M O O D S

by Rich Satkin, Chairperson of MDSG

Why do people come to our support groups? The simple answer is that our patients/consumers and their family members want to achieve normal functioning through proper medication and emotional support.

A survey of 2,200 members last year by the National Depressive and Manic-Depressive Association placed nearly equal value on information and social support. The survey also found that support groups helped people who struggle with their treatment plans to stay the course. Compliance with a treatment plan that works is a fundamental tenet of MDSG.

Social support serves a variety of purposes besides aiding compliance. The consequences of manic or depressive episodes, or a depressed way of living, can be devastating. Our June lecturer, Richard O'Connor, Ph.D., author of Undoing Depression: What Therapy Doesn't Teach You and Medication Can't Give You, spoke to an overflow audience. His message is that many depressives maintain habits of mind, feelings, and behavior that keep them depressed, and that new habits must be substituted to undo depression.

In the face of pessimism, it is important to remember that change is possible. Social support can help by challenging self-defeating beliefs that the future must be bleak.

Discussion groups also provide a place where members can regain or learn important social skills. While we don't "do therapy," our members use the discussion meetings to their advantage, whether with respect to compliance or other issues. That is our experience and our hope.

MDSG wishes to thank Pharmacia & Upjohn, Inc., for an "unrestricted educational grant" to support our activities.

Letters to the Editor

To the Editor:

I wish you had included more about SAM-e (June issue 1999, No. 3), especially the dose. Keeping us waiting until October (October 11 lecture by Dr. Richard P. Brown on SAM-e) for that information is a real tease. I've heard the dose for depression is supposed to be about 1200 mg, a day, but this information came from the health store and is not necessarily reliable. Another point--I have taken SAM-e, and it does cause a side effect: delayed orgasm, just like the SSRIs. I wouldn't be surprised if SAM-e is a serotonergic drug but you don't say.

[name withheld]

Editor’s Reply:

Dr. Richard P. Brown, a Columbia University psychiatrist and author of a new book on SAM-e (Stop Depression Now—see review this issue), said he recommends 400 mg a day for mild depression and 800 to 1600 mg a day for "serious depression." However, he is quick to add that those in the latter category should see an M.D. for treatment. As for side effects, he said loose bowels and headache rarely occur. He added that his patients have not complained of sexual dysfunction.

To the Editor:

I believe the way to fight the stigma of mental illness is by test cases in the courts. There are laws on the books. This is the way it was done for civil rights, abortion, etc. Once a suit is started, it can become a class action (suit). Expert testimony will be forthcoming. Friend-of-the-court briefs from various sources up to and including the U.S. Department of Justice may be filed. It all would begin with a single instance like Roe v. Wade (abortion) or Brown v. Board of Education (desegregation of schools).

Toward the end of identifying good test cases and pooling efforts in researching and preparing such cases, I want to form a law action workshop (L.A.W). Laymen (like myself) can do much to prepare their own cases. Legal research is like any other library research. Nolo Press specializes in do-it-yourself legal books for the layman.

Will anyone interested in forming a law action workshop please write or call me?

David Weinflash
435 Riverside Drive
New York, New York 10025(212) 749-5543

Ask the Doctor     

with Dr. Ivan Goldberg 

Q. Does alcohol interfere with the metabolism and efficacy of psychotropic medication?
A. One of the most common reasons why people do not benefit from antidepressants, mood stabilizers and other psychotropic medications is that they are using alcohol and/or other recreational drugs. While it used to be thought that one or two drinks a day had no impact on the effectiveness of antidepressants and other medications, it has become clear that people taking psychotropic medications should not have more than three drinks per week.

Q. Can antidepressants flip anyone into hypomania or does the person have to have a predisposition to bipolar disorder?
A. There is no doubt that antidepressants can induce mania or hypomania in some individuals. While most people in whom antidepressants induce mania clearly have a history of cyclothymia or bipolar disorder, others have just a family history of possible bipolar disorder.

Q. What is the relationship between panic attacks and depression?
A. There is a significant association of panic attacks with depression and vice versa. A recent study of this relationship found that most individuals with panic attacks have depression, while most individuals with depression did not exhibit panic.

Q. I suffer from seasonal depression and have received conflicting instructions regarding the timing of light therapy. One of my doctors has suggested I expose myself to bright light in the mornings, while another said the time of day is not important as long as I use my light box daily. Who’s right?
A. A number of studies have looked at the effectiveness of morning versus evening light for the treatment of individuals with seasonal affective disorder or SAD. Morning light was found more than twice as effective in reducing depression than evening light.

Q. I have heard that calcium supplementation can help some women suffering from premenstrual symptoms. Is this true?
A. The effects of calcium and placebo on the symptoms of the premenstrual syndrome have been studied. Calcium was significantly better than placebo in reducing premenstrual depression, water retention, food cravings, and pain. Calcium was no more effective than placebo in reducing insomnia and fatigue.

The Reader’s Corner  (Book Review)

by Betsy Naylor

STOP DEPRESSION NOW: SAM-e: The Breakthrough Supplement that Works as Well as Prescription Drugs in Half the Time...with no Side Effects
    Richard Brown M.D., Teodoro Bottiglieri Ph. D., and Carol Coleman
    G.P. Putnam Sons, New York. 1999. 267 pages. $19.95.

Publication of this book coincided with the March 1999 release of SAM-e into the American market. The authors provide information about the chemistry of SAM-e (short for S-adenosyl-methionine), its clinical record, its efficacy and dosage.

A psychopharmacologist, Dr. Brown specializes in depressions resistant to conventional drug therapy. He has prescribed SAM-e for hundreds of patients. Because of its efficacy, it is often his drug of choice. In Italy, it outsells Prozac. Dr. Bottiglieri, a neurobiology and biochemistry research scientist, and perhaps the world’s foremost expert on SAM-e, has studied it for the past 15 years.

Discovered in 1952, SAM-e is found in every living cell, involved in more than 35 processes in the human body. It has been used to treat depression in Europe since the 1970s. The book cites many studies that support the claims made in the book title.

Because Dr. Brown believes strongly that patients should participate in their own care, he outlines four specific steps of an integrated plan for getting better. He suggests beneficial eating habits, exercise, aids to relaxation like yoga and meditation, and cognitive techniques for handling obsessive, destructive thought patterns. MDSG members probably know many of these techniques, but the review provides a helpful reinforcement and some new ideas.

SAM-e is now available over the counter. Stop Depression Now provides dosage information for those trying it without a doctor’s supervision. But these crucial warnings appear more than once: People who are seriously depressed and/or suicidal should seek professional help. People on an antidepressant should not stop taking it cold turkey and switch to SAM-e. Bipolars should take SAM-e only under medical supervision. Just like any other antidepressant, SAM-e can propel them into a manic episode.

Books by legitimate authors about new medications can sweep the reader along with their persuasive arguments. We remember only what we want to hear. Natural products are very appealing, especially when we read there are no side effects. Imagine--no weight gain, no sexual dysfunction, no caffeine effect, no gastrointestinal complaints!

But is this claim believable? Natural products are not necessarily harmless. (What about tobacco, opium, and strychnine?). And in scientific studies even people on placebos report side effects. SAM-e has been scientifically tested on a few thousand patients. Now that it’s easy to obtain here, millions may try it. Who knows what reactions will appear in the larger group?

Depression is complex, and no one substance helps every person. This book is valuable for those who have not improved on anything yet, and others who don’t or won’t seek psychiatric help. At least now these people can learn about SAM-e and its use, information previously unavailable to the general public.

You can read more about Dr. Brown's book and purchase it from Amazon.com by clicking on the link below. Doing so will result in a referral fee being paid by Amazon to MDSG at no cost to you.
http://www.amazon.com/exec/obidos/ASIN/0399145303/themooddisordsup

Slogan Winners 

The contest in the last issue called upon readers to "scramble slogans" by giving well-known sayings a psychological twist.

First-place winner Barbara Chanatry, Brooklyn, wrote: "The left brain doesn’t know what the right brain is doing."

"If at first you don’t succeed, keep trying—unless you’re obsessive compulsive," wrote Rosanne Levitt, New York City, second place winner.

And third-place-winner Joe McGill, New York City, took on Uncle Sam and Freud by writing, "In Freud, we trust."

Cognitive Therapy for Depression: An Antidote to Distorted Thinking

By Elizabeth Saenger, Ph.D.

When we are depressed, our thinking both reflects and reinforces our mood. We are pessimistic; this colors our view of the world; and our bleak perspective justifies cognitive distortions (biases in thinking), which affect mood and behavior.

Cognitive therapy can be as effective as psychopharmacology in the treatment of clinical depression. It breaks this vicious cycle by helping us identify and eliminate distorted thinking. Some common distortions typically addressed in cognitive therapy (and the written homework which often accompanies it) follow.

(1) Focusing on the negative entails filtering out the positive or exaggerating the unfortunate aspects of a situation. For example, a wife may concentrate on a slight from her husband and ignore his praise and affection, making her depressed about the marriage.

(2) Overgeneralization occurs when, for example, a new boss gives us one undesirable assignment and we jump to the conclusion that he will always do so, or when a teenager discovers a classmate doesn’t want to go out with her and decides no one ever will. Words such as always, never, no one, nobody, everyone and everybody often indicate overgeneralization.

(3) All-or-nothing thinking (also called black-and-white thinking, polarized thinking, or thinking in absolutes) involves categorizing situations in your life into one extreme or another.

(4) Global labeling involves extreme overgeneralization or all-or-nothing thinking about people or things. This distortion enables us to believe that someone who lets the door slam in our face is not only rude, but a scoundrel as well.

(5) Mind-reading takes place when we conclude we have failed an exam, done poorly at a job interview, or made a poor impression at a party —all without any evidence.

(6) Fortune-telling means predicting dire outcomes without reason. For example, we may tell ourselves the veterinarian will not be able to cure our dog or the landlord will evict us. These negative thoughts may keep us from taking appropriate action and become a self-fulfilling prophecy.

(7) "Should" and "must" statements. Sometimes we tell ourselves we shouldn’t make mistakes or we mustn’t be tempted by chocolate. When we do not live up to our judgmental expectations, we feel like failures. We would feel better, and be healthier, if we restricted our use of should and must to their moral and legal contexts.

(8) Emotional reasoning occurs when we believe our negative feelings accurately reflect the way things are. This frequently happens when we infer that the reason we are depressed is because our situation is hopeless. When we are suffering from a depressive episode, it is helpful to tell ourselves--and have our friends and family remind us--that feeling hopeless is a symptom of our illness, not the reality.

(9) Personalization takes place when a man berates himself for not being a good mate because his partner has cancer, or when a child blames herself for the divorce of her parents.

(10) Irrational blame is the opposite of personalization and happens when a student faults only his teacher for bad grades, or we when attribute all the problems in a relationship to the other party.

(11) Heaven’s reward fallacy is the belief that if we do what we are supposed to, we will be compensated. This is related to both the belief in a just world and the Horatio Alger myth. It inspires people to work hard in relationships and jobs and results in bitter disappointment if expectations are not met.

(12) Catastrophizing is what a depressive mind does when it finds something wrong: a flat tire will lead to visions of being late to work, which will mushroom into getting fired, followed by a nightmare of financial ruin and homelessness. Similarly, a child’s cough will give rise to thoughts of pneumonia and medical complications resulting in death.

For more information, you might want to read Thoughts and Feelings: The Art of Cognitive Stress Intervention by Matthew McKay, Ph.D. et al. (New Harbinger Publications, 1981) or The Feeling Good Handbook: Using the New Mood Therapy in Everyday Life, a popular cognitive therapy book by David D. Burns, M.D. (William Morrow and Company, 1989).

Dr. Saenger is a psychologist and a writer. She is lecturing for MDSG on September 13, 1999. For more information on her lecture, see our lectures page.

Plan Ahead for Hospital Care

By Jane Cartwright

Sometimes during psychiatric hospitalization, you may be too sick to make decisions regarding your treatment. Now, in advance, you can write down instructions and/or appoint a "health care agent" to represent you. This way, even though you can’t make a decision on the spot, your wishes are known and can be carried out.

Under New York State’s Health Care Proxy Law passed in 1990, you legally have the right to give or withhold consent for a specific medication and/or treatment (such as electroconvulsive therapy). Mental Health caregivers, under law, are obliged to follow your instructions, according to Melanie Shaw, senior attorney with Disability Advocates in Albany.

Check out http://www.peer-resource.org on the Internet for information about writing proxies and a proxy form. The later is also available from the New York State Department of Health.

According to Dawn Lannon of the New York State Office of Mental Health, appointment of an agent to act on your behalf must be in writing (you can do it without an attorney) and it must include the following:

1. Identification of the principal (you);
2. Identification of the agent;
3. Indication that you intend that the agent make health-care decisions for you if you are unable to in the future;
4. The date and your signature in the presence of two adult witnesses other than the agent;
5. Signature from the two witnesses who attest to the fact that you executed the proxy willingly and free from duress.

The agent’s authority to make decisions for you takes effect when the attending physician determines that you’re not able to make them for yourself. You may also identify a date or specific condition upon which the proxy will expire, or set limitations on the agent’s authority.

Are "psychiatric advance directives" legally binding? Since the law went into effect, there have been no challenges in state court, according to Shaw.A spokesman for Bazelon Center for Mental Health Law said: "While advance directives for health care have been around for a long time, their use for psychiatric care is a very new area of law. We do not yet know how courts will deal with them, especially when safety issues arise."

You can’t make decisions in advance via an advance directive about whether you do or don’t want psychiatric hospitalization. New York State Mental Hygiene Law Article 9 governs admission for hospital psychiatric care.

About  MDSG

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..