M O O D S

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: Will Prozac improve memory in patients who are depressed and complain of memory problems?

A: It is quite common for people, when depressed, to have disturbances in attention, concentration, memory, and other cognitive functions. These cognitive changes improve with treatment. A recent study showed that fluoxetine (Prozac) and desipramine (Norpramin) were equal in their antidepressant effects, and that the patients taking fluoxetine had a greater improvement in memory than those taking desipramine.

Q: In people with a history of episodes of recurrent depression, what is the best way to prevent further episodes?

A: There is good evidence that the best way to prevent future episodes of recurrent depression is to continue full therapeutic doses of antidepressants. All too often, when a person with a depressive episode responds to antidepressant therapy, the dose of antidepressants is reduced to a “maintenance dose.” 

Unfortunately, such reduced doses do not offer much protection against future episodes of depression. To have the best chance of preventing future episodes, the dose of antidepressants should not be reduced below that dose which successfully controlled the depressive episode.

Dr. Joe Nieder, Pediatric Psychiatrist

Q: We've been hearing a lot of news about suicide risk in adolescents who use anti-depressants, but what about side effects?  Do side effects hit younger patients differently? 

A: Suicidal ideation, even gestures or acts have received a great deal of media attention and the FDA has responded by adding a special warning to the prescribing information for doctors and patients, but there are a number of side effects related to antidepressant use in children and adolescents, other than an increase in suicidal ideation. Common side effects of antidepressants, especially SRI (serotonin reuptake inhibitors), include indigestion, nausea, diarrhea, headache, rash, loss of appetite with possible weight loss early in the treatment, possible increase of appetite over time, with possible weight gain. Early in the treatment one can see activation, or even agitation, and this can also be related to difficulty falling asleep, staying asleep, or an increase in dreaming, especially very vivid and colorful dreams, sometimes even having a nightmare-like quality.

The side effects of the SRI's are less than the older tricyclic antidepressants, such as Tofranil or Elavil, so the newer SRI's are more commonly prescribed now. Another type of antidepressant is Wellbutrin, which has a different side effect profile. It is a more stimulating antidepressant and thus has stimulant like side effects, including activation, agitation, loss of appetite and weight loss, headache and  difficulty sleeping. It is not sedating as the SRI's might be.

It’s important to note that, while the antidepressants all have possible side effects, this is true for all types of medications, including aspirin, Tylenol, Advil etc. Recently several of the most popular medications worldwide have been taken off the market because of side effects, even after years of extensive use. There will always be a need to weigh the benefit of the medication against the risk or side effects of the medication.   
 

 How could Abraham Lincoln become one of our most important presidents despite his lifelong depression? Lincoln's Melancholy argues that his depression fueled his path to greatness. But how could depression fuel anything but misery? 

Until recently, historians had largely lost interest about the melancholic aspect of Lincoln's character, but author Joshua Wolf Shenk, who himself suffers from depression, delved into this subject and through his considerable research, tells the story behind his paradoxical title. I was concerned that the book might be a sort of psycho-biography with the author making all the kinds of diagnoses and analyses I couldn't trust. But Shenk does not make assumptions, which was a breath of fresh air. In his introduction, he states his purpose is simply "to see what we can learn about Lincoln by looking at him through the lens of his melancholy, and to see what we can learn about melancholy by looking at it in light of Lincoln's experience." 

The book examines Lincoln’s lifelong struggle with depression. He suffered two suicidal episodes, one at 25, another five years later when he was starting out as a lawyer in Springfield, Illinois. Friends took away knives and scissors. They feared for his sanity, and Lincoln likely underwent barbaric treatments available at the time: bloodletting, painful mustard rubs and even ingestion of mercury. It was during the second episode that he wrote these startling words: "I am now the most miserable man living . . . I must die or be better." 

As he got better, though, Lincoln must have decided that he wanted to live. He wanted to be a consequential person who did something important and good. Strong ambitions had always been a part of Lincoln’s character, and his path to political office involved a devotion to the issues of his day. He became intensely absorbed in opposition to slavery. His conviction led him to the work "he felt made to do." Even still, eyewitness writings indicate that his melancholy went on, uninterrupted and that he took no pleasure from his accomplishments. Invariably, people who met Lincoln could not miss the deep sadness in his eyes. And though he was known for a sense of humor that could break his isolation, cut the tension when people disagreed, and give him short respites from his sadness, he always returned to melancholy. Slowly he must have come to the calm resignation, that his depression would never go away, and that the world was a difficult place. 

Shenk argues that Lincoln's greatness at the time our country could have dissolved stemmed from ways he learned to cope with depression. Not only could he look at the worst rationally and empathetically, he had also developed a dogged persistence to get through bad times. And while optimistic people may perceive the world as sunny, they can miss the dark side. Shenk tells us that Lincoln saw it all. 

Regardless of how Lincoln’s depression may have contributed to his greatness, though, I think the important thing to take away from his story is how he was able to transcend that depression. Some phrases from the dictionary definition of transcend caught my eye: "to go beyond the limits of; surpass; excel; to be separate from or beyond." Lincoln was able to focus on what he had to do. Other intangibles must have played a role: Honest and fair, clear-eyed and rational, he took the high road asked others to do the same.

You can purchase (and read more about) Lincoln's Melancholy: How Depression Challenged a President and Fueled His Greatness by Joshua Wolf Shenk from Amazon.com. Doing so will result in a referral fee being paid by Amazon to MDSG, at no cost to you. As of February 2006, the price is $16.50 but this can change at any time.  

Most people would agree that our culture has come along way in de-stigmatizing mood disorders. Celebrities like Jane Pauley, Terry Bradshaw, and Brooke Shields openly share their struggles, and even Tony Soprano has been in therapy. But still, wouldn’t it be great if Hollywood presented a major motion picture that could forever change the way people think about depressive illness—something that would do for depressed and bipolar people what “Brokeback Mountain” did for gay people?

With that in mind, here’s our latest contest. Put yourself in the director’s chair and try to think up a movie title that’s sure to be a blockbuster (at least in the humor category). Your submission should be funny and creative and should spoof an existing title. 

Here are some examples (but we know you can do better):

• The Chronicles of Neurontin
• King Klonopin
• Harry Potter and the Goblet of Self-Medication
• Pride and Paxil
• The Bipolar Express
• SSRiana
• Touch of Elavil
• Gunfight at the I’m OK You’re OK Corral
• The Manic Who Knew Too Much
• You’ve Got Mania!
• Gentleman Prefer Buspar
• Annie Haldol
• Around the World in 80 Mood Swings

The first place winner will receive a dinner for two at Mumbles (on 3rd Avenue at 17th Street in Manhattan). The second place winner will get a copy of The Peace of Mind Prescription and the third place winner will get a tin of Nate’s famous brownies. 

All three winning titles, as well as the runners up, will be published in the next newsletter. You may include as many entries per submission as you wish.

Send your entries to: Movie Contest, c/o MDSG-NY, PO Box 30377, New York, NY, 10011 or email them to newsletter@mdsg.org. Please include your name, address and telephone number with your entry. 

Good luck!

Letters to the editor and other submissions are welcome and will be printed at the discretion of the newsletter editor. Send submissions by postal mail to our Post Office Box, addressed to "Newsletter Submissions", or email them to newsletter@mdsg.org