M O O D S

I saw a commercial on television the other night. The voice over said something like, “Does your doctor only see you like this?” The camera shows a beautiful woman in a doctor’s office looking down, sad, blue and depressed. Then the announcer says, “In order for your doctor to treat you effectively he must see your other moods,” and then the camera shows the same woman made-up, out dancing in a club, her hair flying around wildly. Then they show her vigorously painting her wall red and looking very irritable. 

Now the commercial really has my attention. Are they referring to mania? 

The commercial announcer goes on to mention the WebMD web site and invites the viewer to go to the web site and take a bipolar questionnaire. The idea is that if you fill out this questionnaire online, print it and bring it to your doctor, he or she will understand there are other moods he or she may not have seen. This increases the chances of correct diagnosis and treatment. 

We then see the woman returning to her doctor, questionnaire in hand. He looks over it and an expression of full understanding crosses his face. The woman is then shown looking relieved and calm. Apparently she has been correctly diagnosed, prescribed the right medication and feeling better.

I mute the television and sit, dumbfounded and amazed. Wow! I just saw a commercial, on primetime television that openly addressed manic-depression. My first reaction was joy. I remember other ads relating to mental illness like commercials for Paxil and Zoloft. They mention depression and anxiety. But now, finally, we have a commercial that talks about mania, right out in the open.

I decided to log on to WebMD to take a look. Upon arriving at the web site, there is a clear box offering a bipolar screening test for the cyberspace surfer. I click and the questionnaire is there. It’s about 15 questions long and you just answer yes or no. There are references at the bottom of the page crediting the people who put together the questionnaire, and I recognize them to be some of the most prestigious researchers on bipolar illness.

The top of the page has three things that catch my attention. First, I see the drug company that sponsored the online questionnaire, the company most likely to have paid for the commercial on primetime. Second, I notice our national logo, DBS Alliance (Depression and Bipolar Support Alliance) and third, a disclaimer. 

The disclaimer warns that the questionnaire is not a substitute for seeing a doctor and does not confirm or refute a diagnosis of bipolar disorder. It is to be used to help the doctor make a diagnosis. 

But I was worried. I imagined thousands of people deciding that they have bipolar disorder after filling out the questionnaire. The disclaimer is there, but this simple, easy-to-understand list of questions on the computer screen appears very official. What if people log on and decide that they have this illness based on this questionnaire? After reading through it, I can tell it is not enough to make a diagnosis. 

A friend of mine who has bipolar illness saw the commercial and looked at the questionnaire; she felt that the questions belittle the experience of the illness. She is afraid that although the public may be getting used to hearing the term, bipolar, people may also think that the intensity and profoundness of it is captured in this questionnaire, and it’s not. 

So this is what I realized. The commercial is aimed at the general public. Most of the people at the Mood Disorders Support Group are not that. The people who attend support groups are very sophisticated about mental health. They are educated consumers who know a substantial amount about the variety of illnesses, medications, drug interactions and about how to communicate with doctors. 

Although this commercial, and the questionnaire itself, may appear to some of us to be oversimplified, or even glamorized, I remind myself that all commercials use attractive actors and this can send an important message that educates the public. Ads like this one, and the ones for Paxil and Zoloft, show the public that regular people get mental illnesses and that, in turn, helps alleviate stigma. There was a time when breast cancer and prostate cancer carried incredible stigmas. Nobody would talk openly about them. This is not true anymore. 

We who are more knowledgeable than the general population about psychiatric disorders have to be patient. Change will probably take longer than it has for other illnesses, but I will stay with my initial positive reaction to the commercial. Although most of us know drug companies spend millions promoting medications through these commercials and this turns off many of us, the positive effects of the ads doesn’t change. 

Clearly there are many levels to the impact of this kind of media. Direct consumer advertising that promotes informational web sites and medications and shows people getting better tells the public that anybody can suffer from mood disorders. If I see more ads like this that speak openly about mental illness, especially bipolar disorder, then I will feel that we are moving in the right direction. It lessens stigma and keeps hope alive. 

It occurs to me we often forget to mention the extraordinary work done behind the scenes on the national level by our parent organization, the Depression and Bipolar Support Alliance (DBSA). You’ve known it for years as the National Depressive and Manic-Depressive Association. The name has changed and the reasons are all to the good! 

National decided a name change was necessary for many reasons. It felt awareness and understanding of the illness has increased dramatically, consistent with advances in scientific research and treatment, and legislative support for treating mood disorders as a medical illness is gaining momentum. 

“Recognizing these trends, National DMDA’s Board of Directors approved a new strategic plan for our organization that will take us into 2004,” according to Lydia Lewis, Executive Director. 

“Our primary focus remains unchanged: improving the lives of those affected by depression and bipolar disorder. But the plan calls for some very significant changes including increased focus on the illness from birth to late life, and on co-occurring (mood disorders and other mental illnesses) dual diagnosis (mood disorders and alcohol/substance abuse) and comorbid illnesses (mood disorders and other physical illnesses). In addition, our plan mandates the creation of materials to help family members support the patient (from a patient perspective), and perhaps most dramatically of all – of changing our name. 

“The decision to change our name came only after long and hard thought. There are many reasons the Board of Directors feels this is important,” continued Lewis. “First and foremost, our name is long and difficult for most people to remember correctly. Perhaps even more difficult is saying our tongue-tying acronym - National DMDA. In addition, bipolar disorder is no longer called manic-depression. You may not know that many people are frightened by the term 'manic-depression' and this keeps them from contacting us for help.” 

And help is what DBSA is all about. Those of us at the local level sometimes forget to tell our members how hard our parent is working to help all of us who are affected directly by mood disorders. They provide an invaluable store of up-to-date publications and books on the subject free or at nominal charge to members. All information is vetted by an extraordinary scientific advisory board made up of the finest in the mental health field from around the country. 

DBSA also provides a list of chapters around the country. They offer resources and links to mental health associations and foundations and will help any caller find local mental health experts and assistance. Finally, they also fight our battles in congress to change laws and regulations to put mood disorders on equal footing with other medical disease. 
DBSA is located at 730 N. Franklin St., Suite 501, Chicago, Illinois 60610-7224. You can reach them toll free at 800-826-3632 or go to their web site at www.DBSAlliance.org. 

Starting with the first issue in 2003, MOODS will be mailed folded and secured rather than being stuffed in a large, white envelope, according to MDSG’s Board of Directors. Anyone who does not want an “open mailing” of their newsletter should contact us to cancel their subscription. 

All information in the newsletter is intended for general knowledge only and is not a substitute for medical advice or treatment for a specific medical condition.

Ask the Doctor       with Dr. Ivan Goldberg

Top Of Page

Q. My mother has had bipolar disorder for her entire adult life and her mood swings are well controlled by lithium. However, she is often mean and nasty. Might a medication change help her?

A. First, I’d get a blood test to make sure the amount of lithium in the blood is optimal. If it is not, I’d readjust the dose. If it is optimal, I’d try other things. If the patient is somewhat depressed, and the irritability seems secondary to depression, I carefully add an antidepressant to the lithium. If the irritability seems more like uncontrolled mania, then I’d add an anticonvulsant mood stabilizer or low doses of an anti-psychotic drug. If the behavior seems related to a personality problem, psychotherapy may help.

Q: I recently asked to be taken off Effexor because of the sexual side effects and had a horrible time reducing the dose. What is the proper way to come off Effexor?

A: Effexor (or Paxil), are eliminated from the blood very rapidly, and if the dose is not reduced slowly, dizziness, sweating, visual problems, tremors and other uncomfortable withdrawal symptoms may develop. Try lowering 20 per cent of the original dose every four or five days. If you continue to have withdrawal symptoms, discontinue them even more slowly. Occasionally, it’s necessary for some patients to take some fluoxetine (Prozac) for a few days to eliminate the withdrawal symptoms.

The Reader’s Corner (Book Review)  by Betsy Naylor  Just Checking by Emily Colas  Washington Square Press, 164 pages.  $12

Top Of Page

Emily Colas reflects on her obsessive-compulsive self in comparison to her friend the drug addict:

"Me, I'm just neurotic. I suppose you could go as far as calling me mentally disordered . . . But still, as pathology goes, mine's pretty uncool. Rock stars don't get magazine covers because they kept their audience waiting while they washed their hands twenty times."

Readers of the memoir Just Checking are in for lots of surprises, like the author's irrepressible sense of humor. The many anecdotes draw word pictures of Emily Colas's experiences with obsessive-compulsive disorder (OCD). She sketches a decade of struggle with many raging fears, especially an irrational terror of contamination by germs or blood.

I learned a lot about OCD from this book. It taught me how debilitating OCD can be, how intense the suffering caused by the constant, punishing brain chatter is. 

When a particular fear is in force, it takes away all choices, placing irrational demands on the mind. The author hovered at the point of paralysis, her mind consumed with thoughts of terrible possibilities. So much of her environment seemed dangerous.

The subjects for fear were endless: "Around every corner, behind every door, with every handshake, in every wadded tissue is a potential transmission waiting to happen . . . I possess an endless capacity to keep worry alive." 

At times Ms. Colas found it impossible to leave home, terrified of infection from a speck of blood on the sidewalk. On good days, she could get out, but had to inspect every spot on the pavement for potential contaminants. Her family, especially her husband and two children, had to live with her fear-induced limitations. She enforced a complex, ritualized procedure that he had to follow for taking out the garbage.

Eventually, Emily Colas had that moment of clarity when she agreed with all those who, for many years, had given her a look that said, "I think medication might help you." And it did, releasing her energy for productive activity such as returning to work at a mental health clinic.

I first read Just Checking a couple of years ago and have always remembered this poignant story. Yet Ms. Colas' vignettes are chock full of laugh-out-loud lines. I found this remarkable book worth rereading again and again. And again. Just kidding.

You can purchase (and read more about) Just Checking from Amazon.com by clicking here. Doing so will result in a referral fee being paid by Amazon to MDSG, at no cost to you. The book is available in hardcover and as of December 2002 Amazon was selling it for $9.60 (the price can change at any time). 

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

You should receive your tape(s) in two weeks. Below is a listing of some of the most recent presentations. 

"The Reader's Corner" by Betsy Naylor in our last issue contained errors. Susan J. Blauner, the author of How I Stayed Alive When My Brain Was Trying to Kill Me, is neither a PhD, a psychotherapist nor a neuropsychologist. She does not now dislike taking medication, stating that "medication is part of why I am alive today...it helped me do the work I needed to in order to get well." Her book cites Dr. Edwin S. Shneidman, author of The Suicidal Mind. We regret these errors. 

There is more known about psychiatric illness than ever before. We understand the brain’s complexity better. There are new medications and novel therapies developed constantly. With all this knowledge and information, the fight through the jungle of symptoms and the journey toward stability should be easier. Yet sometimes, all the data and new facts can be just as much a tangle as the illness. Information overload should not be part of the problem. 

Since many people use the computer as a tool to begin sorting through the possibilities and making sense of their struggles, we decided it was time to begin a new feature. Starting with this issue of Moods, we will offer a list of web sites you might find helpful. We are starting with a modest list of standard and helpful sites. In future issues we will add more.

Through links on these sites, you will be able to reach dozens more. Be careful, especially if you happen to connect to chat rooms since you don’t really know who is at the other end posting “authoritative” statements. 

1. www.dbsalliance.org  Depression and Bipolar Support Alliance
2. www.bpkids.org  Child & Adolescent Bipolar Foundation
3. www.afsp.org  American Foundation for Suicide Prevention
4. www.drada.org  Depression and Related Affective Disorders Association
5. www.nami.org  National Alliance for the Mentally Ill
6. www.depression.org  National Foundation for Depressive Illness
7. www.psycom.net/depression.central.html Dr. Ivan's (of “Ask the Doctor”) Depression Central
8. www.mclean.org  McLean Hospital Mental Health Treatment Service & Research for Boston, MA and the World
9. www.lcmedia.com/infinite.htm  Website for The Infinite Mind--a public radio show about behavior and mental health.
10. www.ocfoundation.org Obsessive-Compulsive Foundation

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

If you have any that you want us to check out, send us an e-mail at info@mdsg.org.

Reprinted from the web site, poetz.com, with permission of the author, Alison Carb Sussman. Ms. Sussman is a writer living in New York City.  

MDSG provides award-winning services to New York’s entire mental health community---over 800 individual support groups a year, the distinguished lecture series, our telephone information service, 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..

Our home page provides an overview of our services. To contact us:

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. Our next lecture is:

Different Types of Depression and their Treatments
Monday, January 6, 2003 
Robert Cancro M.D., Med.D.Sc. 
Robert Cancro is a Professor of Psychiatry and Chairman of the Department of Psychiatry New York University School of Medicine. His medical specialties include: Attention Deficit Disorder, Diagnostic Evaluations, General Psychiatry, Neurometrics and Psychopharmacology.