The Roving Psychologist

Once again, as in previous writings, Dr. Gartner confuses hyperthymic temperament with hypomanic states. In this instance, with the result being that he further muddles the issue of treatment considerations in an already muddy arena.

Gartner's assertion that psychiatrists are criminals for avoiding the use of antidepressants as monotherapy in bipolar II disorder, stating that they fear precipitating mania, and not discussing side effects with patients, reveals an unsophisticated understanding of treatment considerations and an unfounded criticism of standards of practice.

While any seasoned psychiatrist would be able to recount instances where addition of an antidepressant revealed an undiagnosed bipolar disorder (I or II), or seemed to accelerate the trajectory toward mania, the greater concern in the treatment of patients with bipolar II disorder is that while antidepressant monotherapy might elevate a patient out of depression (often very quickly), the likelihood is that it will also increase the rate of cycling and shorten the time to relapse back into depression without ever precipitating a full manic episode. The goal of treatment of any of the bipolar spectrum disorders is to avoid cyclicity, up or down.

While the field is still in it's infancy when it comes to treatment of mood disorders, I know of no psychiatrist who would intentionally mislead patients by withholding information or do anything less than attempt to relieve the pain inflicted by their illness. Gartner's article is typically robust with opinion and accusation with little appreciation for his lack of actual experience doing the work.

And so, to label thoughtful psychiatrists, with far more clinical experience using these medications to treat the complex cluster of mood disorder, criminals, reveals a total lack of pharmacotherapy sophistication on the part of the author and a typically limbic charged rush to judgement where a dose of prefrontal restraint might be in order.

This article just explained very adequately what I am experiencing this exact moment and have been for years. The suspect is Seroquel and actually it has not only caused my weight gain and thyroid problem but potentially helped with my recent pulmonary embolism. Now let me state I only read one article about this on Psych Central and it was a British research team that cited a link in those prone to clots which I am.

I have bipolar II and BPD. I am nowhere near the girl I was once. I was a runner before Seroquel and that was four years ago. Average weight was about 160 and now I'm 200. Some of it I have to take accountability for but honestly between mood stabilizers and Seroquel I lost the battle. Now I'm on topamax which supposedly has a huge weight loss side affect but so far not in me. I am trying now to wean off Seroquel for the embolism issue alone. Thank you for your informative article.

You are right doctors have not wanted to listen about the affects of any of these drugs but now they have no choice the evidence is out there and in their face. My pdoc tripled Cymbalta on me and I ended up hallucinating and in the hospital for a week while a new pdoc saved my life...I never got an apology for that either.

Yes! Just as true for bipolar I as for hypomania or for bipolar II. The standard of care is nothing short of a "chemical lobotomy." For me, being treated with Zyprexa is what I imagine going on a bad LSD trip must be like. I remember every sound and image that the television produced coming at me like a thousand demons or mad clowns in an out-of-control circus. In the hospital every sudden noise made me jump and my paranoia went through the roof. I have never experienced symptoms like this in my "normal" life, and have only experienced them while on Zyprexa.

Dr. Gartner violated my trust as his patient. I started seeing him as an adult survivor of child sexual abuse. He reassured me numerous times that this was one of his areas of expertise. He was preoccupied with hearing the details of my story, and offered no sort of helpful therapy. I stopped seeing him when he told me that "the only thing that I have seen is that you've acted nasty". This is a completely inappropriate thing to say to a survivor of sexual abuse. It was scarring to have my trust violated once again.

It is very ironic that the quote of this article is "above all do no harm". Let's not forget that many physicans are in fact the perpetrators. Remember Dr. Levine. I know Dr. Gartner as a psychologist and I believe that he is not a good person.

thankyou for writing this. i don't care about the other comments. i only care about myself and how to feel better. i am trying to keep the highs and control them to stay on an even ship... i know i will go off the rails once in a while, but i will try to limit the damage as much as possible.

Dr. Gartner most definitely has keen insight into how both a Bipolar I, or Bipolar II patient, feels, when that patient is overmedicated and sent out the door with heavy duty meds. He must understand how family members see the "zombie" when a doctor doesn't help the individual find the right balance through active discussion, and 12 step program work, or other daily group therapy. Finding the correct balance, and working on behavior in group therapy, as well as minimum medication makes the most sense. I applaud you, Dr. Gartner, for being forthright, and seeing the "overall picture".