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Kind of funny; I don’t think I’ve been this stable for several years now – since late September my mood has been normal.  Not sure if I can link it to a good medication regimen (a high dose of Lamictal these days, plus Seroquel for sleep and Wellbutrin to take the edge off of any lingering depression from the summer), less change in my life these days (no more classes or teaching; just research and seminars nowadays), the physical (as opposed to long-distance) presence of my partner, regular exercise (the new house is less than 2 miles from school, so I end up walking 4-5 miles a day when you throw in the rest of the places I go), or what.  It’s kind of odd; as the actual effects of the disorder itself fade into the background, I tend to forget about it.  Other than the side effects, that is.

Sleep has been difficult lately; as I type my jaws are aching from the bruxism (teeth grinding) and clenching that’s now a nightly occurrence.  Dropping the Wellbutrin down has helped, but it’s still a problem.  A lot of evidence indicates sleep is a huge factor in successful mood disorder management; for me it’s not a strongly statistically correlated factor, although it does have a strong effect on my pain levels and cognitive performance (to what degree that’s affected by chronic pain, medications, bipolar-induced insomnia, bipolar itself… it’s hard to say, unfortunately).  Thankfully for me the side effects have never been bad enough to make me consider stopping medication; when I need a reminder of why I should never do so, I go back and read my pre-medicated journals:

“i want to have a normal brain.  with sunflowers and sunny fields and why won’t it get better i want to know i don’t think antidepressants will help because i’m not depressed right now mr man i am not depressed right now i am not i am not i swear why won’t you listen to me you said i was depressed and that was true but right now i am as flighty as a sparrow look how sparrows fall didn’t they say something about god and sparrows or was that the story of god walking on the sand and there were two pairs of footsteps…”
Yeah, not something I need to re-experience, even if my poetry was better then.  Not much else to write; I should head for bed.

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One of the complaints I’ve heard raised a lot about medication for bipolar (or, really, for any major psychiatric illness that strongly advises or requires medication) is that the person taking the medication “won’t be the same person any more.”  That somehow the medication will reach in and fundamentally change their personality.

This essay aims to address this concern.  I’ll focus on bipolar disorder because it’s the condition I’m personally familiar with, and also because it seems to have the widest spectrum of medications used to treat it.

First, let’s think a little about the medications themselves.

There are various classes of psychiatric medications used to treat bipolar disorder, including anticonvulsants like Depakote and Lamictal, antipsychotics like Zyprexa and Thorazine, antidepressants like Wellbutrin and Zoloft, anxiolytics like Valium and Ativan, and others like lithium.  All of these drugs do have specific effects on the neurotransmitters in the brain as well as those elsewhere, such as in the gut (which is why antidepressants are sometimes prescribed for people with Irritable Bowel Syndrome).  They generally stimulate neurotransmitter production or release, prevent reuptake, or enhance binding activity.  Some of them have unknown mechanisms, meaning we really don’t know what they specifically do, only that they seem to work.

Second, you have to stop and really consider whether the medications do induce significant personality changes in normal people.

What would happen if you gave these medications to a normal person without bipolar disorder, schizophrenia, etc?  We already give the anxiolytics to people with specific phobias such as fear of flying (Valium, for example), antidepressants such as Wellbutrin to ease the quitting process for smoking, other antidepressants for chronic gastrointestinal problems, still other antidepressants (amitryptyline and imipramine, for example) for chronic pain, etc.  Many of the older antipsychotics like Thorazine and Compazine are used to treat nausea, especially for chemotherapy.  Heck, we give anticonvulsants like Depakote to people to prevent and treat seizure disorders!  The drugs were used for that first, in fact.  Many of these drugs (in multiple classes, in fact) are used for migranes too.  It’s true that nearly all of these “extra” reasons occur at a higher prevalence in people who already have an Axis I disorder like bipolar disorder (bipolar disorder is 153 times as common in fibromyalgia patients than in non-fibromyalgia patients according to one study).  But let’s focus on people without a co-occurring major psychiatric disorder.

It’s definitely true that people taking anxiolytics are more calm and mentally “flat” during the period of several hours after taking the drug on an as-needed basis.  Antidepressants for pain, migranes, and smoking cessation are generally given at lower dosages than antidepressants for depression, and thus probably have less of a mental effect on the patient, although they do still have an effect.  So in theory if an otherwise normal person had a slight blip of depression (depression does affect a large minority of the population at some point in their lives), it would help alleviate that.  The doses of antipsychotics for nausea are lower too.  But the doses of anticonvulsants are roughly the same for either bipolar or epilepsy.

Still, while the medications might effect a personality change in the non-bipolar or non-mentally ill, it’s not something I’ve ever heard anything about, and certainly I’ve never heard the argument that “the Depakote will change your personality!” as an argument against taking lifesaving seizure medications.  Similarly, I’ve never heard of not taking an antinausea drug, smoking cessation medication, or chronic pain medication because it might alter one’s personality.  These medications are lifesaving for the bipolar folks too in many cases.  A mental illness is no different in many ways, especially treatment, from a chronic physical condition (more about this in another essay), and you should think about treatment in the same light.  We don’t deny chemotherapy to cancer patients, or pain medication to people with arthritis, and we shouldn’t deny psychiatric medications to people who truly need them.

It’s all about the right medications, too.  If you’re on medications that dull your mind and don’t really normalize your thought process, just sedate you to heck, then the personality change from the medication may well be worse than the disorder, especially if it’s sporadic.  In that case, though, you need to talk to your doctor and see what can be changed.  There are enough good options out there that you shouldn’t give up until you’ve tried nearly everything in the book.  And there are definitely people who don’t need medications, or shouldn’t be taking them.  The personality disorders (Axis II) aren’t really treatable with medications (just lots of therapy), and the milder mood disorders like cyclothymia or seasonal affective disorder can often be treated with behavioral and non-medication treatments like regular sleep, exercise, light therapy, etc.  Overmedication is another concern I’ve heard people raise in connection with the personality concern, and there are certainly people out there walking around with more medications than they need, but I don’t believe they’re the majority of people on psychiatric drugs.  More on this in another essay too.

Third, there’s the question of personality itself.  A lot of opinions I’ve heard and read appear to be of the form “The medications will change your personality, and you won’t be the ‘old you,’ so you shouldn’t take them.”

What are the sources of personality that we’re concerned with?  There’s emotions, how a person reacts to outside stimuli, their thought processes, memories, and so on.  That seems to cover the major bases.

The very disorders that these medications treat, especially the severe ones like major depression, bipolar disorder, and schizophrenia, already change your personality a whole lot!  In fact, they change it far more than any medication ever could.  A person who cannot get out of bed from major depression, or a person running through the streets at 3am due to bipolar disorder, or someone who constantly hears voices due to schizophrenia – has this person not already experienced major personality changes?  In the cases of the mood disorders (major depression, bipolar, etc), there is a fundamental alteration of personality every time a mood episode occurs.  Your unmedicated mother, son, sister, or husband is not the same way he/she was before due entirely to the disorder.  The thought disorders such as schizophrenia change the very way a person thinks and processes information – is this not a personality change?

It’s certainly true that the medications will change your personality.  I won’t argue with that in the slightest.  The medications (if you’re on the right ones) will change your moods, bring your thinking back to something approximating normal, restore some of your memory and recall ability, and the like.  They’re even known to literally change brain structure.  These disorders all have measurable effects on brain structure.  I’m not kidding.  Ventricles (hollows in the brain) are larger in a schizophrenic identical twin than in the normal identical twin.  There are certain brain scan patterns that are typical of people with bipolar disorder and schizophrenia.  But the medications have effects too.  Lithium, the classic example, actually increases the gray matter (the neuron bodies) in the brain.  The medications don’t just keep you on a vaguely keel, they sometimes actually heal your brain in the long term.

So is the bipolar me on medications the same as the old me before bipolar disorder?  Of course not.  Does my personality change fundamentally in the middle of a mood episode?  You bet it does.  Do the medications get inside my head and mess with my personality?  Of course, that’s how they work.

There are two sides to this same coin of personality changes.  It’s certainly true that the medications affect your personality.  But so does your disorder, and I’d argue that it affects your personality far more (and far worse) than the drugs you take to treat it.  There is no getting back to Square One, except in the very rare cases where people go into full remission.  It is in most cases impossible to be the very same person you were before you developed bipolar disorder or another major Axis I mental illness.  So you have to weigh the options.  Both will change your personality, but if you’re going for getting as close to your old personality as possible, you’re probably better off with the medications than without them.

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