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	May 2005	Table of Contents (all articles are on this page) Peter Kramer to Speak June 13, 2005 Fall Lectures Ask The Doctors Book Bits The Reader's Corner   Membership Fee Increase 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

At Last—Confronting Depression

What if Prozac had been around in Van Gogh’s day? Would his paintings have been as intensely brilliant? The question may have crossed your mind before, but for famed psychiatrist Peter Kramer, the notion has inspired an in-depth look at the way our society views depression. “When you ask people directly, ‘Is depression a disease?’ they invariably say yes,” explains Dr. Kramer, “but over and over again they also say things about it that they would never say about, say, high blood pressure or epilepsy.” 

On the lecture circuit following the publication of his runaway best-seller, Listening to Prozac, audience members frequently asked him the Van Gogh question. The underlying idea was always that maybe treating depression blunts the emotional nuances and deep insight crucial for artistic genius. 

But the possibility that depression was somehow a source of creativity rather than a debilitating illness just didn’t gel with the suffering that Dr. Kramer saw so many of his patients enduring. “While we’ve come a long way in de-stigmatization, there’s still a glamour associated with depression now. I think it’s because for hundreds of years it was not well-understood and there were no good treatments and so certain myths formed about it that have remained an integral part of our culture.” 

At the same time, biological evidence of depression’s effects has emerged. Studies have shown that depression can damage the heart and blood vessels and disrupt brain function. “Still when you ask people, ‘If you could eradicate depression in the same way that polio was eradicated, would you?’ they tend to hedge. They ask things like ‘How would you define ‘depression?’” 

Why does our culture cling to such a romanticized view of depression? How does the “cult of melancholy” that’s been a part of Western culture from Aristotle to the Romantics to the authors of today’s depression memoirs affect our feelings about this dark disease? Is our understanding of mental illness distorted by the myths that surround it? 

Peter Kramer is the famed author of the groundbreaking bestseller Listening to Prozac, and the provocative new book, Against Depression; host of public  radio’s The Infinite Mind; clinical professor of psychiatry at Brown University and practicing psychiatrist.

Come hear Dr. Kramer discuss this fascinating topic. Twelve years ago, Listening to Prozac changed the way we think about antidepressants. Now Dr. Kramer challenges the way we see depression itself. His latest book, Against Depression has everyone debating. Don’t miss this chance to hear him discuss the issue himself! A question and answer period will follow.

“Depression is to our culture what tuberculosis was eighty or a hundred years ago: an illness that signifies refinement.”
    —Peter Kramer, Against Depression
 

Self-Destructive Behavior, Mood Disorders, and Stress

September 12, 2005
Richard O’Connor, PhD 

Dr. O’Connor is the celebrated author of Undoing Depression and Undoing Perpetual Stress. He is also a practicing psychotherapist and always packs a full house. He is back by popular demand. Don’t miss this dynamic speaker. 

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
 

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

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Dr. Ivan Goldberg, Psychopharmacologist

Q: I have had three episodes of mania and two of depression. Is it likely that I will have mixed episodes in the future?

A: People with bipolar disorder usually show a consistency in the kind of episodes they have. Those who have purely manic episodes usually continue to have such episodes just as people who have mixed episodes continue to have mixed episodes. Since you have had no mixed episodes so far, it is unlikely that you will have them in the future. 

Q: How is thyroid function related to depression?

A: Depression is a frequent symptom in people with under- active thyroid glands (hypothyroidism). If depression is purely the result of hypothyroidism, then thyroid replacement therapy, without antidepressants, is all that is needed to control the depression. It is important that such thyroid under-activity be detected since antidepressants work poorly, if at all, in the absence of adequate amounts of thyroid hormones. Depression is also seen in some people with an overactive thyroid. In fact, thyroid function is so closely connected to depression and the effectiveness of antidepressants, that it is of the greatest importance for all patients with mood disorders to have complete thyroid work-ups (measurements of free T-3, T-4 by dialysis, and TSH.) It’s also important to note that hypothyroidism contributes to rapid-cycling in some people with bipolar disorder. 

Q: Does alcohol abuse impact the symptoms of acute mania in people with bipolar disorder?

A: When compared to patients who do not abuse alcohol, patients who do abuse alcohol show significantly more symptoms of mania, higher rates of mood liability and impulsivity. They also demonstrated higher rates of violent behavior and abuse of other drugs.

Dr. Joe Nieder, Pediatric Psychiatrist

Q: My 16-year-old daughter's boyfriend recently broke up with her and she seems to be taking it unduly hard. For the past three weeks she has been crying and she eats very little and sleeps almost 12 hours a day. There is a history of unipolar depression in our family (my husband's sister and mother), but how can you tell the difference between typical adolescent behavior and clinical depression?

A: This is a very difficult diagnosis to make. As standard criteria in DSM-IV published in 1984, depression is considered to begin after two weeks of symptoms. In many people, the sadness following a significant loss can appear much like a depressive episode. For a diagnosis of depression, one symptom must include 1: depressed mood or 2: loss of interest or pleasure. A major difference in adolescents or children is that an irritable mood can appear instead of a depressed mood. 

Other symptoms of depression can include weight loss, insomnia or sleeping too much, agitation or moving very slowly, fatigue or loss of energy, or feelings of guilt or worthlessness.

As is clear from the list, many symptoms overlap between a reactive depressive episode—which occurs in reaction to a distressing event—and an actual clinical depression—which may stem from internal factors. One key difference is that a reactive depression would gradually improve over time, while a clinical depression may not. The difference in diagnosis is very important.

 

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. 

	Darkness Visible: A Memoir of Madness  by William Styron Vintage  Paperback   $11.00 list, $8.80 at Amazon.com (as of May 2005)  In this beautifully written memoir, a well-known author discloses his depression in a trip through a terrible episode.
	You Are Not a Stranger Here: Stories   by Adam Haslett  Anchor Press  Paperback $13.00 list, $10.40 at Amazon.com (as of May 2005)  These entertaining short stories filled with authentic characters who are depressed and bipolar. I could not put it down.
	Electroshock: Healing Mental Illness   by Max Fink, MD  Oxford  Paperback  $13 list,  $10.36 at Amazon.com (as of May 2005)  This book provides an excellent introduction to electroshock therapy and includes patients’ experience, the origins of ECT, and a discussion of who it can help, along with some of the technical features of treatment and an explanation of how it works.

 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    Undoing Perpetual Stress: The Connection between Depression, Anxiety and 21st Century Illness    by Richard O'Connor, Ph.D. 534pp. Berkley.$23.00.

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In his first book, Undoing Depression, an MDSG bestseller, Richard O'Connor helped us look at ourselves and understand what we saw. In his latest, he again offers numerous paths to help undo the damage, but this time he looks at how our culture plays a role.

What is 21st Century Illness? As O'Connor explains it, it’s a condition with many causes: "breakdown of the family, loss of faith in institutions like government and the church, the development of a consumer culture, revolutions in health care and aging, our loss of contact with the natural world," as well as the rate of change and the struggle to keep up. Our nervous systems are overwhelmed by the onslaught of these unavoidable circumstances so that we suffer from perpetual anxiety, depression, and physical illness. As a result, our fight or flight buttons are in the "on" position for too long. Life is even more difficult when we experience these symptoms without being aware of the causes behind them.

So what can we do to help ourselves? Dr. O'Connor fully accepts that medications are helpful, but he keeps coming back to other ways we have to diminish the effects of anxiety and depression. He uses the Buddhist concept of mindfulness, "using the whole mind to observe both emotions and intellect at work,” and feeling emotions without getting overwhelmed or feeling denial. He suggests an approach of compassionate curiosity. In other words, look at yourself, but give yourself a break from judgment.

In observing oneself, certain core issues appear again and again in hypersensitive places. Each aggravation is experienced with intense unhappiness. Dr. O'Connor helps us work on these places, which he refers to as vicious circles of the mind or life traps. 

His approach to such problems is particularly thought provoking. He uses charts to lay out, for example, numerous behavior possibilities, along with potential outcomes as well as backfire possibilities. 

But even if a reader does not choose to follow the specific steps Dr. O'Connor gives, Undoing Perpetual Stress is most valuable and contains a wealth of information. Reading it will help people understand their symptoms as well some of their defenses, both healthy and unhealthy. The book includes a description of just about every psychiatric and personality disorder you could think of, and the pathology section is followed by a substantial number of therapy models which explain how each works and how each helps. In fact, Undoing Perpetual Stress is so full of valuable information, that I had trouble choosing the ideas to include here. This book should really be read slowly bit by bit so that each idea can sink in. 

You can purchase (and read more about) Undoing Perpetual Stress: The Connection between Depression, Anxiety and 21st Century Illness by Richard O'Connor 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 $15.64 as of May 2005 (the price can change at any time). 

Hurry! Last chance to join MDSG before membership fees increase.

After two decades, we’ve finally had to raise our rates. Starting June 1, 2005, admission to lectures and support groups will increase from $4 to $5. (Fundraising lectures will continue to be $10.)

An annual membership for an individual will go from $35 to $45 and a family membership will go from $50 to $65. But if you re-up before the end of May, you can still take advantage of the old rates. Just use the form on the back page of a newsletter and get it in the mail, along with your check for the old amount, by May 31.

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. 

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