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
September 2002	Table of Contents (all articles are on this page) To Disclose or Not to Disclose?  by Li Lippman From the Chair   by Tory Masters New Newsletter Mail Format  Ask the Doctor  with Dr. Ivan Goldberg  Readers Corner (Book Review)  by Betsy Naylor        How I Stayed Alive When My Brain Was Trying to Kill Me Finding the Drug For Me In Just 48 hours ?      Here comes the smart pill . . . Darkness Goes Lyric  (Contest Winners) By Jane Cartwright Forget the Yellow Pages When Finding a Shrink  By Ilene Adler We Get By with a Little Help from Our Friends . . . About MDSG	When printed, this page will automatically re-format itself. Formatted for Printing

So many people spend weeks, months and years fighting depressive and manic episodes, trying to stabilize medication, finding a good therapist. Then they work to redefine relationships with family and friends and return to work.

When you get to the workplace, should you tell your boss and co-workers you have a mood disorder? Or, perhaps you have been working for years and then are diagnosed with a mood disorder and many sick days, hospitalizations or decreased work performance follow. Should you disclose the illness then? Say, people at work are starting to notice a change in you. Do you tell them? 

This question has been discussed in MDSG support groups at great length and the answer does not come easily.

Those who have attended many support groups over the years will attest they have heard an overwhelming number of stories of disclosure ending badly. Many get fired. If not, they are stigmatized as mentally ill and may lose credibility, be assigned to less meaningful work, be passed over for promotions and raises, and experience harassment from co-workers.

The discussion in the support groups usually leads to the conclusion that it is best not to disclose. However, there are stories of people who have confided in their boss and, for one reason or another, he or she understands what a mood disorder is and is not.

Sometimes accommodations can be made. There are advantages to this. Many people who cannot get up early have been able to adjust their hours. Others have been able to take days off when an episode occurs. One person even told a story about how disclosure saved her job. 

She had missed many days for depression. When she disclosed her illness, the company was afraid to fire her for fear of being sued under the Americans with Disabilities Act (ADA) that protects working people who have disabilities. This is where special accommodations come in.

Besides these benefits, many participants of support groups have an impulse to disclose to satisfy their need to share the experience of the mood disorder. Often they want to help fight stigma. They believe they can show others that people with mood disorders can function in the workplace like any other worker and that fighting stigma in the workplace will help eventually reduce it in society.

This is not without foundation. Most of us are aware that times have changed and, our society is becoming more understanding of mood disorders. Wanting to help fight stigma is heroic, but is it smart?

Attending support groups and hearing stories, talking to others, may help you make up your mind about whether to disclose. Every situation is different. You must always take into account your work history, level of functioning, age, gender, resiliency to stress, type of work, culture in the workplace, and many other variables. 

Think about how some of your relationships have changed because of your illness. Mood disorders can put a real strain on you and the people who care about you. If you disclose, those around you may become more vigilant about how you are feeling and may think more carefully about how to communicate with you in a respectful way. There may be others who are not as sensitive.

Supervisors and co-workers—especially those who may not understand your medications or know what to do if you are manic or depressed—may feel uneasy. It may be a bad idea to put this kind of strain on your relationships at work. 

It is wise to attend support groups because you can get help about what to do and even how to avoid disclosure at work, if this is the choice you make. The groups have endless numbers of ideas, too many to list here. For example, people have explained drowsiness from medications by saying they are taking a new antihistamine. Some people have said they are suffering from mononucleosis when they, suffering a depressive episode, have been absent from work for two weeks. Whatever you decide, getting help from support-group participants is important and asking for help about your particular situation is smart. It is wonderful to want to help change the world into a more empathetic place, but we have to protect ourselves and to make the choice that is best for us.

As the newly elected chairman of MDSG, I have been instructed by the “real forces behind the throne”--those members who have served tirelessly and with great passion for years--that it is customary for a new chairman to introduce him/herself by way of an opening letter in our newsletter.

First and foremost, let me thank our out-going chairman, Rich Satkin, who has the unique distinction of being an early MDSG pioneer. Rich helped coax and nurture MDSG into being almost 22 years ago and has worn every imaginable hat from administrator and facilitator to board member and chairman. Luckily for MDSG, the only hat he is passing on is that of chairman. Rich continues to remain active in every other regard. Thank you, Rich, from all of us! 

Now, as promised, a little bit about my background. I am 51 years old, married happily for 17 years and counting, and mother to an exuberant 13-year-old boy. My first career was in television where I worked as a producer for ABC’s Good Morning America, ABC News and Lifetime Cable Network. Circumstances inspired me to leave the business and start my own company 10 years ago. 

I now run a successful relocation firm to help corporate executives move to New York City and Tri-State suburbs to set up new lives, new careers. 

I come from a family with a history of depression and manic depression and know first hand what it’s like not only to be a family member of two afflicted older siblings, but what it’s like to be afflicted myself. I stumbled into my first MDSG support group in 1992 reeling from a severe, year-long depression that had rendered me non-functional. My decision to attend these groups was a crucial turning point in my own recovery process as well as my family’s. MDSG is where I found hope, reassurance and unconditional support. It’s also where I found dignity in the struggle of others like me--seeing first hand how much courage and spirit it takes to live with these debilitating illness.

I look forward to working with all of you. May MDSG prosper! 

Beginning next year, your newsletter will no longer come “blind,” hidden in an expensive, blank envelope. Mailing them “open,” such as folding them in thirds and closing them with staples or pressure seals, will save approximately $3,000 a year. No extra postage for heavy envelopes manually stuffed will free up funds to improve member services.

After much consideration and watching similar organizations shed “blind” mailing, MDSG’s Board of Directors decided to make this move, according to Tory Masters. “We feel the country has come a long way in eliminating stigma,” she said, “and now there’s less need to be quite so discrete.”

But if an MDSG newsletter clearly identified as such reaches your box or desk and makes you uneasy, drop the newsletter by calling, writing or e-mailing us. You can always read the newsletter on our web site. 

Ask the Doctor       with Dr. Ivan Goldberg

Q.  Is Borderline Personality Disorder really a medical problem or is it the result of trauma?

A. A. Borderline Personality Disorder is usually found in people who have a strong family history of unipolar or bipolar depression. Childhood emotional and/or physical and/or sexual abuse are usually part of the picture too. A family history of mood disorders seems to sensitize people to the affects of trauma and increases the probability that traumatic events will cause Borderline Personality Disorder.

Q. I am taking Tegretol for bipolar disorder, but I don't seem to be getting better. Are there other medications I can take? 

A. There are many. Among them: lithium, Depakote, Lamictal, Topamax, Keppra, Gabitril and a number of others. Only by trial-and-error is it possible to determine which medication or combination of medications is right for you.

Q. How successful is Marplan for treatment-resistant depression?

A. In general, Marplan is less successful for people with resistant depression than the other MAOI antidepressants--Nardil or Parnate. BUT, I‘ve seen a small number of people who did poorly with both Nardil and Parnate, but did very well with Marplan.

Q. What can I do personally to prevent a full-blown manic episode?

A. If you suspect early mania, contact your doctor and ask if your medications should be adjusted; take your meds exactly as prescribed; seek psychotherapy aimed at reducing stress; sleep at least seven hours each night; avoid alcohol and all other recreational drugs; limit caffeine (have just one cup of coffee in the morning and no caffeine-containing beverages—such as cola—during the day); and place yourself under house arrest. Shut phones off, turn music down, sit with only one CALM companion who shouldn’t leave the house. Do these things until you feel the mania subsiding.

Q. I was diagnosed with bipolar disorder 15 years ago and have been taking lithium. A recent blood test found that my kidneys were working only 50 percent as well as they should. Why was I started on lithium if it was going to lead to kidney problems?

A. Unfortunately, in some people, lithium damages the kidneys or thyroid gland. Spotting damage before it becomes serious is the purpose of routine blood and urine tests. They should be done every six months. Although lithium has side effects, it is still considered by many psychiatrists to be the best treatment for people with bipolar disorder. There is no mood stabilizer that has been shown to do as good a job as lithium in preventing suicide, for example. 

Q. My mother has had bipolar disorder her entire adult life and is mean and nasty at times. Is there any drug that could be added to her lithium to possibly prevent her from becoming so angry?

A. When a patient of mine is "mean and nasty" while taking lithium, the first thing I do is get a blood sample to make sure the amount of lithium in the blood is optimal. If it is not, I re-adjust the dose. If the level is optimal, however, there are a number of things that can be done. If the patient is depressed, and I believe that the irritability is secondary to depression, an antidepressant can be carefully introduced. If the irritability seems to be more a manifestation of uncontrolled mania, then adding a second mood stabilizer or low doses of an antipsychotic drug is likely to help.

Q. My daughter has bipolar disorder and has been under a doctor's care. We have now discovered she’s been using crack/cocaine when "stressed out." Is this affecting her treatment? 

A. Studies show about 60 percent of people with bipolar disorder abuse alcohol and/or drugs at one time or another. Substance abuse makes it harder for a person to achieve mood stability, and lack of stability makes a person more likely to abuse drugs. When this happens, it’s important both problems are addressed. In some large cities, there are AA groups devoted to helping people with psychiatric disorders control their drinking. So-called "Dual Diagnosis" (psychiatric/substance abuse) units at better hospitals explore how one problem affects the other and vice versa.

The Reader’s Corner (Book Review)  by Betsy Naylor  How I Stayed Alive When My Brain Was Trying to Kill Me  by Susan Rose Blauner  William Morrow, 2002

She wanted to die--or did she? Author and neuropsychologist Susan Rose Blauner survived three intentional drug overdoses. For 17 years, she struggled to stay alive. With help, she came to understand her suicidal thoughts and developed many paths to recovery. This self-help book is about that process.

The author deeply understands the lure of suicide. She theorizes that suicidal thinkers do not really want death—but relief. They crave, in addition, love, understanding, and connection. Often, suicidal ideas begin after stress, hurt, or loss. 

Most of what she says is standard-therapy fare: feelings are not facts; suicide is a permanent solution to a temporary problem; and, given time, feelings always change.

Blauner says there’s a difference between a suicidal thought and being suicidal. She suggests lining up suicidal thoughts with feelings. Like this: "The next time your thoughts focus on suicide . . . say . . . I'm having a suicidal thought and I feel _______.” A list of 80 different feelings prompts the reader.

The third section of the book, “Tricks of the Trade,” consists of 25 lists of activities and exercises to try when you’re in despair, suggestions to change a negative state of mind. Her lists include ways to release anger, physical exercises, distractions, hobbies, a long and creative set of affirmations. She also recommends keeping a journal to record emotional triggers, and progress.

In prescribing these, the author assumes the suicidally depressed person has some energy and initiative--more than many suicidal people do. She encourage readers to act as if . . . they wanted and could do these things, to take baby steps. When feelings are particularly intense, simple activities work best, she says. Important to remember.

I was frustrated the author didn’t relate her material to psychologic principles, cognitive concepts, or biophysiology. The book provides no scientific references, citations, or clinical data. She takes Prozac and credits her recovery to talk therapy and her “Tricks of the Trade.” She does not 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." 

I prefer a less touchy-feely approach. A theoretical recounting would have been more satisfying. She says she still has suicidal thoughts, but she’s safer because she’s developed skills. 

If I were suicidally depressed, I might find this book overwhelming: So many lists. So many choices.
Note: This review has been revised since it originally appeared in print. 

You can purchase (and read more about) How I Stayed Alive When My Brain Was Trying to Kill Me 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 September 2002 Amazon was selling it for $17.47 (the price can change at any time). 

A new study suggests there’s a way to discover whether a particular antidepressant will work in an individual after only 48 hours, or even in one week. This could speed things up tremendously in the tedious, trial-and-error process of using one medication at a time for six weeks or longer to make sure it gets its due.

A new test may mean we can try out four different drugs in about the same time (6 weeks) we now try out one. How many days, weeks, months have some of us wasted waiting to see if this or that pill had possibility?

A simple, painless, non-invasive test to measure brain function with quantitative electroencephalograms (EEGs) and a new measure of brain activity called cordance may make finding the pill that suits us a speedy affair.

The study involved 51 adults with unipolar depression. They received either Prozac (fluoxetine), or Effexor (venlafaxine), or a placebo (inactive pills). Tests were performed before the study, after 48 hours, and after one week. 
Patients who showed characteristic changes in brain electrical activity at 48 hours and at one week while on the medication showed the most improvement at eight weeks of use.

The study from the University of California at Los Angeles School of Medicine appeared in the July 2002 issue of the medical journal, Neuropsychopharmacology. Dr. Ian A. Cook was the lead author. 

Prozac and Effexor effect different brain chemicals—Prozac increases the supply of serotonin, while Effexor works mainly to increase the supply of norepinephrine. 

Despite their different mechanisms of action, Prozac and Effexor responders showed changes in electrical activity in specific areas of their brains as early as 48 hours after medications were begun. As with most antidepressant therapy, mood and other signs of depression did not improve until after four weeks. Patients who showed the greatest early EEG changes had the best responses to medication.

A January issue of the American Journal of Psychiatry featured research from the same study. It indicated that the well-known “placebo effect” has a different mechanism of action than active drugs. Although placebos are by definition inactive, many patients respond to them. It can be hard to determine how much of an individual’s response to any medication is due to this tendency to improve after any change in medication.

In the study, some of the patients who responded to placebos had shown a significant increase in cordance early in treatment. So did the patients taking both Prozac and Effexor.

Prepare for the Smart Pill.

Mental Health: For Depression, a Speedy Switch. June 18, 2002. The New York Times. Vital Signs column, by Eric Nagourney.
Brain scan helps track depression. June 11, 2002. Reuters. On the MSNBC web site. 
Note: Dr. Ivan Goldberg, the medical advisor to MDSG, warns that this study is as yet unconfirmed. He notes that many findings that sound initially promising never pan out when other investigators try to confirm them. In time, he says, this technique may or may not be found to be useful.  

Darkness Goes Lyric       Contest Winners   By Jane Cartwright

“Ninety-five percent of life,” Woody Allen said, “is simply showing up.” But it’s not that simple for the millions of us who suffer from clinical depression. One of the toughest challenges is trying to describe what it is like to “show up” depressed in front of so-called “normal” people. 

What’s depression like for you? We asked in the contest published in the March issue. Tougher, slower, a struggle juggling handicaps in a highly competitive world, you said. That’s what it’s like and it’s sad.

The contest’s first-prize winner, Graham Cooley of New Jersey, put it this way: “Depression: you’re in the longest traffic jam, but you are physically unable to turn on the radio for entertainment.” He wins a $50 dinner for two graciously donated by Mumbles Restaurant at 179 3rd Avenue at 17th Street..

Stella of New York, won second prize saying: “When very depressed, I want to die old as early as possible.” She’ll have the chance to read Unholy Ghost—an anthology of writers on depression edited by Nell Casey.

Winning third prize, Amanda from Connecticut wrote: “I see a severely depressed person showing up at a high school reunion only to realize she’s at the wrong school in the wrong town 25 years too late.” She wins a batch of The Best Cookies Ever for Beating Back Depression. 

Finding the right psychiatrist seems as difficult as finding a mate. Staying stable—in my case-involved sticking with one doctor over a period of years. How I found him is certainly one of the most bizarre stories I have to tell. 

Having tried many different kinds of therapy during the course of a very rocky decade, I was stumped. I traded in therapists one after another and didn't know what was left to try. 

I hadn't read anything substantial for many years, but a book jacket in Barnes and Noble caught my eye. The man pictured on the back was a psychoanalyst. What's more, he had successfully treated manic depressives! My poor mind was once again off and running. Psychoanalysis would surely save my soul. I interviewed several practitioners—and paid dearly for the privilege. Finally, I settled on a little Jewish man whose office was just around the corner from the Guggenheim. He told me he didn't want to handle my drugs and introduced me to a psychopharmacologies he had worked with in the past. What ensued broke my heart and what was left of my spirit.

I got my prescriptions without a glitch. Three days later, I arrived at the psychoanalyst's door for my first session. He told me—with no preamble—that he wanted me to go off my medication. Nothing of the kind had been discussed in our interview.

I did not go off my drugs, but four times a week he prodded me to. The psychopharmacologist was of the opinion that I needed the prescriptions he wrote for me. The analyst told me to tear them up. These two men carved me right down the middle. If they couldn't agree on a course of treatment, how was I—the patient--supposed to make up my mind? Things continued this way for nine months. Then I finally walked away from the psychoanalyst. I had simply had enough. The psychopharmacologist has worked with me for over 15 years. But I paid a heavy price to find him. Years after this incident, I called the psychoanalyst up. He didn't want to speak with me and sounded almost afraid. I asked him if he was aware of the position he had put me in. His response was shocking. He murmured, "Well, the field is divided."

If he knew this, was it ethical of him to take sides? Are we--the patients—being urged to take sides, as well? Do we waste months and years trying to find the right drug or giving up the search completely?

Beware of those with medical degrees who would play both ends against the middle. I hope my story will help keep someone else safe. Life is meaningless when there are no lessons to be learned.

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..

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:

 Social Rhythms Therapy
Monday,  October 7, 2002  
Dr. Frank is currently studying the efficacy of Interpersonal and Social Rhythm Therapy, an adjunctive psychotherapy she and her colleagues developed for the treatment of manic-depressive illness. This treatment focuses on helping patients to increase the regularity of their daily routines and decrease the amount of stress they experience in their day-to-day relations with others.

Subscribe to the MDSG feed

For questions or problems contact webmaster@mdsg.org