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	November 2005	Table of Contents (all articles are on this page) Upcoming Lectures Tis The Season of Giving Ask The Doctors Book Bits   The Reader's Corner Knowledge is Power: Mental Health Resources on the Web 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

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. Allow up to two weeks for delivery. To order, write a letter requesting any lecture by number, make check out to MDSG Inc. and send it to: 
     Lecture Recordings c/o MDSG, PO Box 30377, New York, NY 10011

Dr. Ivan Goldberg, Psychopharmacologist

Q: I have had many episodes of bipolar disorder with psychosis which lithium does a good job of preventing. I have taken lithium during each of my previous two pregnancies. Both of my children were born without any birth defects. I now have a new obstetrician who tells me that she does not wish me to continue lithium through my present pregnancy because of the danger to my baby. How should I manage my bipolar disorder during this pregnancy?

A: Managing bipolar disorder during pregnancy involves some hard choices. If a woman with a history of bipolar disorder stops her mood stabilizers when she discovers she is pregnant, there is a good chance that she will soon have another episode of mania or depression. This risk is especially high in women who have had many and severe episodes. 

At the same time, the use of any mood stabilizer during pregnancy involves some risk. With lithium, there is approximately one chance in 1,000 of the baby being born with a serious, but usually correctable, cardiac malformation. Depakote (divalproex) and Tegretol (carbamazepine) are accompanied by an approximately 5 percent chance of serious central nervous system malformations. Data is currently being collected regarding the safety during pregnancy of newer anticonvulsant mood stabilizers like Lamictal (lamotrigine).

During pregnancy there is usually a need for an increased dose of lithium, but in the week prior to delivery, the dose of lithium should be reduced to prevent lithium toxicity after delivery. A follow-up study of children who had been exposed to lithium in utero—done when the children were five years old—failed to detect any late-developing mental of physical abnormalities. 

Ask Doctor Goldberg a question in person in December! 

Dr. Joe Nieder, Pediatric Psychiatrist

Q: Our 12-year-old son has been diagnosed with ADHD, oppositional defiant disorder, and depression. He seems to have stabilized (he’s doing acceptably well in school and behaving within social norms) with treatment that includes antidepressants, ritalin, and risperdal. Before being medicated he had problems with impulse control and paying attention in school, and he had terrible temper tantrums when his routine was altered. The risperdal seems to control the tantrums, but my question is, why would this medication work for him? Information available on the internet indicates that it’s used to treat people with schizophrenia.

A: In regard to your son’s medications, while the ADHD medication and antidepressant are more commonly used to treat behavioral disorders in children, risperdal is also sometimes used for very severe behavior disorders even though it is FDA approved for schizophrenia. 

This does not mean your child is psychotic or schizophrenic, it just means his doctor is using the drug in a way that differs from what it was originally approved for, a fairly common and generally acceptable practice called “off label” use. As far as side effects go, the major concerns are that it can elevate a hormone called prolactin (which can interfere with the onset of puberty) and can cause large weight gain in some children. These are effects your son’s doctor should be on the look out for. The other concern is that it has not been studied for use over many years in children or adolescents. However, it is a very effective medication. 

Since your son’s problems are substantial for someone his age, though, I would also hope that his doctor or therapist explores any psychological factors that might be exacerbating them, such as family or marital problems, tension at home, etc. I would also look for a family history of any psychiatric disorder, including ADHD, impulse disorders, episodic gambling or alcoholism, or any biologic history in relatives that would suggest a physiologic basis for the disorder. This can lead to a better understanding of the nature of your son’s problem.

Because the problem is so extensive, I would also consider the possibility that he has a pervasive developmental disorder, or perhaps an early form of bipolar disorder. Bipolar disorder can develop at this age, but does not appear in a classic adult bipolar pattern. For example, bipolar adolescents and children may have a more constant “mixed state” in which they are simultaneously irritated and excited rather than the mood swings most people associate with bipolar disorder. A family history of bipolar disorder would be suggestive of this. Establishing the correct diagnosis is important since treatment approaches do vary.

 

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

	When Nothing Matters Anymore: A Survival Guide for Depressed Teens by Bev Cobain RNC Free Spirit, $13.95 list, $11.16 at Amazon.com as of November 2005  Cobain provides practical and to-the-point information for young people coming to the realization that they are depressed. Her book also includes help for those who are suicidal.
	Should You Leave? A Psychiatrist Explores Intimacy and Autonomy—and the Nature of Advice   by Peter D. Kramer, MD Schribner, $25.0 (hardcover) list, $10.88 (paperback) at Amazon.com as of November 2005 A famous psychiatrist examines contemporary relationships. His practice gives him an excellent view of what the struggles are.
	Underercurrents: A Therapist's Reckoning with Depression by Martha Manning. PhD Harper, $20.00 A psychologist recognizes her own worsening depression. No treatment helps until she consents to ECT (shock treatment), which turns out to be vital to her recovery, and to her survival.

A Long Way Down    by Nick Hornby 333 pp. Riverhead Books. $24.95

People who jump to their death prefer particular settings: Niagara Falls, the Brooklyn Bridge, the George Washington Bridge, the Golden Gate Bridge. In London the most popular place is a 15-story building called Toppers' House which is where Nick Hornby’s latest novel. A Long Way Down opens on a New Years Eve. Four strangers have come to the roof interrupting each others' plans to jump. They are: Martin, a fired TV host, just out of jail; Maureen, a dowdy mother saddled with the full-time care for her disabled adult son; Jess, a raging, stoned teenager who has been stood up by a boy she adores, JJ, a musician who has just been kicked out of his band and dumped by his girlfriend.

As luck would have it, JJ is a pizza delivery man complete with pizza and the four potential jumpers, annoyed at not being able to commit suicide in privacy, are distracted enough to eat the pizza. Thus the characters set upon an unplanned journey. These four give words to their feelings: "The ledge felt safe. There was no humiliation and shame there." "I can't get used to the idea that my life is finished, pointless, too hard, completely without hope or color." "Why is it easier to, like, leap into the void than to face what you've done?" "I can't see way forward or back." 

Each comes to understand that no one but the other three has any idea how they feel. These alienated folks become a group of sorts, engaging in R-rated conversation. No one gives advice. No one asks for help and no one mentions therapy. To those of us well-versed in the “why” of behavior and depression their conversation may seem unsophisticated. However one of them has taken the Aaron T. Beck Suicide Potential Scale. The score was 21 out of 30 , so high that this character felt justified in appearing on the roof. 

I thought A Long Way Down would be a change of pace for this column since it’s a novel. But these fictional people suffer in ways we in in MDSG will recognize. Their group helps and some of them come to profound insights about themselves and about life's unevenness and their evening together begins a unique support group. Amidst the fiction is so much truth. All this and funny, too.

You can purchase (and read more about) A Long Way Down by Nick Hornby 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 $16.47 as of November 2005 (the price can change at any time). 

Search the internet for information about mood disorders — or any health topic — and you’re likely to come across all manner of sketchy material. At the same time, there are a plethora of useful sites for keeping up on the latest. As part of an ongoing series, here are some sites worth visiting.

New York Times: Mental Health and Behavior
All of paper’s recent stories about psychology and psychiatry are gathered into this single section online. The content draws heavily from the Tuesday Science section, but also includes articles from other sections. Recent stories have included a feature on whether brain imaging can be used in diagnosing depression, a book review that looks at the cultural context of sanity, and a news story on the FDA’s warning regarding Paxil and pregnancy. The section is updated frequently. 

Medline Plus
This search engine from the National Institutes of Health covers a wide range of health topics and can be used to search for reliable information on depression, bipolar disorder, suicide, therapies and medications. A search of “bipolar,” for instance retrieved, among other things, links to a list of NIH clinical trials on manic depression, a fact sheet from the American Psychiatric Association, and treatment guidelines from the Child and Adolescent Bipolar Foundation. Note: In the printed newsletter, there was a typo in the web site address. It is www.nlm.nih.gov/medlineplus 

Undoing Depression
Noted psychologist and author Richard O’Connor maintains a website that is chock full of self-help information, some of it from his book, some of it in addition to it. Sections on support groups, parenting, divorce, and stress are included. 

Depression and Bipolar Support Alliance
The website of DBSA, the national organization of which MDSG is a chapter, has mood disorder screening tests, a tool for finding support groups in other cities, advocacy updates, and a substantial amount of background information about mood disorders. 

Child and Adolescent Bipolar Foundation
CABF’s website includes online support groups, message boards, a doctor finder, and detailed background information on bipolar disorder and how it affects kids. 

Anxiety Disorders Association of America 
Generalized anxiety disorder, panic disorder, phobias, and posttraumatic stress disorder are all covered on this site. A special section on women’s issues, a chart of anxiety medication, and advice on how to help a loved one who may have an anxiety disorder are among some of the features included. Note: In the printed newsletter, there was a typo in the web site address. It is adaa.org.  

Yahoo! News: Mental Health News Stories
Articles from a variety of sources are gathered and updated throughout the day. Recent examples include an item on St. John’s wort from The New Scientist, a story on caffeine addiction from National Geographic, and an article from the Washington Post on antidepressants.

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 $45 for individuals, $65 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.

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