M O O D S

By Betsy Naylor, MDSG Chair

As someone who helps guide this organization's fortunes, I find it odd that I have mixed feelings about this important announcement. The Mood Disorders Support Group's (MDSG) popular Wednesday night meetings are about to move to a terrific new location, but we are leaving what has also been a terrific place. For nearly 14 years we've been the happy guests of the Jewish Board for Family and Children's Services (JBFCS), however for the last few years, change was in the air.

As MDSG continued to grow, the folks at JBFCS began to initiate evening programs of their own, and there are just so many rooms to go around. Some weeks the space crunch was so tight we could only offer three groups instead of our preferred six. It became apparent that we'd have to relocate. MDSG will always be grateful to our helpful friends at the Jewish Board, especially our patient host, executive vice president, Paul Levine, who understood the predicament and continually tried to accommodate our needs during this difficult transition.

Well lucky us! For every door that closes, another opens. We've found a wonderful new space, in the same neighborhood, just a few blocks west at 910 Ninth Avenue, between 58th and 59th Streets, right behind the Time Warner Center at Columbus Circle. During the day our new site is the renown St. Luke’s/Roosevelt Adult Outpatient Psychiatric Clinic, but every Wednesday night, after it closes, starting September 6th, that's where the Mood Disorders Support Group will be holding forth. As usual, doors open at 7 PM and groups start at 7:30 PM. We'll have enough rooms for Bipolar, Unipolar, Under
Thirty, Family & Friends, and Newcomers. Same facilitators as before, and same support, same information, and same sushi bar. (I'm only kidding about the fish.)

I do want all our members to make note that there will be no interruption of service. Until September 6th, MDSG's Wednesday groups will still meet at our present Jewish Board location: 120 West 57th Street. The last night at our old place will be August 30th and then it's Westward Ho!

Did you miss a lecture of great interest to you? Recordings of past lectures are available through the mail. Recent lectures are on CD; older one are on cassette tape.

Lecture recordings are $13 each (including postage and handling) or $25 for two, $35 for three. Allow up to two weeks for delivery. To order, write a letter requesting any lecture by number, make check out to MDSG Inc. and send it to: 
     Lecture Recordings c/o MDSG, PO Box 30377, New York, NY 10011

Dr. Ivan Goldberg, Psychopharmacologist

Q:  I have been told that a long airplane flight can have detrimental effects on people with bipolar disorder. Is this true?

A: People with bipolar disorder have been known to sometimes have manic episodes after long airplane flights. This is not a direct result of being in an airplane for many hours, but is the result of sleep deprivation. Anything that causes sleep deprivation may trigger an episode of mania. For example, if one flies to Europe in the evening, does not sleep on the airplane, and then has a full day after landing, one may go more than thirty hours without sleep. That is enough sleep deprivation to trigger a manic episode in some people. Asking one's doctor for some sleep-inducing medication that may be taken on the plane to minimize the likelihood of a sleepless night is one way of minimizing the risk of mania resulting from sleep deprivation..

Q: Are there blood or urine tests which may be used to confirm the diagnosis of a mood disorder?

A: The diagnosis of a mood disorder is made on the basis of symptoms, course of illness, and family history. While laboratory tests may rule out various medical conditions that may mimic a mood disorder, there are no sensitive and specific blood or urine tests for the presence of a mood disorder.

Q: Is it a coincidence that many of the same drugs used to treat bipolar disorder are used to treat people with migraine headaches?

A: It’s probably not a coincidence. It may be that the physiological bases of the two disorders are similar. Interestingly, migraine headaches are much more common in people with bipolar disorder than in the general population.

Dr. Joe Nieder, Pediatric Psychiatrist

Dr. Joe Nieder will return to our Ask the Doctors column in our next issue. 

To open each childproof bottle of pills, I must use a screwdriver, a hammer and a certain amount of banging and prying. Only then does the broken cap come off. Otherwise, taking pills is okay with me. But so often, people who need psychotropic drugs for a problem like depression or manic depression feel ambivalent about their medications and they feel strongly about what it means to take those meds. Is It Me or My Meds? explores the many responses people have to taking these prescribed drugs.

The author David Karp, a sociologist, has been attending the Boston chapter’s support group because he himself is depressed and on medication and has sought to understand the experience of people who must take these drugs. To that end, Dr. Karp interviewed fifty people in depth, some from his group, aged 14 to 69. Each one of us will find some of our own thoughts reflected in the quotes from these interviewees. 

Dr. Karp explores the questions so many people ask about the relationship between their medications and their identities: Do these meds change parts of me that I would rather not have changed? If they change my moods and feelings, am I still me? Am I an enhanced me? What parts of me do I loose, what do I gain? Am I still the person I have always known myself to be? Do I want to take these drugs in the first place? 

Since taking medication involves other people, it is inherently a "social activity," as Dr. Karp writes. One may swallow pills alone, but it’s not possible to escape the way others judge medication taking. Not only that, we imagine how friends and family feel about our need for drugs and are affected by their negative opinions. 

Some people strongly resist taking medication, whereas for others, taking their pills is like brushing their teeth. Others may have to go through a number of trials, a process that takes discipline and hope. Sooner or later one learns that the meds are not perfect, that they cannot make us completely well all by themselves. Thus we hear the advice to eat well, sleep regularly, get exercise, and so on.

Although he expresses a positive attitude about medications, Dr. Karp takes a sociologist's look at prescription use as a whole and the everpresent influence of drug companies. Their advertisements promise relief for sadness and social anxiety, and their sales people "educate" our doctors. Patients end up with unrealistic expectations, then in fine print, we may be warned of weight gain and sexual side effects suffered by some underestimated percentage of people taking this drug.

This book helped me to really appreciate exactly what I think and feel about needing medication. (A little more self awareness is always helpful.) I am of the school of thought that these meds allow me to be myself. One woman expressed her success this way: "I've tried to be the person that I am on the drugs, without them. But I can't do it."

By Deborah Perlick Ph.D

When it comes to treating depression and manic depression, many people wonder, “Is therapy really necessary if I’m taking my meds?” The truth is that research has shown that a combination of both medication and therapy seems to be the most successful approach. Not only that, studies have shown that being in psychotherapy promotes better medication adherence, which is in turn is associated with better treatment outcomes.

The term “psychotherapy” refers to therapy that is psychological (as opposed to, say, physical therapy). Its main purpose is to provide a forum for discussing
personal problems and difficulties with relationships and for developing good strategies for managing them. A person doesn’t have to have a mood disorder or any other psychiatric illness to benefit from therapy, but people who suffer from affective illness often face particular challenges that therapy can help address like coping with stigmatization and resuming activities or relationships that have been interrupted by an episode.

Of course finding the therapy and therapist best suited to the individual’s needs and interpersonal style can present a challenge. Traditionally, psychiatrists prescribed the form of therapy they deemed most appropriate or had the most experience with. In recent years, though, empowering the patient to make the choice has become the favored approach, and studies have found that freedom to choose the form of therapy is the best predictor of positive outcomes.

To make the most informed choice possible, it’s best to start by taking inventory of the problems or goals needing to be addressed. For example, someone wanting help with resolving repeated conflicts or with feeling more confident in relationships might consider interpersonal therapy (IPT) which focuses on resolving problems in dealing with others. Someone whose illness has stabilized and is interested in personal growth might consider a more psychodynamically-oriented treatment. 

Age and gender preferences can also influence a therapeutic alliance. Therapists and therapies differ in interpersonal style, too: some treatments or therapists are more active and give direct advice whereas others are more likely to ask questions that help gain greater understanding. It’s a good idea to ask potential therapists to describe their style before making a decision. Doing some homework on the different types of therapy that are available can also be a big help.

Below is a brief overview. Stay tuned for future articles that will go in depth in discussing each one.

Cognitive Behavioral Therapy (CBT)

CBT uses specific strategies that help identify and then change negative automatic thoughts and beliefs about oneself and the world that are maladaptive. These include learning to spot negative thoughts and mood changes and the situations that trigger them. CBT therapists tend to be very active in setting an agenda for sessions, and give concrete feedback and homework assignments. 

Psychodynamic Therapy

This form of psychotherapy involves a great deal of personal exploration and may be best for people seeking a greater understanding of the underlying
factors governing their everyday behavior. Techniques vary with therapists but may include free association, dream interpretation, exploring the impact of childhood on present day behavior and generally involve using reactions to the therapist to understand and improve interactions with family, friends, employers or other important people. Therapists tend to allow the patient to structure the flow of the session, interjecting questions, clarification and interpretations as needed. 

Interpersonal Therapy (IPT) and Interpersonal and Social Rhythm Therapy (IPSRT)

IPT and IPSRT both draw on the idea that mood problems are related to interpersonal and social problems and identify how this relationship affects mood and functioning. Social rhythm therapy looks for and tries to correct problems in the individual’s daily sleep, eating and socialization schedule that may exacerbate symptoms of mood disorder. 

Psychoeducation and Family Psychoeducation 

The major premise of psychoeducation is to educate people and their families about the symptoms, causes, and behavioral management and treatments for mood disorders. Family psychoeducation also promotes improved communication and problem-solving techniques within the family. Variants of psychoeducation include multiple family group, in which families are treated in groups and the family to family program conducted by the National Alliance for
Mentally Ill, in which family member peers conduct the psychoeducation.

Dr. Perlick is a clinical psychologist, associate professor of psychiatry at Mount Sinai School of Medicine and Research Affiliate at Yale University School of Medicine.
  

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