The Mood Disorders Support Group of New York City

	M O O D S
Newsletter of the Mood Disorders Support Group of New York City
February 2004	Table of Contents (all articles are on this page) Winter Lecture Line-up: New Speakers and Old Favorites  Noticed In The Media by Leslie Shaffer Medications and Impending Motherhood by Li Lippman Ask the Doctors with Ivan Goldberg and Joe Nieder The Reader's Corner  Book Review by Betsy Naylor Electroshock: Healing Mental Illness We Get By with a Little Help from Our Friends . . . Contact MDSG	When printed, this page will automatically re-format itself. Formatted for Printing

March 1, 2004
What’s Personality Got to Do With it? 
New Directions in Therapy for Mood Disorders 

with David P. Bernstein PhD Co-Director, Forensic Psychology , Associate Professor, Department of Psychology, Clinical Psychology and Psychometrics Programs, Fordham University 

Many people experience depression so intensely that it seems to grip their lives to the point where they wonder if they have lost their identity completely to the illness. Often in support groups we hear people ask, “Who am I?” Where am I? Am I just my illness or is there a part of me independent from the illness?” And in the Friends and Family group we hear people say things like “Where is the man I married? I don’t see the wonderful, playful and interesting personality that he had years ago. All I see is the psychiatric problems. Which is the real person? Is the man I used to know the real person? Or is the person with the mental illness the real person? Is there something wrong with someone’s personality that causes a mood disorder? There are so many questions. Dr. Bernstein is an expert in this area and has developed therapy to help address these issues

April 12, 2004
Attention Deficit Hyperactivity Disorder and Its Impact on Depression and Manic-Depression

With Paul H. Wender MD University of Utah School of Medicine

A 30-year-old woman is having difficulty concentrating. She has nervous energy. She can’t stay focused and she’s becoming agitated. She is getting in trouble at work. She may even get fired. Her friends and co-workers grow concerned and start to worry. They urge her to see a doctor. Her regular doctor sends her to a psychiatrist. She gives some basic, surface information to the psychiatrist who says that this is clearly Attention Deficit Hyperactivity Disorder and treats her. She gets a little better, but not completely. Was her diagnosis a mistake? Does she really have bipolar disorder? What is the difference? Plenty of people have both ADHD and a mood disorder or just one or the other, but very often the symptoms are similar. How are they diagnosed properly? What are the differences in how they’re treated? If someone does have both, does ADHD change the course of the mood disorder? 

Dr. Wender is one of the leading experts in this field. He has done a lot of research on this issue and can help clear up the confusion about ADHD, depression and manic-depression. 

This is our first Cartwright Memorial Lecture: Made possible by donations given in memory of Jane Cartwright who is affiliated with the University of Utah.

May 3, 2004 
“Ask the Doctor” The Latest Research Findings and Your Questions Answered

with Ivan Goldberg MD

Every culture has perennial favorites like the Christmas tree and the Easter bunny. At MDSG, one of our favorites is our renowned medical advisor, Ivan Goldberg MD. People ask for him over and over again. A psychopharmacologist who keeps up on the latest research, Dr. Goldberg also runs an extensive, frequently updated website for the public, as well as a website exclusively for other doctors and researchers. Why is he so popular? Because he knows more than almost anyone. And he loves sharing. So bring your questions!

More information about our lectures is available on the lectures page. 

Did you miss a lecture? Tapes of our lectures are available - $13 for one, $25 for two, $35 for three. For more, see our lectures page.

by Leslie Shaffer

Fascinating how writers in the gothic genre portray mental illness. Contemporary gothic writers have a very different take from classic gothic: In the Contemporary, the madwoman has clear symptoms of manic depression. Teresa Madeiros’s latest gothic novel, One Night of Scandal includes an afterword describing the symptoms of the illness and advocating that medications like antidepressants and antipsychotics be treated like medication for heart disease and diabetes. She even sends readers to www.bipolarawareness.com for more information. 

In the classic, the madwoman in the attic is getting a makeover. A stock character of the 19th century classic gothic novel, her most famous incarnation came in Charlotte Bronte’s novel Jane Eyre. On what was to be her wedding day, Jane learns her mysterious and brooding Mr. Rochester’s deep secret: His first wife is not only still living, but she is also caged in the attic and becoming increasingly violent. (Bronte doesn’t tell us whether she became violent before or after being locked up.) Literary critics have long seen the first Mrs. Rochester as a metaphor for steadfast Jane’s anger at moving through a succession of roles as abused orphan, abused charity pupil, abused charity teacher, abused governess and abused fiancée. Now if only our madwoman could make it to the end of the novel without dying …    

The Court TV Forensic Files episode titled “The Big Chill” features the case of a bipolar woman taking lithium. She complained of severe side effects to numerous doctors, who all urged her to continue taking the drug. After her death, police discovered that her husband had been poisoning her. (The moral of this story is that if one drug seems to cause severe side effects and you aren’t stable on it, you may need to try a different drug. Doing a background investigation before marrying someone can’t hurt either.)

If you’ve ever wondered what makes antidepressants so expensive … A single truck accident involving a shipment of Wellbutrin XL has cost drug maker Biovail, $10 million to $20 million in sales. Biovail is manufacturing the drug for GlaxoSmithKline. (Reuters October 3, 2003)

The Onion, a national satirical newspaper, reports that after years of drug trials proving it highly effective for treating everything from depression to headaches to heart disease, the FDA has finally approved prescription Placebo. 

By Li Lippman

When deciding to have children, women with depression or Bipolar disorder have an additional issue to consider. Should they go off their medications while pregnant? 

Clearly, the dilemma weighs risks. Nobody wants to harm an unborn child with psychotropic medication. But if taking the mother-to-be off medication poses a large risk of relapse and even hospitalization, then that’s unacceptable also.

 Another option may be to lower the dose of the medication during pregnancy. But that may put the mother at risk of becoming depressed and unable to function like getting to work or taking care of other children. Also, lowering medication may increase the chance of postpartum depression which can effect early attachments with the newborn. Many women stay on their medications through pregnancy. 

The book, Love Works Like This, by Lauren Slater takes a good look at the risks of each choice. Dr. Slater is a writer and psychologist who suffers from depression. She writes a very honest portrayal of her journey through pregnancy and giving birth. She shares quite candidly and sometimes humorously, her emotions and thoughts regarding her effort to be a good mother while preventing a depressive episode. 

Although she is only one case, this book could be helpful to women who need to hear stories from others to help them make their own decision. An article in a recent New York Times Science section stated that some women taper off antidepressants during the first trimester (during fetal organ formation), but then go back on in the second trimester to avoid relapsing. Also, the article sites studies that show that no antidepressant has been linked to serious fetal abnormalities. The doctors in the article explain that no option is completely risk-free. In some cases taking the expecting mother off medication poses a greater risk than the medication would to the fetus. 

This is not a common topic in support groups at MDSG, but the value of having attended a group regularly could be enormous when a time may come for a difficult decision. For instance, if a participant of the Youth Group considers having a family, having attended groups regularly may help them get to know their illness well and how important therapy and/or medication is to them. This could help them in the future with big life decisions like relocating, changing careers or…having a baby. 

Ask the Doctors    with Dr. Ivan Goldberg  and  Dr. Joe Nieder

Top Of Page

Dr. Ivan Goldberg, Psychopharmacologist

Q: My mother was diagnosed with bipolar disorder was when she was 17. I am 18 now, and worry that I might have inherited the disorder from her. What are the chances that I have?

A: If one parent has Bipolar Disorder, the probability of a child having it is about 15%. If both parents have been diagnosed with Bipolar Disorder, the probability of a child developing the disorder is about 50%.

Q: When I feel that I may be beginning to gat manic, what can I do to help myself?

A: If you suspect that you are becoming hypomanic or manic: 

• Inform your physician about what is happening and ask if your medications should be changed.
• Take all medications as prescribed.
• Remain at home spending time reading or doing other quiet activities alone or with one good friend who has a calming effect upon you.
• Spend 8 to 10 hours in bed whether or not you can sleep.
• Avoid all alcohol and any recreational drugs.
• Limit caffeine to 250 mg per day (two cups of coffee).
• Place one's self under house arrest (phones shut off, no loud music, only one CALM companion, never leaving the house).
• If you must leave the house take a minimal amount of money and no credit cards.
• Avoid E-Bay on the computer and QVC on the television

Dr. Joe Nieder, Pediatric Psychiatrist

Q: The parents of a depressive high school student would like to place their daughter in home instruction because of her difficulty with the school schedule. The evaluating team denied their request because they felt it would enable the student’s depression. What is your input?

A: I think a better option would be a special school equipped to deal with the girl's illness and the problems it creates for her at school. If her current school is not working for her, there are other options besides home schooling. A special school, staffed with well-trained teachers and other professionals would likely meet her needs. This setting will allow her to get an education, be with children her age, and allow her to develop peer relationships 
and participate in other activities as well. 

Q: Could stimulant medications trigger manic episodes in children and adolescents?

A: It appears possible, although it happens less frequently with stimulants than antidepressants. Doctors prescribe stimulants far more often than antidepressants and they see less dramatic mood swings in those patients than the ones taking antidepressants. The exceptions would be the use of cocaine, ecstasy or crystal meth in adolescents, which can trigger manic or psychotic episodes.

The Reader’s Corner (Book Review)   by Betsy Naylor  Electroshock: Healing Mental Illness  by Max Fink, M.D.   Oxford University Press, $12.95

Top Of  Page

So intense are our feelings about Electroconvulsive Therapy (ECT), that it is difficult to take in any new information. However, this most frightening psychiatric treatment is most likely to help when medications have failed to relieve depression and certain other symptoms.

I was drawn to Electroshock by a tiny New York Times article which said that the book was a comprehensive and short introduction to this subject. What is its history? Why the stigma? Exactly what takes place? Who can be helped and who can't? Lots of information.

No two patients need the same ECT treatment. Duration, frequency, the amount of electric current can vary for each person. The author's quirky case examples illustrate these differences. Some patients are children, some are senior citizens; some are psychotic, some are catatonic. He tells us most make dramatic improvement. A few patients need follow-up for months or years. If not enough treatments are given, a patient can relapse.

Electroconvulsive therapy has certainly acquired an unappealing reputation (A central concern, memory loss, is covered over several pages). Those who have seen the movie "One Flew Over the Cuckoo's Nest" will never forget Jack Nicholson's portrayal of a brutal shock treatment scene. This and other anecdotes have left the general public with ECT trepidation. 

Dr. Fink explains what takes place. Patients are given anesthetics, muscle relaxants, and then a small electric charge. Electroconvulsive therapy has been refined to be as patient friendly as possible. But the stigma and worry persist. 

"...apprehension about the abuse of the mentally ill with electricity was so broadly circulated that it is still difficult for doctors to apply the treatment. The public misinformation is tragic; it can deprive mentally ill patients of a useful treatment."

In 1972, presidential candidate George McGovern chose Senator Tom Eagleton to be his running mate. Little did anyone know, Eagleton had had ECT. When people learned this, they judged it, and Eagleton was forced to withdraw.

Once in a while, well known people tell us of their ECT experiences. In their memoir's, writers William Styron (Darkness Visible) and Martha Manning (Undercurrents) wrote openly about their terrible depression, and how ECT helped. Dick Cavett has also chosen to speak publicly.

All the information in this book, the successful case examples, even the famous poster people did not completely talk me out of my trepidation about ECT. But if I were living with un-ending depression and medications had not worked, I would certainly turn to Electroconvulsive therapy for help. I would be thankful for this treatment resource and all the research which has made it better. 

You can purchase (and read more about) Electroshock: Healing Mental Illness by Max Fink from Amazon.com. Doing so will result in a referral fee being paid by Amazon to MDSG, at no cost to you. The paperback edition sells for $10.36 as of February 2004 (the price can change at any time). 
  

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