Monday, March 15, 2010

Astra Zeneca free book

The drug rep from Astra Zeneca was in the University of Tennessee Department of Psychiatry office area today. In my mailbox, and in the mailboxes of all of the psychiatry residents (MD's in specialty training) was a free book. It was entitled, "Bipolar Disorder: Disease Management Guide."

Funny thing, there is no mention anywhere in this book of good old cheap, generic lithium, which is far and away the drug of choice for treating bipolar disorder. There was also no mention of the third choice, Tegretol, nor the fourth, Trileptal, nor "typical" (old and generic) anti-psychotic drugs - only information about brand-named atypical antipsychotic meds, Depakote ER, and Lamictal.

What is not discussed in this rather selective "guide" is of course entirely unsurprising. At least our residents have me to point out what this means.

The book also mentions the importance of screening patients for "subthreshold" presentations of the disorder, as well as for the diagnosis of "Bipolar NOS" (not otherwise specified). The book specifies that patients who have the latter diagnosis have hypomanic episodes that may last for only a few hours. Naturally, there is no mention of agitated depression, anxiety, interpersonal discord, or of the affective (emotional)instability characteristic of borderline personality disorder.

The existence of manic or depressive episodes that do not have to last for any significant amount of time is the party line for those drug company shills pushing for the diagnoses of pediatric (child) bipolar disorder, and "bipolar spectrum" in adults, which I like to refer to as B.S.

Let's medicate everyone with expensive, potentially toxic atypical antipsychotic drugs! After all, who among us has never had a mood swing?


  1. Hi. I was diagnosed with BP II after years of having borderline symptoms; also, terribly needy, frightened/paranoid, always "thin-skinned", some mania too w/in public (the need to be the class clown, impulsive, too wired). This ruined my life (I blew a PhD, MS from an Ivy, work) and I was in horrid emotional pain. Depakote works for me: I'm a new person. It's unbelievable. My sense is that this Rx (or others like it?) might work for Borderlline Personality Disorder.

    I have no explanation why I have a new life in my 50s. Can you direct me to any sources re Borderlline and why such Rx' work? Thank you very much.

  2. Anonymous:

    Depakote is effective for true bipolar (I) disorder in preventing mania, but not for necesarily for preventing bipolar depression.

    Obviously I can't say what your psychiatric condition is. In my experience depakote does not help a lot with most people who have borderline personality disorder, although in the literature it's rumored to decrease impulsiveness. Possibly because it can be sedating.

    Also, studies show that a lot of the symptoms of borderline personality disorder do mellow out with age.

    The best book about what you are asking about is by John Gunderson, although it is for professionals: