M O O D S

By Michael Craig Miller, MD

The impulse to gather and store has had evolutionary advantages for the human race. Many people are happy to regard themselves as pack rats, collecting possessions while keeping them in good order and out of the way until they are needed. But some people acquire and keep so much stuff that they no longer have space to live, cook a meal, or pay their bills. They live in squalor, and they risk falling or causing a fire. In the famous Collyer brothers case in 1947, two men living together in a Harlem town house full of junk met their death as a result of hoarding. One died when a pile of rubbish fell on him and the other, who depended on his brother for everything, then starved to death.

This problem, known as compulsive hoarding, is most often associated with obsessive-compulsive disorder—but it can occur among people with mood disorders, too. It can also be seen along with anxiety, eating disorders, schizophrenia, dementia, mental retardation, autism, brain injury, and several personality disorders. Hoarding can even become a problem for a person with no psychiatric illness and no psychiatric history.

A common feature of hoards is vast piles of paper—newspapers, magazines, books, mail, notes, and lists. Some hoarders accumulate old clothes, rotting food, and stray animals. Hoarders are often elderly, socially isolated and suspicious. They rarely seek help, so the hoarding is discovered mainly when a neighbor or police officer notices filth, odors, or junk spilling out of a house into a yard.

Psychologists have described the following characteristics of hoarders: Afraid to discard anything that might be useful some day, they decide to keep everything. Sometimes they acquire junk as insurance against any conceivable future need. Every item seems unique and therefore irreplaceable. They disregard the costs of having more and the advantages of having less. They may be emotionally attached to their possessions or rely on them to feel safe. It’s not clear where these feelings come from, but research shows that they are not correlated with either material or emotional deprivation earlier in life.

Brain scans show that the pattern of activity in hoarders’ brains distinguishes them not only from healthy people but also from others with obsessive-compulsive disorder. Antidepressants work much less well for hoarding than for other obsessive-compulsive symptoms. And there is some evidence that hoarding has distinct genetic roots. The usual cognitive-behavioral therapy techniques have not worked well for hoarders. Researchers are trying new approaches, such as providing feedback about decision-making, clarifying how much accumulation is normal, and confronting unusual thinking about possessions. The hoarder may learn to let some things go, or at least to organize possessions in a way that makes life more livable. 

Although sometimes necessary, simply cleaning out the clutter does not solve the problem: The hoarder will only become intensely anxious and start to accumulate junk again. Legally, social service and community health agencies can do little without permission from the hoarder unless he or she is creating conditions that are dangerous or detrimental to public health.

What can you do if you or a loved one is a hoarder? A lot depends on whether the hoarder wants to change, and recognizing the problem is the first step. Treating the underlying mood disorder and any other psychiatric problems is also important. You’ll also want to bring talk therapists or psychiatrists—who may not be able to pick up on the problem during office visits—into the loop. If the problem is extreme, a social service agency may be able to visit the home and assess risk and help determine whether the person is safe and his or her basic needs are being met. For older people, elder services may be able to provide support to help the person make decisions, organize possessions, and create a space to live and receive visitors. Finally, family involvement and friendly visits can be a great help so don’t be afraid to reach out.

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Michael Craig Miller, MD is editor-in-chief of the Harvard Mental Health Letter. This article originally appeared in the December 2004 issue. Reprinted with permission.

 

Spring Lectures: New Info, Top Experts

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New Meds, Best Meds and What’s in the Pipeline: 
Keeping Up with the Latest Advances in Medications

March 7, 2005
Jack Gorman, MD 

The plethora of new psychiatric drugs coming out each year is great news for anyone with a mood disorder— the only problem is keeping up with them all. Find out about all the new options from the man who has literally written the book on psych meds. Jack Gorman is a widely published author and one of the foremost authorities on the subject. He’s made it his life’s work to know everything there is to know about psychiatric drugs. He’ll discuss the latest, the best, and what’s coming down the pike and then open the floor to questions from the audience. 

Dr. Gorman is Chief of Psychiatry, Mt. Sinai Medical Center; Professor of Neuroscience, Mt. Sinai School of Medicine; author of the classic reference book The Essential Guide to Psychiatric Drugs.

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Fresh Insights into Mood Disorders in Women:
How Gender Differences Play A Role  

May 2, 2005
Lois Kroplick, MD 

The innate differences between men and women have been the subject of endless debate, but when it comes to mood disorders, evidence reveals that the sexes really are wired differently. Does it all come down to hormones? What role does the psychology of being male or female play? Lois Kroplick, who is both a psychiatrist and therapist, will draw on her extensive clinical experience as well as the latest research to shed light on the role of gender in mood disorders.

Dr. Kroplick is a psychiatrist, therapist, and lecturer; founder and past president of the Mental Health Coalition of Rockland County, New York.

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Plus...mark your calendars. Psychiatrist Peter Kramer, renowned author of the bestseller Listening to Prozac and the forthcoming Against Depression, will speak on June 13, 2005. 

Did you miss a lecture of great interest to you? Tapes are available through the mail. Below is a listing of the most recent presentations.

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

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

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Dr. Ivan Goldberg, Psychopharmacologist

Q: While lithium mostly controls my bipolar disorder, feeling slowed down, unmotivated and slightly “fuzzy” in my head upsets me. What can be done about these side effects?

A: Your lithium level should be checked, and if it is high, your dose of lithium should be reduced so that your blood level is at the lower end of the therapeutic range. If that does not help, you might talk with your psychiatrist about the lithium being replaced by another mood stabilizer. Frequently, after a switch to divalproex (Depakote) or lamotrigine (Lamictal) the side effects you mention disappear.

Q: I am a 49-year-old woman who has been depressed for about four months. I was started on Prozac; when I failed to respond to 80 mg a day, my doctor started me on 800 mcg per day of folic acid. What is the purpose of the folic acid?

A: Folic acid is a vitamin that plays an important role in brain metabolism. It has been shown that when small doses of folic acid is taken along with fluoxetine (Prozac), that it improves the effectiveness of the fluoxetine in women. The same effect would probably be seen with other SSRIs and men would probably show an identical response to a larger dose of folic acid.

Dr. Joe Nieder, Pediatric Psychiatrist

Q: I was horrified to see that my 12-year-old son scratched a homemade tattoo into his arm using a pocket knife. He says that his friends all have them, too (though I've not seen for myself). I've heard a lot about adolescent girls cutting or injuring themselves and how this is a sign of poor self esteem and should be taken seriously. Is the same true of my son's tattoo?

A: Cutting or scratching oneself in childhood is usually a negative sign. However, tattoos and piercings are very popular and even fashionable at this time, with many music idols, football and basketball players, and movie stars displaying them. Cuttings or self inflicted marks are often different from going for a piercing. A major issue is the reversibility of the mark, and whether a child can gauge the effect when they are older and maybe wiser. Piercings are usually easily reversed; not so with tattoos. It’s extremely time consuming and expensive to remove a tattoo. Adolescent self -expression can often be achieved by less permanent means.

Q: If bipolar disorder sets in during adolescence or childhood, does it mean that it will be more severe later in life than bipolar disorder that appears for the first time in adulthood?

A: When bipolar disorder appears early in life, such as childhood or early adolescence, there is usually a greater biologic predisposition to the illness. There is often a strong family history, which also suggests a stronger biologic disposition. The untreated course of a bipolar illness appearing in childhood or early adolescence is subject to the mood swings and hormonal changes of puberty and adolescence. However, if the bipolar disorder is treated effectively, and the disorder is brought under good control, the prognosis can be excellent. So much of the prognosis depends on adequate treatment early in the course, and adequate compliance with the entire treatment program. 

In summary, bipolar disorder appearing early in life which is correctly treated could have a far better prognosis than later onset bipolar disorder which is not adequately treated, or for which compliance is poor. 
 

The Reader’s Corner (Book Review)   with Betsy Naylor

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In my capacities as MDSG chair, Reader’s Corner writer, and enthusiastic reader, I’ve read quite a few books about mood disorders over the years — from novels to memoirs to reference books to self-help guides. Of course a subject as rich as mental health inspires plenty of worthwhile volumes, but some are real standouts. Here are some. Stay tuned for more in future newsletters. 

   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.  

 

Holiday Contest Winners

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By Howard Smith

In our last issue, we asked you to play Irving Berlin for a day and write a White Christmas parody that poked fun at mood disorders. So, just in time for, uh, President’s Day, here are the top three. Thanks to everyone who entered!

 

Get your MDSG T-shirts

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The shirts are white cotton with short-sleeves and come in medium and large. The cute cat picture on the right is printed on the front and the back says: 
        Support Someone www.mdsg.org. 

The $16 price includes shipping and handling. Order more for a discount: Two are $30; three are $44. Supply is limited so get them while you can.

To order, send a check payable to the Mood Disorders Support Group/ New York to:

T-shirts orders
MDSG-NY 
PO Box 30377 
New York, NY 10011

Be sure to specify what sizes you need and the address to which your order should be sent. 

News Flash! Inflation Hits MDSG

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After two decades at the same rates, MDSG has finally had to raise contribution fees. Starting June 1, 2005, admission to the discussion groups will be $5. Individual annual membership will be $45 and family membership will be $65. Fundraising lectures will remain the same. 
  

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

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MDSG provides award-winning services to New York’s entire mental health community---over 600 individual support group meetings a year, the distinguished lecture series, our telephone information service, web site and 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.
Note: as of June 1, 2005, individual membership will be $45 and family membership will be $65. 

MDSG has an affiliation with Amazon.com. If you click on the above Amazon logo, you’ll be taken to Amazon’s web site. As long as you have reached their site through ours, MDSG will receive a commission on anything you buy from them -- books, movies, music, or any other merchandise they offer for sale. It’s that simple! 

Contact MDSG

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Letters to the editor and other submissions are welcome and will be printed at the discretion of the newsletter editor. Contributions can be mailed to our Post Office Box (see above), please address them to "Newsletter Contributions".  E-mails should be sent to newsletter@mdsg.org