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As consumers, we have met plenty of people who seem to have the same illness and are doing equally well on different meds. More problematically, we have seen people who don't get well despite the "correct" treatment for their illness. I was one of these.

In 1992, I had my first manic episode after some easy-to-diagnose depressive episodes during which I had not seen a doctor, and I was immediately diagnosed with manic depression. Ten years later I still carry this diagnosis.

I sought out treatment continuously from 1993 on. However, the debate in pharmacology at the time was about "polypharmacy," which means giving more than one psychiatric drug to a patient. Polypharmacy was thought to be a big no-no, showing that the doctor had screwed up his treatment. Therefore I was given lithium alone, followed by Depakote alone. When those didn't help, I was given Tegretol.

I was so extremely depressed during this period that when a fire broke out in my apartment building, I, naked in bed in the dark, refused to leave the building. Being killed in a fire would solve my problems. At that time I was not suicidal enough to do it myself.

Over the next few years, I switched doctors a few times until I got one who was more open to polypharmacy. He gave one drug for each component of the illness (I believe this is still the accepted method). Thus, I was given an antidepressant to go with my mood stabilizer. I had been put on Supplemental Social Security benefits, a far cry from when I had been the recipient of a fellowship for doctoral work in pure mathematics at Brown University From Polypharmacy to Risperdal

The result of this polypharmacy was that I always lived in a netherworld between total anguish and bizarre, silly behavior that was totally out of character. I made a bunch of friends who were bipolar too, and we'd all get hypomanic together. We would do things like throw eggs at a wall, or bake cookies, using lithium instead of baking soda to see if it would make the cookies rise.

I couldn't work because I retreated into bed often, I couldn't do math, write at any length, or concentrate. It was a two-year-long mixed state. After that, I felt different from non-ill folks who followed the social rules that I could no longer make myself obey.

I developed weird perceptions as well as weird behavior, and also became extremely agitated. An antipsychotic, Risperdal, was added to my medication regimen. The effect of the Risperdal was that I got my personality back, my thinking improved, and I was able to concentrate again. For a while I felt cured.

From Risperdal to Polypharmacy

After a few weeks I sank back into a terrible depression, disappointed that the Risperdal wasn't the magic I thought it was. My doctor tried changing my antidepressant to no avail. All I did was sleep.

I became convinced that fatigue was the main symptom of my depression that kept me dysfunctional. I like to work on a lot of projects, take walks, and read. I can usually distract myself from emotional distress, but there was no way to do anything at all while so fatigued.

I came up with the idea that amphetamines would help me, but I was afraid to broach this with the doctor because I feared it would sound like I wanted to get high. Then I read that Dexedrine is used as an adjunct to antidepressants in treatment-resistant depression, so I felt safe asking for a prescription. He gave me a very small dose of Desoxyn to try.

The first weekend was terrific. I suddenly felt the burden of my depression lift, and I could get up and think and read and socialize and be physically active, but soon the effect faded and my desire was to take more and more pills to get the great feeling back. Fortunately, I could see what was happening and I got off the Desoxyn with some difficulty as I was getting psychologically dependent.

In the next few years, I got increasingly depressed, attempted suicide twice, spent a week at a local mental hospital after the second attempt, and felt like I was losing my mind. Then I heard my current doctor give a talk on medicating bipolar disorder that made a lot of sense, and I decided I'd switch to him.

I was considerably better than I had been, but not doing all that well. I ended up with a regimen, which seems to be effective. It involves seven medications, some at very high doses, some at very low. The antidepressant I switched to is old and dangerous, but it is the only thing that has ever helped me.

I ended up in the hospital again. The hospital was horrified by my meds and took me off everything. That made me sicker than I had ever been. I was in total agony and when I wanted medication to calm down, they said I had the worst "medication seeking behavior" they had ever seen.

It took six months to get back on medications. The resulting regimen was almost identical to what I'd had before this last hospital visit. It turned out that trying to replace Risperdal with Geodon (Risperdal gives me bad side effects) was a bad move as I really need Risperdal to keep me from acting weird and getting angry and upset for no reason.

I hope my story is a lesson to doctors who have fixed ideas about how to treat each illness and then give up when their ideas don't work. Doctors have to be very flexible with medications. For instance, I take Risperdal and Adderall, which is an upper and downer combination. This seems suspect theoretically, but it works. Any effort to change either dose causes serious trouble.