As many of you have heard by now, the drug ketamine is being investigated as an antidepressant. Yes, the drug known on the street as “Special K” causing it’s users to fall into a “k-hole” is being researched for clinical, antidepressant use. Ketamine has shown promise both in unipolar and bipolar depression. There are many problems with ketamine, though, not the least of which being that it’s a scheduled substance in the United States and thus very hard to get your hands on. It can be done but it’s awfully pricey. There are also substantial side effects like hallucinations to worry about. (Ketamine is typically used as an anaesthetic in medicine.) Luckily, there is a chemical cousin of ketamine on the horizon that appears to work in a similar way to ketamine but without all the unfortunate side effects.

Today I tuned into a webcast on managing bipolar depression. I wasn’t sure what to expect although I was aware the webcast was designed for doctors so I knew the level of discourse would be high. And I must say it was a great hour. Granted, I knew the vast majority of what was being presented but the nuggets of new items here and there definitely made it worthwhile. What’s more is that this view on managing bipolar depression is evidence-based and they present the numbers behind what’s recommended. They make clear which studies are drug company-funded and which are not. It’s the kind of information that I wish every doctor knew. And, if you have bipolar, especially bipolar depression, it’s the kind of information you should know too.

Two nights ago, I was privileged to attend the National Council’s Awards of Excellence dinner. This is a dinner during which we honor and hear the stories of those who won the awards. I was there because the Bipolar Babe won a Reintegration Award in mentorship, and believe me, no one deserves it more. Being a winner, the Bipolar Babe gets $10,000 for her charity. But what you might notice about these awards is that they are a partnership between the National Council for Community Behavioral Healthcare (mental and addiction illnesses) and Eli Lilly and Company. Now, The National Council, . . . advocates for policies that ensure that people who are ill can access comprehensive healthcare services. We also offer state-of-the-science education and practice improvement resources so that services are efficient and effective. Whereas Eli Lilly is a drug company designed to make money. But what I learned while I was at the awards is that the Eli Lilly folks had neither horns nor tails.

Recently I went through a nasty bipolar medication change. I stopped one antipsychotic in favour of another. Of course, this was to improve my overall treatment. And as I’ve said before, if you change nothing then nothing changes, and in this case, I had to change medications in the hopes of changing my mental wellness. It did not go well. What ended up happening was a gradual slide into horrific suicidality. The new med was not effective for me. But I learned something from this experience. Before changing bipolar medications, it’s a good idea to put into place a medication change safety plan.

I am a very difficult case of bipolar to treat. Believe me. I have been on more bipolar medications than anyone I know and finding an effective cocktail is akin to walking on water. It’s possible, but it’s pretty darn rare. And recently I made a medication change from one antipsychotic to another. It went very badly in a whole host of ways. In fact, I terminated the medication trial early and went back to my previous medication. I see my doctor this afternoon and now I have to tell him the bad news about how it went. And I feel guilty about failing another bipolar medication. I know he will be disappointed and I feel bad about it.

Recently, our blogger Natalie Jeanne Champagne wrote a post: Mental Illness: Understanding Rational and Irrational Fears and this got me thinking about the fears I, and others, have had about bipolar medication. Some of the bipolar medication fears are completely justified and rational while some really are not. Some are fears that stem from real possibilities while others are often propagated by fear-mongering groups online or our own internal catastrophizing.

Last time, I wrote about the terrors of getting on new bipolar medication. Many people identified with this, including one commenter who said: Sounds all too familiar. I’ve been drug free for several years and seriously doubt that I will ever put myself through that trial and error program again . . . at least for me, that relief is not to be found at the bottom of an orange vial with a childproof cap. I hope you find something to relieve the pain. I also hope you consider the notion that you’re likely stronger and more resourceful than you think you are. Now, I’m not calling out this commenter for doing anything wrong. I have no problem with his comment, nor with him. However, I find this comment insulting. Not because the commenter meant it to be, but because it suggests that people who don’t take medication for bipolar disorder are “stronger and more resourceful” than those who do.

I have been on every bipolar medication you can name and likely a few you could not. I have been on more medication combinations than I can remember. I have spent years dealing with medication side effects. There is very little medication pain that I cannot tolerate. I have taken medications that have made me feel amazingly well and bipolar medications that have made me feel intolerably ill. I’ve seen treatment miracles and treatment devastations. And still, I feel nothing but terror when I think of taking new bipolar medication.

Some time ago, I wrote about generic medications. I explained that generic medications are bioequivalent to brand name medications within a given margin. Generic medications may use binding and other inactive agents that are different from the brand name medication. All of this can lead to a generic being less effective than the brand name drug in a small percentage of cases. Usually though, the generic works just fine for people and the switch is unnoticeable. And all that information was correct. But new information has arisen. And it’s alarming information to me. It’s information on exactly how bioequivalence is determined for medication and in the case of one generic medication, the generic of Wellbutrin XL 300 mg, it caused an ineffective drug to be allowed on the market for many years.

I wish someone had asked me before naming a class of drugs “antipsychotics.” I mean, I understand that to psychiatrists it might not be a big deal, but to the medication-taking public out here, let me just say that the stigma around medication is about 10-fold when you say you’re on something called an “antipsychotic.” Tell someone that you’re on “antipsychotics” sometime and watch them back away slowly. I’m not kidding. It’s like they think an axe is about to magically materialize and you’re about to use it to chop off their head.*