Imagine if you can, being on one of the moving walkways that are most common in airports. Try if you can to envision your life being spent moving on the “walkway” of life. The platform moves at a nice, easy pace allowing you to function as you move; being able to pick up the things you need and easily observing the reactions of others as well as your interaction with them. Then imagine that the platform starts moving faster and faster causing a feeling of vulnerability, and maybe even fear as functions become more difficult. As you try to grab things moving by you begin to knock them over and drop them. Interaction with others becomes blurred and processing the names and faces as they move by becomes more confused. Then imagine the walkway starts to move so fast that you can no longer function at all. The fear and the confusion dominate your mind and all you can do is hang on and hope it will somehow slow down enough for you to function or that you will find a way to get off of the platform altogether. Given the situation, a person will do one of two things; the fight or flight instinct will kick in and you will either lash out in response to your situation or you will try to find a way to escape. The picture is a bit like the famous episode of “I Love Lucy” where Lucy and Ethyl take a job at the candy factory and find themselves not being able to deal with the assembly line moving past them. This is sort of an inverted picture of that episode which has one major and serious distinction. Lucy’s problems at the factory were funny and they were merely a show. The scenario for those with Bipolar is not funny and they have no way to turn the TV off if they don’t like the view.
This is the dilemma that medicine must solve for those with Bipolar. It is not an easy application such as antibiotics treating an infection. With an infection, the prescription is fairly easy. Take the antibiotic for 10 days and the infection goes away; don’t take the medicine and the infection grows. With Bipolar the challenge is more difficult for doctors as they are chasing a moving target. If the medicine is too strong then the platform slows down to what feels like slow motion for the patient; and if the medicine is too weak then the platform continues to careen out of control or at least too fast for the patient to properly function. Keep in mind that the platform doesn’t stop for this process to occur so doctors and patients have to experiment with a combination of drugs trying to find a balance that keeps the platform from moving too fast while not causing it to move too slowly.
Over the last 50 years, much research and development has been invested in the medicines that treat Bipolar and other mental illness. These drugs fall into a category called psychotropic medications and now include over 150 different drugs that are used in combination to treat patients. Making it more difficult is that each patient reacts different to the various medications so what occurs is a trial and error, wait and see process that can go on for months and even years while the patient, in the meantime, is still spinning out of control on the “walkway”. Given the 150 or so drugs available; that means that even if these drugs are broken down into 4-5 categories there are still hundreds of combinations to work with.
This reality of Pill Roulette creates great anxiety for the patients of Bipolar. Not only do they hate the stigma of being labeled with a mind altering illness, they now have to add the label of being a “mental drug taker” and they rarely see positive results in the early goings of the prescribed medications. The sad result is that the patients soon lose hope and confidence in the drugs that they didn’t want in the first place so they either quit taking them or they turn to their own form of medications. A very large percentage of Bipolar patients turn to illicit drugs in an effort to self-medicate which in the short term might provide relief but almost always ends in creating even greater problems that they previously had. While they observe their doctor trying to find the right combination of drugs, they are trying to find their own combination on the streets. The result is even a greater of variables thrown into the mix of trying to find a reasonable combination of drugs (legal and illegal) to normalize their world.
Our case has seen its own version of this story. Justin (as he has well documented on Facebook) has experimented with everything from the omission of prescribed drugs to the experimentation of his own. He now has a Medical Marijuana card and uses the Cannabis to treat his symptoms. He does so in the wake of great resistance from his medical caregivers but when his mind is spinning out of control he finds temporary relief from his mental prison. As loved ones, we struggle with this decision as it “feels” wrong for a number of reasons; yet we have to admit that we have observed a positive difference in behavior when he takes moderate amounts of the Marijuana. Time will tell if his use will be a long term aid or just a temporary relief valve.
In summary, drugs are a part of the Bipolar world. All of the drugs are potentially dangerous, most are insanely expensive and they are almost always part of a fragile game of chance that most patients find themselves being required to play. Their minds will not function properly on their own and there are so many options to sort through to find the magic combination that allows them to function normally and productively. Hopefully research will reveal better answers and faster methods; but in the meantime patients of Bipolar struggle to find the answers.