M O O D S

My name is Kurt. I am a college graduate, have been happily married for 19 years, have a terrific 17-year-old son, have worked for over 20 years, and have had 21 electroconvulsive therapy (ECT) treatments for severe depression.

I’ve suffered, as did my father and his mother before him, from depression on and off most of my adult life, but it had never been severe enough for me to miss more than a few weeks of work, or to attempt suicide. Medication kicked in and/or the depression simply ran its course and lifted.

My depressions always start when everything is going well. No sad or stress-filled event seems to trigger them. And so it was that February. I just woke up—for no reason at all—completely depressed. It took hours just to get out of bed to go to the bathroom or to the kitchen. I barely made it to most of my appointments with my psychiatrist and therapist.

Five or six weeks went by and nothing changed. I knew I was in deep trouble. For some reason, this depression was different, worse than ever before. Suicidal thoughts kept coming, and I started to cut myself on purpose with a razor blade, knowing that, fleetingly, the physical pain would feel better than the emotional pain.

Then my psychiatrist mentioned ECT. I was dead set against this at first (I’d seen One Flew Over the Cuckoo’s Nest), but my wife, Valerie, got me to agree to research it at least. Between us (mostly Valerie), we found and read 17 articles on ECT. Each pointed out the safety of today’s procedure. The only major problems we read about seemed to happen to patients in extremely poor physical health who shouldn’t have had the treatment in the first place . The death rate as a result of ECT, we read, is six in 10,000 or .06 percent. These are better odds than crossing the street.

We discovered that ECT is the treatment of choice of pregnant women who can’t take antidepressants, because they might harm the fetus. Partial memory loss can be a major side effect. But—let me tell you—considering the fact that I was cutting myself and near suicide, we concluded the risks were worth taking.

The ECT was done at Gracie Square Hospital in New York City. I can honestly say the worst part was waiting for the procedure to start. The actual ECT, if I can be so cavalier, was a piece of cake. After I was wheeled into the room, I was given an anesthetic and fell asleep in five seconds. I woke up feeling groggy but none the worse for wear. Since the whole thing was done on an outpatient basis, I was able to go home within 30 minutes of waking up. I lost some memories that day, but they returned the next.

The first treatment did not lift the depression, but I knew from my reading that it usually takes three to five procedures for substantial improvement. Sure enough, sometime after the fourth treatment or so, my suicidal thoughts lessened considerably, and I stopped cutting myself altogether. I had a few more treatments and was close to feeling normal again. Then I was scheduled to go on maintenance treatments, one a month for six months. 

At this point, I, in my infinite wisdom, figured I was doing pretty well, and I didn’t need any more ECT. I was starting to fear memory loss, even though I had no problems with permanent loss from any previous treatment.

Big mistake.

Within two weeks, I was back in bed thinking of the best ways to kill myself, and I began to cut myself again. When the severity of the situation hit me, I began to take ECT once more and I recovered in a few weeks. 

My current status? I am working full-time now.

ECT saved my life, and I’m grateful. I think it should always be considered in cases of life-threatening depression.

From the Chair

by Rich Satkin, Chairperson of MDSG 

MDSG is working on a long-range strategic plan to guide us over the next three to five years. We have hired a professional planning consultant. A key concern is understanding the needs of current and potential members and deciding what services should be offered. 

This question is all the more crucial since more people may have bipolar disorder than previously thought. In an address titled, “The Spectrum of Bipolarity,” delivered last May to a standing-room only symposium at the American Psychiatric Association, Dr. Hagop Akiskal and Dr. Charles Bowden reported that the prevalence of bipolarity rises from one to five percent of the population when "softer" expressions of bipolar disorder are included in the definition.

Though the symptoms are not as distinct as those of Bipolar I or II, these softer expressions can interfere with normal functioning, and treatment sometimes is indicated. Some of the features of Bipolar II such as overconfidence, over-optimism, and over-involvement in new activities are also characteristic of the softer forms.

At one end of the bipolar spectrum are the more difficult cases: rapid-cycling, concurrent substance abuse, or classic Bipolar I disorder. Recovery for people suffering from these is often problematic and slow. Despite their real everyday struggles, such people are among the most highly motivated and consistent participants in our support groups. The support group helps build self-confidence through social interactions.

At the other end of the support-group spectrum are people who are medically stable for the most part. They come to MDSG to reinforce their sense of mental health, and to work on personal, family, work, or career issues. They come to lectures to acquire cutting-edge knowledge of mental-health topics addressed by experts.

Some people connect to MDSG through the newsletter or web site, because they realize that unipolar and bipolar disorders are lifelong illnesses. Episodes may recur despite medications, and up-to-date medical information may be key to treatment.
The APA report on soft bipolar disorder has implications for support groups like MDSG. The number of people with bipolar disorder in its softer forms may increase over the next few years.

Since the diagnosis implies problems with normal functioning, support groups may be dealing with a larger group of higher-functioning, but still distressed, individuals. How to provide treatment for them is a current issue for psychiatrists and a future support issue for groups such as MDSG.

This is a daunting, but very exciting, activity for MDSG as we approach our 20th anniversary in 2001. MDSG is still an all-volunteer organization. About 100 volunteers facilitate support groups at three locations, produce an expert lecture series, publish a quarterly newsletter, and maintain a web site. How we intend to grow is a significant question we must answer in our strategic plan along with how best to serve you.  

Disabilities Law

an interview with John A. Gresham  (Mr. Gresham will lecture to MDSG on October 2, 2000) 
by Jane Cartwright 

The Americans with Disabilities Act (ADA), which prohibits discrimination in employment on the basis of impairment, turns 10 years old this fall. How well has the law done for those of us with psychiatric illness? Are people with mental illness are better off on the job than they were a decade ago.

John A. Gresham, an attorney with New York Lawyers for the Public Interest, Inc. is an expert on the ADA. He will address MDSG on Monday, October 2, and talk about whether people with mental illness are better off on the job than they were a decade ago. 

The attorney himself is as interesting as the subject. Despite being legally blind, he graduated from Harvard College and Harvard Law School with top honors and has worked as an attorney ever since. Although he is the first to admit the stigma of poor eyesight doesn’t begin to approach that of mental illness, he is well versed both personally and professionally on what it’s like to struggle with a disability.

For example, how should you answer these questions on a job application form or during an interview: “Have you ever been hospitalized for a psychiatric illness?” Or, “Have you ever suffered from a mental illness?” Are these questions legal? How should you respond?  “The frustrating thing is that there are no magic answers,” Gresham told Moods (the MDSG newsletter) in a recent interview. “You can frame the issues, but people must decide for themselves. There are no silver bullets. There are no clear-cut answers. In some ways the law isn’t very satisfactory. It tries to draw a distinction between questions that are permissible on an application or in an interview and those that aren’t. But the line is fuzzy.”

Gresham said both the questions above “are probably illegal questions,” but that doesn’t really solve the problem. What should you do if you’re asked? “There are really no good choices,” he said. “Basically, what you have to do is make a choice and take your chances.”

However, he does not advise people to lie. “I can’t,” he explained. “I’m a lawyer. In many circumstances, if you get the job, lying may provide a separate basis for firing you, and in some cases, it is a crime.” On many government employment applications, your signature stipulates that you’ve told the truth under penalty of perjury.

One choice you have is to take the application to an administrative agency such as the Equal Employment Opportunity Commission (EEOC) and lodge a complaint. But don’t expect quick action. Gresham said there’s “an enormous backlog.” If you need the job right away, this isn’t an option. “Other choices,” said Gresham, “are to say to those in charge: ‘This is not a proper question,’ or to not answer it at all.” He pauses and laughs. “Neither is a great choice. As I said there are no immensely satisfactory answers.”

Once you have the job, you may ask for an on-the-job accommodation because of your illness—this is permissible under ADA. But the problem is you may have to explain why you need the accommodation. Is it always safe to do so? “That’s not always such a good deal,” admitted Gresham. “But this is important. If you’re going to need an accommodation, you’ve really got to ask for it before you get into any trouble, before your performance suffers and you find yourself in a hole. “If you need to reveal, try to wait until you’ve established yourself as a valued worker on the job.” So, does the ADA only protect people who develop mental illness after being on the job a while? “It’s probably easier to protect somebody with an established work record before a disability begins,” he said.

Asked where MDSG members can go for affordable legal representation if a problem arises with discrimination and employment, Gresham said: “That’s not an easy question.” His agency doesn’t accept individual cases. New York Lawyers for the Public Interest only takes cases that affect a large number of people. Gresham did add that as with civil rights litigation, attorneys can accept ADA cases on a contingency basis. If you win, the defendant pays the legal fees.

Are we really better off with the ADA?

“Fewer obnoxious questions are turning up on job applications,” Gresham said. “You still see it, but you see it less.” He added that a ruling by the Supreme Court last year might have opened up a “can of worms.” If you have a psychiatric illness, for example, and, with medication, you function normally on the job, are you still considered disabled?  “What does your medication do for you?” asked Gresham. “Does it bring you to the point that you function so well, you don’t have a significant impairment? If it does, then you may not be covered under the ADA and no accommodation [such as being allowed to sip water all day at a cashiers’ workstation while on lithium or other psychotropic drugs] would have to be approved by the boss.”

Gresham sees another possible cloud on the horizon: The states are asking the Supreme Court to decide if Congress has the authority to apply the ADA to the states.

Ask the Doctor        with Dr. Ivan Goldberg

Q. While the biological causes are often discussed, there’s little discussion of childhood experiences that lead to depression. What are some typical childhood experiences at the root of depression in adults?
A. Both biological and environmental factors contribute to the development of depression. Research has identified four childhood experiences frequently found in the background of adults who become depressed. These are:
    -Separation or divorce of parents;
    -Death of a parent;
    -Much parental conflict;
    -Loss of at least one parent in whom to confide.

Q. How frequently does depression or mania show up in people with AIDS?
A. Manic symptoms are found in about 10 percent of people with AIDS, while major depression has been diagnosed in almost 40 percent of cases. These rates are much higher than those found in the general population.

Q. My doctor says I suffer from a "soft bipolar disorder.” What did she mean by "soft bipolar?" 
A. Many individuals have symptoms suggestive of bipolar disorder but not severe enough to meet the official diagnostic criteria. “Soft” signs include rapid mood swings, irritability, energetic activity and mild hypomania—the symptoms of bipolar disorder but not as extreme. When people with soft bipolar disorder are treated with antidepressants alone, they may improve but also exhibit periods of anger, irritability or agitation. These patients do much better when treated with a combination of mood stabilizers and antidepressants. You may find more information on soft bipolar disorders on my web site.  

Q. I have treatment-resistant rapid-cycling bipolar disorder. My doctors suggested I take Mexitil. What is it and why is my doctor suggesting it? 
A. Mexitil (also known by the generic name mexiletine) has been available in the USA since 1985. It was used to treat people with disturbances in the rhythm of the heart. Recently, however, Mexitil has been used successfully for treatment-resistant bipolar disorder. Patients with rapid cycling and mixed states seem to respond best. Side effects of Mexitil include nausea, lightheadedness, tremor, nervousness, and coordination difficulties. About half of the patients I’ve treated with Mexitil significantly improve. For further information about Mexitil, from the NIH web site, click here. 

Poetry:  I Know

I know my son, who is mentally retarded, lives in a group home not because of his disability, but because I couldn’t handle him.

I know my wife’s life would have been much better if she had married someone more stable than I.

I know I must be insane since I’ve needed over 20 shock treatments so far.

I know God has it in for me.

I know my entire life has been a waste.

I know I am the weakest person on the planet.

I know I have disappointed everyone close to me.

I know I am a pussy for not having the guts to kill myself.

I know I am a curse to myself and everyone around me.

I know my son is retarded because of something I did.

I know I deserve everything I get.

I know that murderers as well as people who abuse their children live happier, more contented, and more peaceful lives than I, and have less guilt.

I know I am being punished for something I did in a previous life.

I know it would be better for everyone if I had never been born.

But then. . . . just like that. . . . .

My latest major depressive episode starts to lift and 

Reality returns, 

Thank God.   

Contest Winners

As we said in introducing this contest in the last newsletter, writing haiku is tricky—especially if you have to combine the strict form the poetry must take with a mood disorders theme. This ancient Japanese art has rules: first line, five syllables; second line, seven syllables; third line, five syllables. Within those 17 syllables there is supposed to be a transcendent image that gains deeper meaning the more you think about it. The last line is meant to deliver a zen-like “aha.” The challenge didn’t stop MDSG members from putting on their thinking caps. 

First prize, a $25 gift certificate from Pamela’s Café in Greenwich Village, goes to R.L.:
    Red-circled May date
    My spring ambulanced away
    Cut flowers don’t heal

P.P. won second prize, a copy of The Essential Guide to Psychiatric Drugs by Jack Gorman, M.D.:
    Shock of ECT
    Electroconvulsive jolt
    Remember my name

And R.A.B. won third prize, a seven-day, 28-slot pillbox and pill splitter/crusher:
    Mood disorders theme
    My self a buried language
    Hieroglyph learn one 

What’s Funny About Being Sick?

Mood disorders aren't funny, but sometimes humorous things happen to us because of our illnesses.  For example, one member of MDSG recalls that during a manic episode, a college psychiatrist prescribed Thorazine in massive doses. Then, first thing Monday morning, the doctor called her at her dormitory and had someone wake her and summon her to the phone to find out whether she was finally getting some sleep.

Have you ever been amused by the behavior of the mental health professionals who take care of you?  If so, send your anecdote or story to newsletter@mdsg.org.  The deadline is September 30, 2000. 

First prize is a $25 gift certificate from Pamela’s Café in Greenwich Village; second prize is a copy of The Essential Guide to Psychiatric Drugs by Jack Gorman M.D.; third prize is a seven-day, 28-slot pillbox and pill splitter/crusher.

About  MDSG

  The Mood Disorders Support Group
  P.O. Box 30377
  New York, N.Y. 10011
  Phone_______(212) 533-MDSG
  Fax________ (212) 675-0218
  E-mail_____ info@mdsg.org
  Web________ 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 lectures are:
Bipolar Disorder Monday,  September 11, 2000  Frederick Goodwin, M.D.  
Dr. Goodwin will discuss the forthcoming revision of his classic textbook on bipolar disorder. Come find out what's new in manic depression from the best. Note: This is a  fund-raising lecture.
Disabilities Law - Americans with Disabilities Act Monday,  October 2, 2000    John Gresham 
Mr. Gresham is an attorney and an expert on the Americans with Disabilities Act. He will be speaking about disclosure issues and legal rights for individuals with psychiatric disabilities under the ADA. 

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..