The Mood Disorders Support Group of New York City

		M O O D S
	Newsletter of the Mood Disorders Support Group of New York City
Previous Newsletter	August 2005	Table of Contents (all articles are on this page) September Lecture: Self-Destructive Behavior Fall Lectures Support Group Advice From The Folks in the Know A Funny Thing Happened on the Way to My Shrink's Ask The Doctors with Ivan Goldberg and Joe Nieder Book Bits The Reader's Corner   Print This Newsletter as a PDF We Get By with a Little Help from Our Friends . . . Contact MDSG	When printed, this page will automatically re-format itself. Formatted for Printing	Next Newsletter

Richard O’Connor, PhD
Celebrated author of Undoing Depression and Undoing Perpetual Stress, and practicing psychotherapist.
September 12, 2005
Self-Destructive Behavior, Mood Disorders, and Stress

Binge drinking. Drug use. Overeating. All too often self-destructive behaviors like these accompany mood disorders — but it doesn’t have to be that way. “People sometimes think that the two go hand in hand, that if you’re depressed, that’s just part of the territory. But self-destructive behavior is something that should sometimes be addressed as an issue on its own,” says Dr. Richard O’Connor, our September lecturer and renowned author of Undoing Depression (1999) and Undoing Perpetual Stress (2005). 

While certain acts involve an obvious element of self-harm, other behaviors are more subtle. “There’s active self-destruction, when you know something’s bad for you and you go out and do it as a form of rebellion, but there’s also a form of self-destruction that’s passive, and that largely comes because of the lack of energy and focus that comes with depression,” says Dr. O’Connor. Examples include staying home and watching too much television, avoiding exercise, and eating poorly. 

But whatever form it takes, self-destructive behavior can be avoided if we recognize the motivation behind it. 

“On some level people see these things as a way to bring some fun into their lives. Most of the time we play by the rules and color inside the lines, but we all have a little 4-yearold inside of us who wants to stick out his tongue and say, ‘You’re not the boss of me,’ even when we’re really our own bosses,” says O’Connor. 

Find out how to recognize harmful patterns and hear about healthy ways to combat these self-destructive urges. Dr. O’Connor is an MDSG favorite and is back by popular demand. Don’t miss this dynamic speaker! 

Dr. O'Connor also wrote Active Treatment of Depression (2001). 

And be sure to catch the other first-class lectures in our fall series (below). 

Archived Lectures Available by Mail

Did you miss a lecture of great interest to you? Recordings of past lectures are available through the mail. The most recent lectures (beginning with #47) are on CD; previous lectures are on cassette tape. 

Lecture recordings are $13 each (including postage and handling) or $25 for two , $35 for three. To order, write a letter requesting any lecture by number, make check out to MDSG Inc. and send it to: 
Lecture Tapes c/o MDSG PO Box 30377, New York, NY 10011
 

By Dena Croog

Want to know the secret to a great support group experience? Just listen to what some of our facilitators have to say.

"I always get the most out of the groups when I'm focused on simply listening to others. The thoughtfulness and courage individuals display weekly at the support groups is a constant inspiration." -- Paul

“Speak up for yourself and listen to others. This is the MDSG 1-2 punch. See you in the ring, I mean circle.” -- Carl

“Don’t ‘Dear Abby.’” -- Max

"My most meaningful groups take place when members are willing to risk telling us their experiences from deep inside. They share their shame, their fear, their self-hatred. Not finding the judgment or ridicule usual in the non-MDSG world, group members offer identification and support and warmth. Such openness can lead to getting better." --Betsy

And keep these ten guidelines in mind when attending an MDSG support group: 

1. Groups provide a safe environment where you can share thoughts and feelings.
2. Everything is confidential—what’s said in the group stays in the group.
3. Always remember to display kindness, courtesy and consideration for your fellow group members.
4. Don’t interrupt when others are speaking.
5. Give everyone a chance to talk.
6. Shut off all cell phones and pagers during the group.
7. No one is an expert.
8. Speak in reference to yourself; i.e.- “what works for me.”
9. Steer away from trying to solve other people’s issues.
10. Support each other by sharing experiences. 

Remember this advice and we’re sure you’ll have a more rewarding experience. As Carl says, “See you in the ring!”
 

Depression. Anxiety. Therapy. Where’s the humor in these difficult topics? All over the place, if you know where to look. Just listen to what some of our culture’s critics, comedians and cartoonists have had to say.

"After twelve years in therapy, my psychiatrist told me something that brought tears to my eyes. He said, 'no hablo ingles' ." — Ronnie Shakes

"I've developed a new philosophy...I only dread one day at a time." —Charles Schulz

“I envy paranoids; they actually feel people are paying attention to them.” –Susan Sontag

"Maybe if we lie down our brains will work." — Jerry Seinfeld

"Life is full of misery, pain and tremendous suffering, and it's all over much too quickly."— Woody Allen

“We experience moments absolutely free from worry. These brief respites are called panic.” –Cullen Hightower

“Life is just a bowl of pits." ---Rodney Dangerfield 

"He who laughs last is probably depressed." —H.S. Smetanka
  

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

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Dr. Ivan Goldberg, Psychopharmacologist

Q: Since antidepressants have the ability to cause mania or hypomania in some people with bipolar disorder, does this mean that someone with bipolar disorder should never take antidepressants?

A: Various studies have found that antidepressants cause mania or hypomania in about 17 percent of people with bipolar disorder who are taking mood stabilizers, and may play a role in rapid cycling. Despite this risk, many people with bipolar disorder who are severely depressed require antidepressants to recover from an episode of depression. When antidepressants are taken by people with bipolar disorder, they should be taken with a mood stabilizer and should be taken in as low a dose as possible.

That said, patients taking long term antidepressants have been shown to have about half of the rate of relapses of depression as patients who stopped antidepressants after feeling well and some people will require long-term treatment with an antidepressant to remain depression-free. 

Furthermore, lithium has been found to protect against antidepressant-induced mania/hypomania better than other mood stabilizers, while Wellbutrin (bupropion) and the MAO inhibitors are the antidepressants least likely to cause a switch into mania. 

Unfortunately, there are still many psychiatrists who refuse to prescribe antidepressants to their patients with bipolar disorder who are depressed. This leads to unnecessary suffering and even to suicide in some cases. 

It’s worth noting that bipolar depression can also often be controlled by the use of the antidepressant mood stabilizer Lamictal (lamotrigine), which has an even lower risk of inducing mania or rapid cycling than antidepressants.

Dr. Joe Nieder, Pediatric Psychiatrist

Q: My 11-year-old nephew has been having behavioral problems for several years now. He threatens other children, gets into fistfights, breaks windows and has been caught starting fires in the neighborhood. He was put into a classroom for children with behavioral disorders last year, but he doesn't seem to be improving. What might be going on here? Are there medications that can help?

A: For an 11 year old with behavior problems, I would first get a complete history. I would be interested in knowing any family problems or issues that might be related to the behavior. Children can develop behavior problems without any family issues, but events such as divorce, separation, death or loss of a pet can trigger these problems.

If there were no family events, I would look for changes in the school, loss of friends, academic problems, being teased, etc. Being put in a special education class could adversely affect a child's self esteem. I would also look for symptoms of an earlier disorder, such as ADHD or a conduct disorder. A careful history would include a family history of mood disorders, behavior disorders, or alcohol and drug abuse.

Finally, I would think of medication if there were a strong suggestion of a family mood disorder. What looks like a behavior problem at age 11 could turn out to be the early signs of a mental disorder later in life.

 

Book Bits

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by Betsy Naylor

Some books on depression and mood disorders are classics. As part of an ongoing Reader’s Corner’s series, here are some more must-read volumes. 

	My Depression: A Picture Book by Elizabeth Swados Hyperion $16.95 list, $11.53 at Amazon.com as of August 2005 You are not alone. In her new book, Elizabeth Swados draws and writes about emotional states we can all identify with. Each page has a cartoon with captions and sometimes cartoonish comments in a bubble. Some pages are laugh out loud funny, some speak our feelings, and some do both.  What Swados has her characters think and say (especially her own) is so true to the reality of being depressed. Nowhere else have I seen such accuracy. When her anxiety turns to rage, she kicks a taxi. Look for the tiny name of the cab company (Gremlin). On the next page, she is watching a Law and Order marathon, trying to lie flat on a chair. Her posture illustrates the caption: "The truth is much more dull." The way she presents her depressed, acting out self, you would never guess how successful she is, a Broadway playwright, composer and so on. Despite her accomplishment and fame, she writes in one caption, "I avoid friends by telling them how successful and busy I am. When in fact the idea of work terrifies me." Give this book to a friend in the hospital. Give it to your misunderstanding family. And give it to yourself. You will find your own feelings in the words and pictures.
	Detour: My Bipolar Road Trip  by Lizzie Simon Paperback. Adobe $13 list $11.20 at Amazon.com as of August 2005.  An accomplished young woman hits the road to find herself and figure out how to live with her disease. Detours ensue. Recommended especially for 20-somethings.
	Down Came the Rain: My Journey Through Postpartum Depression By Brooke Shields Hyperion Hardcover $25.95 list, $14.99 at Amazon.com as of August 2005  This public woman shows her private self in a personal account of post-partum depression, a form of depression that is misunderstood, but very common.

 You can purchase (and read more about) these books by clicking on the titles above. Doing so will result in a referral fee being paid by Amazon to MDSG, at no cost to you.  

The Reader’s Corner (Book Review)   with Betsy Naylor     Against Depression   by Peter Kramer, M.D. 358 pp. Viking $25.95

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Isn't everyone against depression? If we were, argues Peter Kramer, then wouldn’t we want to wipe it out like smallpox or polio? Or at least fully treat all depressed people? Kramer, famous for his book Listening to Prozac, has written another provocative book. He says that if we really understood the price we pay for depression, we would want to eradicate it.

But instead, Kramer points out, our society has grown accustomed to depression and even holds some values which contribute to its current status: widespread and under-treated. For example, depression is taken to be part of human nature. Some depressive traits (like quietness) are considered attractive, and some men are drawn to depressed women. It’s even become common to view depression as a component of an artistic temperament.

But Kramer debunks the popular idea that depressed people are inherently creative. Rather, he claims people are creative despite of, not because of, their illness. In Kramer’s view there is actually no redeeming value in depression.

And in fact, there is quite a bit of danger associated with a depressed state, even without factoring in the risk of suicide. As Kramer points out, the physical consequences cannot be ignored. Long bouts of depression and stress cause the body’s fight or flight switch to stay on. Stress hormones pour out in quantities that are harmful. In this state the body is ready to be wounded. Blood platelets get sticky, preparing to clot. The heart beats too fast for too long. Over time, bones loose calcium. Dr. Kramer even describes some alarming studies which show that depression causes shrinking of two parts of the brain: the hippocampus and part of the prefrontal lobes.

"Depression in the brain looks eerily like depression in the person. It is fragility, brittleness, lack of resilience, a failure to heal. Depression is chronic and progressive, with each episode — perhaps each day!—leaving damage in its wake." But the news isn’t all bleak. All of this recent research has an upside because it means that we are moving closer to a more complete picture of this terrible disease. The more we know about it, the better we will be able to treat it—so we have good reason to believe that untreated depression will one day be a rare thing.  As Dr. Kramer concludes his book, "How glorious it will be to free ourselves of depression." 

Dr. Peter Kramer can be heard on the National Public Radio program, The Infinite Mind, Sundays at 7 a.m. on WNYC 820 AM. A recording of his June lecture for MDSG “At Last — Confronting Depression,” is available by mail. For details, see the item above about the Fall lectures. 

You can purchase (and read more about) Against Depression by Dr. Peter Kramer from Amazon.com. Doing so will result in a referral fee being paid by Amazon to MDSG, at no cost to you. The hardcover edition sells for $17.13 as of August 2005 (the price can change at any time). 

This issue of MOODS is the first one available for downloading and printing as an Adobe Acrobat PDF file. To download it, right click here. In Internet Explorer, use "Save File As". In Firefox use "Save Link As". It is 126K. 
   

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Note: as of June 1, 2005, individual membership will be $45 and family membership will be $65. 

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