McMan's
Depression and Bipolar Weekly
Note:
This excellent newsletter is available weekly from:
http://mcmanweb.com/newsletter1.htm
Feb
6, 2002 Vol 4 No 6
OUT
OF MIND, OUT OF SIGHT
Not long ago, Mary, who has had two full-blown manic episodes, posted this
thoughtful and provocative comment on my website:
"The issue of personal responsibility during hypomanic and depressive
episodes is critical - even if only to our justice system. Here is my take on
it: Though I sometimes have felt quite out of control, even in serious fog, I
find that certain REALLY important considerations can break through, such as the
welfare of my children, basic compassion for my pets, the need to drive safely
to not injure others, the need to not hurt others' feelings. Therefore, I have
concluded that, short of raving psychosis, I must be responsible for my actions.
I submit this because I see a trend toward using mood disorders as an excuse for
all kinds of heinous behaviors."
She goes on to say: "Short of a frontal lobe injury or a documented
psychotic episode, it would not be wise to count on the justice system letting
anybody off when a bank is robbed or bankruptcy is declared. The issue of
personal responsibility goes to the heart of who we believe we are - a pile of
biochemical charged synapses, or thinking, soulful being? Don't neglect your
soul while you are trying to find an admixture of pharmaceuticals that works for
you."
There was something about what Mary said that jolted me into one of those Newton
under the apple tree kind of revelations: Namely, what gets us into trouble much
of the time is not doing wrong in a manic or hypomanic state, but committing an
excess of doing right. We give things away, we give our employers incredible
productivity, we embark on great projects, we light up the lives of others, and
we pursue a spiritual path to its extremes. In these states of mania, our moral
compass gives us a false reading - our actions and behaviors are in perfect
alignment with that inner arrow pointing true. Something in our judgment is
fundamentally flawed, but the mind in pure rhapsody over mania'm sure he will be looking to put his life back together when he
gets out. Unfortunately, I suspect his first job will involve saying, "Do
you want fries with that?"
Some days, accepting this illness can be a bit tougher than others.
DEPRESSION
AND HEART
An Emory University study
of 2,501 participants with an average age of 74 has found: Nine percent of the
women were depressed at the beginning of the study. Of these, 19 percent
developed heart failure over 14 years vs 10 percent of nondepressed women. Five
percent of the men were depressed at the beginning of the study, but only 12
percent of these developed heart failure compared vs 15 percent for the
nondepressed men. The men's results may be attributed to men developing
heart failure earlier than women, according to the authors of the study.
VNS
Past Newsletters have reported on vagus nerve stimulation for depression, which
involves implanting a pacemaker-like device in the chest that sends electrical
signals up a wire in the neck to the base of the brain. Recent results of an
open trial tracking treatment-resistant patients over two years have found
depression scores continued to improve. Cyberonics, the company that
manufactures the device, received a recent major setback, however, when results
of their double blind study showed no significant difference between the VNS
group and the control group. In that 240-patient study, half the devices were
switched on and the other half left off.
In the double blind study, the VNS signals were set lower than the pilot study,
according to Richard Rudolph MD, Cyberonics'
Vice President of Clinical
and Medical Affairs and Chief Medical Officer, and this may explain the
disappointing results. When settings were adjusted upward by individual doctors,
he explained, the figures went up over time. "Our conclusion," he
says, "is that this is a study that failed, not a failure of therapy."
The company is planning a new study.
CAVE
MAN DIET
Further insights into Omega-3:
Researchers from Purdue University and Colorado State University have conducted
chemical analyses of the meats people ate 10,000 years ago. Grass-fed steers and
wild ruminants such as elk and deer have approximately two parts omega-6 to one
part omega-3, far lower than the ratios of five-to-one to as much as 13-to-one
for grain-fed steers. Other studies of present day hunter-gather societies have
found modern maladies such as heart disease, high cholesterol and diabetes rare
in these populations, notwithstanding that their diets exceed recommended
guidelines for fat.
MORE
Andrew Stoll MD of Harvard published his groundbreaking pilot study of omega-3
for bipolar in the Archives of General Psychiatry early in 1999. The results of
a larger trial he is conducting will be available in two years. In the meantime,
a study by Robert Post MD of the NIMH is nearing completion.
MEANWHILE
Newsletter 4#4 reported on a treatment-resistant depression patient who achieved
remission after taking eicosapentaenoic acid, the EPA that is one of the active
ingredients in omega-3. David Horrobin MA, DPhil, BM, Bch has informed this
Newsletter that an article on an EPA study will soon appear in the Archives of
General Psychiatry, and another one by an Israeli author will appear in the AJP.
EPA (LAX-101) is not commercially available. Its manufacturer, Laxdale of
Scotland, plans to go ahead with a full pharmaceutical development program and
is looking to submit EPA for FDA approval in two or so years.
SOCIABILITY
A King's College (London) study
of 60 healthy volunteers taking either reboxetine (a selective noradrenaline
inhibitor), the SSRI Celexa, or a placebo involved subjecting them to various
social interaction exercises. The authors of the study found "reboxetine
had clear effects on social behavior. Noradrenaline was related to increased
social engagement and cooperation and a reduction in self-focus. [Celexa] had
less effect on cooperative behavior but serotonin may be associated with
protection of the self from the negative consequences of social
interaction."
POSTPARTUM
A University of Birmingham study
of more than 2,000 new mothers in the UK found those who received individual
care from home visits by nurse-midwives were 40 percent less likely to develop
depression than the standard care group (also involving home visits from
nurse-midwives).
In the UK, new mothers receive up to seven nurse-midwife home visits as standard
care vs one visit from a health care professional in the US.
HORMONE
TREATMENT
A four-year multi-center study
of 2,763 postmenopausal women with coronary artery disease has found that those
with flushing (hot flashes) who received hormone therapy had improved mental
health and fewer depressive symptoms compared to those receiving a placebo, but
the treatment led to faster declines in their physical function and energy
levels.
SUNSHINE
It may be more than a skin cancer risk:
A Reuters report cites a Harvard study of suicide rates in 20 countries over the
last four years, which found suicide rates for countries located in the northern
hemisphere highest in the months of May or June while those in Australia and New
Zealand peaked in November or December. Suicides in Greece were 50 percent more
likely to occur in June while suicides in Australia were 21 percent more likely
to take place in December.
The study's authors speculate that the hormone melatonin may be
implicated. Melatonin is produced in response to nighttime darkness and helps
regulate circadian rhythms. The authors caution that singling out melatonin is
premature, but conclude treatment with the hormone to at-risk patients could
have "substantial preventive implications."
WORSE
THAN THE ILLNESS
Michelle
Witte, a recent graduate, joined a firm that was too small to qualify for a
group health plan. Her employer, however, would pay for an individual policy, so
she applied to CareFirst Blue Cross Blue Shield. But when she disclosed that she
had been prescribed antidepressant medication for a short time while in high
school, the plan rejected her. In the words of CareFirst:
"Upon review of the Individual Health Evaluation Questionnaire, you have
documented that you have been or are currently being treated for depressive
disorder. Based upon our medical underwriting criteria, we are unable to approve
this coverage for you."
MORE
BEING TREATED
A University of Bristol study
reports that the number of prescriptions for antidepressants in the UK has more
than doubled over the last three decades. In 1998, UK doctors wrote 23.4 million
prescriptions for antidepressants.
YOUTH
CRISIS
A University of Chicago analysis of data from 26 developed nations has found
that although the rate of death among adolescents and young adults has decreased
by nearly 50 percent, their death rates from motor vehicle accidents, homicide,
and suicide have risen by 17 percent.
The study's "laissez-faire culture"
and the availability of firearms. "People are freer here," he told
Reuters, "but to some extent, they are also freer to hurt themselves, or
put themselves at risk."
STEPPING
OUT
Sarah writes:
In recent weeks, I have received several reminders that this is the year for my
(gulp) 35th high school reunion. Having done this once (can't recall which -
20th? 25th?), I am not tempted to do it again. However, the latest reminder
included an invitation to submit an entry into a "classbook" - an
accumulation of self-histories of the past 35 years. As I headed with it towards
the trash can, some little bell went off in my head.
My "serious mental illness" and I have been hiding together ever since
my first break and hospitalization in my junior year in college ('69). Sure,
once I sent a very tongue-in-cheek contribution to my college alumni notes that
I had been "researching the inside story on mental health treatment in
America," but I am afraid that with all the other glorious reports of
achievements, awards, honors, perfect babies and travels to exotic lands, it
went completely unnoticed.
Since then, I have simply done nothing when it came to past schools' reunions,
alumni notes, etc.... as I was about to do with the invitation to submit some
sort of account of the past 35 years. Then suddenly it occurred to me that this
was an OPPORTUNITY to speak out.... to become, as it were, a "mental health
poster child" for the Class of 1967.
I have very little to lose under the circumstance, as none of these people
figure in my present life. But perhaps - just perhaps --I could get through to
one, or two, or five of them that folks with a major mental illness are not
monsters lurking in the shadows, but people they grew up with and maybe even
liked. And maybe - just maybe - they might spread the word to two or three
others, etc.
So I am at this moment about 87.36% decided that I will write the damn
self-history and "come out" to my classmates. But I'm sort of curious
what others think....if any have done the same and had either positive or
negative experiences as a result.
I'm also wondering what might happen if we made this a "movement" of
sorts.... if everyone who reads this newsletter -- and folks they know in
similar situations -- "came out" at approximately the same time, what
might the impact be?
[Feel free to help out Sarah by emailing jmcmanamy@snet.net]
APPEAL
FROM HELL
"I would happily give up any of my strengths if I could get rid of the
weakness in the process. I have God-given talents that I desperately want to
use, yet I can't function for more than an occasional day or two at a time. My
life is torture. I want it to end. I need it to end.
"I often wonder if I haven't already died and gone to Hell. Because in
Hell, pain is never-ending. And in Hell, no one cares."
You can check out Barbara's latest contribution to my website at:
http://www.mcmanweb.com/article-170.htm
... or you many want to start with her first piece, the beginning of a
frightening mother and daughter journey through hell, at:
http://www.mcmanweb.com/article-153.htm
MCMAN'S
WEB
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