Medicating Mania

Question: Why did you finally turn to medication?

Kay Redfield Jamison: I, quite literally, woke up from a coma, from having tried to kill myself and it was very clear to me what my psychiatrist had been saying for years. The choice is not between a drug that has side effects or not, life is not ideal. Yes, your drug has side effects and yes if you don't take it you're going to die. And I—that had been clear to me, but there is something really crystal clear about actually nearly dying. I have not, since I emerged from my suicide attempt, there has not been a day that I have not taken my medication.

Question: Could you have coped with manic depression if you hadn’t been a doctor?

Kay Redfield Jamison: It's hard to say. I mean, I had the advantage, as I said, of having been treated by someone I knew was a superb clinician. Most people don't have the advantage of being able to evaluate their doctor in advance. So, that I think was a huge advantage and particularly since, in my particular illness, one of the worst things that can happen for a certain kind of severe bipolar illness is be given antidepressants, is that my psychiatrist knew better and didn't do that or only for a very short term and very controlled periods; very, very short and only once or maybe twice. So I am very fortunate in that respect. I would never say how fortunate I was. On the other hand, there were real difficulties because I was constantly concerned about losing my license, somebody finding out, so I didn't go into a hospital and the California Commitment laws were such that I could keep out of a hospital and I should have been in a hospital. I should have had ECT and I now have Advanced Directives written out for my doctor and my family that say, "This is what I want done. If I get severely depressed again, if I get manic again, I want ECT, I want to be treated at John's Hopkins, I want to be treated by the following doctors. I do not want the following medications. I do want the following medications." All the things that you know we encourage people to do in advance, I do. But at that time, it wasn't really possible.

Question: How do you identify manic depression?

Kay Redfield Jamison: Again, it's hard. One of the things that has been great over the last ten years or so are people a lot more educated about it, particularly young people. I spent a lot of time on college campuses because it is an illness that hits young. I am just staggered by the amount of information, not all of it accurate, but a lot of information that people have, much more than their professors and their administrators do about these illnesses, particularly about depression. I think that one of things, you know—for example, at Hopkins we have a very active program that goes out into the public and private schools in Baltimore and Washington and now across the country and just teach people the symptoms of depression. Just in a very straightforward way say, "These are the symptoms, really treatable illness, important that you are treated early." Matter of fact and so forth. Teach the teachers. Teach the parents; parents learn all about these mondo bizarro diseases that nobody gets and they don't learn about depression, which is what is actually most likely to hit one of their kids.

So I think there is more education out there. With bipolar illness it is more complicated because it often gets tied up with alcohol and drug abuse, agitation, problems with behavior that people don't necessarily associate with psychiatric problems.

Question: Are anti-depressants over-prescribed?

Kay Redfield Jamison: Well I think that—a couple of things. First of all, I am a huge advocate of prescription drugs given wisely and for the right reasons and the right diagnosis and also psychotherapy. I think psychotherapy saves lives and is hugely meaningful and I think that one of the unfortunate aspects of prescription drugs working well is that people tend to think that's enough. Usually it's not enough; sometimes it is. There is no question in this day and age that I think there is a lot of over-prescription. From a public health point of view, still the overwhelming problem is that people are not treated enough for depression; depression remains under treated. But are there certain zip codes, education levels, areas of the country where people are medicated if they are just a little volatile, little moody-broody, series of bad days, break up with a relationship? Yeah. There are and it's outrageous. I don't think anybody would defend bad practice and it's against gets along your earlier question about medicating grief or medicalizing grief. It's the same thing. It's the last thing you want to do is be medicating people because, a, there—these drugs do affect the brain. Now, they affect the brain in a lot of good ways as we're finding out in terms of regenerating parts of the brain that are damaged and it's important to put it in the perspective of both mania and depression are very toxic conditions to the brain. They are really bad for the brain and most of the medications are really pretty good for the brain, but for sure they're definite pockets of society where people are just over-prescribed.

Recorded On: September 30, 2009

 

After waking up from a coma after a suicide attempt, Kay Redfield Jamison realized that medication was her only remaining choice.

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