Recently I switched from antipsychoticX (aX) to antipsychoticY (aY). I despise changing medications; however, this change was necessary due to the general lack of success of the previous cocktail. And in spite of the fact that given the tiny doses there shouldn’t have been any dramatic effects from this change, naturally, there were. A medication change is pretty much always pain on a stick (that hits you, a lot).

People with mental illness have various levels of functioning. Sometimes a good day is when you talk in your group therapy session at the psych ward. Sometimes a good day is getting out of bed. Sometimes a good day is going to the doctor. And sometimes a good day is giving successful presentation to a bunch of executives. It varies from person to person. And while anyone can tell you to “take your meds,” that doesn’t really tell you how to get from non-functional to functional. It’s true no one has the exact answer, 33 high-functioning people with bipolar disorder identified six things that keep them moving forward.

I’ve written about what to do when your doctor gives up on you and while I consider this to be unacceptable, it does happen. And you have to deal with it. But sometimes, you need to give up on them. Sometimes you need to fire your doctor.

As most people know, when a drug is developed, the drug manufacturer receives a patent on that drug. The patent means no one else may produce that drug for a period of time. Drug patents in the US are 20 years, but these patents begin before clinical testing, so really, the drug manufacturer has about 7-12 years of patent protection once the drug is on the market. After the patent expires, other companies may produce the drug, these are called generics. Do you really need to pay the high price for brand name Prozac or is the generic, fluoxetine, just as good?

Recently I read a great article on the use of brand names when referring to drugs. The author, a doctor, decries the practice and says doctors should use the name of the drug rather than the brand name. The brand name of the drug, after all, was chosen by a marketer and a focus group and is really just advertising for the drug. The only trouble is, patients don't know, or can't remember, the actual names for drugs.

I recently read an impassioned plea from a doctor for health care professionals to stop referring to drug by their brand name. The brand name, he argued, was basically just an advertisement for the drug. This got me to thinking, how do drugs get their names anyway? The answer is marketers, researchers, doctors, focus groups, the FDA and about $2 million. Really.

In response to some of the comments I see here and elsewhere, here is my response to another ten myths about bipolar disorder.

Antipsychotic medications were so named as they were initially used to treat psychosis in disorders like schizophrenia. Antipsychotics include medications like Haldol, Thorazine, Seroquel, Abilify and Zyprexa. These medications are now being used, more and more, in the treatment of other disorders like bipolar disorder and major depression. One of the major problems with these medications is a side effect called tardive dyskinesia. Tardive dyskinesia is a disorder involving involuntary muscle spasms and can be (but isn’t always) permanent – even if the medication is discontinued. How can you and your doctor look for the signs of tardive dyskinesia?

I hate shrinks. Shrinks should die. Shrinks are evil. (Thank the commenters (not an individual) for that.) OK I get it, you don’t like psychiatrists. Personally, I would find a more intelligent way to express an argument, but your point is clear nonetheless. You’re ranting. I get that. I rant. We all do. It’s a healthy expression of the frustration seen when dealing with so many things outside of our own control. But at some point you have to stop hating, wishing for murder and committing moral condemnation and actually do something useful.

I get asked quite a bit for specific treatment recommendations. People will tell me a few medication details and then ask what to do, or someone will ask what my experience has been on a certain treatment. My answer is always the same: only your doctor is qualified to talk to you about your treatment as they know your personal history and health. My experience is only one person’s and cannot be generalized to any other person. And that is the right answer. But unfortunately, it’s one people don’t want to give (or get). A clear example is seen on Patients Like Me, a web site designed for patient-to-patient communication.