Alexia had been in-and-out of intensive psychiatric therapy for nearly two decades by the time we met. She suffered from bipolar disorder, which meant that she cycled between explosions of boundless energy and black holes of suicidal despair. Despair brought her to our unit.
Her long chart chronicled how previous psychiatrists had emptied the armory: antidepressants, antipsychotics, anticonvulsants, mood stabilizers, group and intensive inpatient therapy, psychotherapy, dialectic and cognitive behavioral therapy. Nothing had a lasting effect.
What struck me was the shotgun approach: try everything. Her medications spanned the molecular gamut: some stopped the disposal of the neurotransmitter serotonin, allowing more to be present in the brain; some focused on norepinephrine; others blocked the action of dopamine; yet others had an unknown target but had proven helpful to some patients. The imprecise approach to treating this most sophisticated of organs, the brain, seemed odd.
Read Full Article »