M O O D S

A major goal of this organization is to reduce the stigma associated with mood disorders. Accomplishing this in today's society is probably going to be a long-term, difficult undertaking. More within the reach of each of us is avoidance of a kind of internalized stigma, a preoccupation with our limitations that can inhibit our self-esteem. Of course we must recognize and respect situations that may provoke episodes, such as travel across time zones or risky or stressful jobs. But in addition, we must devote our attention and energy to finding opportunities for growth, rather than losing time to regret or other negative thoughts.

Our episodes are not caused by biochemistry alone. Environmental factors often trigger an individual's genetically determined predisposition. Because these environmental factors vary so much among individuals, however, they are hard to research. Understanding them may take decades. Meanwhile, we blame ourselves for our illness, even though we know that we cannot predict or control these potentially harmful situations.

As a group and as individuals, we work for the full development of each person's potential. "Normal" people - what one facilitator calls the not yet diagnosed - have a host of conditions that limit their potential. "Normal people with mood disorders" - those of us who try to lead "normal" lives despite our disorders - need to identify and respect our environmental triggers. The point is not to dwell on them but to move on, making the ground for the growth of self-esteem as fertile as possible.

Many thanks to Elizabeth Saenger for her work as newsletter editor. She balanced news with humor, book excerpts, book reviews, and added new features. 

"Sammy" (SAM-e) Makes Good

by Betsy Naylor

In mid-March a new alternative to prescribed antidepressants called SAM-e (sammy) began to appear on the shelves of GNC, CVS and even K-Mart. Its virtues? It goes into effect quickly-often in several days to a week-and its's thought to have few side effects.

Sam-e an acronym for S-adenosyl-methionine, is a natural compound found in every human cell and involved in over 35 biochemical processes in the body. It is possible to have too little SAM-e,and a low blood level has been correlated with depression. Discovered in 1952, SAM-e has been studied for 20 years and has been used for treating depression and osteoarthritis in Europe.For those who have not been resonded to several antidepressants, SAM-e may be an option. It is not related chemically to other antidepressants.

At this time, there are no plans to submit SAM-e for FDA approval. This requires huge amounts of money for several years of clinical trials and is not financially viable to BSAF, the company that bought the U.S. patent. Without FDA approval, a package of SAM-e cannot list drug claims nor can it advise the amount to take.

Some psychiatrists worry that people will buy SAM-e over the counter and take it without being monitored by a physician. Bipolar patients are advised to take SAM-e only under medical supervision to insure that their mood does not go up too fast or too far.

Unfortunately, SAM-e is expensive and is not covered by medical insurance. A 20-pill supply of Pharmavite's Nature Made costs about $25 in many stores.

Want to know more about SAM-e?

• Dr. Richard Brown, a Columbia University psychiatrist, will give a lecture on this exciting new "nutraceutical" on  October 11, 1999. For details, see our lecture page. 

Ask the Doctor

In March 1999 Dr. Ivan Goldberg, the medical advisor to MDSG gave a lecture "How to Tell If Your Doctor is Truly an Expert Psychopharmacologist". After the lecture, he answered many questions from the audience. Below are three of these questions and his answers. 

Q. What is "Substance P"?
A.  Substance P is a neurotransmitter found in both the peripheral and central nervous systems. Substance P is involved in the perception of painful stimuli throughout the body. Some believe substance P plays a role in the regulation of mood, especially depression. One of the large drug companies has recently done a study with a substance P blocking agent to see if it has clinically useful antidepressant effects and to see how it compared with Prozac and other antidepressants. To date the results have been disappointing. It doesn't look as if a new antidepressant that works on the substance P system will be released for clinical use in the near future. 
Note: After his lecture, Dr. Goldberg further commented on Substance P:
I think the substance P issue is up in the air. It is time that drug companies start looking beyond the three of four neurotransmitters that we hear about all of the time. There are about 350 possible neurotransmitters in the brain and I have no doubt that many of them play some role in the pathophysiology of mood disorders. It is quite possible that a substance that affects substance P will turn out to have antidepressant effects. The problem seems to be that the compound that was recently tested by Merck did not perform as well as was hoped. Perhpas they will be able to come up with something else that does a better job. 

Q. Is there clinical evidence that the new mood stabilizer Topamax causes weight loss?
A. Studies of Topamax in people with seizures or mood disorders have demonstrated that 20 to 50 percent lose a significant amount of weight. Topamax is the first mood stabilizer that has weight loss as a possible side effect.  

Q.Is an MAOI patch in the pipeline? What are its advantages?
A. MAO inhibitors taken by mouth require that a diet be modified to prevent the interaction between the drug and foods rich in tyramine such as red wine and cheese. Such interactions can lead to dangerous increases in blood pressure. If MAO inhibitors could be absorbed through a patch, there would be no need for food restrictions. While such patches have been used experimentally, it is not clear how effective they will be for depression.

Q. I have been diagnosed as being in an episode of "Bipolar Depression." I have had hypomanic episodes in the past, and now I am too depressed to work. My doctor says I have to "tough out" my depression, because he believes any anti-depressant I might take may push me into mania, a mixed state, or rapid cycling. Is there any medication I can take to treat my depression?
A. For people with "bipolar depression", lamotrigine (Lamictal) has been shown to be a safe and effective antidepressant. Because lamotrigine has both antidepressant and mood stabilizing activity, it is unlikely it will push one into mania, mixed states, or rapid cycling. While the F.D.A. has approved Lamictal only for the treatment of individuals with seizure disorders, many psychiatrists are now using it to treat people with bipolar disorder.   

Contest: Keep a Stiff Upper Lithium Level

by Howard Smith

Did you ever go "slogan scrambling?" It's quite simple: just take half a saying from here, twist it around an expression from there until you can come up with something nice and peculiar. Here' what I mean:

• He's caught between an HMO and a hard place.
• Early to bed, and early to rise, means your medications are fnally working.
• With a name like "Selective Serotinin Reuptake Inhibitor" it has to be good.
• Don't count your chickens before you're cured of Attention Deficit Disorder.
• Don't put off till tomorrow what your cognitive therapist says you should do today.
• Hell hath no fury like a classically trained Freudian psychoanalyst when your health plan refuses to pay him for another decade of couch therapy.
• Just because you're paranoid doesn't mean everyone in your support group isn't staring at you.
• The customer is always right-unless he develops tardive dyskinesia.
• You can't teach old bipolars new tricks-unless you take away their credit cards.

Get the idea ? Some people have a knack for this phrase-play. If you do, you can enter the contest. To win, just rewrite a proverb, a motto, aphorism, or chiche, always with a mental illness slant. After all, we are members of the Mood Disorders Support Group. Send in up to five of your examples.

First prize is dinner for two at the Bendix Diner East, 167 First Avenue. Runners up will receive copies of Martha Manning's Undercurrents or Kay Redfield Jamison's An Unquiet Mind. Here are more of my scramblings just to prime the pump.

• A little knowledge is a dangerous thing, unless you memorize the DSM-IV.
• All work and no Prozac make Jack a dull boy.
• The bigger they are, the harder they need Haldol.
• With an antidepressant like this, who needs enemies?
• Just what the doctor ordered, if the HMO lets him.
• He who hesitates is on Thorazine.
• It's not over until the fat lady stops having an acute manic episode.
• People who live in glass houses shouldn't be paranoid schizophrenics.
• Pull yourself up by your Buspar.
• When the depression gets tough, the tough get a pillow and go to sleep.
• Dr. Livingston, I presume . . . you know something about mood disorders?
• Uneasy lies the head that wears a transcranial-magnetic stimulator.

Send as many entries as you like to newsletter@mdsg.org.  Include your name and telephone number. The decision of the judges is final.

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..