Where Black Box Warnings Go Wrong for Bipolar Disorder
Lately, the media has given a lot of attention to “Black Box Warnings” for increased risk of suicide for patients under 18 years of age to mid-20s who are prescribed psychotropic medications.
For every highly publicized individual instance of a radically adverse response to medication, there are thousands of patients who have benefitted from treatment and demonstrated no comparable reaction. There are also other factors that frequently go unreported, such as abuse of the medication, combining with alcohol or illegal substance, or suddenly terminating the medication without tapering off under the supervision of a physician.
Another important factor in the “black box warnings” controversies that has not received sufficient attention concerns the widespread confusion over separate and very different disorders.
Most reports to the media from family and treating doctors fail to distinguish between unipolar and bipolar disorders. The problem is this: When a patient with undiagnosed bipolar disorder is treated with antidepressants, the medications can produce an activating effect that can destabilize them and push them in to mania. If the patient is unstable, the risk of suicide may be increased.
Bipolar disorder – much more common than previously recognized – is glaringly the most under-diagnosed, misdiagnosed and mistreated mood disorder today. As a result, a reevaluation and adjustment needs to be made regarding black box warnings. As so many more patients suffer from depression and anxiety rather than bipolar disorder, there needs to be greater clarity regarding the supposed connection of medications and suicide. Otherwise, too many people are deprived of the opportunity to enjoy the benefits of an improved feeling of well-being and a more positive outlook on life.
It’s my job to carefully screen for bipolar disorder prior to treatment, as well as discuss suicidal ideation with the patient and give firm instructions to patients and caregivers to immediately contact us should thoughts of suicide arise. You and/or your loved ones deserve nothing less than from your care provider. To discuss this further with me, just ask me directly through the website, or make an appointment to see me in person.