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The Mood Disorders Support Group of New York City |
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M O O D S |
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Newsletter of the Mood Disorders Support Group of New York City | ||
November2000 |
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by Jane Cartwright
Surely this is one of the cruelest ironies some of us face: you are very depressed and, naturally, you don’t feel like having sex. Then, your doctor gives you an antidepressant, and the depression lifts. Bingo! Your sex drive . . . doesn’t change a bit, and, in fact, may get worse.
You can’t stop the antidepressant, but, hey, the antidepressant is choking your sex life. You don’t feel desire, arousal isn’t what it used to be, and orgasms are delayed and feel more like a “sneeze”--if they happen at all. In addition to antidepressants, neuroleptics and mood stabilizers also can dampen desire, blunt arousal and delay orgasm in both sexes, according to Barbara Bartlik, M.D., a psychiatrist, sex therapist, and assistant professor of psychiatry at Weill Medical College at Cornell University.
What can we do?
When men and women suffer from sexual dysfunction caused by psychotropic medications, Viagra increases arousal, improves orgasmic sensation and leads to longer periods of excitement after sex, Dr. Bartlik said. This lingering excitement may fuel desire and lead to more sex—good news for many who’ve felt mentally well but sexually dead. But don’t count on Viagra to create much desire in either sex, she said. Viagra, which is not yet approved for women by the FDA, does not do much to inflame passion.
For men, she recommends 50 milligrams of Viagra. “It helps men improve erections (arousal) and men are then more confident,” she said. “If a guy has lost his sex drive because of his medication and his ability to become erect also is impaired, he’s going to pull back and avoid having sex.”
So, Viagra may help men on psychotropic medication. But what about women? Dr. Bartlik explained that there are no conclusive studies on the effect of Viagra on any women period, let alone those who take psychotropic medication.
“Some studies show that Viagra is not effective in menopausal women with sexual dysfunction; other studies show the contrary,” she said.
“So, we are still waiting for more research to be done, so we can tell what’s really going on.”
There have been no controlled studies on patients who take antidepressants and Viagra. A couple of anecdotal studies—one, which includes men and women and the other just women—are “both very positive,” Dr. Bartlik said. “Women’s sexual experience significantly improved with oral Viagra with regard to arousal, lubrication, orgasm, and general satisfaction.”
But, in addition, she has been prescribing a Viagra cream (used on the genitals) made up by a special compounding pharmacy. Does the cream work better for women than Viagra taken by mouth? “Yes, I think it does,” said Dr. Bartlik. “Sometimes women—like men--are bothered by some of the side effects of Viagra (flushing, dizziness, nausea). Women don’t get side effects when using the cream, but the therapeutic effects are preserved. Since the vaginal mucosa is exceptionally thin and permeable, women have the option of taking medication topically, right where they need it most, according to the psychiatrist. “Viagra cream seems to help a woman with arousal (lubrication), and I think it eases orgasm. It also makes a woman a little more receptive afterwards. She remains excited a little longer—sometimes two to three hours.”
Is there any hope that there will be treatment for sexual dysfunction caused by psychotropic drugs in our lifetime?
“Oh, yes,” she replied. “There are dozens of sex-positive medications now being researched. For years, the government and the drug companies shied away from researching drugs that improve sex—except for erectile dysfunction in men. “That they’ve been working on for 30 years and they’ve made real progress there. Now we have to work on treating sexual dysfunction in women. I think we are beginning to make headway.”
Psychiatrists traditionally have tried three tactics to help patients on medication revive their sex lives: reducing the dose of the offending antidepressant; changing antidepressants; or recommending a brief drug holiday.
Four antidepressants that don’t affect sexuality are: Wellbutrin, Serzone and Remeron, and Desyrel, according to Dr. Bartlik.
But, for many of us, the selective serotonin reuptake inhibitors (SSRIs) are the most effective antidepressant group and they “change sexual functioning in up to 70 percent of patients,” Dr. Bartlik said. And taking a brief drug holiday, say on the weekends, may set off withdrawal symptoms. This is not such a good choice either.
So what else can be done?
Dr. Bartlik says some psychiatrists also prescribe stimulants such as Dexedrine. But she looks beyond drug remedies for this drug-induced malady. “A lot of my patients on antidepressants tell me that normally they don’t get out the [X-rated] videos—they use them, instead, just to spice things up occasionally,” she said. “But they find that when they’re on antidepressants, they have to use all the stimulation they can get—which means the most powerful vibrator, the most powerful erotic imagery they can find. “My advice: Don’t be embarrassed about using these things.”
Choose between mental health and sex? Maybe, we won’t have to.
by Rich Satkin, Chairperson of MDSG
Recovery from a mood disorder can be viewed from several perspectives. From the viewpoint of a person who has lost a job, it may mean returning to employment, and nothing less will do. Recovery for others may mean emerging from an acute episode to resume most, if not all, normal activities. I find it useful to conceive of recovery in three stages. First, however, let me say that I know recovery takes decades for many people, and these comments are not meant to trivialize their struggle.
In stage one, you’ve emerged from the acute phase of a major depression or manic episode, but you’re in a kind of limbo. Recovery seems uncertain until a sufficient period of stability has passed, until the time you gain confidence that your mood is more likely to stay normal. During this time, your doctor and you find the therapeutic dose of medication(s). The length of the first stage clearly varies from person to person.
Stage two is a period of reflection and/or regret about inappropriate behavior during an episode; this is often accompanied by self-recrimination, which you wouldn’t have after other illnesses. A sense of personal responsibility is common even though we know mood disorders are fundamentally caused by biological forces not under our control. Feelings of self-blame are usually misplaced and destructive. They come at a time when self-confidence has been battered, and the piling on of negative thoughts and feelings further diminishes self-esteem. Stage two clearly can go on for a long time. MDSG’s support groups and education can help.
Stage three involves making changes in lifestyle. It is now widely believed that mood disorders result from a combination of environmental and biological forces. Environmental “triggers,” often called “stressors,” vary not only from person to person but within an individual over time. You need to identify your stressors and learn new ways to cope in order to stay well. In mood disorders, research into “life events” that trigger episodes is ongoing. Because stressors vary from person to person, it’s hard to get good measurements. And sometimes episodes occur without any apparent connection to external events. Stage three may require that you accommodate yourself to any job or career changes necessary to reduce stress. And you must remain vigilant about possible relapse without becoming unduly worried.
Recovery from a mood disorder may not mean the restoration of things as they were. It can and does mean a return of interest in people and things you enjoy. You begin to aspire to reasonable goals and take appropriate risks--just as “normal” people do.
By Jane Cartwright (Dr. Sachs lectured to MDSG in December 2000)
On Rapid Cycling
Many members of MDSG ask questions about rapid cycling in bipolar illness. Because Gary Sachs, M.D., is one of the country’s leading researchers on bipolar illness, Moods asked him about rapid cycling during a recent interview:
Q. Would you please briefly describe rapid cycling in lay terms?
A. Rapid cycling refers to shifts from high to low [mania to depression] or vice versa with at least four such episodes a year. It can be considerably more frequent.
Q. What about so-called ultra-fast rapid cycling with pronounced mood swings in a day?
A. This is much more controversial. There are people who within a single day experience lots of feelings, highs and lows—technically these would be called mixed episodes. It’s extremely hard to distinguish mixed episodes from ultra-rapid cycling. If we call them mixed episodes, that means people have both depression and mania at least once nearly every day for a seven-day period.
Q. What causes rapid cycling?
A. We don’t really know. It may be brain chemistry. It may be electrical activity. But we don’t know if we’re looking at the cause or effect of an abnormal mood state. The simple notion that it’s a chemical imbalance is actually a pretty good model. And that chemical imbalance may be manifested as an alteration in regional brain metabolism.
Q. Can both people with both bipolar I and people with bipolar II be rapid cyclers?
A. Yes. But the majority of rapid cycling bipolar patients have bipolar II (major depression and hypomania, as opposed to mania). And there are, interestingly enough, no unipolars among rapid cyclers.
Q. What about unipolars who “cycle” with dysthymia? Isn’t this a kind of rapid cycling?
A. In dysthymia [chronic low-grade depression], you have chronic unstable moods. Dysthymics are well at least half their days, but professionals are not willing to call the good days separate episodes. The usual recovery criterion for dysthymia is eight weeks, and this would qualify as one continuous episode of dysthymia. With bipolars, even if you have just a couple days of clearly high mood, this separates your lows; we would call these distinct episodes.
On Stressors
If you suffer from bipolar disorder, it’s important to avoid “triggers” or “environmental stressors” that may bring on an episode. Helping patients identify what they are is part of the largest National Institute of Mental Health study of bipolar illness now underway at 20 research centers across the country. The study will follow 5,000 patients.
Dr. Sachs said that researchers think the following stressors are among those that can trigger an episode:
Perhaps the most subtle, but powerful, trigger may be hostile family interaction, particularly what is called “negative expressed emotion,” Dr. Sachs said. “When you can’t get out of bed, and somebody says, ‘You lazy bum, you’re no good,’ or ‘You’re not even trying.’ there are consequences—-whether or not the family at other times says very nice things,” according to Dr. Sachs. “Hostile comments have an impact on the illness,” he continued. “They can triple the length of an episode.”
Dr. Sachs said data show this is particularly true when the family has trouble coping with your personality style. How dangerous is this? “For some folks, this is something medication just can’t overcome. So addressing that pattern of interactions can really help someone with bipolar illness.”
Do some family situations just prove too stressful? “We like to think of certain family members as drugs—an ineffective dose, an effective dose and a toxic dose,” Dr. Sachs said. “For certain family members, the toxic dose is just a few minutes; for others, the effective dose might require hours.
“We like to get family members to be more constructive, more involved in the care, to bring in family members as the crew while the patient remains captain of his ship. This sounds a bit tricky, but, in practice, it can be done.
“If family members don’t want to cooperate, we try to give the patient alternative crew members. We make this a high priority, and we think of these external supports just as we would a liver or a kidney—they’re vital organs.”
On the Future
Asked how the treatment of mood disorders might be improved in the near future, Dr. Sachs, answered with a personal wish: a simple change of vocabulary.
“A number of my patients complain about the term 'bipolar mood disorder.’ They’re not so sure the most disturbing aspect is their mood. They also have trouble with thinking, impulsivity, and energy. “They say, ‘ I don’t know why they call this a mood disorder. We might be better off with the term ‘bipolar brain disorder.’
“I think patients are absolutely right. These are clearly brain disorders. It would be destigmatizing as well as scientifically more accurate to refer to them as such. Of course, for plenty of people mood is the primary aspect, but, in all fairness, these people would agree that they have problems with energy, sleep, and concentration, too. “One day we’ll understand so-called mood disorders differently. A lot of our problems in psychiatry and in medicine, in general, are vocabulary problems—what to call things.”
Ask the Doctorwith Dr. Ivan Goldberg |
 |
Q. In addition to medications and psychotherapy, how can I speed my recovery from depression?
A. Here are some simple things you can do. The more of these you make yourself do, the faster you’ll feel better.
By Judy Hoffmann
An estimated 600 people participated in a 5K walk in lower Manhattan on Sunday, October 22, as part of the Minds in Motion Depression Awareness Campaign. At least 15 MDSG members and friends took part in the walk or volunteered to register walkers and help along the route.
The event raised an estimated $20,000 to benefit the National Depressive and Manic-Depressive Association (MDSG's parent organization) and the National Alliance for the Mentally Ill (NAMI). MDSG members raised at least $1000 in registration fees and contributions, and our organization expects to receive approximately $1600 as a result of the event, according to MDSG Chairman Rich Satkin.
Minds in Motion is the first national initiative in which top athletes have helped to raise awareness of depression. Speakers included: Olympic soccer star and gold medallist Julie Foudy; Hall of Fame thoroughbred racer Julie Krone; Olympic skier Heidi Voelker; Olympic gold medalist and basketball All-Star Teresa Witherspoon; and Olympic bronze medalist and world champion diver Wendy Williams.
John H. Greist, M.D., of the Johns Hopkins University School of Medicine, Baltimore, also spoke briefly, mentioning that depression is a serious physical illness that can be successfully treated with medication and psychotherapy. Although one theme of the event was that depression affects even star athletes, only Ms. Williams said that she had suffered from the illness. The walk, a 3.1-mile circuit, took place in and around Battery Park. Information on depression was distributed.
Michael Horowitz, MDSG’s webmaster , says: Go to www.mdsg.org/newsletter.html to look at back issues of our newsletter, Moods. Copies there date back to March 1999. And Amazon.com will give a portion of what we spend there for books and CDs back to MDSG. But this is true only if you go to www.mdsg.org/contribute.html and click on the link to Amazon. If you go to Amazon directly, no referral fee is returned.
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:
Become Your Own Cognitive Therapist
Monday, January 8, 2001 Judith S. Beck, Ph.D.
Cognitive therapists not only help you overcome depression, they help you avoid
relapse. Dr. Beck is the director of the Beck Institute for Cognitive Therapy
and Research. She lectures nationally on how cognitive therapy is used to treat
psychiatric disorders and psychological problems. Find out how she can help you.
Diagnosis and Treatment of Anxiety Disorders
Monday, February 5, 2001 Donald Klein, M.D.
If anxiety is one of the predominant symptoms of a mood disorder, how is an
anxiety disorder different from unipolar or bipolar disorder? And what are the
most effective treatments for anxiety these days? Dr. Donald Klein is a
professor of psychiatry at Columbia University and is considered to be the dean
of American psychopharmacology.
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..
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