Mood stabilizers seem to interupt this kindling by helping to prevent the next episode. Fewer episodes in a lifetime mean there is less opportunity for kindling to occur. Still, full compliance with medication therapy in bipolar disorder does not guarantee one will not have another episode. A vast majority of those with BiPD do have another episode, but the incidence of these episodes seems to decrease.
>
> Some people with BiPD do not respond to mood stabilizers (or certain mood stabilizers) and this just emphasizes the point that BiPD is a collection of syndromes, with similar presenting symptoms.
>
> - Cam
>
>
> > Although I only have a sample of one, myself, I question the merits of maintenance therapy, specially because it lumps together BPI, BPII's and unipolars. I had a long remission period during which I was symptomatic but functional, fifteen years and unmedicated. In retrospect and after seeing that withdrawal from lithium causes severe anxiety (in my case) I think avoidance of episodes, which may come anyway, by medication which can have devastating side effects should not be automatic.
>
This is the end of the thread.
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