M O O D S

by Howard Smith 

Winston Churchill, one of the most famous sufferers of depression, called the illness his “black dog.” I once heard a woman say her depressive episodes feel like swimming through molasses and she never reaches the other side. 

In our mood disorders support groups we most often hear “. . . And then this dark cloud descended on me.” Writers struggle to depict what a character endures when stuck in the depths of despair. Using mere words to reveal the complexity of such a painful affliction ain’t easy. Well, why not a contest about this descriptive dilemma? Prizes too.

To win you just have to compose a phrase in 50 words or less that eloquently communicates what depression feels like to you, The tone can be sad, ironic, comical, horrific—whatever you decide.

A friend of mine told me whenever he has to leave his apartment his depression makes him feel like a lonely alien, hopelessly marooned among people who stare. Another friend said his depression makes him feel like he is buried alive in a coffin and doesn’t care if anyone knows he is down there. Maybe I need some new friends.

Here are the contest rules: you can send in as many entries as you wish but each one can’t be longer than 50 words. The deadline is April 5, 2002. Each submission must be accompanied by your phone number and, of course, your name and address. Please send submissions to newsletter@mdsg.org. 

Here are the prizes:
· First: $50 dinner for two graciously donated by Mumbles Restaurant at 179 3rd Avenue at 17th Street
· Second: Unholy Ghost, an anthology of writers on depression edited by Nell Casey
· Third: A batch of The Best Cookies For Beating Back Depression

From the Chair

by Rich Satkin, Chairperson of MDSG 

In the 1976 satirical movie, ‘’Network,’’ a TV host tells his audience: “’I'm mad as hell, and I'm not going to take this anymore!" His anger is infectious and produces unexpectedly high ratings. As we all know, anger has benefits and disadvantages depending on the its intensity and appropriateness. For some people with mood disorders anger may be excessive, habitual, and can get in the way of recovery. This kind of pervasive anger was addressed by Jan Fawcett, M.D., at the annual National Depressive Manic-Depressive conference last summer (note: as of August 2002 NDMDA is known as the Depressive and Bipolar Support Alliance).  

Dr. Fawcett, a leading psychopharmacologist and founding medical advisor of NDMDA in the mid-1980s, urged the audience to deal with anger because, it so often impedes recovery and leads to failure to take medications and other steps necessary to ensure continued good mental health and stability. People coming to MDSG support groups are often severely affected by a mood disorder sometimes compounded by other psychological complications. Many participants have “treatment-resistant” mood disorders (estimated to be 30 per cent) and anger at these illnesses is certainly understandable, even appropriate. 

What do MDSG support groups do to help people who are habitually and, some might say, excessively angry, given that we are neither clinicians nor therapists? Our facilitators help the group respond to anybody in distress and this includes those stuck in anger. Individuals in the group often get through to an angry person. Someone else's “story” may be much worse, yet he or she is coping well, displaying little or no bitterness. Often it‘s simply that others have experienced major depression or bipolar disorder and, therefore, give credible advice.

Those who have been seriously affected by mood disorders often feel like victims and are tremendously angry about the hand they've been dealt. Getting past the anger is by no means easy especially when accompanied by feelings that things would have turned out right had it not been for the illness. While we don’t offer professional services, our support groups are full of wise people who know the well-being of everybody in the room lies in looking forward—rather than backward in anger. 

Just Say NO! 

by Judy Hoffmann

How would you respond to the following offers?

• “How'd you like to take care of my puppy Rufus for two weeks while I'm on vacation? He doesn't eat much for a Saint Bernard, and he's almost completely paper-trained. And you're the perfect person to help with that, because you're home all the time and could watch him. Plus your stuff isn't expensive, so it doesn't matter how much he chews on it..”
• “I'm bored with my volunteer work. How'd you like to take over for me for the next six weeks?”
• “My friends are putting on a new play--well, performance piece--in an unheated garage somewhere way out in Alphabet City. It's all improvisation, but what's new and different is that the audience does the improvising. The tickets are $50.00. Wanna go?”

Well, unless you consider suffering part of your job on earth, you'd probably respond, “No way!” So why do depressed people so often find ourselves encumbered with unwelcome visitors, doing favors that will never be returned or attending Tupperware parties when we don't have anywhere to put these wares in our kitchens?

One reason: We're afraid saying no will be offensive. People with depression may be unusually susceptible to this problem, because we too easily imagine the negative consequences of anything we do. We're afraid that if we refuse, we’ll lose a friend. Another reason may be the feelings of worthlessness that come with depression. We're so overwhelmed with gratitude at every invitation, we can't bear to turn one down, even a request for the pleasure of our company on-line at the Department of Motor Vehicles. 

Guilt and shame may make us self-sacrificing, susceptible to abusive demands. Or maybe the isolation of the depressed lifestyle makes us unusually willing for any offer of human contact, even if distasteful. Well, MDSG's MOODS will make you an offer you can't refuse: a lesson on how to say “no” nicely.

Just say, “I'm terribly sorry, but I just can't.” It's that simple. 

“Gee, why not?” your friend may ask. Here's where it's easy to go wrong. Just say, “I'm afraid it's just impossible.” You can say this as often as it takes. Then change the subject, if you can. 

It's also perfectly okay to fall silent at this point, but don’t give a specific reason for refusing. Giving a reason may lead you into one of two traps. 
The real reason may lead to an argument---about the loyalty of Rufus, the appropriateness of the volunteer work, your duty to support the arts, how special this or that event may be or whatever. 

You may be tempted to make up false reasons---fibs about mythical previous engagements, home repairs, or illnesses you plan to have on the key date. This is a mistake. You will have to remember what you said in case your friend asks about it later. He or she may ask follow-up questions, leading to increasingly farfetched explanations. You may even get so embarrassed by these whoppers that you’ll 'fess up and agree to do whatever is asked.

More advanced students can try a more long-winded refusal: “Oh, thank you so much for asking me. It's such a shame to have to tell you that I’m not able to do that right now. It's so kind of you to think of me, and if it ever does become possible for me, I'll be sure to let you know, but I just don't see it happening any time in the foreseeable future.” 

Note the total absence of specifics. I can go on like this for at least five minutes, by which time everyone else has left the room. Stop when you see glazed eyes. Here's another common social dilemma: “I've got some great stuff [fill in the name of a nonprescription, illicit psychoactive substance]. Want some?”

For this, "No, thank you" is the appropriate answer. This also applies to goodies that aren’t on your diet or drinks that interfere with your medications. Once again, do not explain why you’re refusing. You could wind up saying more than you want to about the details of your illness or your life. 

But what about this situation? 

“I'd love to hear all about your hospitalization/firing/family troubles. Please don't leave anything out, because it's painful or embarrassing. You can tell me.”

Special techniques can be used here. So-called normal people (I call them the not-yet-diagnosed) can display a morbid curiosity about your illness, your treatment, your career difficulties, or the fight you had with your sister. Neither the details of what happened nor your feelings about it are anybody else's business unless you want them to be. But it's rude, even if accurate, to say so. Practice this line: “I'd really rather not talk about it right now.” Another good reply: “Oh, that's such a long, boring story, you really don't want to hear it.”

And then change the subject. How? Ask, “But what about you? How have you been?” 

People love to talk about themselves. Give them the opportunity, and they may not notice you didn't answer their question. What's more, they'll regard you as a charming conversationalist. Works every time.

The Readers Corner  (Book Review)

by Betsy Naylor  

  
  Who Moved My Cheese: An Amazing Way to Deal with Change in Your Work and in Your Life
  By  Spencer Johnson, M.D.
  94 pages
  Putnam $19.95 

This book, written for those managing businesses, is well suited for people with mood disorders and anyone else who finds change difficult. The author illustrates many insights about change with a wonderful story, a parable.

Four mouse-sized characters are faced with the sudden loss of their cheese when someone moves it to a different spot in the maze. Cheese is their favorite nourishment and a symbol for anything highly valued in life. Each mouse responds differently, adapting to the change with varying degrees of success. Of course, each choice brings different consequences.

Members of MDSG may find this book valuable, because changing circumstances often trigger stress, anxiety and other unpleasant emotions. Life is full of change: An episode sends you to the hospital, but not before you trashed your life. Cutbacks leave you job-hunting in a recession. Your long-time significant other leaves. 

The book opens up the possibility of adopting new attitudes to cushion the shock of change. For example, a loss can lead not to being a victim but to making a different and better plan, one more likely to be under your control. If change lands on us, and we do not change our attitude, the results tend to be the same. Having shown us how and why to change our coping mechanisms, the book suggests we take a risk and do it differently next time.
We may gain more control, improve coping skills and enjoy a more satisfactory outcome.

You can purchase (and read more about) Who Moved My Cheese 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 March 2002 Amazon was selling it for $13.96 (the price can change at any time). Sample pages are available on the Amazon web site. 

Ask the Doctor        with Dr. Ivan Goldberg

Q. To help my depression and bulimia, I've been taking Prozac daily for almost eight weeks. I've studied cyclothymia and my mood swings resemble its cycles. Will Prozac help?

A. Prozac often does a good job of controlling bulimia. Cyclothymia, frequent shifts between hypomania and depression, however, may get worse with Prozac. You may cycle faster on this drug if you have cyclothymia or any form of bipolar disorder. Print this questionnaire and discuss your bipolar symptoms with your doctor. 

Q. I would like to know how after 22 years of manias and depressions I can adjust to everyday life. It all started around the age of 17; I’m 39 now and my life feels so empty. How can I go out and join a world I know very little about? I feel like a teenager when it comes to the knowledge and skills necessary to find and hold down a job. How frustrating!

A. Many people who’ve had bipolar disorder for many years have a hard time developing a positive self-image and enough confidence to live a full life. Even if the episodes are under relatively good control, it’s often difficult. Psychotherapy, both individual and group, helps. Basically, you need to learn social skills and to repair your damaged self-image. Then, you can train for a specific job through vocational rehabilitation. Good luck!

Q. Despite the diagnosis of bipolar disorder years ago, my paranoia has been getting worse. Is paranoia a symptom of bipolar disorder? Also, I was told by a family doctor that Xanax is not good for the anxiety that comes with my paranoia. What should I be taking?

A. People with bipolar disorder can experience paranoid thinking. If this is not controlled by mood stabilizers such as Depakote, it can often be controlled by neuroleptics such as Zyprexa or Risperdal. If paranoid thinking is accompanied by a good deal of anxiety, an antianxiety medication may also be useful. Xanax {a member of this drug class} is very addicting, and usually when an antianxiety medication is necessary, I prescribe lorazepam (Ativan). 

Q. Is it ever necessary/safe for someone with bipolar disorder to take an antidepressant?

A. Yes, it’s often necessary but involves some risk of inducing mania or hypomania. The co-administration of a mood stabilizer reduces but does not eliminate the risk. Lamotrigine (Lamictal), an anticonvulsant with both mood stabilizing and antidepressant properties, is often useful for the treatment of bipolar depression. With it, there’s little chance of mania or hypomania. 

Q. My brother has been diagnosed with bipolar disorder, and we think he may have inherited it through our mother. Can it be handed down from generation to generation?

A. The chance a child of a parent with bipolar disorder will inherit the disorder is about 15 percent. If both parents have the illness, the odds increase to 50 percent. 

Q. I have been taking benzodiazepines or benzodiazepine-like drugs for over 10 years and would like to stop taking Restoril because I still have problems with sleep and I'm not convinced it's doing anything. But I am concerned that perhaps the Restoril acts as a mood stabilizer in somewhat the way Klonopin might and that stopping the Restoril might be destabilizing. 

A. I’m not a fan of using benzodiazepines such as Klonopin as mood stabilizers. Evidence that Klonopin is an effective mood stabilizer is minimal, and many people who take it develop treatment-resistant depression. They often remit when the drug is discontinued. I’ve seen no reports suggesting that Restoril has mood stabilizing properties. Rapid discontinuation of it may be destabilizing,, but not because it’s a true mood stabilizer. If I had a patient who’d been taking Restoril a long time, I'd decrease it 10 percent every 10 days until gone.

Q. I've been diagnosed with bipolar disorder by four different professionals. Recently, my doctor put me on Wellbutrin and Neurontin and I feel edgy and nervous. I had been taking Xanax as needed only, but this doctor took me off it immediately. I, in fact, have panic disorder, too. Why couldn’t I take Ativan or Xanax? Is Ativan less addicting? Safer? This doctor put me on some anti-anxiety medication Atarax, I think,--an antihistamine that makes me feel more irritable, listless, angry, and, as a matter of fact, incapable of doing anything . I feel like a zombie. I just can't take it. I'd rather have the flu. The flu feels better.

A. Many people have both panic and bipolar disorder and they often receive poor treatment. Too many doctors are reluctant to prescribe effective antidepressants with anti-panic activity because they fear that the antidepressant will worsen the bipolar disorder. They are also unwilling to prescribe effective anti-anxiety medication . . . usually out of a misguided fear of prescribing addicting medications. While Atarax has some sedating properties, it has no anti-panic activity. There are a number of ways to go: 
 · Wellbutrin + Neurontin + Ativan (Ativan is much less addicting than Xanax)
 · (lithium or Depakote) + (Effexor or an SSRI)
 · (lithium or Depakote) + ( Serzone or Remeron)
These combinations help keep mood and anxiety symptoms under control.

Q. I am a 38-year-old woman diagnosed five years ago as Bipolar I with psychotic features. Currently, I’m undergoing a series of electroconvulsive treatments (ECT). Each treatment seems to leave me even more depressed. Is this normal? 

A. Occasionally people don’t feel any improvement until the end of a course (a series) of ECT. If it doesn’t work, retry some antidepressants that haven’t worked in the past. After a series of apparently unsuccessful ECTs, antidepressants, formerly ineffective, often do the job. 

Q. I was diagnosed with a bipolar II disorder about 18 years ago. I was successfully treated with lithium only until last July when, much to my surprise and dismay, I experienced significant depression. First of all, I didn't think it was possible to experience a severe depression, because lithium had protected me for so many years. I sought top-notch medical care and was told I had had a “breakthrough episode” created by “kindling” that had stacked up, ignited and broken through the lithium barrier. What do you think? Also, how can a person manage the kindling , therefore lessening the chances of another breakthrough? 

A. Lithium and other mood stabilizers reduce the probability that someone will have manic or depressive episodes but they do not reduce the probability to zero. Kindling is a hypothesis for which there is no experimental evidence. I'd look first at what the lithium level was just before the breakthrough depression. If the level was low . . . less than 0.8 mEq/l . . . I'd increase the lithium to that level. If the level was 0.8 or over, I'd add another mood stabilizer to the lithium. I'd probably prescribe Lamictal but Depakote, Tegretol or Trileptal would be other possibilities.

Q. I have a 23-year-old male friend who says he is bipolar and, after being hospitalized once while in college, he now says that he no longer takes his medications to control this disease. He says he is in "remission." Is it possible to be in "remission" and not take any medication to stay on an even keel? 

A. The problem with "remissions" in people with bipolar disorder is that remissions last an average of 6-12 months. They are then usually followed by another episode. Unfortunately the more episodes a person has, the more severe the subsequent episodes are likely be. Also the more episodes a person has, the more frequently they are likely to have future episodes. Because of this it is very important to prevent episodes through the long-term use of mood stabilizing medications.

We Get By with a Little Help from Our Friends . . . 

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..

About MDSG

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. Our next lecture is:

Why Do Eating and Mood Disorders Go Hand In Hand?
Monday,  April 1, 2002  Charles Murkofsky, M.D. 
Why do mood disorders and eating disorders co-exist so often? Although each illness may have different causes and symptoms, there are overlapping psychological, biological, as well as nutritional factors which tie these two illnesses together. Dr. Murkofsky is the director of Gracie Square Hospital's Program for Managing Eating Disorders, and past president of American Anorexic Bulimic Association. Through actual case studies, Dr. Murkofsky will discuss effective treatment models which aim to combat medication side effects, and help individuals with mood disorders learn to cope with the dual diagnosis.