“My Adventures in Psychopharmacology”

There’s a great article in New York Magazine about a young woman whose psychiatrist started her on a roller coaster of medications at the age of 16. She found out about Cognitive Behavior Therapy (CBT) several years later when she read an article her parents had mailed to her. She said that CBT was:

“…a treatment Dr. Titrate [not his real name] had always dismissed. After I read it, I set up an appointment. When I related my personal history and described my symptoms to the cognitive behavioral therapist, she said… “You sound like you’re bipolar II, a form of manic depression.”…[She told my mother:] “Your daughter has been misdiagnosed and mis-prescribed,” she said. I felt ecstatic and oddly vindicated… I’m back in college now, in my senior year… The therapy is different from any I’ve ever had. I feel like I’m taking a college course on myself… The only medication I’m on now is Lamictal, the mood stabilizer… I have been free of manic feelings and suicidal thoughts.

3 replies
  1. Kevin Benbow
    Kevin Benbow says:

    I guess my question is whether this client is on medications now in addition to CT. I know very few people personally who can manage a condition like BPD without some sort of mood stabilization.

    On the other hand, had the previous prescriber thought the client depressed, my understanding is that antidepressant therapy alone would be a disaster.

    So, if this person is receiving only CT for BPDII I would be quite interested in how it is happening. 🙂

    Reply
  2. CT Today
    CT Today says:

    Yes, she’s taking a mood stabilizer in addition to CBT, which, as you said, is typical for long-term management of BPD. We just included an excerpt of the article with a link to the full text. At the end of the article, the author says, “The only medication I’m on now is Lamictal, the mood stabilizer.” I’m going to add that sentence to the post so that it’s more clear to readers – thanks.

    Reply
  3. Howard Schneider
    Howard Schneider says:

    It is unfortunate that it took a while for the patient to be managed successfully with the lamotrigine and CBT. However, BPDII is not always straightforward to diagnose, and psychopharmacological management still relies heavily on imperfect clinical feedback.

    A large advantage of doing CT with your patients is that it gives you a chance to get to know your patients better (which lets you make a better diagnosis) and collaborate with your patient with regard to psychopharmacological management.

    Howard Schneider, MD
    Toronto, Canada

    Reply

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