Nothing exciting to report - the treatment went well…
However, I would like to tell you about the people that are
providing me with the rTMS. This is a new adventure for them and an exciting
opportunity for me. They are all being extremely kind, and very supportive. They have been very open to trying new things,
and listening to suggestions. All in all, a very good start to what I am hoping
is a very successful process.
Let’s talk about Treatment Resistant Bipolar disorder…
Treatment-resistant bipolar disorder
By James C-Y Chou, MD | 06 July 2011
“Sachs3 suggested that the term “treatment-resistant bipolar
disorder” should be reserved for patients who do not respond to a combination
of 2 standard medications in a specific period, such as 6 weeks for mania, and
6 months or 3 cycle-lengths for maintenance. Others have required multiple
trials of combinations or that patients fail to respond to nonstandard
treatments, such as antidepressants.4,5
Treatment resistance in unipolar depression and
schizophrenia is usually defined as failure to respond during an acute episode
to 2 adequate monotherapy trials of agents with established efficacy and
implies that a novel treatment should be considered. In schizophrenic patients,
this makes sense because clozapine has shown efficacy for treatment-resistant
schizophrenia. In unipolar depression, this conceptualization of treatment
resistance may be less useful because failure to respond to one SSRI is not
associated with an increased risk of not responding to another.6
Treatment resistance in bipolar disorder is even harder to
define. Standard care in any phase often includes more than 1 medication, which
implies some degree of resistance in most patients.7 Furthermore, treatments
lack any unifying mechanism of action, an evidence-based rationale for
combining is lacking, and dosing of combinations has not been standardized.
The process of selecting medication combinations is often
simplified by grouping treatments into classes, such as anticonvulsants and
atypical antipsychotics—distinctions based on their uses in epilepsy and
schizophrenia. Unfortunately, specific medications within these classes have
considerably different efficacy.”
So they say, “The term
“treatment-resistant bipolar disorder” should be reserved for patients who do
not respond to a combination of 2 standard medications in a specific period”.
Well I cannot tell you exactly how many medications I have been on, but it FAR
exceeds their suggestion. This is a small number of the medication I have been
on: Lithium, Lamotrigine, Paliperidone, Sertraline, Pms-Moclobemide, Zoloft, Mirapex,
Divalproex Sodium, Propranolol, Abilify, Lorazepam, Dihydrochloride, Zyprexa, Seroquel,
Zeldox, Trazodone, Mirtazapine, Requip, Risperdal, Trileptal, Wellbutrin, Effexor,
Temazepam, Remeron, Topamax, Divalproex , Clonazepam, Lorazepam (again these are only a small percentage of
the medication I have tried.) In fact, in desperation for relief I even travel
to Bethesda Maryland to participate in a drug trial – that’s right I was a guinea
pig. The medication they were studying was Ketamine, yes ‘Special K’ … I think
I will save that story for another blog, and I will include some photos of the
amazing journey.
So that my friends is why I
was so excited to find, and have success with rTMS!!! I only hope we can have that success again, this time maintain it!!!
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