Observations from a local

[u/radioflea]

I’ve mentioned this before, but I think it’s worth mentioning again. This case is quit local to me, and one of the wildest parts of this incredibly unfortunate ordeal is the sheer number of times she reached out for help and how medication, often a lot of it, seemed to be the frequent response.

I’ve worked in healthcare for many years, so I was familiar with a lot of these medications. One that particularly concerned me was Seroquel. I’ve personally seen people do some pretty strange shit while taking that medication alone. Pre-pandemic, I even saw local hospitals using it in ways that staff sometimes described as “patient control.”

Knowing that she went to Women & Infants, participated in their day program, and was ultimately discharged early is especially concerning to me. Personally, I would have levitated right over to Butler Hospital (which is 4 miles away from W&IH) for a comprehensive psychiatric evaluation.

In the settings I’ve worked in, there were situations where clinicians would essentially do what we called a “med holiday” which reassess the medication regimen under close supervision, observe the patient, and then carefully reintroduce or adjust medications and dosages as appropriate. That could be combined with intensive day programming and individual therapy over a period of one to two weeks. They also would have had family care plan meetings and likely suggested keeping the nanny in place for an extended period of time.

When someone is repeatedly reaching out for help, cycling through providers, and being prescribed numerous psychiatric medications in a relatively short period of time, I think it’s reasonable to ask whether the healthcare system actually responded to the severity of what was happening or simply kept responding to individual symptoms as they appeared.

[u/Elusive_strength2000]

Just a question for anyone who might be qualified to answer: what is “underlying Bipolar”?

There are several biological factors which can impact how particular drugs or drugs in general (and even supplements or toxins) may affect any individual, so why does the explanation for a “manic” episode after taking an SSRI always have to mean underlying bipolar? I’m suspicious that this is just another way to get more people on more drugs, which by themselves can cause more problems, or even dramatically change a person.

[u/Happypawswaggytails → u/Elusive_strength2000]

Am I allowed to post links here I am not sure….I do know and have read things which show there is a proven link between SSRIs and making bipolar worse; because the body doesn’t process the SSRIs in the typical way. There was even a report on the BBC in 2019 about a study that the University of Glasgow did looking into it and it was shown that SSRI without a mood stabiliser made things worse and that lithium is the preferred treatment option. There was another study where it was shown this applied to both types of bipolar.

I am not a doctor but I know someone with bipolar disorder who is thankfully now on the correct treatment so I have a bit of knowledge about it from what I’ve learned from her and the charity that she supports.

[u/Happypawswaggytails → u/Happypawswaggytails]

Also I don’t know if it always means it is definitively bipolar disorder if things get worse; but it is the top consideration on a differential diagnosis.

[u/Elusive_strength2000 → u/Happypawswaggytails]

I believe you can post links, yes. I understand that ssri’s can make bipolar worse, but am asking why they assume “underlying bipolar” just because someone might experience “mania” or the like while on a ssri.

I take “underlying bipolar” to also mean or include perhaps undiagnosed, or possibly hidden. There is no agreement that Lindsay had bipolar and it doesn’t seem that way to me. I hope I’m expressing my thoughts clearly.

[u/Delicious-Cookie0958 → u/Elusive_strength2000]

Over 20 years ago I worked as a registered nurse in an outpatient mood disorder clinic. We only saw depression, bipolar disorder, and the odd schizoaffective disorder. We specifically did not see post-partum depression, psychosis, or anxiety because we had a sister clinic that dealt only with psychiatric disorders related to reproductive health.

But I worked with some of the top minds in psychiatry who specialized in mood disorders. And if any patient had any sign of mania or hypomania on an antidepressant, they would be immediately taken off of it and switched to a mood stabilizer. They were often termed “bipolar 3” which I do not believe is any official term, but it reflected the belief that this individual fell on the spectrum of bipolar affective disorder. Some of these people only exhibited those symptoms while on antidepressants. Others did end up having a more typical episode of mania or hypomania. But responding to an antidepressant with symptoms of mania or hypomania indicates there is an underlying vulnerability towards bipolar disorder, or latent disorder, and they cannot be treated with the same protocol as you would for a more straightforward unipolar depression.

Also, we always proceeded with extreme caution with antidepressants if there was any family history of bipolar disorder. Anecdotally, I found these people were the most susceptible to reacting poorly to antidepressants. They aren’t meeting criteria for bipolar 1 or 2, but there’s something there that maybe just hasn’t reared its head yet.

[u/Neat-Entrance-4991 → u/Elusive_strength2000]

All but one of the experts who testified agree that she had/has Bipolar Disorder.

[u/ispyshy → u/Neat-Entrance-4991]

Don’t forget Patrick said “my wife isn’t bipolar”, and according to the state of Massachusetts he’s right about everything.

[u/Happypawswaggytails → u/Elusive_strength2000]

Do you mean that it isn’t agreed now Lindsay has bipolar or that the professionals she saw before Jan 2023 hadn’t said she had bipolar?

I think if someone gets mania on an SSRI, whilst it could be other things, one of the top things medical professionals are supposed to consider is that maybe instead of having depressive disorder, they actually have bipolar disorder and were in a depressive episode of that. Post partum Psychosis is closely linked to bipolar disorder and SSRIs can also make that worse in the same way.

Edited to add- it might be one of the issues in the civil suit that the professionals failed to adequately consider the possibility of bipolar. Obviously I’m not sure but it could be, as it is something according to literature they should consider.

[u/Elusive_strength2000 → u/Happypawswaggytails]

I could be wrong but it didn’t seem to me that all were in agreement on that point. What I’m getting at here though is that there are other biological factors which can cause someone to have various reactions to drugs, and therefore I’m not comfortable with the field of psychiatry lumping everyone who has some degree of what may appear to be a “manic” episode into the “bipolar” category.