M O O D S

MDSG has entered the Internet age with the January 1999 introduction of its web site: www.mdsg.org. This may produce two distinctly different reactions. Those familiar with the web will be excited by the news and the possibilities. The site now contains a schedule of discussion meetings, lecture dates, membership information, an e-mail link for questions or comments, and links to recommended sites. Additional content and links will make our site increasingly useful.

Those unfamiliar with the web or without a convenient computer may wonder why we need our own web site. It is important to MDSG members in several ways.

First, it facilitates communication of information and ideas. For example, e-mail sent to info@mdsg.org will be answered as quickly and fully as possible.

Second, it provides another way to publicize information that cannot wait for the next newsletter, such as changes in meetings or lecture dates.

Third, it enables browsers to identify recommended resources, such as Dr. Ivan Goldberg's Depression Central web site, which contains a tremendous amount of pertinent material.

Of course,  many of our members do not have a computer or easy access to our web site. To them I can only say that the major education and empowerment activities of MDSG - discussion groups, lectures and the newsletter - will not be displaced by the web or e-mail. The face-to-face sharing of experiences is still the cornerstone of our support group.

Free Materials on Patient Rights and on Moods

You can obtain two free booklets - the eight-page "Rights of Outpatients" and the fourteen-page "Rights of Inpatients" - by calling the New York State Office of Mental Health at (800) 597-8481. 

Free pamphlets on depression in the elderly, in students, and in the workplace -- as well as a new one about co-occurring disorders -- are available from a general information request line at the National Institute of Mental Health at (800) 421-4211.

The Reader's Corner (Book Reviews)

by Betsy Naylor

Undoing Depression: What Therapy Doesn't Teach You and Medication Can't Give You
  by Richard O'Connor, Ph.D.  Berkeley Books, New York. 1997. 358 pages. $12.95.

"The essential question that patients and therapists ask themselves over and over is: Why is it so hard to get better?" Thus begins the first chapter of Undoing Depression. The author's premise is that depressed people become habituated to depression, developing routines and defenses that help them cope with it. Getting better requires replacing this habitual depressed behavior with undepressed traits. If we don't replace it, our habits will continue to keep us down and make us more vulnerable to relapse.

The specific descriptions of defensive habits and negative thought patterns typical of depression are extremely helpful. For example, many depressed people seem emotionless and numb. Classically, depressives cut themselves off from their feelings in an attempt to avoid more pain. This tactic works, but at the expense of an inability to recognize their own feelings, feelings they need to know to make decisions based on complete perception.

The book carefully spells out the tasks of undoing depression, such as tracking feelings in a chart or journal to connect mood changes with life events and correcting distorted ways of thinking that breed low self-esteem,  hopelessness, and pessimism.

Dr. O'Connor believes that depressed people can do this work only with the help of antidepressants. Without them, the depressed person might lack the energy and self-discipline. This assumption, however, leaves many people out, like those in our support groups whose medications are not yet fully effective. Until these people feel better, this program may be too overwhelming. Dr. O'Connor does acknowledge the value of support groups, and lists the National Depressive and Manic Depressive Association, our parent organization as a resource.

A psychologist, Dr. O'Connor illustrates his points with believable examples taken from his many years of patients and from his own episodes of depression. His voice is authentic and filled with common sense.

This book optimistically preaches that we who are depressed can gain greater control over our feelings. In these pages, any of us might find his or her own modus operandi, along with ways to change it. I have just given a copy of this valuable book to a depressed friend for his birthday. 

When Nothing Matters Anymore: a Survival Guide for Depressed Teens
   by Bev Cobain, R.N. Published by Free Spirit Publishing: Minneapolis, 1998. 165 pages. $13.95.

Many high school students, living at home with their parents, come to the realization that something is terribly wrong. Nothing matters anymore. This book is intended for them.

Bev Cobain is an expert in this subject, not just as a psychiatric nurse who treats teens, but as a member of a family afflicted with depression, addiction, and suicide. Her cousin, rocker Kurt Cobain, killed himself in 1994. She begins her candid discussion of suicide, continued throughout the book, with a touching letter to him. She lists his missed opportunities to feel better and the consequences of his suicide for those left behind.

Ms. Cobain offers lots of well-organized information about depression designed to help young people put their feelings into words. She details the steps to take to feel better. When she urges the reader to get help, she describes exactly whom to talk to: someone at school known as a good listener, types of professionals who can understand, perhaps even a parent. She opens up so many possibilities that finding assistance seems easy. Her many lists include symptoms and things to do. Among these, the strongest is the list of ways to open a conversation with an adult about feeling bad, or even suicidal.

I especially enjoyed the wonderful graphics: different type faces, little line drawings, cartoons, readably short sections of text. Some pages start with a postage-stamp sized photograph of the teen-ager whose story follows in his or her own words.

The key message is that those vague, unlabeled feelings of misery need not last for life. 

You can read more about this book and purchase it from Amazon.com by clicking on the link below. Doing so will result in a referral fee being paid by Amazon to MDSG at no cost to you.    ww.amazon.com/exec/obidos/ASIN/1575420368/themooddisordsup

A Personal Account

by Martha Manning, Ph.D.   
Dr. Manning is a clinical psychologist and former professor of psychology at George Mason University

I still feel like I am being punished for being a bad person, a weak person, a neurotic person. It is hard to reconcile my old concept of a merciful God with my recent experience of a hateful, spiteful God who plays fifty-two-pickup with people's lives.What did I do to deserve what I got? Will God keep me permanently on the shit list? Will I ever be forgiven?

[My psychiatrist] listens to my rantings and smiles. "Martha," she says, "I don't think we're talking about God forgiving you. I think we're talking about you forgiving God."

*     *    * 

Our answering machine has joined the basement graveyard of machines that in very short periods of time have become indifferent to our messages. [My husband] Brian searches the newspaper ads for the good buys. I announce that I do not want to replace it, that I could do without the burden of receiving and answering people's calls. Without a moment's hesitation, Brian and [my daughter] Keara override my veto. Brian buys it, installs it, and tries to explain the basic functions to me. I pretend to listen but comprehend and retain nothing.

He leaves very early this morning for work. There is a note on the dining room table telling me to leave a message for him using the Memo button on the new machine, so that he can call in and see how I'm doing.

I feel like shit, get dressed, and force down half a piece of toast. With my briefcase and keys in hand, I remember his request. I press the button and leave a message in a pathetic voice, "Hi. I feel really awful. I didn't sleep, so what else is new? I am so depressed. I don't know how I am going to get through the day. I hate my life."

Two hours later Brian leaves me a message on my office phone saying, "You have made a huge mistake. Call home." I dial my number, wait for the four rings before the answering machine kicks in, and prepare to hear Brian's voice announcing, "You have reached the Manning-Depenbrock residence...."  Instead, my own half-dead voice comes on the machine. "Hi. I feel really awful. I didn't sleep, so what else is new? I am so depressed. I don' know how I am going to get through the day. I hate my life." I press the remote. There are six messages, all hang-ups. I furiously dial Brian's number at work.

     "Oh my God, what happened?"
     "You must have hit the New Message button rather than the Memo button."
     "Well, can't you change it?" I implore.
     "I haven't learned how to change this one by remote yet and the manual is at home. Why don't you just run home and change it?"
     "I'm booked solid for the next five hours."

I spend the next afternoon sitting and trying to listen to patients while wondering who is calling my house and hearing my pitiful message. So much for trying to keep my pain to myself. I might as well take out an ad in the Washington Post.

*    *    *

Whenever anything lousy happens and I begin to feel sorry for myself, I ask, "Is this worse than depression?" And when the answer is no, then I tell myself, "Shut up." It's not that I lack compassion for my difficulties. It's just that my baseline for awful will never be the same. After you've been through an earthquake, those ruts in the road will never feel quite as deep.  

Depression as a Pathological Stress Reaction

by  Linda Carpenter, M.D.  Dr. Carpenter is Chief of the Mood Disorders Program and Assistant Professor of Psychiatry and Human Behavior at Brown University.

The relationship between stress and mental illness seems obvious. Too many stressful events and feelings can injure a person's emotional well-being. But what types of stress do the most damage? When is stress most likely to cause long-standing psychiatric problems? In the last decade, neuroscientists have advanced our understanding of the biology underlying stress and depression. This article reviews some of the research indicating how childhood stress may make an individual vulnerable to symptoms of depression and anxiety as an adult.

What is stress? To survive, organisms must maintain a state of overall balance in the face of disturbing forces or "stressors." Stress is defined as a threat of any type to this balance. Stress provokes responses designed to restore this state of well-being. Each stressor triggers a biological fine-tuning of the organism's response to the situation. Three glands, the hypothalamus, pituitary, and adrenal glands, called the HPA system, generate most of the chemical signals regulating the response to stress. The HPA system releases hormones that help the body defend itself from the stress at hand by preparing to fight or run. The heart rate and blood flow to arm and leg muscles increase, the body's fuel stores become available for fast movement, the immune system revs up, and the drives to eat and mate drop.

How is this response harmful? The HPA stress system controls its own activity, using the same hormones that turn the stress response on to turn it off. This protects the organism from over-exposure to stress hormones. Animals exposed to unbridled or prolonged stress hormones will develop symptoms like fidgeting and restlessness, hypervigilance or anxiety, and diminished sleep, appetite, and sexual function, a pattern like the cardinal features of major depression. Four decades of research support the idea that in mood disorders something has gone wrong with the regulation of the HPA stress system.

Compared to people who are not depressed, depressed people have higher levels of stress hormones in blood, saliva, urine, and spinal fluid. Autopsied brain tissue from depressed people who killed themselves suggests that their HPA stress systems were overactive, compared with the tissue from nondepressed people who died of natural causes. In depressed subjects, the stress system cannot shut itself off properly to damp down the release of stress hormones. In people with depression, CT and MRI scans show enlarged adrenal and pituitary glands, a sign of overactivity of the HPA system. Depressed people seem to have high blood levels of corticotropin-releasing hormone (CRF), a key messenger released from the hypothalamus gland. CRF tells the body to respond to stressors nonstop. In depressed people, antidepressants or ECT not only relieve symptoms, they return the levels of stress hormones, including CRF, to normal.

What makes the stress system overactive in depression? We don't fully understand how stress leads to mental illness, but psychosocial stressors and bad things happening to good people are prime suspects. Of course, scientists can"t test these theories in real people, so much of the research is done with rats.

Work with rats shows that stress just before and after birth profoundly and irreversibly changes their behavioral and hormonal responses to it. Separating newborn rats from their mothers causes stress during early brain development. When they grow up, these rats are more anxious and synthesize more stress hormones (such as CRF) than normal rats. In addition, they seem unable to shut down their stress response.

In another kind of animal experiment, scientists make the availability of food unpredictable, making it hard for the mother to find. This lessens mother-infant bonding and leads to neglectful mothering. In non-human primates, this causes long-lasting increases in CRF in the grown offspring. In most of these animal studies, the abnormal HPA stress responses return to normal after antidepressant treatment.

What's next? Animal research on stress tells us about the biological events that my lead to depression and other psychiatric disorders. In the next decade, we may discover just how a person's responses to stress determine the development, prevention, course, and treatment of depression.   

Don't Fall Into the Gap!

by Judy Hoffmann

Its a standard New Yorker cartoon situation. Not the psychiatrist's office for once, but the job interview. The business-suited applicant is replying to the interviewer, "I could explain about the gap in my resume, but then I'd have to kill you."

Many of us MDSG attendees have gaps in our resumes that we'd rather not explain truthfully to a potential employer. Although as a rule honesty is the best policy, dealing with irrational stigma is an exception. A job search is not a good time to raise anyone's consciousness about mood disorders.

Start with your resume. Here are a few ways to camouflage a gap in your job history.

1. Be vague about dates. Sometimes just leaving out the month will hide the space between jobs.
2. If you have only one long time-out to cover, get it as far down the resume as possible. If it was recent, begin with your first job. If it was way back when, start with now and work backward. My resume fills two pages. Almost no one scrutinizes the second.
3. Use functional rather than chronological format. If you've had more than one kind of job or can boast of different skills, arrange your resume by topic, listing where and when you got your experience beneath. You can also include skills you developed in hobbies or volunteer work - even MDSG! For example, if you've interrupted your career to go back to school, group your life into Employment and Education. If you've gone back and forth between teaching and working in publishing, separating the two kinds of jobs makes it harder to see the holes.

What do you do if the interviewer spots the gap, despite all this smoke and mirrors? Memorize one of the following explanations. Most of the them may not be exactly true, but on the other hand, they're not exactly false either. More important than their truth or falsehood is that they're hard to disprove. With a little help from your references, you'll have a confident alternative to "Oh, then? I was in the locked ward."   

1. "I was writing a book." Most people believe they could write a Danielle Steele/Stephen King best-seller if only they had the time. Since your interviewer probably hasn't even tried, you'll get credit for initiative, even if all you've ever written is a brief attempt at keeping a journal. If the interviewer asks about you book, say it was a thousand-page autobiographical novel that didn't work out. The interviewer will then change the subject. No one, not even your shrink, wants to hear that much about you.
2. "I was taking care of a sick relative." Don't reveal that the relative was yourself. If the interviewer asks how the illness came out, you say that the person is all better now. If pressed for more detail, say it was a painful, tedious time and you'd really rather not go into it. If you tell people something is a long, boring story and they don't want to hear it, they'll believe you, or at least leave you alone.
3. "I came into some money and decided to quit work." Let the interviewer think you won the lottery or inherited a bundle. Your future employer doesn't need to know you're talking about disability. How did you spend the time? Volunteer work. Especially if you really were doing volunteer work. Use someone at the volunteer organization as a reference. If you didn't volunteer, say you did at a hospital that you've actually visited. Be careful not to say you helped with the other mental patients.
4. "I saved up enough money to go to Europe (the West Coast, Tahiti), so I went." The father away, the better, as long as you've actually been there. Add that the trip was a lifetime dream. Now you've been there, done that, and you play to stay put. The interviewer shouldn't think you're planning to fly away again in a few months.

Check with your references to make sure they won't contradict you on whichever explanation you choose. Now your only challenge will be if you run into someone you know from MDSG. They'll have that same "Please don't out me" look in their eyes as you do. Be ready. Quick! Before they stammer something inappropriate: You met doing volunteer work at Beth Israel or Methodist Hospital. Didn't you? 

Recent Drug Headlines

• Depakote is prescribed more often than lithium for the treatment of mania.
• Experimental drug ABS-103 shows promising results in animals. It may be as effective as Depakote and may have fewer side effects.
• Taking Prozac longer is associated with a longer remission after treatment is stopped.

Wrong Shrink Contest

by  Howard Smith

Oh, the terror of trying to find the perfect psychiatrist. Is this shrink smart enough? Not quite. Nice enough? Maybe. What about the hard-to-reach office? Is the price OK? Careful-you don't want to waste months in treatment only to discover you've picked a dud. And don't forget those subtle qualities that count even more than the hard facts,like: does the shrink have crumbs in his beard? Does her perfume remind you of a bordello? Many warning signs can tell you if the doctor is cuckoo! And therein lies our latest contest.

Submit your own ideas of psychiatrist danger signals. They can be funny, serious, perverse or whatever else you think will tickle the fancy of the judges. My personal experience has led me to the following:

• You're at the wrong shrink if there is a pay phone in the waiting room.
• Several demerits if all the plants are dried up and dead.
• Alarms should sound if you hear these words:" This medication has never caused any side-effects ever."
• Any psychiatrist who says, Why don't you take off all your clothes and lie down on the couch?" is probably not thinking of your serotonin.
• Ditto if you are asked for a date.
• If, when you've finished sobbing about how deeply depressed you are, the shrink retorts, "Snap out of it!" - run for the door.
• Personally, I don't trust any psychiatrist whose shoes don't match.
• I'm also nervous if I can read the handwriting on the prescription.
• All right, I'm picky, but I find it hard to connect when a shrink falls asleep while I'm talking.
• It makes me uneasy if they look too much like Sigmund Freud.
• Never trust a psychiatrist who says, "Just trust me."
• If you can hear the doctor yelling at the patient who has the appointment before you, that's a bad sign.
• You have the right to get violent if you ar told, "Depression is just anger turned inwards."
• Call me judgemental, but I'll go elsewhere if the shrink is wearing a clown suit.

Well,these are my warning signs that I'm at the Wrong Shrink. What are yours?

The contest is over. First prize was dinner for two at the the cool Bendix Diner East, at 167 First Avenue. Runners-up received copies of Martha Manning's Undercurrents or Kay Redfield Jamison's An Unquiet Mind.

About  MDSG

  The Mood Disorders Support Group
  P.O. Box 30377
  New York, N.Y. 10011
  Phone_______(212) 533-MDSG
  Fax________ (212) 675-0218
  E-mail_____ info@mdsg.org
  Web________ www.mdsg.org

MDSG/NY sponsors a series of  lectures on various aspects of mood disorders. Anyone can attend our lectures. More detail about our lectures is available on our lectures page at http://www.mdsg.org/lectures.html

The Mood Disorder Support Group depends on membership fees and contributions for its operating expenses. A one year individual membership is $35, a one year family membership is $50. Memberships and contributions to MDSG are tax-deductible to the extent allowed by law. MDSG is an IRS-recognized 501(c)(3) organization..