Depression and Bipolar info explaining the latest research in everyday English

4Jun/15Off

Effects of alcohol on Bipolar Disorder

Water's Edge. Copyright Lee Hopkins

An interesting article from out of the Netherlands on the effects or otherwise (there’s a clue) of alcohol on mood state, in particular looking to see if excessive drinking leads to excessive mood states.

Previous research has shown a link between heavy drinking and onset of either depression (in women) or mania (in men). But this research was novel in that it followed up with research participants every day for a year, so it could see if increased drinking led to an adverse effect (depression or mania).

It turns out the effect is limited — AS LONG AS you stick to your medication. The participants in this study (137; 66% Bipolar I, 34% Bipolar II) all stuck to their medications and the effects of their drinking was limited.

But what wasn’t able to be determined was whether increased drinking led to minor depression or hypomania — the study hadn’t been designed for such eventualities. Something for a repeat study to consider, perhaps.

So the message is clear — ensure you stick to your medications and the likelihood of excessive drinking bringing a full-on adverse reaction are reduced.

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van Zaane J, van de Ven PM, Draisma S, Smit JH, Nolen WA, van den Brink W. (2014). Effect of alcohol use on the course of bipolar disorder: one-year follow-up study using the daily prospective Life Chart method. Bipolar Disorders 2014: 16: 400–409

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15Sep/11Off

I’m back

Apologies for being away for so long, but the bipolar took hold of me and threw me around a fair bit in the last nine months. Please expect more regular updates now.

Also, I want to let you know that I've just launched a sister site to this one, DefeatingBipolar.com, where you will find books and dvds hand-picked to help you care for yourself or for those you love who suffer from this evil disease. Please feel free to visit the site often, as I'll be updating the information on there regularly.

Thanks for still being around,
Lee

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4Jan/11Off

When to suspect bipolar disorder

The Journal of Family Practice has a useful practitioner’s guide to identifying when a patient may be presenting with bipolar disorder symptoms.

As the authors say, bipolar disease is often misdiagnosed, sometimes repeatedly.

The authors—Muruga Loganathan, MD, Kavita Lohano, MD, R. Jeanie Roberts, MD, Yonglin Gao, MD, and Rif S. El-Mallakh, MD—report that close to one-third of patients with bipolar disorder seek medical care within a year of the onset of symptoms, but nearly 70% do not receive an accurate diagnosis until they’ve seen four physicians.

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) defines 4 types of bipolar illness: bipolar I, bipolar II, cyclothymia (the most mild form), and not otherwise specified The key feature of all 4 types—and the distinguishing characteristic that diagnosis typically hinges on—is a manic or hypomanic episode.

Although a full-blown manic episode may not be hard to identify, hypomania is easily missed. By definition, hypomania—with its heightened sense of well-being and productivity—is not problematic and is rarely a patient’s primary complaint.

Mixed mania, a feature of bipolar I, is the worst of both worlds: It is a state in which a full manic episode is superimposed on a full depressive episode—a depression with all the energy and force of a mania. Patients who have experienced one episode of mixed mania have a 12-fold increase in mixed states, 6.5 times more depression, and 1.7 times more dysthymia than those who experience manic episodes without the overlay of depression.

I and countless others can attest as to how horrible it is.

The authors recommend using the Mood Disorder Questionnaire (MDQ) constructed by Hirschfeld et al. as a useful guide to bipolar disorder identification. There’s a copy of the MDQ in the JFP’s article, as well as the original source article.

If you or someone you know is wondering if they might have bipolar disorder (and one psychiatrist I know of is convinced that all ‘depressive’ patients have an element of mania within their history and should therefore be considered in a new, bipolar, light) then ask their GP to administer the MDQ, or refer them to someone who can.

It could be the help they need to get them on the path to managing their illness appropriately.

Sources:

Hirschfeld RM, Williams JB, Spitzer RL, et al. Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. Am J Psychiatry.
2000;157:1873-1875.

Loganathan, Muruga; Lohano, Kavita; Roberts, R. Jeanie; Yonglin Gao; El-Mallakh, Rif S.  When to suspect bipolar disorder. Journal of Family Practice, Dec2010, Vol. 59 Issue 12, p682-688, 7p


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10Sep/10Off

Today is World Suicide Day

World Suicide Prevention Day is observed on September 10 each year to promote worldwide action to prevent suicides. Various events and activities are held during this occasion to raise awareness that suicide is a major preventable cause of premature death.

One hand holding another hand.
World Suicide Prevention Day promotes issues such as suicide prevention. This photo is used for illustrative purposes only. It does not imply the attitudes, behaviour or actions of the models used for this photo. ©iStockphoto.com/Valentin Casarsa

Nearly 3000 people on average commit suicide daily, according to the World Health Organization. For every person who completes a suicide, 20 or more may attempt to end their lives. About one million people die by suicide each year. Suicide is a major preventable cause of premature death which is influenced by psycho-social, cultural and environmental risk factors that can be prevented through worldwide responses that address these main risk factors. There is strong evidence indicating that adequate prevention can reduce suicide rates.

World Suicide Prevention Day, which first started in 2003, is annually held on September 10 each year as an IASP initiative. The World Health Organization co-sponsors this event. World Suicide Prevention Day aims to:

  • Raise awareness that suicide is preventable.
  • Improve education about suicide.
  • Spread information about suicide awareness.
  • Decrease stigmatization regarding suicide.

In Australia our annual toll of deaths by suicide is greater than the number of deaths on our roads, yet we only hear about the road toll. Mental health organisations are making slow but steady inroads into the macho culture of Australia and getting politicians and fund holders to realise that reducing the mental health burden of our country is good for our country’s health – fiscal, physical and mental.

There are plenty of places to go if you think you or someone you know might be in need of help to cope with anxiety, depression of suicidal thoughts. Try any of these:

  • Lifeline Australia – tel 13 11 14
  • Kids Helpline - 1800 55 1800
  • Suicide Line (only in Victoria, Australia) – 1300 651 251
  • SANE Australia – 1800 18 SANE (7263)

1Sep/10Off

A review of findings from the world’s largest study of Bipolar Disorder

The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) ran from 1998 to 2005, with over 4,000 sufferers of Bipolar Disorder (BD) taking part in various trials and assessments over a two-year period.

Researchers were looking at how BD progresses through a person's life, how related it is to other psychiatric disorders, and how related it is to suicidality.

It found that few treatments alone were successful in treating BD, however psycho-social interventions (such as Cognitive Behaviour Therapy) and psycho-education interventions combined with mood stabilizers showed the most positive results.

BD was also shown to be strongly related to substance abuse and smoking, both of which affected the success or otherwise of chemical and psychological treatments.

Interestingly, paroxetine or bupropion were shown to be no more effective than a placebo in achieving sustained recovery (in this instance, determined as eight weeks of 'stable' behavior). So, too, were lamotrigine, risperidone, and inositol found to deliver minimal positive effects.

To the vexed, 'hidden', taboo subject of suicide -- the 'S' word not spoken of by the media (although thankfully that is slowly changing, at least in Australia). Suicidality persists with BD, even when treatment outcomes are good. The biggest predictor of suicidality being previous attempts.

The authors' conclusions
The authors of this review paper note seven contributions of the STEP-BD program:

1. Antidepressants remain poorly effective in treating BD;

2. BD is particularly disabling (tell me about it), and frequently doesn't respond to medications;

3. BD does respond modestly to intensive psycho-social interventions;

4. Other psychiatric disorders are common and destabilizing, yet anxiety disorders and smoking are able to be treated and when treated positively impact on BD;

5. An early age on onset of BD usually results in a more severe course of the illness, but rapid-cycling usually diminishes;

6. The sub-syndrome of Depression may be so strong as to mask the manic pole of BD, therefore careful symptom appraisal by psychiatrists is essential;

7. Suicidal thoughts persist in BD sufferers, and a previous attempt is a good indicator of a future event. However, by reducing feelings of 'hopelessness' in particular, there is the possibility of reducing the risk of suicide.

 

Source: Parikh, S.V., LeBlanc, S.R., & Ovanessian, M.M. 2010. Advancing Bipolar Disorder: Key Lessons From the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). The Canadian Journal of Psychiatry, Vol. 55, No 3, p.p. 136-143.

 


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31Mar/10Off

Psychological Effects of Dog Ownership

a dog, yesterdayDo dogs help us cope with depression, or do they cause us additional stress?

Do they provide us with comfort support and unconditional love, or is their love and presence placing yet another burden on our already overwhelmed shoulders?

The answer, it seems, depends on your gender, age and marital status.

North America reportedly has 75 million dogs and 39% of North American homes have at least one dog, according to the American Pet Products Manufacturers Association.

Dr Krista Marie Clark Cline from the University of Missouri–Columbia saw that the existing literature on pet ownership and depression didn’t break down what type of pet caused what result. Keen to know if dog ownership was the ‘godsend’ some dog owners had reported, Krista created a telephone survey lasting some 45-60 minutes that aimed to delve deeper into the research question.

Two hundred and one responses later, she ran several regression analyses (‘stats’ is not my strong point; see the original source article for more detailed descriptions) and came to some interesting conclusions.

But before I get to them, let’s consider a couple of theories about dog ownership and how dogs might interact with depression.

One theory, Role Strain Theory, holds that the individual with multiple roles – marital partner, employee, parent, friend, sibling, etc., – will possibly find adding another role, that of dog owner, to be one burden too many, leading to feelings of lower self-efficacy due to not being able to meet adequately the self-set expectations of each role.

Role Enhancement Theory, conversely, holds that the individual with, for example, too few roles will find the addition of a dog-owner role to be an affirming one, providing them with greater opportunities for feelings of emotional support, exercise (we all know that exercise is good for our mental health) and increased social interaction. Similarly, those individuals with too many roles may find the addition of dog owner a useful emotional buffer and a friend where one can go to for unconditional love and affection (because we all treat our dogs like they’re human, don’t we?).

So, to recap: having a dog may help us if we are living alone and are older in our years (because we have less role demands, are more likely to be single than when we were younger, and have less opportunities for social interaction); equally, having a dog may be a hindrance because they add one more burden to our lives and yet another expectation that we must meet, which can be overwhelming when we already have the role expectations of marriage, parenting, friendship, employment and familial duties.

 

So what’s the result of the study?

 

Dr Clark Cline found sex and marital status differences in the relationship between dog ownership and well-being, with women and single adults more likely to benefit from dog ownership.

But, as she points out herself, there are some serious flaws with the study. 

Although dog ownership leads to higher well-being for single individuals and women, the reverse may also hold. People with more depression may seek out dogs as sources of companionship. The direction of causality is a question that can only be answered by carrying out longitudinal studies.

Meaning that we might go out and buy that puppy in the window, the one with the waggily tail, precisely because we are feeling great, only to find that our mood slips; or that we buy the puppy because we were feeling sad, only to find that our mood increases.

Equally, there is no distinction in the study between dogs who are pets and dogs who have some utility: guard dogs, ‘seeing eye’ dogs, and such like. It would be useful for future studies to make some sort of comparison between the utility of the dog and its companionship, including if the guard dog during the day becomes the family pet at night when everyone comes home from work, for example, and what impact that might have on our scant knowledge of the benefits or otherwise of dog ownership when looking at depression.

Although pets have a positive influence on health and well-being (Garrity & Stallones, 1998), no consistent relationship between dog ownership and well-being has been documented

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Sources:

American Pet Products Manufacturers Association (APPMA) (2008). 2007-2008 National
Pet Owners Survey.

Clark Cline, K.M. (2010). Psychological Effects of Dog Ownership: Role Strain, Role Enhancement, and Depression. Journal of Social Psychology, Mar/Apr2010, Vol. 150 Issue 2, p117-131

Garrity, T. F. & Stallones, L. (1998). Effects of pet contact on human well-being: Review
of recent research. In C. Wilson and D. C. Turner (Eds.), Companion animals in human
health
. Thousand Oaks, CA: Sage

Mutrie, N. (2002). Healthy body, healthy mind? Psychologist, 15, 412–413.


Please see our medical disclaimer.

28Mar/10Off

Options for mild or moderate depression

The Harvard Mental Health Letter (HMHL) is reporting on the implications of a meta-analysis study into the efficacy of medication for mild, moderate and severe major depression.

[That sounds/reads bizarre, doesn’t it? Surely ‘major’ means that it’s flown past being a ‘mild’ or ‘moderate’ depression… but I digress.]

The study by Fournier et al reduced 2,164 studies to just six worth analysis (by their standards) and found that medication only helps those with severe depression.

There are, of course, limitations with the study – the low number of studies in their meta-analysis being just one, but it does allow the HMHL an opportunity to remind us that exercise, psychotherapy and relaxation are powerful aids in the fight against the black dog for those suffering mild to moderate depression.

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Source:

Fournier JC, et al. “Antidepressant Drug Effects and Depression Severity: A Patient-Level Meta-Analysis,” Journal of the American Medical Association (Jan. 6, 2010): Vol. 303,
No. 1, pp. 47–53.

Harvard Mental Health Letter, April 2010 – www.health.harvard.edu


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11Jan/10Off

The hardest post I will ever write?

the double helix splits and colours me with strong shades of night and day - and nothing in-between. Image from http://bipolar.hs.columbia.edu/This may be the hardest post I will ever to have write.

In a way, I am ‘coming out’.

No, I am not gay (although my best man at my wedding was; and so was his partner – what are the odds?!).

I have Bipolar Disorder I.

There, I said it. Publicly [phew!].

No, I don’t want pity, nor do I want to be excluded from events because someone with little or no knowledge of mental disease is worried I’ll do something dangerously psychotic (I’m not psychotic, I can assure you).

Here’s what Beyond Blue say about Bipolar Disorder:

Bipolar disorder, which used to be called manic depression, involves both periods of feeling low (depressed) and high (mania). 

Most people experience a range of moods depending on what's happening in their lives. When good things happen, like getting a new job, going on a holiday or falling in love, it's natural to feel happy. On the other hand, when there are difficulties like losing a job or a loved one, having money or family problems, it can make a person feel down. 

However, people with bipolar disorder experience extreme moods that can change regularly and may not relate to what is happening in their lives, although their mood swings may be triggered by certain events. For more information see What puts a person at Risk?

[Sydney’s Black Dog Institute is another excellent resource, as is NIMH]

What happens with me is that I can be delightful and witty and engaging one day, sunk in despair the next, maxing out the credit cards on day three, back into despair on day four, and on and on. At this stage of my just-started treatment there is little of the ‘middle ground’ that the vast majority of the population would call a ‘normal’ day.

I cycle fast through the ups and downs because I have been undiagnosed and therefore untreated for so many decades and my brain now ‘rapid cycles’, which means I could be in a ‘blue funk’ one day and buying flowers for all the women in Adelaide the next.

My emotional palette has hues far richer and more subtly nuanced than the average person could ever possibly believe; the ‘highs’ are intoxicating in their beauty and joy – everything glows with beauty, enthusiasm and positivity, my thought race at twice (if not more) the speed of the common man, I am more creative, more bottom-spankingly brilliant than just about anyone else around me.

If only I could permanently live in that ‘hypo’ state, but alas I can’t. The ‘mini-highs’ mutate into mania – where thoughts run too fast to capture, where irritation starts to become outright anger, where sleep is what ‘mere mortals’ do.

After which, of course, comes the inevitable ‘crash’. As in science, what goes up must come down; the higher the flight, the deeper and longer the trudge through the valley floor.

My depths are soul-wrenching and almost beyond bearance. In fact, sufferers of bipolar disorder have a vastly higher rate of suicide than the ‘common man’. You’re not going to convince me that Albinoni’s famous ‘Adagio’ wasn’t written when the man was sobbing his heart out – you can hear the strings weeping! Similarly with Barber’s Adagio for Strings, Opus 11 – whilst it *is* a tad more optimistic than Albinoni’s heart-tearer, you can ‘feel’ the grief. Well, I can, anyway.

 

image
Image courtesy K&J Investigations

All is not lost

But all is not lost. It is only early days of my diagnosis (finally; I’ve suffered from BP since I was a child, but it’s only recently been diagnosed) so my team and I are still working out the right medications and dosages for me.

The list of creative people who have made an impact on the world whilst still suffering from this dreadful, incurable disease is long, including: Adam Ant, Russell Brand, Michael Costa (Australian politician), Ray Davies (the Kinks), Patty Duke, Carrie Fisher, Stephen Fry, Paul Gascoigne (English footballer), Mel Gibson, Macy Gray, Graham Greene, Linda Hamilton (Terminator movies), Kay Redfield Jamison, Andrew Johns (Aussie rugby player), Kerry Katona, (English television presenter), Vivien Leigh, Jenifer Lewis (US actress), Kristy McNichol (actress), Edvard Munch, Florence Nightingale (yes, *that* Florence Nightingale), Sinéad O'Connor, Ozzy Osbourne, Jane Pauley, Edgar Allan Poe, Charley Pride, Axl Rose, Michael Slater (Australian cricketer), Margaret Trudeau, Jean-Claude Van Damme, Kurt Vonnegut, Brian Wilson

Well, you get the idea. The disease, whilst something that will be with me forever, is not the end of the world. It is manageable and treatable, and I am fortunate to have a great team around me helping me do just that: manage it.

Does it hurt my consultancy work or any job prospects?

Are you kidding me? I’m 51 years of age – job prospects were something one had in one’s 30s! No one hires 50-somethings these days. So the consulting life is probably going to be mine unless someone does something unheard of and hire a 50-something for more than just greeting people as they enter the supermarket.

But the medication and the therapy and the maintenance team I have built up around me means that the ‘average’ person (who didn’t know my past, nor my present condition) would have no clue as to the disease playing ‘hidey’ with what some have laughingly called my ‘brain’.

So why ‘come out’, Lee?

I wanted to be ‘out and proud’, as it were. Having only recently been diagnosed with Bipolar, I wanted to let the world and my friends know that I suffer from a disease, but that I am *not* the disease.

In other words, “Lee Hopkins suffers from Bipolar Disorder, not Lee Hopkins is Bipolar”. Just like diabetes, Bipolar Disorder is manageable, treatable but also incurable. Like a diabetic I have to watch what stimulants I intake (endless coffees, late nights and bucket loads of alcohol are three that will have to go), but in return I get to live a life with far less of the crushing burden of depression, far fewer times when I can turn around and see the ‘black dog’ faithfully padding along just behind me.

Far fewer times, too, when my thoughts race like a shotgun cartridge of pellets let loose in a paint tin on a paint tin shaker at the hardware shop.

So all I ask is that you understand if I leave your party early, just as it’s getting interesting. Or that you understand when takes me a couple of days to respond to your email or voicemail that it’s not a deliberate snub – just my disease telling me to ‘slow down and smell the roses’.

Or that you understand that my wearing by ear buds whilst working at your premises is also not a snub, or me trying to be ‘hip’; it’s just me listening to something soothing to stop the thoughts racing, or else it’s just me listening to something positive to stop a slide down the snake before it gets going.

So there you have it: “Lee Hopkins has Bipolar Disorder.” Just sayin’…


2Jan/10Off

Personality, health and coping

A Singaporean and Australian co-study, 189 Australian and 243 Singaporean university students (therefore, not a typical subset of the population, please note) completed the ‘Life Orientation Test-Revised’ and found some interesting differences.

Australians tended to be more agreeable, more conscientious, more optimistic and more satisfied with their lives.

On the other hand, Singaporeans tended to be more neurotic and pessimistic.

Using regression analysis, the researchers found that ‘optimism’ is the only significant predictor for life satisfaction.

Which means that if we want to be satisfied with our lives, being optimistic is an essential psychological component; without it we won’t be satisfied.

Similarly, if we want to be less stressed, we need to be less neurotic.

I know, it sounds obvious, doesn’t it. But obvious or not, such findings lend credence to previous findings that neuroticism is not a single ‘thing’ in our psychology, but comprised of many things (such as a lack of optimism, self-doubt, self-blame, emotional instability and worry).

Optimism, on the other hand, is a singular element in our psychology – you either have/create it within you or you don’t.

There is a difference, allegedly, between how the two nationalities deal with stress: Australians use more ‘tactics’ (both helpful and not-so-helpful) such as:

  • distraction
  • denial
  • substance use/abuse
  • emotional support
  • behavioural disengagement
  • venting and self-blaming
  • humour
  • reframing
  • acceptance (the ‘it is what it is’ or ‘build a bridge and get over it’ tactic)

Singaporeans, however, when faced with stressful situations are less likely to use any of the above positive tactics, which the authors of the study suggest may imply a general apathy toward coping tactics, no matter how adaptable that tactic might be to the situation at hand.

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Source:
Wong, S.S.; Lee, B.O.; Ang, R.P.; Oei, T.P.S.; & Ng, A.K. 2009. Personality, Health, and Coping: A cross-national study. Cross-Cultural Research, 43, 3; pp. 251-279


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25Sep/09Off

It’s ‘All in the Mind’

Lee and some of his alts

Query: can the ‘alts’ of Second Life and other virtual worlds be akin to ‘alters’, the various alternative states of sufferers of Dissociative Identity Disorder and Multiple Personality Disorder?

Is the act of having several ‘alts’ a quasi-therapeutic way of dealing with those ‘alters’?

Prompted by listening to an episode of ABC Radio National’s superb show, ‘All in the Mind’.


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