#sidenote that's not relevant if anyone ever has any questions about bp or wants advice or whatever my askbox is open

[flightysquip]

also time for some mental health babbling

this isn’t a rant or a complaint.  this is genuinely me curious.

so like

not that there are a ton of depictions of bipolar disorder in media (*that actually focus on treatment or humanizing the character or whatever, that isn’t just shorthand for Evil Or Slutty Person) but most of them i can think of off the top of my head (and i’ve been guilty of this myself in my writing in the past), when they name a medication, immediately go to lithium

which, like, i get it in a sense.  it’s an easy shorthand for bipolar treatment (i would guess a similarity would be ‘depressed person always prescribed prozac’ but my knowledge of antidepressants is not the strongest, the only experience i have with antidepressants was celexa and resulted in hospitalization).  and, like, it also sounds hardcore and medieval as fuck (well, that’s at least my reaction when i hear it mentioned), so it probably makes it easier to justify the inevitable ‘bipolar person stops taking their meds’ storyline that will inevitably pop up.  those are just sorta my guesses.

my question is

like

does anyone’s doctor, when they’re first starting treatment for bipolar (and i’m talking bipolar 1 specifically), actually jump immediately to lithium?

my experiences are limited, of course, and i’m just talking about myself personally.  and i’m sure factors like family history and severity and all of that come into play, maybe affects of other drugs on the patient or whatever.  i don’t know.  i really don’t.  i was initially diagnosed by a, like, a standard MD or whatever, like, a primary care doctor (i just mean she wasn’t a psychiatric doctor).  I made an appointment, went in because i thought i had depression, she did her assessment, diagnosis, and started discussing treatment options.  she DID mention lithium, but not in a “this is a possible route we could go” way but as a sort of, like, potential escalation if other meds didn’t work.  she also stated that she’d rather not go this route because taking lithium requires routine bloodwork and, I think her exact words were that it was a much more ‘high maintenance course of treatment’ than lamictal or some of the other options (i mean, obviously with lamictal you have to worry about the infamous “rash”, but no blood work was required, no concerns about it damaging your liver or anything in the same way that you have to monitor with lithium--again from my understanding with what she communicated that day).

she also started me on a really low dose, too, and built me up.  it wasn’t just ‘here’s a mindnumbing dose of this medication you’ve never taken, go on your way’.  i guess i can understand why this isn’t as explored in media though--it’s not really sexy or exciting, the little microadjustments and all that.

anyway, when i was eventually hospitalized (and taken off the celexa that i’d been prescribed to help with anxiety lol), once again the doctors in the psych facility did assessments and discussed treatment plans and all of that.  and i had another med added in addition to removing the celexa and keeping the lamictal.  and once again, lithium was discussed, as a sort of “if these meds don’t work, we have other options up to and including this form of treatment” and once again i was given the “we would rather not go that route” talk (i’m not saying this means lithium is bad btw!  i have no experience taking it, and different meds work for different people.  i just mean it’s a little ??? that almost all media i’ve consumed that features bipolar/manic-depressive patients, lithium is usually so casually namedropped).  side note, the whole experience of being committed involved a lot of assessments of other possible diagnoses because, like, bipolar holds a lot of similarities to other disorders (shoutout to my bpd and adhd sibs!)

and when i was released from the hospital and starting seeing a psychiatrist, once again we touched on treatment options, diagnosis, etc etc.  once again i went through some mild adjustments and communication about treatment options and so on.  and, like, i guess the reason i bring that up is, i’ve had multiple different levels of assessment (general practitioner, crisis/emergency psychiatric care, specialized week by week psychiatrist), and a fair discussion of meds and options, i’ve never been prescribed lithium or even had it seriously considered.  and, though again this is all anecdotal of course, i have a fair amount of friends/associates/familywhatever you want to call them who have bipolar disorder too, and i think maybe one of them has disclosed taking lithium (shit this makes it sound like i spend all my time sitting around talking about meds and symptoms with anyone who discloses their mental illness to me lmao fuck i’m obnoxious!).

you know what med universally gets brought up though across the board?  lamictal (my uncle even got that infamous rash, so i know it’s not actually a scare tactic!).  this isn’t me saying this should be the new shorthand medication in shows with bipolar characters.  but it’s just funny to me, i guess, that my personal experience doesn’t have a running narrative of “evil personality warping lithium!!!!” instead it’s “so hey i’m having my dose adjusted on this developed-as-an-antiseizure-med and hey does this look like a cluster of pimples or is it a rash because apparently if i get a rash i gotta hurry my ass to the doctor or i’ll die”

and i don’t know if maybe experiences with psychiatric care are just radically different elsewhere in the country, or if hollywood is just being hollywood, if it’s just out of date information or if my experiences are abnormal or what.  i mean, i guess it’s more, like, some variety would be nice, maybe?  not just in meds either, but all aspects.  some variety would be cool.