M O O D S

A new season of lectures begins in September with renowned speakers and compelling topics. 

September 8, 2003
Anger, Irritability and Mood Disorders

with Stephen J. Donovan, M.D. 
Assistant Professor of Clinical Psychiatry and Research Psychiatry at Columbia University Psychiatric Institute

One of the most terrible aspects of mood disorders is anger and irritability. Certainly, no one enjoys fuming all day against your family and friends, your
boss, your neighbors, your doctor, the TV, the whole world, and when you think about it, you're even furious at yourself. Many people in our support groups say that if an illness as destructive as depression or manic-depression destroys your life, you'd be angry all the time too. 

Fair enough, except how do we explain all the other mood disorder sufferers whose lives were similarly devastated, but they don't feel hostile or mad. Does that make any sense? The truth is, there is more to anger and it's ugly side kick, irritability, than we realize. Is it a basic symptom like sadness or grandiosity? Is there a scientific cause behind all this hostility and what role does psychology play? Whether you need to know for yourself or someone you love, come hear Dr. Stephen J. Donovan, a leading expert who will help unravel this complex issue. 

October 13, 2003
Depression Is Not Simple: Identification and Treatment of Mixed States in Mood Disorders

with Francis Mas, M.D.
Professor of Clinical Psychiatry, NYU Medical School and Associate Clinical Director of the Brain Research Laboratory of NYU Medical Center

Many people don't know that a serious obstacle to the successful treatment of their mood disorder is something called Mixed States. It's a variety of this illness that is particularly intriguing because it's among the most difficult to recognize and medicate properly. Dr. Mas believes this complex form of mood disorders needs a comprehensive approach in which the entire patient and every aspect of their illness can be understood and then the appropriate treatment can be used. 

Dr. Mas states, "There are common pathways to a number of conditions that share a common expression like depression. Same way a fever is not specific to pneumonia or the flu, depression does not tell you the specific brain condition you are treating." Learn what else this top psychopharmacologist in the field says about the challenge of mixed states; you might not even know you have it.

November 3, 2003
Medications: Getting the Full Effect, Losing the Side Effects

with Heidi Wehring, Pharm.D.       (Fundraiser: $10 non-members, $6 members)
Assistant Clinical Professor of Clinical Pharmacy Practice at St. John's University

Medication side effects can be as devastating as the illness they treat. As if that idea weren't upsetting enough, there are so many confusing directions to follow to ensure that the medication will work at its optimum effect, For instance, if the prescription says "take with food," what does that mean? A cracker? A full meal? Then there's the question about water? How much is the right amount? A sip? A tall glass? Which tablets are OK for cutting in half? Are the generic brands just as good as the name brand? Are expired medications dangerous to take? Even if by 3 months? A year? If you get heartburn right after swallowing the designated dose, will an antacid neutralize the action of the drug? Is it OK to lie down and sleep right after popping a lot of pills or should you stay upright for awhile? The questions are endless. 

Dr. Wehring is an expert in pharmacy practice whose particular focus is psychiatric medications. She will explain how to get the most out of medications as well as address the difficult to manage side effects. And by popular demand, Dr. Wehring will stay to answer any queries from the audience.

Did you miss a lecture of great interest to you? Most of the people who come to hear these experts speak, tell us how helpful the information has been. Not only do we find out about the latest scientific breakthroughs, but we also learn new coping skills from these cutting edge researchers, clinicians and authors. Tapes of our lectures are available through the mail. Tapes are $13 for one, $25 for two, $35 for three. For more information, see our lectures page.

The Reader’s Corner (Book Review)   by Betsy Naylor  Depression Fallout: The Impact of Depression on Couples and What You Can Do to Preserve the Bond  by Anne Sheffield  276 pages. Quill. $13.95

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Sometimes depressed people can be particularly aggressive and angry toward those they love. Anne Sheffield has studied such behavior and the patterns of those responding to it. This time she focuses on love relationships.

Chapter 1 begins:

"Love and depression speak different languages. Every man and woman in a relationship touched depression comes face to face with this unpleasant truth. The behavior of both partners conforms to a predictable pattern. One participant acts according to the dictates of his or her depression: Be critical, unpredictable, sullen, illogical, angry, touchy, put-upon, distant yet occasionally tender, and deny anything is wrong with you. The other follows the rules governed by depression fallout: Be confused and bewildered, blame yourself for the relationship's problems, become thoroughly demoralized, then get angry and resentful, and, finally, yearn to escape."

Ms. Sheffield, an MDSG member, attended the Friends and Family group many, many Fridays. The poignant stories compelled her to write her first book, How You Can Survive When They're Depressed, which is a bestseller at every MDSG event.

Her inquiry continued, especially when she discovered on her website's message board (www.depressionfallout.org) that viewers wrote about close relationships with depressed people, including those in complete denial. As in MDSG support groups, partners of depressed people validated each other's experiences over and over again.

Denial is such a powerful defense that it leaves no room for negotiation. Having lost hope, the depressed person's partner clings to the possibility of change, if only the depressed person could be treated. and other treatments are not the whole solution, but only when the depressed mate gets better can the real work of getting along begin.

But life is never quite that simple: What if the depressed partner is not the only one with problems? What if the couple is dealing with a Treatment Resistant Depression? Or the treatment has worked and they find themselves very off-center. The medications have worked so well, that the depressed partner stops taking meds and relapses.

Depression can make people quite self-involved. They miss a lot of what is going on around them, like their partner's feelings. Imagine you are the depressed mate in a loving relationship. Today you are just trying to get through the day. Your lover's requests and questions make you anxious. You get angry and just want to be alone. Your partner equals stress. Would you think of your lover's feelings before you dismiss the requests saying something cutting or blameful? No wonder the person who is not depressed loses self-confidence. With luck and perseverance there is help: from MDSG, message boards, but especially from this book.

Depression Fallout is intended for the person who does not suffer from depression. However, anyone who is depressed will gain a valuable glimpse from the other side. I believe that anyone concerned about depression would find some unexpected gems.

People in the fallout of their partner's untreated depression will find their dilemmas in Depression Fallout. With tremendous empathy, Sheffield offers clear, practical guidance through some of the most difficult predicaments. The mood disorder library is so much richer with Anne Sheffield's books.

You can purchase (and read more about)  Depression Fallout: The Impact of Depression on Couples and What You Can Do to Preserve the Bond from Amazon.com. Doing so will result in a referral fee being paid by Amazon to MDSG, at no cost to you. The paperback edition sells for $11.16 at Amazon as of November 2003 (the price can change at any time). 

 By Howard Smith

Your brain is thick slog. You might be conscious, but your thoughts are trapped in mud. It's Dead Morning Syndrome (DMS), that awful stretch after awakening when cerebral circuits connect in slo mo, if at all. A common symptom of mood disorders and a common side effect of psychiatric medications, it's a double whammy that can last two to five horrible hours. What to do? What to do? This a.m. torture test can cause acute levels of anxiety, "Oh no, one more late day and I'll lose my job." And being stuck to the mat makes those no longer employed feel just as desperate. 

OK, enough complaining. Here's my bag of tricks for combating DMS. If you have any new ideas, let us know. 

1. Sour Ploy: cut lemon in quarters, place in dish next to bed night before. Alarm buzzes, suck lemon.
2. Same as above but use Tabasco sauce, hot mustard, or horseradish---or all three together in emergency.
3. Multiple Alarm Theory: use at least three, all loud, located all around the room, none within reach. No snooze buttons. If your alarm has one, jam it with toothpicks.
4. Don't set clock radio to music, unless it's music that you hate. News, foreign language, and most jarring talk shows are good. Robin Quivers laugh has been known to wake the dead.
5. Ultra strong coffee made the night before when most depressives are hopeful and focused, and/or fingers work better. Put the Thermos next to bed. When alarm sounds, pour into mouth immediately.
6. Place vibrating alarm device under pillow. Can be ordered from Maxi-Aids, a company serving the deaf and blind communities. For catalog, call 1-800-522-6294.
7. DMS causes stumbling, difficulty standing in a.m. Put plastic chair in shower the night before. Sit under shower. Cold water shocks best.
8. Arrange with friends to phone five minutes after alarm. Talking, especially arguing quickens brain wake-up. Suggested topics: male vs. female, Yankees vs. Mets, conservatives vs. liberals, do extraterrestrials live among us?
9. Train dog, using treats, to pull off covers and lick your face when alarm sounds. Don't keep treats near bed, so you must get up to calm canine.
10. One guy swears by this surefire get-up-quick trick: soon as alarm jerks him somewhat alert, he places clasp style clips on earlobes and nose. Pressure naturally increases---impossible to dose off again.
11. Check with your shrink about Seasonal Affective Disorder (SAD) light boxes as alarm. Set timer to turn on. Place box so that light focuses directly on face. Be careful-can trigger mania or sunburn.
12. Lay out tomorrow's clothes before going to sleep. A smart strategy used even by the non-medicated, non-depressed. Similarly, shave the night before for one fewer hand/eye coordination problem.
13. Place a water spray bottle, the type hairdressers' use, next to bed. Trying to stay conscious? Spritz face and hair until sopping wet. May lead to divorce.
14. Yell really loudly over and over for an adrenaline rush. Shouting curses especially effective. Neighbors may call 911. Police breaking down door is best alarm.
    
    Howard Smith, who suffers from depression himself, is known for mixing serious recommendations with levity.

  By Li Lippman

These days, with cutbacks and layoffs happening everywhere, career changes are very common. However, in the Youth Group, this has been a popular topic of discussion for years-long before the economy had anything to do with it. Usually, it's after an episode that people talk about leaving their job, returning to school, or somehow taking steps to change their career path. I have heard many success stories in Youth Group from those who actually completed career shifts after bad episodes. Why does this happen?

Perhaps during severe illness, especially episodes of depression, a person reflects upon his or her life. Episodes usually mean hours, days, weeks or more of isolation, time to think and ponder. Often that reflection is turned inward and people may spend a lot of time asking themselves questions. They wonder why this is happening to them. They think about their life, the decisions they have made and what meaning their life has in the world.

Sounds heavy. But it also sounds a lot like a mid-life crisis-except that Youth Groupers are around the age of 30 and under. Maybe we could call this an "early mid-life crisis." I have often thought that when sufferers of mood disorders are well, they can appreciate life more than the average person. I also see that they can be wise beyond their years in other ways. Wouldn't it make sense that they may become self-reflective earlier than people without mood disorders? Since most people are too busy in their 20s to examine themselves and their lives, perhaps these terrible episodes can bring on that kind of self-reflection earlier for depressed or manic-depressed individuals. This in turn can lead them to make decisions such as career changes.

Many people would argue that episodes cause a lot of people to lose their jobs or fail out of school and thus they are forced to find new careers. Of course this may be the case for some, but I think it's possible that many people change jobs, not because they can't have the career they want, but because they change what they want to do. I have met lawyers who have become social workers, finance gurus and dentists who have become psychologists, and so on.

Asking yourself questions, examining your life, and finding meaning in what you do can happen at any age. Although these thoughts are usually associated with a mid-life crisis, apparently they can come earlier when mood disorders are part of the picture and many positive changes can occur because of it. 

Ask the Doctors    with Dr. Ivan Goldberg  and  Dr. Joe Nieder

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Dr. Ivan Goldberg, Psychopharmacologist

Q: My mother has had bipolar disorder for her entire adult life and her mood swings are well controlled by lithium. However, she is often mean and nasty. Might a medication change help her?

A: When a patient of mine is "mean and nasty" while taking lithium, the first thing I do is to get a blood test to make sure that the amount of lithium in the blood is optimal. If it is not I readjust the dose of lithium. If the lithium is optimal there are a number of things that can be done. If the patient is somewhat depressed, and I believe that the irritability is secondary to depression, an antidepressant can be carefully added to the lithium. If the irritability seems more likely to be to be more a manifestation of some uncontrolled mania, then one of the anticonvulsant mood stabilizers or low doses of an antipsychotic drug can be added to the lithium. If the mean and nasty behavior seems related to a personality problem, psychotherapy may help.

Q: When severely depressed I hear voices that tell me how rotten I am and that I should kill myself. I am referring to actual voices, not simply thoughts in my head. While I have never tried to kill myself, I hate these voices. How can I get rid of them?

A: When depression gets so severe that one is hearing things not only is that uncomfortable, but it is potentially dangerous. There is a new antipsychotic medication that is very effective when it comes to depressive hallucinations. It is not associated with weight gain so it is a major advance over drugs such as Zyprexa and Risperdal.The drug is called ziprasidone (Geodon), and it is available throughout the USA.

Dr. Joe Nieder, Pediatric Psychiatrist

Q: I am the parent of a 2-year old, and my family has a history of mental illness. Most of the time my daughter is a sweet, well-behaved baby. However, she seems to be hypersensitive to sounds and often shows unprovoked aggression. Could these be early warning signs of mental illness?

A: Mental illness would be too strong at two years old, but such strong reactions bear watching, especially if there is a family history of bipolar disorder. Early signs of illness at your daughter's warrant your attention even though it would be unusual to see an illness at this age. However, some 3 and 4 year olds show cyclical mood and temperament cycles or swings. It makes sense to watch any progression of mood swings or aggression in your child.

Q: Is there a medication for pre-school age children who have ADHD with aggression?

A: The first choice of medication for the treatment of ADHD in a preschool child with aggression, is a stimulant such as detroamphetamine. The stimulant is easy to administer and works within hours if the dose is adjusted correctly. If the reaction is negative, the medication will be mostly out of the body in four to five hours. Stimulants work for ADHD in a high proportion of children.

However, if the child has a family history of bipolar illness, or shows severe aggression, it might suggest bipolar disorder. If this is a possibility, be very cautious about extended trials of stimulants, and extremely cautious about the use of any antidepressants. 
   
    

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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..

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.