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.

Please see our medical disclaimer.

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

-----

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.

[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.

----------

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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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 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’…

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.

----------

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

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’.

The hefty research literature around cognitive therapy and pharmacotherapy therapy confirms that both are really good ways of treating depression.

But are there some symptoms and variables that would predict a superior response of one treatment over another?

This is the research question that Jay C. Fournier and colleagues decided to investigate. To do so they randomly assigned 60 depressed outpatients to cognitive therapy and 120 to antidepressant medications. Both groups were given a treatment regimen that lasted for 16 weeks.

They found that chronic depression, older age and lower intelligence didn't augur well for either type of treatment. Conversely, marriage, unemployment and having experienced a greater number of recent life events predicted a better response to cognitive therapy than pharmacological.

By the way, 'life event' is the total number of life events reported on the Psychiatric Epidemiology Research Interview Life Events scale, a 102-item self-report measure (Dohrenwend, Krasnoff, Askenasy, & Dohrenwend, 1978). This instrument is agnostic as to whether life events are positive, negative, or neutral.

Previous studies of depression and age had found (albeit not conclusively) that the older the sufferer was, the less likely they were to recover quickly from their depression.

Interestingly, dropout rates were lower for those who suffered from chronic depression; someone with nonchronic depression was approximately four times more likely to drop out of treatment. Although chronically depressed patients were likely to report less symptom relief, they at least 'stayed the course' -- although exactly why they stayed is open to discussion. There is the possibility that the chronically depressed were more motivated to complete their treatment course in the hope of achieving some degree of relief from their long-standing pain.

The researchers also found that those who were married/cohabiting, had a greater number of significant events in their lives and those who were unemployed were far more likely to benefit from cognitive therapy than medication. To me, that's interesting. I have tried CBT but had so little success with it that I dropped out after four weeks of a ten week program. Something to be discussed with my psychiatrist the next time I see them, methinks.

Sources:

Fournier, J.C.; DeRubeis, R.J.; Shelton, R.C.; Hollon, S.P.; Amsterdam, J.D.; & Gallop, R. (2009). Prediction of Response to Medication and Cognitive Therapy in the Treatment of Moderate to Severe Depression. Journal of Consulting & Clinical Psychology, Aug, Vol. 77 (4), 775-787

Dohrenwend, B. S., Krasnoff, L., Askenasy, A. R., & Dohrenwend, B. P. (1978). Exemplification of a method for scaling life events: The PERI Life Events Scale. Journal of Health and Social Behavior, 19, 205-229

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This is the internet age, where instant access to just about everything is but a mouse-click away.

It is also an age where face-to-face access to mental health professionals is harder and harder to gain, most especially in times of crisis. So it makes sense to turn to a more readily-available source of counselling, support and encouragement, doesn't it?

That was the question that Vicki L. Rogers and some of her colleagues posed to 328 Facebookers via an online survey.

And the result? Unsurprisingly, the vast majority (263:65) preferred face-to-face interaction. But that assumes that face-to-face is a readily-available option, which I can confirm is not the situation here in Australia, especially in rural and remote regions, and if you are aboriginal. I am not based in a rural and remote area, nor am I aboriginal, but getting any F2F (face-to-face) time with a competent practitioner able to deal at the required level of care and intervention is not something easily achieved.

Between the F2F group and the online group there were significant differences for the emotional self-disclosure subscales of depression, jealousy, anxiety, and fear, but no differences between them for subscales of happiness, anger, calmness and apathy.

However, of value to practitioners at low-level and early-intervention stages, both the F2F and online groups self-reported moderate to high willingness to disclose their emotions to a therapist, to the researchers suggesting that either format would be a viable option for nurses to provide individual therapy.

As they conclude,

Given the high number of participants reporting a history of therapy it would seem there is a need for psychiatric nurses to expand their repertoire of therapy delivery modes to include Internet based approaches. This would better equip them to serve clients in the younger Internet savvy age group. The emerging field of IT therapy offers nurse researchers and practitioners many opportunities to advance their knowledge and expertise in this field, thus allowing for delivery of quality care to those who would prefer this therapy format.

Source: Rogers, Vickie L., Griffin, Mary Quinn, Wykle, May L. and Fitzpatrick, Joyce J.(2009) 'Internet versus Face-to-Face Therapy: Emotional Self-Disclosure Issues for Young Adults', Issues in Mental Health Nursing, 30:10, 596 - 602

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"If you're African American, male, and you live in the United States, depression is a fact of life." (Kendrick et al., 2007)

That is a quote from an African American male and it is changing the way research into depression is being conducted with minorities.

Prior to the study and resultant paper by Lorna Kendrick and her colleagues research into the life and experiences of minority groups was very often conducted according to the whims and research interests of the researcher. As one of the authors of the current paper (Kendrick et al., 2009) notes,

"too often when members of minority groups are asked to participate in research, we are expected to answer questions the researcher believes are important. On many occasions we have attempted to tell a researcher that none of the questions and/or answers fit our experiences. Yet in most situations, we have been told "just choose the answer that comes 'closest' to the way you feel." Well the truth is none of the questions or answers were ever close to how we feel or experience life."

They expand on this...

"Many of the questions we were asked were presented as though the therapist/doctor did not believe what we were saying.

...

We do not respond well when health care providers quote research findings and make general statements about how we as African Americans should feel or respond. We "the patients" are sitting right in front of them, reporting what we feel, yet they did not seem to focus on us but on their "diagnostic criteria" which often we do not fit."

I have no doubt that it is not just African American males who can report feeling this way; I'm sure our own Aboriginal men, as well as the men from any number of minority non-white populations from around the Western world, can empathise with their African American peers.

With the election of Barak Obama as U.S. President there has been many expressions within popular media of a feeling of 'hope', not just among African Americans but the world in general, a much-reported feeling that [positive] 'change is in the air'. One of the changes the authors wish for is that research moves from a position they believe is only the post-hoc justification of false beliefs and predetermined thoughts and ideas.

It is hoped by Kendrick and her co-authors that research is needed that actually uncovers the 'real', not the 'imagined' or proscribed experiences of ethnic minorities and their mental health concerns really are. In turn, they hope, data will be more truthful and from that data more successful interventions and programs can be designed.

I am sure they are not alone in wishing, in this new era for the globe, for research that is more accurate, based on actual life experiences and not predetermined, white ethno-centric research questions.

Sources:

Kendrick. L., Anderson, N.L.R., & Moore, B. (2007). Perceptions of depression among young African American men. Family and Community Health, 30(1), 63-73

Kendrick. L., Moore, B., Thomas, C., & Matlock, J. (2009). African American Men and Mental Health: Is the Climate Changing. Issues in Mental Health Nursing, 30, 587-588

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The Harvard Mental Health Letter is reporting that the US Preventive Services Task Force is recommending that 12-19 year olds get screened for depression.

BUT, they stress, ONLY if there are adequate systems in place for treatment and follow up care. Which I am sure is comforting for those who live in rural and remote, or extremely poor, areas where such services and systems are lacking.

According to the Harvard Mental Health Letter, major depression affects nearly 3% of children younger than 13, and 5.6% of those ages 13 to 18.

They also note that major depression is so disabling, with long-term consequences, and yet most youngsters who are depressed go undiagnosed and untreated. I am sure I am not alone amongst us all in knowing from personal experience how true that is.

It's also interesting to note that the US Task Force recommended NOT screening pre-teens for depression, on the very sound grounds that there is not enough research into how effective screening tools are, nor is there enough research into how effective therapeutic and psychopharmacological treatment programmes are and what longer-term side effects medicines in particular may generate.

Source: U.S. Preventive Services Task Force. "Screening and Treatment for Major Depressive Disorder in Children and Adolescents: U.S. Preventive Services Task Force Recommendation Statement," Pediatrics(April 2009): Vol. 123, No. 4, pp. 1223-28.; cited in Depression screening in adolescents, Harvard Mental Health Letter, September 2009, p.7

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