Medicating for Bipolar Disorder

When a patient is first admitted to a psychiatric unit, the treating psychiatrist must make a determination as to the administering of medication. There are two basic models the doctor can choose from. He can start from a zero medication format where he begins with a low, minimum dosage level and adds small incremental amounts of medication until a level is reached whereby the patient approximates a normal behavioral level; or he can flood the patient with a large dose of meds to quickly bring the patient to a non-symptom level and then reduce the meds until a normal behavioral level is achieved. Either method is an acceptable treatment, although many people who are uneducated about treatment believe over-medicating is a bad thing no matter the results.

We are not well-served by a knee-jerk reaction in judging a particular regimen. In the case of “flooding” someone with medication, a person in the throes of a flagrant manic attack would best be served by bringing them down from the manic heights as quickly as possible. There will be time enough to adjust the dosage once they have returned to a semblance of normalcy. In the event of a depressive slide into despondency, we may have the luxury of slowly increasing meds over time, although suicidality ramps up the need to respond with speed of action.

Dogmatic adherence clouds perception whatever the situation and enhances the prospects of not making the best decision. Many times education is the avenue to wise treatment. I went for years not understanding the principle of over-medicating, assuming keeping someone in a stupor was at all times bad for them. It was only several years ago that a cousin who is a physician explained to me the intricacies of dosage decisions in treatment. It is this I am trying to pass on to others.

The general public is not aware of some treatment factors such as those of medicating. It seems it is rarely explained to family or patients. The psychiatric community would be serving a public good if they were to be more explicit about the logic of their decisions. An educated public is the best treatment outcome.

My remarks are not out of a narrow finger-pointing toward clinicians who work long hours under pressure to make the right decision, but to bring an understanding to what goes into a medical decision. This is often not addressed due to lack of time. Treatment would be improved if families and patients were more enlightened.