I have just received a comment that is so outrageous that I’m interrupting everything else to respond. The comment is: “Effective treatment of bipolar disorder is often based on the combination of several elements including the following: PHARMACOTHERAPY. The drugs are the key to treatment of bipolar disorder.”
This is totally untrue.
All depression—bipolar and unipolar—begins with a genetic vulnerability. According to research from the National Institute of Mental Health, there is a certain gene that comes in a long form and a short form. If you inherit two longs, you will never get depressed. It is not in your makeup. If you inherit one or two short genes, then you are at risk for depression.
Having a genetic vulnerability does not mean that you will get depressed. It takes a trigger to turn it on. The trigger that turns on depression is the perception of powerlessness. You may or may not be powerless but if you feel that you are powerless then depression may be turned on.
Bipolar depression is basically a tiny seizure in the brain. As one doctor described it to me, most people can moderate their mood by dialing it up or down. However, the brain of a person with bipolar disorder has a toggle switch instead of a dial: you’re either on or off, and don’t have the medium settings in between.
The correct pharmaceutical response for bipolar depression is a mood stabilizer and a mood elevator. Mood stabilizers, such as lithium, Neurontin and Depakote, prevent the “seizure.” Mood elevators are antidepressants, dozens of which are available on the market.
However, drugs are not necessary for the treatment of bipolar disorder. Not only are they not necessary but also they can be ineffective, physically damaging and make the disorder worse. I took them every day for twenty-six years. I know.
During the years that I took drugs for depression, I required inpatient treatment about fifty times and spend about three years locked down. I attempted suicide about a dozen times. I acquired damage—ranging from inconvenient to life-threatening—to my immune system, kidneys, heart and respiratory system. After nearly three decades of psychiatric drugs, I now sleep in a hospital bed, travel in a wheelchair, and am cared for daily by aides. It has been this way since I was fifty-four years old.
Ten years ago, I stopped taking drugs and was evaluated by another doctor who taught me that powerlessness is the trigger for depression. Then he tried to get me to take more drugs. Instead, I figured that if the perception of powerlessness is what turns on depression then acting with power should turn it off.
We like to think that depression is in the patient. It is the patient’s problem and if we can just fix the patient then everything will be all right. In fact, depression is between the patient and the world. Powerlessness exists in the relationship between the person and the person’s significant others. What needs to be fixed are the relationships, whether they are personal, institutional or corporate.
A growing child who needs independence but is in the care of an over-controlling parent may get depressed. Likewise a child who is being bullied and doesn’t have the skills to deal with it. Any student with an undiagnosed problem that prevents learning may get depressed, e.g., having a learning disability or needing glasses. Depression is not within; it is between.
Relationship problems can be depressing at any age: you want to be with someone who won’t be with you and you have no power to compel the other person. Death and divorce also can be depressing because you can’t stop the person from leaving you. You have little or no power to control the relationship.
A bad economy in which you can’t get a job is depressing: you feel powerless to change the economy, but what you can do is get re-educated to work in a subject area where there are jobs, or move to a different geographical area where there are jobs. You act with power and your depression goes away.
It goes away because acting with power changes the chemicals in your brain. Taking drugs also changes the chemicals in your brain, however, it doesn’t fix the problems in your life. Consequently, only about thirty percent of antidepressants work. They change your brain, not your life, and sooner or later the life problems catch up with you again.
The cure for depression is to become an activist. I was frequently depressed because I couldn’t get to the doctors by Medicaid transportation. The county had let a no-bid contract for a quarter-million dollars for Medicaid transportation to a couple ambulance drivers who didn’t know what they were doing, and were being rewarded for corruption. I worked the problem through the system and in the end the ambulance drivers got investigated by the Medicaid inspector general and had to pay back $80,000 and accept oversight.
My sisters variously were controlling, disrespectful, or blamed me for their own problems. It took me three years to come to terms with the fact that our relationships were an illusion, not a reality. It was necessary to estrange myself from them in order to disrupt the repeated pattern of depression. It is terribly, terribly hard to divorce yourself from your own family, but if they refuse to change their part of your relationship, then it has to be done if you are to go on to be emotionally healthy. Life is not easy. If you take drugs, it may deaden the pain for a while. If you actively deal with the problems, you can go on to genuine happiness.
The proper treatment for depression is therapeutic support to help you take action. When you become powerful in your own life then you no longer will suffer depression or any “chemical imbalance.” A psychiatrist of my acquaintance affirmed that this is true, then sadly added, “It takes too much time. Prescribing pills is quicker.”
Drugs are not the treatment for bipolar disorder. The treatment is learning to take action and develop personal power.