|
The Mood Disorders Support Group of New York City |
| NEWSLETTERSLECTURESDEPRESSION IN THE NEWSCONTRIBUTELINKSDIRECTIONSCONTACT US |
M O O D S |
||
Newsletter of the Mood Disorders Support Group of New York City | ||
May2001 |
|
When printed, this page will automatically re-format itself.
Formatted for Printing |
by Jane Cartwright
After The New Yorker published Andrew Solomon’s riveting account of how his depressions left him unable to get out of bed for days, to shower or to cut up his meat, many of his colleagues didn’t believe it. “Some of them were saying to other people, ‘Oh, I know Andrew Solomon . . . He’s a very together person. He would never really do any of that. I think he just made a lot of that up for sensation.’ The idea that I would make that stuff up was bizarre to me,” he said.
I could imagine the confusion. The man before me was animated, articulate, funny and, well, very together. But, when depressed, he, like us, shuts himself away from what he calls “the alien world.”
His new book, The Noonday Demon: An Atlas of Depression, will be published in June by Scribner. He will join a writers’ panel on depression at MDSG in January.
Yet Solomon is unlike most of us who fumble describing depression and end up with, “Put it this way: It’s hell.” He finds unforgettable metaphors and analogies to help the non-depressed—or as a friend of mine says, “the not-yet diagnosed”—to see, feel and touch depression.
The book begins: “Depression is a flaw in love. To be creatures who love, we must be creatures who can despair at what we lose, and depression is the mechanism of that despair.” And it ends: “. . . The opposite of depression is not happiness, but vitality, and my life . . . is vital, even when sad . . . I have discovered what I would have to call a soul, a part of myself I could never have imagined until one day, seven years ago, hell paid me a surprise visit. Almost every day I feel momentary flashes of hopelessness and wonder every time whether I’m slipping."
“For a petrifying instant . . . I want a car to run me over and I have the grit to stay on the sidewalk until the light [turns]; or I taste hungrily the metal tip of a gun in my mouth; or I picture going to sleep and never waking up again. I hate those feelings, but I know they have driven me to look deeper at life. . . Every day I choose, sometimes gamely and sometimes against the moment’s reason, to be alive. Is that not a rare joy?”
The author freelances for The New Yorker, ArtForum and The New York Times, is working on a second novel and thinking about possible nonfiction books on dwarfs, the deaf. He graduated magna cum laude from Yale and then studied in Cambridge, England, where he was the first foreign student to place first in his graduate class. He’s written three critically-acclaimed books; he’s all of 37.
In his new book, he is remarkably candid about his struggle with mental illness. Doesn’t this make editors, a nervous and unforgiving lot at deadline, vocal about whether he’ll be well enough to come through? “My editor,” he said, “asked the question when bids were coming in for my new book, ‘Now, you’ve got this depression under control, right? You’re not going to have a breakdown and not be able to go out and promote it?’
I thought, ‘Maybe yes, and maybe no.’ “But I said to her, ‘The depression seems to be under control now. I’m on a good regimen of meds, and I have no reason to anticipate anything like that.’ “Two-thirds of the way through writing the book, I had a very bad episode. One of the first things I did was call my editor and my agent and say, ‘The book’s going to be at least a few months late. And I’m really sorry, but there’s nothing I can do about it.’
“My editor, who is really a lovely woman, said, ‘Well, can’t you get an extra researcher to speed things up?’
“’No, I can’t; I’m really sick. When I’m feeling better, I’ll do everything I can to catch up.’
“‘Well, if there’s anything you can do, it would really be great if you
would just do it.’
‘I’m sorry,’ I said, ‘but believe me, this extra breakdown will make really good material for this book. You’ll get your money’s worth.’”
Perhaps the most moving passages tell how his father and close friends took care of him during bad times. In one, a friend helps him take the “15 steps” (he calculated) necessary to get him from bed to shower. In another, his father cuts up his lambs chops at the dinner table. And when a bad reaction to meds while on tour to promote his last book left him too weak to stand, a friend talked him out of lying face down indefinitely in the mud.
So what advice would he give to friends and family?
“The most important thing—and, perhaps, the most obvious thing—is to be patient,” he said, “to accept that no matter how distorted a depressed person’s reality may seem, it’s his reality. “Just being there physically in the same room or even in the next room can make a huge difference.”
He added that, of course, encouragement to get professional help is imperative. Yet he cautioned against being too demanding. “You need to strike a balance, and it’s a very fine line between encouraging the depressed to get up and do what they’re capable of but not pushing them to dance on broken legs.”
One gets the impression that Solomon for all his candor is a private man. “I think if you reveal a great deal about yourself, you keep whatever you don’t reveal extremely private,” he said. “It’s hard to say there was anything I liked about my depressions, but one good lesson they’ve taught me--it’s possible to let down some of my defenses and be a little bit less glossy and controlled.”
Let’s hope some of what he hasn’t revealed shows up in his future books; we’d all be the richer for it.
There is a web site for Mr. Solomon's book at www.noondaydemon.net with reviews of the book, a downloadable copy of the first chapter, and a copy of a recent article written by Andrew Solomon.
by Rich Satkin, Chairperson of MDSG
The work of Donald Klein, M.D., one of the pre-eminent psychiatrists of the past 50 years, has led to better treatments for people with mood disorders. But, like any great scientist, he’s not satisfied. Recently, he shared some frustrations that resonate with me and surely with many of us.
Given the advances in biological psychiatry and medications, why are so many people with mood disorders treatment-resistant? What is the point of consensus conferences during which experts come up with the best treatment available yet fail to help so many? Why isn’t there rigorous research to treat “failures?”
In Dr. Klein’s words, “Consensus development is required, because insufficient systematic clinical data have accumulated to allow a data-based, substantive selection of likely hypotheses concerning what to do when the first or second treatment fails.
“Such data are not available because research-oriented clinical facilities that could generate such data do not exist.”
He calls for the creation of such facilities, describes how they would work and concludes they could produce “predictive assessments . . . needed to identify patients who are likely to respond poorly to standard interventions, thus allowing earlier alternative treatment approaches.”
This is the wish of hundreds who attend our support groups each month. I suppose critics would argue funds would always be better spent on conventional approaches such as basic research or the development and testing of new drugs. But I find Dr. Klein’s arguments persuasive, especially since many we see at MDSG take several medications and yet remain ill. Studying those who don’t respond fully or at all can mean better treatment more quickly.
The
Readers Corner (Book Review)by Betsy Naylor
Of 2 Minds
The Growing Disorder in American Psychiatry
By T. M. Luhrmann
337 p. New York: 2000
Alfred A. Knopf $26.95
Of 2 Minds is a great read, describing how two models of psychiatry—biomedical and psychodynamic—developed, their relationship to each other and where they stand now. The author, Dr. T. M.
Luhrmann, is evenhanded in her treatment of both.
Because most participants of The Mood Disorders Support Group have been treated by both a psychopharmacologist and a therapist, Of 2 Minds may be of particular interest.
In her introduction, the author sets forth this objective: “As an anthropologist, I was interested not in answering the question of which approach was more correct but in understanding how the approaches worked as ‘culture’ for the psychiatrists and thus for their patients.”
Dr. Luhrmann attended classes with psychiatric residents while doing her research. Residents are already physicians (having completed four years of medical school and one year of internship). They then complete at least three additional years of specialty training in psychiatry. The author interviewed residents, professors, staff, sat in on case discussions, and, eventually, in on treatment interviews with patients.
Residents are expected to learn both biomedical and psychodynamic practice of psychiatry. The first sees mental illness as a brain disorder, an illness to be treated by medical science. The latter views the problems of the mentally ill as problems of emotional conflict, past and present. Residents must be both doctors—diagnosing and prescribing—and psychotherapists working with psychodynamic theories to resolve conflict and heal emotional pain.
Dr. Luhrmann begins her survey with Emil Kraepelin, the German psychiatrist who first described mental illnesses by listing symptoms, and follows with Sigmund Freud who believed human behavior could be explained by unresolved conflicts stemming from childhood. His concepts reached the United States by the 1940s. Freudian psychoanalysis, requiring psychiatric residents to go through psychoanalysis themselves to become analysts, became immensely popular. However, then, as now, only the healthiest and wealthiest of Americans could profit from the frequent, emotionally intense sessions of analysis.
The psychotropic drugs lithium and Thorazine were introduced in the 1950s; other drugs soon followed. They helped patients improve quickly, and they helped the seriously ill. Talk therapy took a lot longer and was of no help to the psychotic.
Whereas psychotherapy had few, if any, outcome studies, drugs proved to be effective in scientific trials. The scales began to tip in favor of biological psychiatry.
Yet, psychotherapy and psychopharmacology may be most effective when used together. Frederick Goodwin, M.D., who lectured to MDSG September 10, said studies of patients receiving both showed fewer hospital admissions, medical problems and a greater sense of well being. The author agrees. She sees psychodynamic therapy as essential to psychiatric training. The psychiatrist without it may be like a painter who starts out painting abstracts without learning the fundamentals of drawing real forms.
However, Dr. Luhrmann worries that managed health care, with its emphasis on the quickest, least expensive fix, will discourage psychotherapy. How can reimbursement be rationalized for a single psychotherapy session—let alone a year or more of them—if there’s no hard, scientific proof therapy is medically necessary? Biological psychiatry, on the other hand, with its emphasis on medication proven through scientific, clinical trials, is necessary. Or so proponents argue. And insurance companies are listening.
Gone are the days not only of lengthy, frequent therapy, but long hospitalizations. A few years ago, the New York State legislature passed a law mandating that insurance companies reimburse for 30 psychotherapy sessions a year.
Our greatest hope, as consumers, may be the biopsychiatric scientists looking for miniscule patterns in the brain to explain mental illness in its very specific disease phases.
This is a perceptive, compelling book. A lot has been happening in this field.
You can purchase (and read more about) Of 2 Minds, The Growing Disorder in American Psychiatry 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 May 2001 Amazon was selling it for $21.56 (the price can change at any time). There are 12 reader comments and readers rated it 4 stars (out of 5). The paperback edition is scheduled to be published August 14, 2001. Amazon is now taking orders for it at $11.20.
Ask the Doctorwith Dr. Ivan Goldberg |
 |
Q. My psychopharmacologist started me on 40 mg daily of the new antipsychotic Geodon (ziprasidone) to help stabilize my bipolar, rapid-cycling, moods. On the third night, I began hallucinating (both visual and auditory), something I’d never done before. Doctors in the emergency room diagnosed drug-induced mania and gave me mild tranquilizers. Within 24 hours, everything was fine. Now, I’m worried other bipolars may experience this. What do you think?
A. Your experience with Geodon seems VERY idiosyncratic. While Geodon is FDA-approved only for schizophrenics, many psychopharmacologists have been using it over the past few years with great success for people with mood disorders.
By the way, you may have been misdiagnosed in the ER. The rapid onset of visual hallucinations after starting a new drug almost always indicates toxic delirium—a reaction to the drug—rather than activation of psychiatric symptoms for which the drug is prescribed.
Q. After a manic episode that lasted a year, I’ve never felt completely well. I’m taking Seroquel, lithium and Zoloft. In addition, I think I have obsessive-compulsive disorder (OCD). Can you help me?
A. Many people with bipolar disorder also have obsesessive-compulsive disorder. To feel well, both disorders must be under control. Report any residual depression, hypomania and/or symptoms of OCD to your psychiatrist, so medication can be tailored to your needs. Psychotherapy also is important for recovery.
Q. My grandfather is being treated by a psychopharmacologist for depression. He takes 50 mg of Zoloft and 1 mg of Risperdal daily and has improved some in the last four to five months. However, for the past few weeks, he has been restless, repeatedly getting up, lying down, getting back up in the night. Is this due to drug side effects or is it agitation—a symptom of depression incompletely treated?
A. It may be from depression, a side effect, or some undiagnosed medical condition. Report your grandfather’s behavior to his internist and his psychopharmacologist.
The Youth Group on Friday night at the Bernstein Pavilion, Beth Israel Medical Center, now begins at 7:30 P.M. instead of 7:00 P.M. This will allow MDSG to handle large numbers of participants more efficiently.
The new, 90-milligram pill is specially coated so it dissolves slowly into the bloodstream. A four-week supply will cost $63 wholesale, slightly less than a month's supply of the currently available 20-milligram daily version.
For those who really want to save money on Prozac and its active ingredient, fluoxetine, there's more important news. Barr Laboratories intends to launch a generic 20-milligram fluoxetine in August. This should be as effective as Prozac at a much lower price. However, Eli Lilly has filed a suit in appeals court to delay Barr’s entry into the marketplace to sell the popular antidepressant.
New antipsychotic promises less weight gain
Many people with mood disorders take antipsychotic medications for mood stabilization not psychosis. These drugs may cause troublesome side effects--the older products are associated with movement disorders like troubling mouth twitches--and the more recent with drastic weight gain.
A new antipsychotic, Geodon (ziprasidone) may promise less weight gain for overweight patients. According to the manufacturer, Pfizer, Inc. of New York, "Ziprasidone [has] an essentially neutral effect on patients' weight levels."
Although more patients on Geodon than on placebo gained a significant amount of weight in clinical trials (defined as more than 7% of baseline weight--if you weigh 120 pounds, that's 8.4 pounds), the gain was different for people of different degrees of excess weight.
Underweight people gained, average weight people maintained, but overweight people lost weight. Note that these data apply to people with schizophrenia who take Geodon as their main psychiatric medication. There were no clinical trials done on people with mood disorders.
Withering news for St. John’s wort
In other drug news, an article in the April 18 issue of The Journal of the American Medical Association meant bad news for St. John’s wort, the popular herb for depression.
A Vanderbilt University study concludes that St. John’s wort is useless in treating major depression—defined as a cluster of depressive symptoms lasting two weeks or longer. The study involved 200 adults diagnosed with major depression at 11 university medical centers across the country.
This contradicts several dozen smaller studies attesting to the herb’s merit. Vanderbilt bills its study as the first, large, scientifically rigorous, look at St. John’s wort. The other studies are flawed, their researchers say. For more information, read about the research in the April 18 issue of The Journal of The American Medical Association.
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..
| Postal Mail | Telephone | Fax | Web | |
|---|---|---|---|---|
| The Mood Disorders Support Group P.O. Box 30377 New York, N.Y. 10011 |
(212) 533-MDSG 533-6374 |
info@mdsg.org | (212) 675-0218 | www.mdsg.org |
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 at www.mdsg.org/lectures.html. Our next lecture is:
Hope: Myth and Realities
Monday, June 4, 2001 Richard O’Connor, Ph.D.
Hopelessness is a primary symptom of depression. In an acute episode, we sometimes believe we’ll never recover. Some who have suffered from depression a long time give up hope.
Sometimes we hope again when we hear about a new medication, but if it doesn’t work, we throw up our hands again.
Eventually, it may seem too painful to get interested in or excited by the prospect of feeling better. We believe we’ll just be disappointed again, so why bother.
Richard O’Connor, Ph.D., returning to speak to us for the third year, will challenge some of our beliefs about hope and recovery. He’ll explore the answer to these questions: Is depression a chronic disease; if so, will we ever feel better?
Dr. O’Connor is the author of Undoing Depression: What Therapy Doesn’t Teach You and Medication Can’t Give You and Active Treatment of Depression.
| NEWSLETTERSLECTURESDEPRESSION IN THE NEWSCONTRIBUTELINKSDIRECTIONSCONTACT UStop |
Subscribe to the MDSG
 feed |
For questions or problems contact webmaster@mdsg.org |