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
May 2003	Table of Contents (all articles are on this page) In Memoriam  Jane Cartwright, Carol Mager Lecture on June 2, 2003 Knowing Your Illness to Prevent Relapse by Li Lippman More Web Sites on Mental Health  The Reader's Corner. Book Review by Betsy Naylor The Bipolar Disorder Survival Guide-What You and Your Family Need to Know The Hierarchy of Mental Illness, A Group Member's Viewpoint     by Vanessa Ferney Ask the Doctors with Dr. Ivan Goldberg and Dr. Joe Nieder More Tapes, Better Prices     We Get By with a Little Help from Our Friends . . . About MDSG

Editor in Chief of the Harvard Mental Health Letter to Speak on June 2nd

When MDSG chooses speakers for the lecture series we always reach out for the top experts in the various areas of mood disorders. Many of these prestigious few have an especially broad understanding of issues because they work in many aspects of their field. They might conduct research, see patients, and teach, for example, or write, lecture and teach, or any other combination of these. Michael Craig Miller MD is just such a broad-based expert. 

Not only is he a leading author, clinician and researcher, he is also the editor-in-chief of the Harvard Mental Health Letter. This newsletter is unique in that it is both highly respected by professionals and easily read by the lay person. 

The Harvard Mental Health Letter prints articles addressing the most cutting edge topics. If you read the last issue of “MOODS,” hopefully you saw the excellent article written by Dr. Miller about the amount of personal information you need to have about your therapist. That was originally printed in the Harvard Mental Health Letter. Other stories in the Harvard Mental Health Letter have covered the placebo effect and the effect of heart disease on depression. Clearly, the most fascinating and challenging topics cross Dr. Miller’s desk.

On June 2, Dr. Miller will speak on many important topics, including some of the issues he covered in his article on personal information and therapists. He will also answer any questions from the audience. Don’t miss this exciting lecture. 

By Li Lippman

I thought it might be interesting to write about preventing relapse. Although many participants of MDSG support groups first arrive in crises, there are many who continue attending groups after they are stable. Not only can they provide help and hope for those who are still getting better, but they share invaluable information and managing skills in preventing another episode. 

One way to prevent relapse is to get to know your illness as well as you can. I interviewed an individual with depression to give some examples of ways that one can get to know their behaviors and spot a possible relapse before it becomes an episode. 

Usually, if someone takes an antidepressant, they do not feel depressed even when a relapse is beginning to occur. Often, you can spot your own behaviors that warn you that you are about to relapse. Remember, many of these behaviors are very similar to the behaviors of a person who is already depressed so don’t wait until it’s too late. Once you know what your normal routine is, you can spot early warning signs before you feel the full weight of the depression.

The person I interviewed has been stabilized on an antidepressant for a few years. He is healthy, a teacher, a facilitator and long time volunteer of MDSG. Here are some of the things he notices early that are different from his normal behaviors that alert him that he is getting depressed and it’s time to call the doctor.

• “I suddenly notice that I haven’t shaved in a week.”
• “I realize that my bills have piled up.”
• “Certain housekeeping is left undone, like there’s a pile of dishes in the sink and the litterbox is dirty (I’m usually pretty good with these chores.).”
• “I don’t do my job to my own standards. So, the work gets done, but I’m grading papers later than I like and not planning lessons the way I like.”
• “I may not always be quick to do my laundry, but I know I’m getting depressed if I find that the dirty laundry is on the floor, instead of in the laundry bag.”
• “I spend less time interacting interpersonally and more time interacting on the computer or sitting in front of the television.”
• “I can’t get to the gym or do any exercise even though I know it always makes me feel better.”
• “I stop cooking for myself and I end up ordering in more often.”
• “I turn down invitations to socialize with my friends because I just don’t feel like it.”
• “I take my sleeping pill more regularly.”
• “I can tell I’m getting depressed before I actually feel depressed when the corner of the fitted sheet comes up on the bed, and I don’t tuck it back in!”

It is important to have an idea of what you do normally before you start noticing your signs of relapse. Although many of these signs overlap with those of when you are already depressed, you may see some of them as warning signs before you become immobilized and you can contact the doctor early enough to prevent a relapse. 

Since we believe that having information is essential for getting better and staying well, and because we know that too much information can boggle the mind as much as the illness, we have been running this regular feature. We hope this helps bring order to your search for data. Here are more websites about mood disorders that we hope you will find helpful. As usual, be careful as you surf, you never know who is acting in an authoritative manner on the Internet, especially in chat rooms.

1. www.nmha.org National Mental Health Association
2. www.criseslink.org  Suicide Prevention Website
3. www.healthyplace.com  Information about Mood Disorders
4. www.adaa.org  Anxiety Disorders Association of America
5. www.bpso.org  Bipolar Significant Others Website
6. www.psycom.net/depression.central.famous.html  Famous People with Mood Disorders
7. www.schizophrenia.com/family/ect1.html Information about Electroconvulsive Therapy

We have a web page devoted to links about Mood Disorders.

The Reader’s Corner (Book Review)   by Betsy Naylor  The Bipolar Disorder Survival Guide    What You and Your Family Need to Know  by David J. Miklowitz, PhD.   322 pages. The Guilford Press. $18.95

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This book sold out when Dr. Miklowitz addressed MDSG in February. If you read one thick book a year, the Survival Guide should be the one for 2003.

Dr. Miklowitz is a professor of psychology at the University of Colorado. On July 1, 2003 he will become director of the clinical program at the department of psychology at the University of North Carolina at Chapel Hill. The valuable information in this book includes some of his cutting-edge research on bipolar disorder. 

What dilemmas occur in the lives of people affected by bipolar disorder! In short sketches the author illustrates frustrating situations. For some people a correct diagnosis takes years. Family and friends see symptoms like irritability or a wild streak as ordinary aspects of personality. 

A bipolar diagnosis brings its own challenges from the extreme of denial to feeling overwhelmed by the bipolar label. Then come the frustrations of dealing with friends and family. “You don’t need to remind me to take my pills every day.” Or “I can’t just pull myself up by my own bootstraps.” 

The author is so accurate in describing the experiences of a bipolar person, I felt he knew some of my friends -- and me.

"You're not alone in feeling that mania and depression are very personal and intense experiences. Nor are you alone if you are wary of any stranger's ability to understand what you're going through, no matter how highly qualified as a medical professional. Many people experiencing bipolar symptoms postpone seeing a doctor as long as possible because they already feel thoroughly misunderstood.”

The Bipolar Survival Guide helped me feel more understood than any other book I have read on Bipolar Disorder.

In most books on mood disorders, bipolar depression is discussed under Unipolar depression. While depression is depression, the mania pole makes bipolar depression have its own characteristics. The mania pole makes it different because antidepressants can make a person manic. (This factor underscores the importance of finding the right meds.

Dr. Miklowitz emphasizes the importance of taking medications as prescribed. But his name for this is concordance, rather than the more familiar compliance. To my ear, compliance is about rules, while concordance implies harmony and agreement.

The text on drugs is organized in user-friendly pages, where the clear writing teaches easily. He discusses why some newer drugs are better than older ones (except for the old standby lithium). He details the optimum uses of each drug, the evolution of combination “cocktails,” and many other questions.

The author lays out pragmatic advice for the bipolar person and family. For example, a chart that rates moods and lists simultaneous events shows clearly how moods move up and down. The same daily bedtimes and alarm clock times support wellness.

He acknowledges that these feats are difficult, but the bottom line could be the difference between being okay and doing well.

Throughout, Dr. Miklowitz addresses the experiences of family and friends when symptoms are at their worst. Dialogs demonstrate constructive problem solving. In a nonjudgmental manner, he helps family and friends understand the bipolar person so that everyone feels heard.

The writing is especially satisfying and clear. Short, illustrative sketches of patients and others come alive. Even with its serious subject matter, the book kept my attention from beginning to end.

Wouldn't you like to know specific actions you could take to minimize bipolar symptoms, reduce the number of episodes, and be as well as you can be? Dr. Miklowitz provides so many tools that almost everyone can find ways to improve. The Bipolar Survival Guide offers hope in every chapter.

You can purchase (and read more about) The Bipolar Disorder Survival Guide: What You and Your Family Need to Know 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 $13.27 at Amazon as of May 2003 (the price can change at any time). The hardcover edition is $38. 

by Vanessa Ferney

Mental illness is becoming increasingly less stigmatized in our society. A certain hierarchy, however, is still in place that leaves certain types of illness more stigmatized than others. Many unfair perceptions exist because people are unfamiliar with mental illnesses, and even those of us who suffer from one ourselves are often guilty of judging others. 

There was once a time when people were reluctant to disclose that they were depressed. It was considered a sort of weakness by society at large. Many felt that seeing a therapist meant a person was unstable and a misfit. 

Though that might still be true to some extent in many parts of America, in New York City depression and therapy are often just considered part of life, as if life in the Big Apple is a Woody Allen movie. In the arts, it is often considered normal to be depressed and in therapy. The public at times thinks that Prozac is consumed like candy, and it is almost unfashionable not to be depressed from time to time. 

Manic depression is now loosing its stigma as well. Mania has a reputation for being exciting and fun sometimes, and many people think that the depressive phases are the only negative aspect of the condition. Though anyone with serious manic depression knows that mania can also be quite horrific - at times involving paranoia, delusions, or even hallucination – it seems to me that if someone says they are bipolar, it is still somewhat acceptable. 

Other mental illnesses still remain stigmatized to varying degrees, especially those that tend to involve symptoms like paranoia , hallucinations, and delusions. 

Take schizoaffective disorder, which combines the symptoms of schizophrenia with those of a mood disorder-- either unipolar or bipolar type. A person with schizoaffective disorder may suffer from symptoms of either depression or manic depression while also experiencing the more florid and prevalent schizophrenic symptoms. 

Schizoaffectives are thought to have a “better” prognosis than schizophrenics but a “worse” prognosis than either mood disorder alone. This, however, is not always the case. There are many people with depression or bipolar disorder who are actually less functional at some points than someone with schizoaffective disorder or schizophrenia. 

Every individual is unique, and symptoms affect each person’s level of functioning differently. The general public, however, seems to feel that being schizophrenic is always worse than being bipolar, which in turn is considered worse than being depressed. 

Ironically, the mentally ill tend to stigmatize themselves and each other as much as others stigmatize them. Many mentally ill people are afraid to disclose not just to society, but to each other as well, and sometimes with good reason. Manic depressives are sometimes considered “crazier” than depressed people, especially by depressed people. That often goes double, triple, quadruple for schizoaffectives and schizophrenics. 

Suppose you were in a room full of people with mood disorders. It is perfectly acceptable to discuss your depression, how hard it is to get out of bed, your medication regimen, your therapy, and so on. A bipolar person may discuss these things as well, but she adds information on her manic symptoms -- delusions of grandeur, singing to people in the street, and buying a large plot of land in the South Pacific. The added manic symptoms are foreign to the depressed person and so often he will consider the bipolar person “crazier.” 

A schizoaffective in such a group may have depression or mania as well, but then he might add something about how his phone is being bugged or how difficult it is for him to learn how to fax a letter. All the more “bizarre” to the depressed person, and even to the bipolar person, not because it is “crazy,” but because it is something someone who suffers from depression or mania alone has not experienced. 

The impression is that the schizoaffective is less functional than the depressive because he is paranoid or is having cognitive problems. But consider the depressive who stares at the cracks in the ceiling and cannot get out of bed, compared to the high functioning schizoaffective who writes great works of fiction, or the schizophrenic who is effectively medicated and thus very articulate though still somewhat afraid of the police. 

Who is “lower” or “higher” in the hierarchy in these cases? The truth is that you can’t judge a book by its cover, and you can’t judge a person by his diagnosis. 

Those of us who suffer from mental illness should know better than that. If we judge each other, then we cannot blame the public for judging us as a group. We need to make a positive impression upon everyone we encounter, mentally ill or not, and prove our abilities. We should begin by giving each other a chance, so others will follow our own example.

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

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Dr. Ivan Goldberg, Psychopharmacologist

Q: I recently started taking Trileptal as a mood stabilizer. I've been on it for about 1 month and my right eye started twitching a few days ago. Could this be a side effect?
A: Most people find Trileptal to be a relatively easy drug to take because it is unlikely to produce severe side-effects. Twitching of the sort you mention is an uncommon side-effect of Trileptal. In my experience it usually disappears with continuing treatment . . .even if the dose is increased.

Q: Is it true that when one takes one of the new atypical antipsychotic drugs such as Zyprexa or Risperdal, that there is a chance of developing diabetes?
A: Olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel) and clozapine (Clozaril) have all been associated with the development of adult-onset (Type II) diabetes. Male, African-Americans, who are overweight prior to starting one of the atypical antipsychotic drugs are at especially high risk for the development of diabetes. 

While drug-induced weight gain increases the risk for the development of diabetes, it is upsetting that 50% of those who developed diabetes while taking atypical antipsychotics did not gain weight. In some people, the atypical antipsychotic drugs induces a state in which blood sugar increases because the body becomes resistant to the effects of insulin.

Olanzapine and clozapine are the atypical antipsychotic drugs that are most likely to induce diabetes and ziprasidone (Geodon) is least likely.

Dr. Joe Nieder, Pediatric Psychiatrist

Q. My son is only 8 years old and our doctor thinks he has bipolar disorder. Is it possible that such a young child can have bipolar disorder?
A. Yes it is possible that your 8 year old son has bipolar disorder. It is more common in the late adolescent years, but can occur at age 8 or even younger.

Q. How can you tell the difference between ADD and bipolar disorder in children?
A. The differentiation between ADHD and Bipolar Disorder in a hyperactive child is difficult. The behavior in a bipolar child is often more extreme, with severe tantrums, behavior shifts, and rapid mood swings. There is often a different biologic family history if available.

Q. I am 17 years old and on Prozac. How many years can I stay on Prozac safely?
A. The evidence to date is that Prozac is safe for extended use. Some people have taken Prozac for over 5 years. However, the longest study by the manufacturer is one year, I believe.

Q. My high school daughter has depression and has difficulty getting up for school on time. Are there special schools for kids with depression that may accommodate her?
A. Difficulty getting up in the morning for early morning classes is a major problem for depressed children and adolescents. The problem is dramatically lessened when the person is in college and can elect to take only afternoon or even evening classes. I don't know of a special school in the New York area that would accommodate her, but that might be arranged with any school.    

Did you miss a lecture of great interest to you? Most of the people who come to hear these experts speak, tell us how helpful the information has been. Not only do we find out about the latest scientific breakthroughs, but we also learn new coping skills from these cutting edge researchers, clinicians and authors. 

Tapes of these popular lectures are now available through the mail. Below is a listing of the most recent presentations. 

Tapes are $13 (including postage and handling) or $25 for two tapes, $35 for three tapes. To order by mail, simply write a letter requesting any tape by number.  You should receive your tape(s) in two weeks. Include a check payable to MDSG Inc. and send it to:

MDSG provides award-winning services to New York’s entire mental health community --- over 600 individual support groups a year, the distinguished lecture series, our telephone information service, our web site and this newsletter. And all at the lowest possible cost, through volunteers. 

The $4 contribution for meetings doesn’t cover all our expenses. We need your help to pay the phone bill, print the newsletter, promote MDSG in the media, and meet other needs.

Annual membership is $35 for individuals, $50 for families. Your membership card is a free ticket to support groups and most lectures. Contributions are tax deductible. So be a friend of MDSG--support us as we support you!

Memberships and contributions to MDSG are tax-deductible to the extent allowed by law. MDSG is an IRS-recognized 501(c)(3) organization..

MDSG/NY sponsors a series of  lectures on various aspects of mood disorders. Anyone can attend our lectures. More information is available on our lectures page. 

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