Relapsing [Without Being a Moron About It]

 A Bumpy Road: Dealing with Relapse

There may not ever be a last episode, but there are ways to fend off and mitigate the next one.

By Jodi Helmer

Doctors never talked to Elly L. about RELAPSE.

Although she was hospitalized during a manic episode and diagnosed with bipolar disorder, doctors never mentioned that it could happen again. Instead, Elly was stabilized, handed a prescription for mood stabilizers and discharged. She had no idea that she’d be battling mania and depression for the rest of her life.

“I was told that as long as I took my medications, I’d be okay,” recalls Elly, a mental health coach in Toronto, Ontario.

Elly experienced at least eight relapses between her diagnosis in 1978 and 1991. Each time, she was hospitalized, often placed in restraints and taken to the psychiatric ward in a police car or ambulance. Upon discharge, Elly always promised herself it would be her last hospital admission-but she had no idea how to stave off future relapses.

In bipolar disorder, relapse is defined as the return of depression or a manic or hypomanic episode after a period of wellness. According to a 1999 study published in the American Journal of Psychiatry, 73 percent of those diagnosed with bipolar disorder experienced at least one relapse over a five-year period; of those who relapsed, two-thirds had multiple relapses.

“You can never say that someone with bipolar disorder has had their last episode; relapse is part of the illness,” explains Alan C. Swann, MD, professor and vice chair for research in the Department of Psychiatry and Behavioral Sciences at The University of Texas Medical School at Houston and director of research for the University of Texas Harris County Psychiatric Center. “Relapse is self-perpetuating; once it happens, the more likely it is to happen again.”

Searching for Answers

It’s possible to do all of the right things- follow a proper medication regimen, eat well, exercise, minimize stress and get enough sleep-and still experience relapse. Unfortunately, there is no clear understanding of why this happens.
“There may be changes in the cellular level that cause cycling but their cause is unknown,” says Joseph R. Calabrese, MD, director of the Mood Disorders Program at the Case Western Reserve University School of Medicine in Cleveland, Ohio.

While the neurological causes of relapse are unknown, a few things are certain: Those who are diagnosed with bipolar II are more likely to relapse than those with bipolar I. Their episodes of depression, mania or hypomania are often shorter than the episodes experienced by those with bipolar I but tend to return more often, according to Calabrese. It’s also far more common to relapse into depression than into mania or hypomania. Calabrese estimates that in bipolar II, there is a 40-to-1 ratio of depression to mania; the ratio of depression to mania drops to 3-to-1 in bipolar I.

“The key to recovery is a low tolerance for relapse,” says Calabrese.

In fact, Dr. Roger S. McIntyre, MD, associate professor of psychiatry and pharmacology at the University of Toronto and head of the Mood Disorders Psychopharmacology Unit at the University Health Network, believes that even the mildest symptoms of depression and mania should be treated as potentially hazardous.

“The takeaway message is that we need to seek complete elimination of symptoms as our treatment objective,” he says…

Click here to read the full article, “A Bumpy Road: Dealing with Relapse”

“bp Magazine” is a wonderful “shot in the arm.”  I would suggest that you get a subscription, and for a friend as well.

 cropped-cropped-cropped-christiangraffiti1-11.jpg

Join NAMI today!

When you become a member of NAMI, you become part of America’s largest grassroots organization dedicated to improving the lives of persons living with serious mental illness. And now you can join online.

http://www.nami.org/template.cfm?section=About_NAMI

Are You Depressed, Or Just Human?

rainy-day

Depression can be devastating. Its worst form, major depressive disorder, is marked by all-encompassing low mood, thoughts of worthlessness, isolation, and loss of interest or pleasure in most or all activities.

But this clinical description misses the deep, experiential horror of the condition; the suffocating sense of despair that can make life seem too arduous to bear. Here’s something else we can say confidently about depression: it is complex. The cause is often a mix of factors including genetic brain abnormalities, sunlight deprivation, poor nutrition, lack of exercise, and social issues including homelessness and poverty. Also, cause and effect can be hard to tease apart — is social isolation a cause or an effect of depression?

Unfortunately, we can make one more unassailable observation about depression: the disorder — or, more precisely, the diagnosis — has gone stratospheric. An astonishing 10 percent of the U.S. population was prescribed an antidepressant in 2005; up from 6 percent in 1996.

Why has the diagnosis become so popular? There are likely several reasons. It’s possible that more people today are truly depressed than they were a decade ago. Urbanized, sedentary lifestyles; nutrient-poor processed food; synthetic but unsatisfying entertainments and other negative trends, all of which are accelerating, may be driving up the rate of true depression. But I doubt the impact of these trends has nearly doubled in just ten years.

So here’s another possibility. The pharmaceutical industry is cashing in. In 1996, the industry spent $32 million on direct-to-consumer (DTC) antidepressant advertising. By 2005, that nearly quadrupled, to $122 million. It seems to have worked. More than 164 million antidepressant prescriptions were written in 2008, totaling $9.6 billion in U.S. sales. Today, the television commercial is ubiquitous:

  •  A morose person stares out of a darkened room through a rain-streaked window.
  • Quick cut to a cheery logo of an SSRI (selective serotonin reuptake inhibitor, the most common type of antidepressant pharmaceutical).
  • Cross-fade to the same person, medicated and smiling, emerging into sunlight to pick flowers, ride a bicycle or serve birthday cake to laughing children.
  • A voiceover gently suggests, “Ask your doctor if [name of drug] is right for you.”

The message — all sadness is depression, depression is a chemical imbalance in the brain, this pill will make you happy, your doctor will get it for you — could not be clearer. The fact that the ad appears on television, the ultimate mass medium, also implies that depression is extremely common.

Yet a study published in the April, 2007, issue of the Archives of General Psychiatry, based on a survey of more than 8,000 Americans, concluded that estimates of the number who suffer from depression at least once during their lifetimes are about 25 percent too high. The authors noted that the questions clinicians use to determine if a person is depressed don’t account for the possibility that the person may be reacting normally to emotional upheavals such as a lost job or divorce (only bereavement due to death is accounted for in the clinical assessment). And a 15-year study by an Australian psychiatrist found that of 242 teachers, more than three-quarters met the criteria for depression. He wrote that depression has become a “catch-all diagnosis.” What’s going on? It’s clear that depression, a real disorder, is being exploited by consumer marketing and is over-diagnosed in our profit-driven medical system.

Unlike hypertension or high cholesterol — which have specific, numerical diagnostic criteria — a diagnosis of depression is ultimately subjective. Almost any average citizen (particularly one who watches a lot of television) can persuade him or herself that transient, normal sadness is true depression. And far too many doctors are willing to go along. The solution to this situation is, unsurprisingly, complex, cutting across social, medical, political and cultural bounds.

But here are three major changes that are needed immediately: Medically, thousands of studies confirm that depression, particularly mild to moderate forms, can be alleviated by lifestyle changes. These include exercise, lowered caffeine intake, diets high in fruits and vegetables, and certain supplements, particularly omega-3 fatty acids. Physicians need to be trained in these methods, as they are at the Arizona Center for Integrative Medicine at the University of Arizona in Tucson. See Natural Depression Treatment for more about these low-tech methods, or the “Depression” chapter in the excellent professional text, Integrative Medicine by David Rakel, M.D. (Saunders, 2007).

Politically, if Congress — which seems hopelessly addicted to watering down all aspects of health care reform — can’t manage to ban all DTC ads in one stroke, it should start by immediately ending those for antidepressants. Personally, be skeptical of all DTC ads for antidepressants. The drugs may turn out to be no more effective than placebos. Many of them have devastating side effects, and withdrawal, even if done gradually, can be excruciating. While they can be lifesavers for some people, in most cases they should be employed only after less risky and expensive lifestyle changes have been tried.

Finally, recognize that no one feels good all the time. An emotionally healthy person can, and probably should, stare sadly out of a window now and then. Many cultures find the American insistence on constant cheerfulness and pasted-on smiles disturbing and unnatural. Occasional, situational sadness is not pathology — it is part and parcel of the human condition, and may offer an impetus to explore a new, more fulfilling path. Beware of those who attempt to make money by convincing you otherwise.

…………………………..

Weil's-new-book-availableAndrew Weil, M.D., is the founder and director of the Arizona Center for Integrative Medicine and the editorial director of http://www.DrWeil.com. Become a fan on Facebook. Follow Dr. Weil on Twitter. Read more at: http://www.huffingtonpost.com/andrew-weil-md/are-you-depressed-or-just_b_307734.html

Bipolar Disorder– Basic Stuff

 

If you have bipolar disorder, you may recognize many below. Not everyone has exactly the same symptoms. Talk with your healthcare provider about your symptoms at each visit.

  • Feeling sad or blue, or “down in the dumps”
  • Loss of interest in things you used to enjoy, including sex
  • Feeling worthless, hopeless, or guilty
  • Sleeping too little or too much
  • Changes in weight or appetite
  • Feeling tired or having little or no energy
  • Feeling restless
  • Problems concentrating or making decisions
  • Thoughts of death or suicide

 

Symptoms of mania may include:

  • Increased energy level
  • Less need for sleep
  • Racing thoughts or mind jumps around
  • Easily distracted
  • More talkative than usual or feeling pressure to keep talking
  • More self-confident than usual
  • Focused on getting things done, but often completing little
  • Risky or unusual activities to the extreme, even if it’s likely bad things will happen

Here are some behaviors that may be seen in people with bipolar disorder. Please note some of these behaviors may also indicate a different problem, so proper diagnosis is important.

  • Agitation
  • Alcohol or drug abuse
  • Irritability
  • Excessive gambling
  • Violence
  • Poor judgment with decisions
  • Careless spending, buying sprees
  • Talking about hurting oneself
  • Risky sex or change in sexual activity
  • Impulsive financial investments
  • More arguments
  • Change in energy level, appetite, or sleep pattern
  • Relationship problems at home or work
  • Mounting debt
  • Drinking or drugging for ‘escape’ or maintenance purposes
  • Legal/criminal issues
Visit http://www.webmd.com/depression/guide/bipolar-disorder-manic-depression for more detailed information about bipolar disorder and its symptoms.

bry-signat-1

cropped-christiangraffiti1 (2)