Sunday, May 11, 2008 – The Styles section of yesterday’s edition of The New York Times ran an interesting article by Gabrielle Glaser entitled “‘Mad Pride’ Fights a Stigma.” In the article, Glaser highlights the fact that people with mental illnesses or “dangerous gifts” are speaking more and more openly about severe mental illness in an attempt to break down the stigma surrounding it.

I think this trend is a move in the right direction, although I do share the concerns of other doctors quoted in the article about the “medication is optional” belief in some Mad Pride groups. As Dr. E. Fuller Torrey, executive director of the Stanley Medical Research Institute in Chevy Chase, Md., was quoted as saying, “Would you be pro-choice with someone who has another brain disease, Alzheimer’s, who wants to walk outside in the snow without their shoes and socks?”

Still, I think that this growing openness is going to have a positive effect on de-stigmatizing mental illness and could perhaps even raise the bar for pharmaceutical companies and professionals who provide treatment.

A visitor to the Bipolar Blog asked this question: “Do some medications used to treat bipolar disorder actually cause anxiety attacks as a side effect?”

This is an interesting question and one that I hear quite often often. I always explain that even if I have never seen a certain side effect from a medication in the past, it is still something to consider, because individual brains are so different in how they respond to different medications. However, some side effects are more or less common with different medications, and it is worth looking at these trends.

It is uncommon, for example, for the mood stabilizing agents Lithium and Depakote to cause panic or anxiety. In fact, Depakote is sometimes used as an adjunctive treatment for anxiety.

The atypical antipsychotics - Risperdal, Zyprexa, Abilify, Geodon, and Seroquel are also unlikely to have the side effect of anxiety or panic, because they tend to “cool down” the brain responses rather than rev them up. But I have seen some paradoxical anxiety reactions with some of these medications including Seroquel and Geodon.

Lamictal, another mood stabilizer that has anxiety listed as a potential side effect, but I have not seen Lamictal increase anxiety very often in my patients.

The antidepressants all carry some risk of exacerbating anxiety in certain individuals, in addition to the risk of triggering mania.

If you are concerned that anxiety has started or increased after beginning any new medication or increasing the dose of a medication, be sure to go over this with your doctor who prescribed the medication. As I said, even if it isn’t a common side effect, your body and brain are different from anyone else’s and so you could have a unique response.

If you have a question about bipolar disorder, please post it on our Bipolar Blog Post a Question page. I cannot guarantee that I will answer every question, but your questions will help me identify the most compelling questions to address in future blog posts.