By Jen Laskey
While your doctor usually asks the questions during an exam, you can respectfully and proactively take charge, too. In fact, asking the right questions can make a big difference in the way you manage your bipolar disorder. Your health is important both to you and to your doctor, so don’t hesitate to inquire about any topic you feel is relevant to your condition, whether it’s a question about your bipolar diagnosis, something regarding your bipolar medication, curiosity about complementary or alternative therapies for bipolar disorder, or concern about your emotional health, your financial health, or any other lifestyle issue.

Engaging in a dialogue with your doctor will help educate you about bipolar disorder and the treatment options available to you, and it’ll give your doctor a better sense of who you are and how bipolar disorder is affecting your health and your life. With the lines of communication open, you and your doctor will be able to develop the best treatment plan for your individual needs.

But remember, your time with your doctor is limited, so be sure to arrive at your appointment prepared and ready to discuss bipolar disorder and the questions that are important to you. Start by:

Researching bipolar disorder. It’s a good idea to get a better understanding of bipolar disorder before your appointment. Through research, you may even be able to answer some of your own questions. Visit Everyday Health’s Bipolar Disorder Center, the Depression and Bipolar Support Alliance, the National Institute of Mental Health, and MedlinePlus.
Strategizing. Your family doctor may not be able to answer all your questions about bipolar disorder; some may be better addressed by a psychotherapist or psychiatrist who specializes in treating people with bipolar disorder. Discuss this with your doctor, set up a plan for addressing your concerns, and follow up with a specialist, as directed by your doctor. You can also do additional research of your own.
Keeping records. Consider keeping a journal about your bipolar disorder between visits to the doctor, and share any relevant information with your doctor, such as changes in mood or behavior and how well your medicine is working. Taking notes during your appointments will help you remember important details after your visit. Alternatively, you may consider bringing a recording device or inviting someone to accompany you and take notes.

General Bipolar Disorder Questions

If you haven’t yet been formally diagnosed with bipolar disorder, talk to your doctor about arranging an evaluation with a specialist, such as a physician, psychologist, or psychiatrist with experience in diagnosing and treating mood disorders.

Once you have a formal diagnosis, your doctor will give you information about the condition and recommend a course of treatment. You may have questions or concerns about your diagnosis and how bipolar disorder will affect your health and your life. Consider asking your doctor the following:

What type of bipolar disorder do I have? How severe is it? Can you explain the disorder to me?
What is the best method (or combination of methods) of treatment for bipolar disorder?
Does bipolar disorder change with age? Do people ever outgrow it?
How will bipolar disorder affect me over the long term?
What are the key components for successfully managing the challenges of bipolar disorder?
Are there other types of medical or mental health specialists who should be involved in my care?
When might hospitalization be beneficial or necessary?
Should I (or a member of my family) alert you if there are any changes in my behavior?
What kind of changes do you want to be informed about?
What should I do if I feel I’m in crisis or need emergency help?

Prescription Considerations

Mood stabilizers, like lithium, or anticonvulsant drugs are commonly prescribed to help manage the symptoms of bipolar disorder. Your doctor may also recommend other types of medication, such as antidepressants and antianxiety and antipsychotic drugs. It is important to understand the medication your doctor is prescribing. Ask your doctor about it, read the insert the pharmacy includes with your prescription, and take the medication as directed by your physician. Knowing how your medication is supposed to work will help you evaluate its effectiveness and whether it’s the right medication for you. Here are some questions you may want to ask your doctor about bipolar disorder medications:

Do I need medication, or can I be treated effectively without it?
What types of medications are used to treat the manic and depressive mood swings of bipolar disorder?
How often and for how long will I need to take this medication?
Is there medication that I can take on an as-needed basis?
What type of drug are you prescribing for me, and how does it work?
Where can I get more information about this drug?
How will the medication make me feel, and how will I know if it’s working?
When can I expect to notice improvements in how I feel?
What are the risks if I don’t take my medication as directed, or if I forget to take it?
How has this medication been tested? Are there any recent clinical studies on it?
What should I do if I experience any side effects? Are there any that may require me to call a doctor? Are there any that may require me to stop taking the medication immediately?
Is this drug habit-forming?
Can I take this on an empty stomach, or should it be taken with food?
Could this medication interact with other medication I’m taking?
Are there any foods, drinks (such as alcohol), vitamins, herbal supplements, or over-the-counter drugs that I should avoid while taking this medication?
Can other conditions affect or be affected by my medication? What if I have a family history of heart disease?
What is electroconvulsive therapy (ECT)? Is it still used to treat bipolar disorder?

Complementary and Alternative Therapies

Doctors often recommend a combination of therapies to treat the symptoms of mania and depression. In addition to your medication, you may consider complementary or alternative therapies, such as practicing meditation, taking a yoga class, or trying a dietary supplement. Ask your doctor whether any of these options might be beneficial for you:

Are there any complementary or alternative therapies I should consider?
Do any clinical trials or research support these complementary or alternative therapies?
Do you recommend any herbs or other natural supplements, like omega-3 fatty acids or Saint John’s wort?

Emotional Health

Bipolar disorder can take a toll on your emotional health and your relationships, but your doctor can help you find ways to cope with the emotional stress, manage your manic and depressive symptoms, and handle the impact bipolar disorder is having on your relationships. Psychotherapy, in particular, can help people with bipolar disorder recognize changes in their personality that may signal an oncoming mood swing. It can also help with other challenges, such as manic episodes, spending sprees, substance abuse, and withdrawal during depressed phases. Ask for a referral to a good therapist or support group and find out what else you can do to improve your emotional health while living with bipolar disorder.

Should I seek any emotional support from a support group or a therapist? Can you give me some referrals?
How will I know if my therapist is right for me?
Will I need to see both a psychologist and a psychiatrist? If so, why?
What is cognitive-behavioral therapy? Am I likely to benefit from this type of therapy?
Is social rhythm therapy effective at helping people with bipolar disorder improve their relationships and organize their daily routines?
How should I explain my condition to my spouse, family, and friends? What, if anything, should I say to my boss and co-workers?
How can my family and friends help me? Are there specific things I should ask of them?
What should I do if I feel I’m being discriminated against at work or school?
What should I do if I feel that I can’t keep up at work or school? What accommodations can I ask for? Where can I get more information about work- and school-related issues?
How is my condition likely to affect my relationships, and what can I do to improve my situation?

Health and Lifestyle Concerns

Maintaining a healthy lifestyle is one of the best ways to keep yourself in good shape. Participating in a physical fitness regimen, following a balanced diet, getting adequate rest and sleep, quitting smoking, moderating your alcohol consumption, and avoiding substance abuse of any kind can all contribute to your overall health. Check with your doctor to see whether you need to make any lifestyle changes or whether there’s anything he or she recommends that you do at home, work, or school to help you better manage your bipolar disorder:

Do I need to make any changes in diet, exercise, or how much I rest?
Can stress, drinking alcohol, smoking, or using drugs affect my condition?
Are there any activities I should avoid?
Should I make any special accommodations for school, home, or my work?
Can you recommend any good books, magazines, organizations, or online resources that focus on bipolar disorder?

Financial Health

The costs associated with your bipolar disorder treatment will have an effect on your finances. It’s crucial to find ways to balance your physical health with your financial health. Ask your doctor about ways in which you may be able to offset the cost of your treatment.

Will my medication be covered by my health insurance plan?
About how much will my medication cost?
Is there a generic version of the medication that would be more affordable? If not, are there other, equally effective medications that are available as generics?
Do you have any samples or discount coupons for my prescription?
If I need to be hospitalized, will the hospital accept my insurance? How much of my care can I expect to be covered? If my hospitalization is not covered by insurance, will I have any payment alternatives?
Are there separate fees or charges at the hospital for doctors, therapists, caretakers, or anything else? If so, what kind of charges can I expect?
If I choose a complementary or alternative therapy, is it likely to be covered by my insurance? If not, what kind of out-of-pocket costs can I expect?

Additionally, people with bipolar disorder sometimes get themselves into financial straits during manic phases in which they go on spending sprees or gamble. If this is a concern for you, consult your doctor or therapist and ask:

What can I do to control my spending during my manic highs?
How can I get help for a gambling problem?

By Dennis Thompson Jr.
Lots of people consider a pint of ice cream the perfect cure for the blues. Others indulge in sugary snacks as a way to get an energetic high. But for people with bipolar disorder, sugar and other simple carbohydrates may harm more than help.

Carbohydrate cravings in bipolar patients are legendary, so much so that increased intake of sugary treats is considered a clue to bipolar disorder during diagnosis. People who are depressed munch on sugary snacks to make themselves feel better and then, in the throes of a manic high, mindlessly devour high-carb junk food.

The question is, should those with bipolar disorder put the brakes on sugar intake?

Bipolar Disorder: Sugar and the Brain

Blood sugar and carbohydrate intake are very important to the brain. Your brain runs on glucose and depends on carbohydrates to supply the energy it needs. But for bipolar patients, carbohydrate intake also prompts the production and release of important neurotransmitters. The body produces tryptophan, an amino acid that the brain converts into the neurotransmitter serotonin. Serotonin creates a feeling of calm and well-being and reduces depression. So people with bipolar disorder are indulging in a form of self-medication when they eat sugary snacks during depressive lows or manic highs.

Doctors believe that people use this natural reaction to try to ease their bipolar symptoms when they have depression or mania. Eating large amounts of sugar can soothe a deep depression. It also can take the edge off a manic high.

But compulsive sugar intake is not an exact form of treatment, and people who eat too much sugar may find their mood swinging wildly — a terrible prospect for people with bipolar symptoms. They also face an inevitable “crash” following the intake of simple carbohydrates like sugar. Sugary foods burn hot and fast through the body, and their effects on brain chemistry and other bodily processes tend to be immediate, intense, and abrupt.

Bipolar Disorder: Getting the Right Carbs

Bipolar patients should not cut carbohydrates out of their diet. Because they are linked to the mood-controlling neurotransmitters, carbohydrates are important to managing bipolar symptoms. Instead, swap out simple sugars in the diet for more complex carbohydrates. Complex carbohydrates burn slow and long, ensuring a more controlled release of neurotransmitters to the brain. Complex carbohydrates are also healthier for you overall, keeping your blood glucose levels more stable and preventing the development of type 2 diabetes.

To help eliminate sugar cravings and maintain good blood sugar levels and healthy brain chemistry, you should:

Eat more fruits, vegetables, and whole grains, which are rich in complex carbohydrates.
Be sure to eat enough protein, which can improve alertness without the rush of a sugar high. Lean meats, poultry, fish, beans, and low-fat dairy products are good, healthy sources of protein. Poultry, oil-rich fish, baked potatoes, beans, oats, nuts, and seeds are protein sources that have the added benefit of being rich in tryptophan and can help the brain produce serotonin in a controlled, healthy fashion.

It might help to create a food and mood journal for keeping track of when you eat, what you eat, and any abrupt changes in mood you experience. These notes could hold the key to determining if certain foods are influencing your bipolar symptoms in a positive way.

By Traci Pedersen Associate News Editor

Mom’s Education Impacts Adult Kids’ Depression RiskA new study shows that children of women who didn’t graduate from high school have double the risk of experiencing major depression in early adulthood, compared to children of mothers who graduated.

“Our research indicates that a mother’s lack of high school education has a robust impact on her child’s risk of major depressive episode in early adulthood,” said senior author Amélie Quesnel-Vallée, Ph.D., of McGill University.

The higher risk of depression in children of mothers with less than a high school education could not be attributed to parental history of depression, early life adversity, or the children’s own education and income in early adulthood.

The study is the first in Canada to distinguish the impact of a mother and father’s education on depression in early adulthood.

For the study, researchers looked at a sample of 1,267 individuals from Statistics Canada’s National Population Health Survey.

Participants were first interviewed in 1994, when they were between 12 and 24 years old, and living with their parents. They were then followed for 12 years, and their risk of major depressive episode was assessed between the ages of 22 and 36.

“Depression in early adulthood strikes at a critical time,” said Quesnel-Vallée.

“An individual may be pursuing studies or apprenticeships, or starting a career or a family. A disruption caused by depression can potentially derail these events and have lifelong consequences.”

Interestingly, the father’s level of education has no impact.

“This, along with the fact that the effect of mother’s education was not explained by the children’s own education or income, suggests that mothers’ parenting skills may be at play here,” she said.

Alison Park, a researcher at the Institut National de Santé Publique du Québec who worked on the research for her master’s degree, said, “Education gives people practical skills, such as communication, analytical and problem-solving skills, as well as an increased sense of mastery.”

“A better-educated mother might be more confident in coping with difficulties arising from child-rearing. This increased confidence and feeling of self-mastery might serve as a model for her children.”

The research is published in the journal Social Psychiatry and Psychiatric Epidemiology.

Source: McGill University

Empowering yourself to challenge your inner critic.
Published on April 18, 2012 by Melanie A. Greenberg, Ph.D. in The Mindful Self-Express
“Loser!”

“You messed up again! “

“You should have known better!”

Sound familiar?

Of course it does! It’s that know-it-all, bullying, mean-spirited committee in your head. Don’t you wish they would just shut up already? I know I do!

The Committees in Our Heads

We all have voices inside our heads commenting on our moment-to-moment experiences, the quality of our past decisions, mistakes we could have avoided, and what we should have done differently. For some people, these voices are really mean and make a bad situation infinitely worse. Rather than empathize with our suffering, they criticize, disparage, and beat us down at every opportunity! The voices are often very salient, have a familiar ring to them and convey an emotional urgency that demands our attention. These voices are automatic, fear-based “rules for living” that act like inner bullies, keeping us stuck in the same old cycles and hampering our spontaneous enjoyment of life and our abilities to live and love freely.

Where Do the Voices Come From?

Psychologists believe these voices are residues of childhood experiences—automatic patterns of neural firing stored in our brains and dissociated from the memory of the events they are trying to protect us from. While having fear-based self-protective and self-disciplining rules probably made sense and helped us to survive when we were helpless kids, at the mercy of our parents’ moods, whims, and psychological conflicts, they may no longer be appropriate to our lives as adults. As adults, we have more ability to walk away from unhealthy situations and make conscious choices about our lives and relationships based on our own feelings, needs and interests. Yet, in many cases, we’re so used to living by these unwritten internal rules that we don’t even notice or question them. And we unconsciously distort our view of things so they seem to be necessary and true. Like prisoners with “Stockholm Syndrome,” we have bonded with our captors!

What Happens When the Committee Takes Charge of Our Lives?

If left unchecked, the committees in our heads will take charge of our lives and keep us stuck in mental and behavioral prisons of our own making. Like typical abusers, they scare us into believing that the outside world is dangerous, and that we need to obey their rules for living in order to survive and avoid pain. By following (or rigidly disobeying) these rules, we don’t allow ourselves to adapt our responses to experiences as they naturally unfold. Our behaviors and emotional responses become more a reflection of yesterday’s reality than what is happening today. And we never seem to escape our dysfunctional childhoods.

The Schema Therapy Approach
Psychologist Jeffrey Young and his colleagues call these rigid rules of living and views of the world “schemas.” Based on our earliest experiences with caregivers, schemas contain information about our own abilities to survive independently, how others will treat us, what outcomes we deserve in life, and how safe or dangerous the world is. They can also get in the way of our having healthy relationships in life, work, and love.

How Negative Schemas Affect Our Lives & Relationships

Young suggests that negative schemas limit our lives and relationships in several ways:

(1) We behave in ways that maintain them.

(2) We interpret our experiences in ways that make them seem true, even if they really aren’t.

(3) In efforts to avoid pain, we restrict our lives so we never get to test them out

(4) We sometimes overcompensate and act in just as rigid, oppositional ways that interfere with our relationships.

The Abandonment Schema – Diana’s Story

A woman who we will call Diana has a schema of “Abandonment.” When she was five years old, her father ran off with his secretary and disappeared from her life, not returning until she was a teenager. The pain of being abandoned was so devastating for young Diana that some part of her brain determined that she would never again allow herself to experience this amount of pain. Also, as many children do, she felt deep down that she was to blame; she wasn’t lovable enough, or else her father would have stuck around; a type of ‘Defectiveness” schema.

Once Diana developed this schema, she became very sensitive to rejection, seeing the normal ups and downs of children’s friendships and teenage dating as further proof that she was unlovable and destined to be abandoned. She also tried desperately to cover up for her perceived inadequacies by focusing on pleasing her romantic partners, and making them need her so much that they would never leave her. She felt a special chemistry for distant, commitment-phobic men. When she attracted a partner who was open and authentic, she became so controlling, insecure and needy that, tired of not being believed or trusted, he eventually gave up on the relationship.

Diana’s unspoken rule is that it is not safe to trust people and let relationships naturally unfold; if she relaxes her vigilance for even a moment, the other person may leave. In an effort to rebel against her schema, she also acted in ways that were opposite to how she felt; encouraging her partner to stay after work to hang out with his friends, in an attempt to convince herself (and him) that she was ultra-independent. This led to chronic anger and feelings of dissatisfaction with her partner’s lack of understanding of her needs; she neither understood nor acknowledged her own role in the cycle.

What Can We Do?

Schema Therapy can help Diana (and her partner) understand how their schemas result in ways of relating to self and others that are repetitive, automatic, rigid, and dysfunctional. By acknowledging and empathically connecting with her unresolved fears and unmet needs, Diana can become more flexible and free. These new theories and therapies can help to heal couples conflict and individual problems such as anxiety, depression, personality disorders, grief, and childhood trauma. The schema concept helps us understand how early childhood events continue to influence adult relationships and mental health issues. We need to recognize their influence, pay attention to what our automatic inner voices are saying, and (with professional help, if necessary), begin to free ourselves from their grip.

Resources
Schema Therapy Website: http://www.schematherapy.com/

About The Author

Melanie Greenberg, Ph.D. is a licensed Clinical Psychologist, and expert on Mindfulness, Positive Psychology, Emotion Regulation, and Relationships. Dr Greenberg provides workshops and speaking engagements for organizations, life, weight loss, or career coaching, and psychotherapy for individuals and couples.

Visit my website:

http://melaniegreenbergphd.com/marin-psychologist/

Follow me on twitter @drmelanieg
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Read my Psychology Today blog & personal blog

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By Therese Borchard
“There is no question that the most common destructive behavior affecting depressed patients, barring suicide, is alcoholic or any substance abuse,” writes J. Raymond De Paulo Jr., M.D., of the Johns Hopkins School of Medicine in his book “Understanding Depression.” He does not mince words on the seriousness of alcoholism and drug addiction to the recovery of depression:

Nothing makes the job of a psychiatrist treating depression and manic depression harder than alcohol and drugs. The most difficult treatment situations that I have ever seen patients and families confront, since I started my training in psychiatry twenty-seven years ago, occur when the patients’ illnesses are complicated by what we call addictive behaviors. While I have seen many successful outcomes, none were easy to achieve.

Here are some important facts you need to know about the relationship between depression and substance abuse: why addiction impedes recovery from depression and why depression sustains drug dependence.
1.Depressive illness makes people prone to destructive behaviors.
2.Destructive behaviors make depression and mood disorders worse.
3.Depressed people drink and use drugs to self-medicate.
4.There is a greater risk of abusing alcohol or drugs by people who have moderate depression than those who have depression that is severe.
5.There is a high relapse rate with drugs and alcohol when it occurs along with depression and mania. Depressed people who drink or abuse drugs are far more likely to suffer a relapse.
6.Approximately one-third of people with all mental illnesses and approximately one-half of people with severe mental illnesses also experience substance abuse.
7.More than one-third of all alcohol abusers and more than one-half of all drug abusers are also battling mental illness.
8.People with manic depression are particularly at risk. One study suggests that as many as 60 percent of people with Bipolar I have substance abuse problems at some point in their life.
9.The likelihood of developing alcoholism or substance is abuse is far greater in people with bipolar disorder than in those with unipolar depression or the general population.

A new study in the Archives of General Psychiatry found that alcohol abuse may actually cause major depression. The research results showed that alcohol use could trigger genetic markers that increase the risk of depression. In other words, the depressant effect of alcohol could lead to depression itself.

By Janice Wood Associate News Editor
Reviewed by John M. Grohol, Psy.D. on February 17, 2013

Adults undergoing bariatric surgery who are more physically active are less likely to be depressed, according to a new study, which found that being active for as little as eight minutes a day made a difference.

Obese adults are nearly twice as likely to have a major depressive disorder (13.3 percent) or anxiety disorder (19.6 percent) compared to the general population (7.2 and 10.2 percent), according to Wendy C. King, Ph.D., an epidemiologist at the University of Pittsburgh Graduate School of Public Health.

“Typically, clinical professionals manage their patients’ depression and anxiety with counseling and/or antidepressant or anti-anxiety medication,” she said. “Recent research has focused on physical activity as an alternative or adjunct treatment.”

Just one hour of moderate-intensity physical activity a week — or eight minutes a day — was associated with 92 percent lower odds of treatment for depression or anxiety among adults with severe obesity.

Similarly, just 4,750 steps a day — less than half the 10,000 steps recommended for a healthy adult — reduced the odds of depression or anxiety treatment by 81 percent.

“It could be that, in this population, important mental health benefits can be gained by simply not being sedentary,” said King, who also was the lead author of the study.

The researcher notes it is important to treat depression and anxiety prior to bariatric surgery. Preoperative depression and anxiety increase the risk of these conditions occurring after surgery — and have been shown to have a negative impact on long-term surgically induced weight loss.

As part of the Longitudinal Assessment of Bariatric Surgery-2, an observational study designed to assess the risks and benefits of bariatric surgery, King and her colleagues assessed participants’ physical activity for a week prior to undergoing bariatric surgery using a small electronic device worn above the ankle. Participants also completed surveys to assess mental health, symptoms of depression, and treatment for psychiatric and emotional problems, including depression and anxiety.

The study included 850 adults who were seeking bariatric surgery between 2006 and 2009 from one of 10 different hospitals throughout the United States.

Approximately one-third of the participants reported symptoms of depression, while two in five reported taking medication or receiving counseling for depression or anxiety.

The researchers noted that the link between physical activity and less depression was strongest when only moderate intensity physical activity was considered. However, the number of steps a person walked each day, no matter the pace, also was related.

“Another goal of this study was to determine physical activity thresholds that best differentiated mental health status,” said King. “We were surprised that the thresholds were really low.”

Because this was an observational, cross-sectional study — meaning patients’ regular physical activity and symptoms of depression were measured at the same time — the study could not prove that a patient’s physical activity influenced mental health.

“Results of the study are provocative, but we would need further research to verify that physical activity was responsible for lower levels of depressive symptoms in this patient population,” said study co-author Melissa A. Kalarchian, Ph.D., associate professor at Western Psychiatric Institute and Clinic, part of University of Pittsburgh Medical Center (UPMC). “Nonetheless, physical activity is a key component of behavioral weight management, and it is encouraging to consider that it may have a favorable impact on mental health as well.”

The study is published in the Journal of Psychosomatic Research.

Source: University of Pittsburgh Schools of the Health Sciences

If you’re depressed, antidepressants can help you minimize those feelings of sadness and hopelessness — but will the drugs also undermine your ability to feel joy?

Emotional blunting — an overall unfeeling or numbness — is a common complaint of depression patients prescribed to certain antidepressants. This diminished capacity to have feel-good emotions during positive moments can be a significant side effect for some people taking selective serotonin reuptake inhibitors, or SSRIs.

And when research supporting the idea was first discussed at a national conference in 2002, mental health professionals nodded in agreement over the existence of this unwanted side effect, recalls psychiatrist Heidi Combs, MD, an assistant professor of psychiatry at the University of Washington in Seattle.

However, emotional blunting is largely based on what doctors hear from their patients, as opposed to results from clinical research. So what can be done about it?

Who Experiences Emotional Blunting?

SSRIs are a class of antidepressants that affect the way the brain uses the neurotransmitter serotonin. Their effect is intended to relieve the symptoms of depression — and they’re often successful in doing so. Unfortunately, explains Dr. Combs, the drugs also act on the reward pathways in the brain — the pathways that bring us pleasure. For some people, this means that they experience emotional blunting, or the sensation that all their emotional responses are dulled.

“If something positive is going on, these patients might not have the full response,” Combs says. Though there are many case studies, the lack of large clinical studies makes it difficult to predict which people will experience this side effect — and which ones won’t.

Part of the problem is the very nature of depression. People struggling with depression often complain that they have lost some of their ability to respond emotionally to events and people around them. So for a long time, emotional blunting caused by antidepressants was written off a as symptom of hard-to-treat depression.

However, says Combs, it’s fairly easy now for physicians to tease apart the symptoms of depression itself and this antidepressant side effect. If the depression symptoms have improved, but emotional blunting persists, it’s likely due to the antidepressant. If, on the other hand, the emotional blunting continues alongside unrelieved sadness, weepiness, and other depression symptoms, then it’s more apt to be part of the original disorder, she explains.

Get Your Glee Back: What to Do About Emotional Blunting

To regain your pleasure response, Combs recommends these solutions:

Switch antidepressants. It may be a good idea to move to another class of antidepressants entirely because someone who responds to one SSRI drug with emotional blunting may respond the same way to another one.
Add a second medication. If switching to another class of drugs just leaves you with more troublesome symptoms (which can happen if you’re dealing with anxiety), ask your doctor about adding just a small amount of another antidepressant to free the reward pathways.
Talk it out. If you’re feeling an overall loss of emotional response, working through the problems that are causing stress and depression in the first place (including solving practical problems like those related to housing or income) may help.

If you find that your depression medication is edging out all your emotions, talk to your doctor. This is a real effect, emphasizes Combs, but the good news is that it has real solutions.

By John M. Grohol, Psy.D.
Bipolar disorder, which is also known by its older name “manic depression,” is a serious mental disorder that responds to treatment with both medication and psychotherapy.

Not everyone who has bipolar disorder (manic depression) experiences every symptom. Some people experience a few symptoms, some many. The severity of symptoms varies with individuals and also varies over time. The top 10 signs of mania, one part of bipolar disorder, are:

Abnormal or excessive elation
Unusual irritability
Decreased need for sleep
Grandiose notions
Increased talking
Racing thoughts
Increased sexual desire
Markedly increased energy
Poor judgment
Inappropriate social behavior
People with bipolar disorder must not only meet the criteria for the signs and symptoms listed above, but also for an episode of depression.

But those who live alone not at increased risk, study shows Feeling lonely, as distinct from being/living alone, is linked to an increased risk of developing dementia in later life, indicates research published online in the Journal of Neurology Neurosurgery and Psychiatry. Various factors are known to be linked to the development of Alzheimer’s disease, including older age, underlying medical conditions, genes, impaired cognition, and depression, say the authors.

But the potential impacts of loneliness and social isolation – defined as living alone, not having a partner/spouse, and having few friends and social interactions – have not been studied to any great extent, they say. This is potentially important, given the ageing population and the increasing number of single households, they suggest. They therefore tracked the long term health and wellbeing of more than 2000 people with no signs of dementia and living independently for three years. All the participants were taking part in the Amsterdam Study of the Elderly (AMSTEL), which is looking at the risk factors for depression, dementia, and higher than expected death rates among the elderly.

At the end of this period, the mental health and wellbeing of all participants was assessed using a series of validated tests. They were also quizzed about their physical health, their ability to carry out routine daily tasks, and specifically asked if they felt lonely. Finally, they were formally tested for signs of dementia.
At the start of the monitoring period, around half (46%; 1002) the participants were living alone and half were single or no longer married. Around three out of four said they had no social support. Around one in five (just under 20%; 433) said they felt lonely.

Among those who lived alone, around one in 10 (9.3%) had developed dementia after three years compared with one in 20 (5.6%) of those who lived with others. Among those who had never married or were no longer married, similar proportions developed dementia and remained free of the condition. But among those without social support, one in 20 had developed dementia compared with around one in 10 (11.4%) of those who did have this to fall back on. And when it came to those who said they felt lonely, more than twice as many of them had developed dementia after three years compared with those who did not feel this way (13.4% compared with 5.7%).

Further analysis showed that those who lived alone or who were no longer married were between 70% and 80% more likely to develop dementia than those who lived with others or who were married. And those who said they felt lonely were more than 2.5 times as likely to develop the disease. And this applied equally to both sexes. When other influential factors were taken into account, those who said they were lonely were still 64% more likely to develop the disease, while other aspects of social isolation had no impact. “These results suggest that feelings of loneliness independently contribute to the risk of dementia in later life,” write the authors.

“Interestingly, the fact that ‘feeling lonely’ rather than ‘being alone’ was associated with dementia onset suggests that it is not the objective situation, but, rather, the perceived absence of social attachments that increases the risk of cognitive decline,” they add. They suggest that loneliness may affect cognition and memory as a result of loss of regular use, or that loneliness could itself be a sign of emerging dementia, and either be a behavioural reaction to impaired cognition or a marker of undetected cellular changes in the brain.

Almost one-fifth of youngsters with bipolar disorder will make a suicide attempt. Two red flags at intake are a family history of depression and depression severity; three causes for concern over the short term are persistent depression, substance abuse, and mixed bipolar episodes. These findings, obtained in a five-year prospective study, are reported in the November Archives of General Psychiatry. The lead scientist was Tina Goldstein, Ph.D., of the University of Pittsburgh.

“I think it’s an excellent study,” Paula Clayton, M.D., medical director of the American Foundation for Suicide Prevention, said in an interview with Psychiatric News. Another valuable finding to emerge from the study, she believes, is that more than half the subjects were on psychotropic medications when they made their suicide attempts. The implication is thus “that treatment wasn’t enough to prevent them from making an attempt. It was maybe too much, too little, or the wrong treatment…. [So if a child with bipolar disorder] makes a suicide attempt, then I think we should reexamine the medications.”

Information about managing the care of children with bipolar disorder can be found in American Psychiatric Publishing’s Clinical Manual for Management of Bipolar Disorder in Children and Adolescents and in the just-published Clinical Manual of Child and Adolescent Psychopharmacology, Second Edition.

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By Wray Herbert I have a vivid memory of dropping my oldest son off at college, the first day of his freshman year, many years ago. He stood outside his dorm, waving as I drove away, and I was overcome by a complex mix of emotions. I was unquestionably sad — the tears testified to that — but I wasn’t morose or agitated, and I kind of knew that this sadness would pass. In fact, I was in the same moment keenly aware of a range of powerful and positive emotions — pride that my son had earned his way into a fine university, relief that he seemed well-adjusted and untroubled and had solid friends. He seemed to be landing OK, and the moment was bittersweet.

Bittersweet. It seems like a contradiction, but in truth our emotional states are rarely simple or tidy. We don’t feel good this moment, bad the next. More discrete feelings like pride and excitement and frustration and shame spill over one another and mix, and it’s up to us to differentiate the nuances. What I was doing in those minutes as I drove away from campus — sorting out my welter of feelings and making sense of them — is what most people do in some way every day.

If they’re lucky, that is. Research has shown that people vary greatly in their ability to do this fine-grain emotional sorting, and the inability to do such emotional calibration may take a toll. Emotions are information to the human mind, and when we experience a discrete emotion like sadness, we try to process that emotion and conceptualize it in a meaningful way. In that way we can explain the feeling to ourselves in a reasonable way, and act appropriately. If on the other hand we experience an undifferentiated emotional mush, we’re likely to misconstrue the causes, and act in ways that don’t make sense and may indeed be harmful.

At least that’s the theory, which has been pieced together in several labs over many years. It’s also the departure point for new work by Emre Demiralp of the University of Michigan, who with several colleagues decided to investigate whether people who suffer from serious depression might experience a disability in this kind of emotional parsing. The idea makes sense theoretically, because depression has long been associated with impoverished perception and memory and thinking. The scientists wanted to see if depressed people’s emotional states are also less rich and textured.

The problem with studying emotions is that they are very difficult to tap and measure. Feelings are subjective, so scientists can’t simply ask people what they are feeling and expect an accurate and meaningful answer. To circumvent this problem, the scientists used what’s called “experience sampling.” They recruited a group of volunteers — half healthy, half clinically depressed — and gave them Palm Pilots to carry with them for a week. Over this time, the scientists beeped the volunteers at random times, and asked them to stop what they were doing and rate how much — on a scale of zero to four — they were experiencing eleven different emotions at the moment — anxiety, disgust, guilt, alertness, happiness and so forth.

Demiralp and his colleagues wanted to assess the richness of the volunteers’ emotional lives, and to do this they looked for patterns of correlation. For example, if a volunteer experienced fluctuations in anger over the week, and those fluctuations correspond closely with that volunteer’s fluctuations in sadness, this would suggest that this person does not differentiate much between anger and sadness. They are linked together into a vague sense of feeling bad. The scientists predicted that the depressed volunteers would show such a pattern, while the healthy volunteers’ emotions would not correlate closely. What’s more, because depressed people have a bias toward negativity, the scientists expected that depressed volunteers would parse their positive emotions just as finely as healthy volunteers.

And that’s exactly what they found. As reported in-line in the journal Psychological Science, the volunteers suffering from serious depression tended — much more than healthy controls — to lump all their bad feelings together; shame and frustration and sadness were all parts of a vague sense of feeling bad. They did not do this with positive feelings. Importantly, this inability to parse negative emotion works independently of emotional intensity or instability. In other words, it’s a fundamental characteristic of the depressed mind.

The scientists believe that finely discriminated emotions are more adaptive for mental health, because they are less likely to be attributed to the wrong cause. People suffering from clinical depression often have distorted thinking, blaming themselves for situations they can’t control, and it could be that mushy emotional states contribute to that harmful thinking. A vague undifferentiated unpleasantness is much harder to explain, and therefore much harder to regulate.

Casual sex increases a teenager’s odds for clinical-level depression nearly threefold. The effects are the same for boys and girls, though younger teens (13-15 years old) who had so-called “nonromantic sex” faced substantially greater risks for depression. Dating alone was not linked to depressive symptoms.

Published in the Journal of Abnormal Psychology, the the study provides evidence that “context is key” when trying to understand how teen relationships and sex affect their well-being.

“Many historical and media perspectives have presented adolescent sexuality as an indicator of problematic or even socially deviant behavior,” says Jane Mendle, assistant professor of human development in Cornell University’s College of Human Ecology. “But this study and other recent findings are showing that’s not the case, and adolescent dating and sexuality can be viewed as normal developmental behavior.”

Using a novel behavioral genetics approach that compares siblings growing up in the same home, Mendle and her co-authors analyzed responses from 1,551 sibling pairs ages 13-18 from the National Longitudinal Study of Adolescent Health, a nationally representative sample of US high school students initiated in the mid-1990s. Among other topics, teens answered questions about their mental health and dating and sexual history. Nearly two-thirds of the sample’s youth had dated, and two-thirds were virgins.

By comparing siblings in their study, the authors could control for family and environmental influences that might also raise one’s risk for depression.

“We designed the study to give us a purer way to isolate many of the factors that could be contributing to depression,” Mendle says. “It allows us to compare specific types of social activities—in this case, dating and romantic and nonromantic sex—to see their overall effect.”

The paper notes that not all the associations at play can be unraveled, however. For instance, some teens who have depressive symptoms or clinical depression may be more likely to engage in casual sexual behaviors.

Mendle, a licensed clinical psychologist who studies how such developmental processes as puberty and sexual maturation influence teens’ emotional growth, believes adolescent sexuality is important to study because it is closely tied to how well people transition into adulthood.

“One of the hallmarks of adolescence is the formation of romantic relationships, and we know that what happens in adolescence is strongly related to your psychological, physical and financial well-being for years to come,” Mendle says. “Findings like this can help shape the dialogue and public debate about how to best support teen sexual health, psychological development and other areas.”

By Madeline Vann, MPH Medically reviewed by Lindsey Marcellin, MD, MPH
Welcoming a child into the world is always a joyous event, right? In truth, the “baby blues” strike a significant number of women — by some estimates, up to 85 percent of moms feel some sadness after their baby is born. But for 7 to 13 percent of women, baby blues are more like mood indigo: a diagnosable condition called postpartum depression.

If you’re planning a pregnancy, it’s natural to wonder whether you’re at risk for this type of depression. In fact, many researchers and doctors say they wish more women would seriously consider postpartum depression’s risk factors. That way, new moms could get help before depression wreaked havoc on their lives and their parenting.

Will You Feel Blue After Your Baby Is Born?

Fortunately, new studies are shedding light on just what those risk factors are. A recent review of data from 1,863 new mothers (surveyed as part of the 1996–2006 Medical Expenditure Panel Survey) showed that more than half the women who had postpartum depression had a history of mental health issues, either before or during pregnancy. Those whose mental health problems occurred before pregnancy were twice as likely to have postpartum depression, while those who struggled with mental health issues during pregnancy had an 11-times higher risk of postpartum depression.

“We really showed that a woman’s mental health status before and during pregnancy is a strong predictor of poor mental health after delivery,” says study author Whitney Witt, PhD, MPH, assistant professor in the department of population health sciences at the University of Wisconsin School of Medicine and Public Health in Madison. “We looked at the domino effect: If women are in poor mental health before pregnancy, then they are more likely to have poor mental health during pregnancy, and even more likely to have poor mental health afterwards.” Dr. Witt’s study is the first to consider the predictive value of mental health during pregnancy as a risk factor for postpartum depression. “There are a substantial number of women who have poor mental health postpartum who could be identified earlier,” she says, adding that women should let their doctors know if they have concerns about their mental health status. In addition, these results speak to the need for access to quality health care for women before and during pregnancy, she says.

10 More Risk Factors for Postpartum Depression

In addition to your mental health status before and during pregnancy, other risk factors exist — and they vary in degree.

Hormones. After delivery, a woman’s shift in hormones is often blamed for intense mood swings. However, current research shows that there may be a more subtle interplay between hormones (even during pregnancy) and the risk for postpartum depression. Race. Women of Asian or Pacific Islander descent have three times the risk for postpartum depression than other women. Age. Some studies have found that younger mothers have an increased risk for postpartum depression (with moms younger than 20 at highest risk, and moms 20 to 24 next in line) — but other studies are inconclusive. Education. Women who have not achieved a high school education have been found to have a four-fold higher risk. Stress. Some studies have shown a link between the risk of postpartum depression and stressful life situations, such as difficult relationships with partners, low income, or problems balancing the needs of all children in the family. Pregnancy complications. Conditions of pregnancy that correlate with postpartum depression include anemia, preterm birth, pregnancy-related high blood pressure, diabetes, low lying placenta, and toxemia. Pain after delivery. Severe pain in the first 36 hours after delivery triples the risk for experiencing postpartum depression two months later. Health status. Generally poor physical health during pregnancy puts a woman at risk for postpartum depression. Family history. Women with a family history of depression or bipolar disorder are more likely to have postpartum depression. Previous postpartum depression. Women who had postpartum depression in a previous pregnancy are 50 percent more likely to get it a second time. Researchers are gaining a better understanding of the risk factors for postpartum depression. And as they do, women and their physicians will have more information with which to make appropriate medical decisions — such as whether to consider early intervention for a mood disorder or to have pain levels after delivery monitored more carefully.

Symptoms of physical pain often are associated with mental health issues. People who have anxiety or depression may experience a number of somatic symptoms long before they are diagnosed with a mood issue. But can these somatic symptoms, which often go untreated, be an indicator of future psychological concerns? When adolescents experience depression, it can put them at risk for future mood problems. However, when they experience physical pain with no identifiable physical cause, they often are never referred for psychological evaluation. Hannes Bohman of the Department of Neuroscience at Uppsala University in Sweden wanted to find out if somatic symptoms in adolescence predicted future mental health issues.

Bohman conducted a study that compared somatic symptoms and mental health symptoms in adolescence to adult outcomes 15 years later. In all, Bohman had longitudinal data from 369 individuals. He found that the best indicator of adult depression was the presence of somatic symptoms and depressive symptoms in adolescence. However, Bohman also found that adolescents without depression, and only somatic symptoms, had a high risk of future mental health issues. “Several somatic symptoms concurrent with adolescent depression are strongly linked to later high rates of suicidal attempts, bipolar disorders, psychotic disorders, posttraumatic stress disorder, recurrent depression, and chronic depression,” Bohman said.

As the number of somatic symptoms increased, so did the severity of future issues. Specifically, those with the most somatic symptoms in adolescence were at risk for bipolar, psychosis, and suicidal ideation. The most common and telling somatic symptom was abdominal pain, a symptom often dismissed by health care professionals as anxiety related even though it may not be. This suggests that somatic symptoms, and adolescent abdominal pain in particular, may be more accurate indicators of adult psychological issues than symptoms of depression. Bohman believes that the link between adolescent abdominal pain and adult mental illness should not be ignored. Further, he hopes that the results of this study will prompt other research efforts aimed at isolating factors that could identify young people most at risk for mental health problems in adulthood.
Reference:
Bohman, Hannes, et al. Prognostic significance of functional somatic symptoms in adolescence: A 15-year community-based follow-up study of adolescents with depression compared with healthy peers. BMC Psychiatry 12 (2012): 90. Health Reference Center Academic. Web. 28 Sep. 2012.

Internet use can be a great convenience but overuse can turn into a sad and lonely state

Can too much time on the Internet lead to depression and loneliness? Is the Internet addictive? Internet use has carved out a niche of research in communication and psychology.

A recent study surveyed tech savvy Internet users to investigate problematic Internet use.

These researchers looked at the difference between excessive and compulsive Internet use, which often showed a person’s lack of ability to curb or stop spending time on the Internet.
Talk to a therapist about compulsive Internet use.

Joseph Mazer, PhD, assistant professor of communications at Clemson University, and Andrew M. Ledbetter, PhD, assistant professor at Texas Christian University, led the investigation.

For the study, researchers recruited participants via university campus, Facebook and a professional listserv of people interested in communication and technology.

A total of 352 participants were selected, aged 18-59, 69 percent of which were undergraduate students.

Each participant answered a 31-question survey to determine thoughts and attitudes about Internet use. Questions focused on opinions about self-disclosure, social connection, apprehension/anxiety, communication/miscommunication and convenience.

Researchers looked at problematic Internet use by separating it into excessive Internet use (EIU) and compulsive Internet use (CIU).

Convenience and communication/miscommunication were found to be at the root of EIU. Problematic emotional or psychological outcomes did not appear to result from EIU.

People with CIU felt more comfortable with online self-disclosure and social connection, which often resulted in anxiety, depression, loneliness and reduced social contact.

Authors said, “[E]xcessive users seem to have a more realistic perception of online communication as temporally convenient but sometimes limited by [a lack of nonverbal communication that can only be understood in person].”

“In other words, whereas anxiety motivates CIU, efficiency seems to motivate EIU.”

Further research is needed to determine the best methods of intervention and appropriate treatment for compulsive Internet behavior.

This study was published in October in Southern Communication Journal.

By Rick Nauert PhD A new study suggests a mother’s depression and use of a common class of antidepressants can influence language development in babies.

Researchers at the University of British Columbia (UBC) and Harvard University determined that maternal depression treatment with serotonin reuptake inhibitors (SRIs) can accelerate babies’ ability to attune to the sounds and sights of their native language.

Conversely, maternal depression untreated by SRIs may prolong the period of tuning.

The research is published in the Proceedings of the National Academy of Sciences. “This study is among the first to show how maternal depression and its treatment can change the timing of language development in babies,” said Dr. Janet Werker of UBC’s Dept. of Psychology, the study’s senior author.

“At this point, we do not know if accelerating or delaying these milestones in development has lasting consequences on later language acquisition, or if alternate developmental pathways exist. We aim to explore these and other important questions in future studies.”

The study followed three groups of mothers – one being treated for depression with SRIs, one with depression not taking antidepressants and one with no symptoms of depression. Researchers measured changes in heart rate and eye movement to sounds and video images of native and non-native languages. From this, the language development of babies at three intervals, including six and 10 months of age was calculated.

Researchers also studied how the heart rates of unborn babies responded to languages at the age of 36 weeks in the uterus. “The findings highlight the importance of environmental factors on infant development and put us in a better position to support not only optimal language development in children but also maternal well-being,” said Werker, who adds that treatment of maternal depression is crucial.

“We also hope to explore more classes of antidepressants to determine if they have similar or different impacts on early childhood development.” “These findings once again remind us that poor mental health during pregnancy is a major public health issue for mothers and their infants,” said co-author Tim Oberlander, M.D.

“Non-treatment is never an option. While some infants might be at risk, others may benefit from mother’s treatment with an antidepressant during their pregnancy. At this stage we are just not sure why some but not all infants are affected in the same way. It is really important that pregnant women discuss all treatment options with their physicians or midwives.”

Previous research by Werker has found that during the first months of life, babies rapidly attune to the language sounds they hear and the sights they see (movements in the face that accompany talking) of their native languages. After this foundational period of language recognition, babies begin focusing on acquiring their native tongues and effectively ignore other languages.

Findings from the current study show that the key developmental period – which typically ends between the ages of eight and nine months – can be accelerated or delayed, in some cases by several months. In another recent study, Werker has found that this development period lasts longer for babies in bilingual households than in monolingual babies, particularly for the face recognition aspects of speech.

By Gerti Schoen, MA, LP
Exercise can be just as effective against depression as medication, especially in mild to moderate cases. Study after study has come to this conclusion, and it can help even with major depression and to prevent reoccurring episodes of it.

Just like many alternative health professionals talk about how “food is medicine”, the corresponding view is now “exercise is medicine“. For example, a recent news item claimed that exercise is more crucial in managing diabetes than food.

Having a stronger body increases overall well being even in people with low self esteem. Body and mind cannot be seen separately – an insight that athletes back in ancient Greece were well aware off.

Of course, it’s difficult to motivate yourself to move when you are depressed. It’s important to find an activity that suits the pace you are comfortable with. If walking is all you can do, then walking it is (especially when done in nature). If dancing feels possible, do that. If you like Yoga, great.

You don’t have to hit the gym. Find something that appeals to you. Being active on a regular basis (say two or three times a week) is much more beneficial than doing something strenuous once in a while.

If you can avoid medication and exercise regularly instead, even better. Drugs can have serious negative side effects, especially when taken over a long period of time. Some studies even suggest that antidepressants can lead to chronic depression.

This phenomenon seems to occur in many people, who had an initial positive response to SSRIs, then stayed on the drugs, relapsed and became treatment-resistant. This is when the depression may become permanent.

Other cautionary tales include that psychiatric drugs have led to impairment in brain development in animal studies. Robert Whitaker, author of “Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs and the Astonishing Rise of Mental Illness”, points out that the widely believed theory of chemical imbalances in the brain had turned out to be false.

It is undeniable that drugs have helped and still help countless people, especially with severe mental illness. It’s equally undeniable that many people take medication that is unneeded and may turn out to be harmful.

Everybody has to evaluate their individual situation very carefully. Take control of your treatment and inform yourself of the pros and cons of it.

There is no one treatment that fits all. Ultimately, you are the one who knows your body and mind best.

By Juhie Bhatia Creativity and mental disorders often go hand-in-hand in popular culture. In particular, bipolar disorder, marked by extreme mood swings of mania to depression, has been associated with creative types, whether it’s the image of a mad genius or a tortured artist.

The relationship between bipolar disorder and creativity isn’t quite so clear-cut, though. Bipolar disorder (formerly known as manic depression) affects approximately 5.7 million American adults, according to the National Institute of Mental Health. It’s unknown what percentage of those affected are creative, though many famous people have been linked to bipolar disorder, including artist Vincent van Gogh and writer Virginia Woolf. More recently, creative people in the public eye including actor and writer Carrie Fisher and musician Sinéad O’Connor have spoken about having bipolar disorder. Ample research and anecdotal evidence also supports this connection.

“There seems to be a higher prevalence of bipolar disorder among successful creative people, so we believe that there is probably a link. We don’t know, however, exactly what it is,” says Daniel Z. Lieberman, M.D., associate professor of psychiatry and behavioral sciences at George Washington University in Washington, D.C.

Several studies support the bipolar disorder-creativity link. For example, Nancy Andreasen, M.D., of the University of Iowa, found that creative writers were far more likely to suffer from mental illness, primarily bipolar disorder, than their counterparts in other occupations. More recently, Stanford University researchers led by Terence A. Ketter, M.D., found that children who either had or were at high risk for bipolar disorder scored higher on a creativity index. Psychologist Kay Redfield Jamison, Ph.D. — who herself has bipolar disorder — has also studied the connection between creativity and bipolar disorder, as she relates in her book Touched with Fire: Manic-Depressive Illness and The Artistic Temperament.

However, some researchers believe that there’s no correlation between bipolar disorder and creativity. In a 2001 issue of Psychiatric Quarterly, Albert Rothenberg, M.D., wrote: “There have been in recent years increasing claims in both popular and professional literature for a connection between bipolar illness and creativity. A review of studies supporting this claim reveals serious flaws in sampling, methodology, presentation of results, and conclusions.”

Bipolar Creativity: What’s the Source?
Although there may be a connection between creativity and bipolar disorder, researchers don’t know why. Igor Galynker, MD, director of The Family Center for Bipolar Disorder at Beth Israel Medical Center in New York and professor of clinical psychiatry at Albert Einstein College of Medicine, says there probably are many reasons, such as the tendency for bipolar people to have higher IQs. There may also be a genetic component, caused by a gene that is expressed abnormally in bipolar people, which could lead to unorthodox thinking. Also, people who are manic for a prolonged period of time think and process information faster, which could produce results that are more creative and more productive.

Dr. Lieberman points out, however, that although mania may be associated with a feeling of being creative, often nothing of value is produced. He adds that personality traits may also contribute to this bipolar-creativity link, since people with bipolar are often very confident risk-takers, making them all the more willing to experiment with new modes of expression. Dr. Ketter, who has done numerous studies on the topic, agrees that temperament may provide an advantage to those with bipolar disorder.

Still, most exprts agree that those with bipolar disorder — whether they’re creative or not — should seek treatment. Dr. Galynker says that the right treatment can harness the out-of-control part of the illness, while keeping the creative part intact.

“If a person has bipolar disorder and has a fantasy that without taking their medication they’ll become a genius during the manic phase, this is a recipe for disaster,” he says. “The suicide rate in bipolar illness is 10 percent. You don’t want to take any chances.”

Q: My 14-year-old son has been on Concerta (methylphenidate) for three years. Lately, he has lost weight and been depressed. His grades are also falling. The doctor was concerned about the weight loss and switched him to Strattera (atomoxetine). He said it should help with my son’s depression and appetite. What else can I try for my son? He just seems sad all the time.

A: The first thing you can do for your son is educate yourself. Depression is a whole-body illness; it involves changes not only in mood but also in almost every area of a child or teen’s life. Depression impairs sleep, appetite, energy and general health, and can lead to stomachaches and headaches. It interferes with the ability to concentrate more than ADHD does, and hinders quick thinking.

In depressed children, school performance often declines, and moodiness and emotional outbursts put a strain on family relationships. Friendships tend to suffer as a child with depression becomes increasingly withdrawn, isolated, aggressive or argumentative. If your son fits this description, he may be having a major depressive episode. You should ask your son’s physician to refer you to a psychiatrist who has expertise in the area of children’s psychiatric problems and response to medications.

If your son has been taking Concerta, a slow-release form of methylphenidate, successfully for the past three years and now has sudden weight loss and depressive symptoms, this might be the result of a different psychiatric or medical problem rather than a side effect of his ADHD medicine. Strattera can work as an anti-depressant, but it is marketed as a medication specifically to treat ADHD.

I assume your physician has considered the possibility that the weight loss and mood changes are related to some specific medical condition (for example, mononucleosis).

Learn more in the Everyday Health ADD/ADHD Center. Medically reviewed by Ed Zimney, MD

By Michelle Castillo CBS News) About 1 out of 10 Americans report having depression, according to the Centers for Disease Control and Prevention. While prescription medication is one way to treat the symptoms, the American Psychological Association (APA) is urging people in new videos to consider an alternative form of treatment first, psychotherapy.

“By arming people with information, APA is encouraging those with symptoms of depression or anxiety to ask their primary-care practitioners about psychotherapy as a first course of treatment,” Dr. Katherine Nordal, executive director for professional practice at the American Psychological Association, told CBSNews.com by email. “We want Americans to know that when it comes to treating depression and anxiety, they have choices about treatment, and psychotherapy is one of them.”

The National Institutes of Health calls depression one of the top 10 chronic health problems in the United States, affecting more than 14 million people. The National Healthcare Quality Report reported that mental health problems accounted for 156 million visits to the doctors’ offices, clinics and hospital outpatient departments in 2005.

Throughout this time, the number of people taking antidepressants has risen but the number of people seeking psychotherapy has fallen, the APA says.

Consumer Reports notes that U.S. doctors prescribed $9.9 billion worth of antidepressants in 2009, a 3 percent increase from 2008. And according to the CDC, one-third of Americans taking one antidepressant medication and less than one-half of those taking multiple antidepressants have seen a mental health professional in the past year.

In order to promote psychotherapy as a viable treatment option, the APA has started a campaign to raise awareness. Part of the campaign includes two videos that parody television commercials for antidepressants.

“Our message is in cases of mild to moderate depression, psychotherapy has been shown to be effective and give people some tools on how to deal with their depression,” Luana Bossolo, APA assistant director for public relations, said to CBSNews.com.
Bossolo said that pharmaceutical companies spend $4.2 billion on advertising, and the APA just wants to balance the trend and show people that they may have other options.

“In some cases, medication is appropriate, but what we’re trying to do is arm people with information,” she added.

Nordal added on the APA blog “Your Mind Your Body” that psychotherapy helps people work through their problems, and is a safe and secure way to help deal with depression.

“Psychotherapy provides a safe and effective treatment with enduring effects that can result in improved mood, increased energy, better job performance, more satisfying relationships, and enhanced functioning in other areas of life that are negatively impacted by depression,” she said.

By Chris Iliades, MD
Medically reviewed by Pat F. Bass III, MD, MPH What if you could avoid depression with a better diet? Recent research supports the idea that certain foods could be connected to depression, and that some types of diets can lower your risk of becoming depressed.

“When researchers came up with the term ‘brain chemical imbalance’ to explain depression, the next step should have been to supply the brain with nutrients. However, chemicals were prescribed instead,” says Carolyn Dean, MD, an author and medical director of the Nutritional Magnesium Association.

Some recent studies are showing that a diet rich in whole foods lowers the risk of depression, while a diet containing mainly processed foods may increase your risk of becoming depressed. Whole foods are natural foods that have all their nutrients intact and don’t contain additives. Processed foods are foods that may have additives and often have lost some of their nutritional value through being altered or processed. The loss of these vital nutrients from processed foods may be one of the causes of depression.

“We know that nutrients such as magnesium, essential fatty acids, and vitamin B6 and B12 help create neurotransmitters, and we are also learning that a deficiency in these nutrients can lead to a chemical imbalance in the brain,” says Dr. Dean. Neurotransmitters are chemicals in the brain that transmit signals between nerve cells. When these transmitters get too low depression can result.

Recent Research on Diet and Depression

Recently published studies are contributing to our knowledge of how nutrition might influence depression. These studies suggest that a poor diet is as dangerous for your mental health as it is for your physical health:

A study published in the American Journal of Psychiatry compared a whole-foods diet of fruits, vegetables, whole grains, and fish with a diet high in processed meats and grains and fast foods. People in the study who ate the whole-foods diet had a one-third lower risk of becoming depressed.
Another study in The British Journal of Psychiatry compared a diet rich in vegetables, fruits, and fish with one heavily loaded with sweetened desserts, fried foods, processed meats, and processed grains. The researchers concluded that after five years, eating mostly processed foods increased the risk of depression while eating whole foods decreased the risk of depression.
One small study, published in the British Journal of Nutrition, found that people with a low fat intake had a 25 percent higher risk of depression compared to those with those who consumed healthy sources of dietary fat, such as omega 3 fats, which can be found in fish like salmon and tuna, flaxseed, and walnuts.
A diet high in processed foods, sugar, and fat increases the risk of obesity. A study published in the Archives of General Psychiatry found that people who were overweight increased their risk for becoming depressed.

Diet Tips for Depression

Depression is a serious medical condition, and diet alone is not a substitute for depression treatment. If you have symptoms of depression, talk to your doctor. However, research does suggest that diet plays a role in depression and that good nutrition can lower your risk of being depressed. Consider these nutrition tips:

Eat right. Enjoy plenty of fruits, vegetables, low-fat proteins, and whole grains. Avoid processed and fatty foods, fast foods, and foods with lots of added sugar.
Watch your weight. Maintain a healthy weight with the right mix of diet and exercise.
Get your omega-3s. Make sure your diet includes foods high in omega-3 fatty acids like deepwater fish. “Among healthy volunteers, low plasma concentrations of this fatty acid found in fish predict low concentrations of a marker of brain serotonin turnover,” says Dean.
Don’t skip meals. “When you are hungry or skip meals, you lower your blood sugar. Pound for pound, the brain uses more blood sugar than any other part of the body. With balanced meals to prevent low blood sugar, you can protect yourself against depression, anxiety, and mood disorders,” says Dean.
Make sure you get enough B vitamins. These are important for maintaining brain health. “Research at the University of California at Berkeley by Dr. Bruce Ames shows that certain people have an increased need for nutrients due to minor genetic mutations,” Dean says. “Ames says that inadequate intake of folate, B12, or B6 leads to chromosome breaks just as if radiation caused those breaks.”
Get enough magnesium. “Serotonin, the feel-good brain chemical, depends on magnesium for its production and function. A person going through a stressful period without sufficient magnesium can set up a deficit that, if not corrected, can linger and cause depression,” warns Dean. Magnesium can be taken as a dietary supplement and can also be found in green vegetables and whole grains.

Depression affects so many people that it is often called the common cold of mental illness. The Centers For Disease Control estimates that 19 million Americans suffer from it. At some point in their lives, 10% to 25% of women and 5% to 12% of men will become clinically depressed. The sputtering economy and tenuousness of the job market doesn’t help: The Consumer Confidence Index just plunged to its lowest level since 1980.

Depression is no fashionable affliction. In it is real, insidious, and when in full bloom, debilitating. Yet far too many people are oblivious to their own deep sadness or simply refuse to recognize it. Emotional vulnerability? Verboten–especially among the achiever set. They’re less likely to ask for help than Tea Party members are to ask for a tax hike.

Here are 10 ways to detect depression early and let the healing begin.

1. You are over-confident and fearless.

Many people–and especially high achievers–cope with depression by acting in ways opposite to how they feel. (Shrinks call this “escapism.”) Engaging in daredevil pursuits, be it mounting a takeover of a rival company or quitting your job to open a restaurant, makes you feel invincible, when you’re really in the dumps. There is a method to this madness: The major cause of depressions–those not born of biochemical imbalances, of which there are plenty–is feeling out of control or helpless. Achievers loathe that feeling and fight like hell to deny it through action. But that, ultimately, won’t work.

2. You’ve gone from one drink with dinner to three before appetizers.

“Alcohol is the anesthesia by which we endure the operation of life.” Bernard Shaw’s observation is as true now as it was then. Drinking alcohol is the most common tactic people take to self-medicate emotional pain. The problem with this strategy is that when you finally recognize the pain driving you to drink, you’ll have two disorders to contend with rather than one.

3. You’re obsessed with achievement in bed.

Have a limp libido? Going on a Hugh-Hefner-like tear may not lift your spirits. If you find you’ve traded serial monogamy for seducing any partner that will have you, there is a good chance you’re trying to keep depression at bay.

4. Conflicts quickly escalate into fights.

One common but exceedingly dumb way to dull the feeling of helplessness brought on by depression is to show people you’re nobody’s patsy. Get cut off on the highway? Run the bastard off the road. Have an idea shot down at a brainstorming session? Take the opinionated punk outside and pummel him. If you’re lucky, maybe you’ll have enough bruises to distract you from your emotional pain.

5. You feel nothing.

Rather than be sad, many people would choose to forgo feeling altogether. But some people end up getting stuck in neutral–dooming them to invite the same pain again and again. Worse, this zombie-like approach creates anxiety in those around you and alienates those who care for you.

6. You can’t stop socializing.

Immersing yourself in group activities sounds healthy–and for many people it is. However, if the sole purpose is to keep you from wrestling with your thoughts and feelings, having a brimming social calendar is not the answer (and you probably won’t be all that fun a companion anyway). Like the toxic mortgage securities still stinking up bank balance sheets, you have to flush out the dreck before you can start investing anew.

7. You can’t concentrate.

Everyone suffers from scattered thoughts now and again. Those who are depressed but who possess too much control to act out recklessly may do so in fantasy. But how to distinguish a healthy daydream from potentially dangerous ones? Healthy dreams involve changes in your life that you can realize in a handful of steps. Unhealthy ones take you from middle-class to movie-stardom overnight.

8. You have trouble accepting praise or goodwill.

Martin Seligman, the psychologist who revolutionized our thinking about depression, studied the behavior of dogs that were given electric shocks. Eventually, they would lay helplessly in their cages, not responding to tugs on their leashes that would have moved them to safety from the shocks. The human corollary: If you find yourself ignoring favorable gestures or simple interpersonal warmth, chances are you’re not a malcontent. You’re depressed.

9. You work harder, not smarter.

When people are depressed, they have trouble seeing novel solutions to their problems. Instead, they do more of the same. The classic example is trying to exercise your way to happiness: If you already log a few hours a week at the gym, spending another 30 more minutes every day may briefly lift your spirits. But that relief is ephemeral. When it dissipates, get off the treadmill and get to the root of what’s bothering you.

10. You laugh and cry at times that don’t call for it.

In psychiatry, the concept “inappropriate affect” refers to behavior that is emotionally out of sync with the stimulus that prompted it. People who are depressed but do not know it exhibit a unique variant of this problem: They over-react to insignificant sadness, and ignore major league bad news.

This flavor of depression, a stepchild of alexithymia which causes a gross lack of appropriate feelings, can really make you feel out-of-control. I first came across it when one of my clients told me of taking his children to the movies: “I cried in the theater when a deer lost its mother,” he said, “but when my partner handed me the legal papers demanding a dissolution of our business, I threw them in my ‘In Box’ and proceeded to order lunch.”

Abraham Maslow, one of America’s most influential psychologists, observed: “What is necessary to change a person is to change his awareness of himself.” Fess up to how you feel so you can fight on.

You’ll be amazed at how relieved you’ll feel when you do.

http://www.forbes.com/sites/stevenberglas/2011/08/17/ten-signs-youre-depressed-but-dont-know-it/

Two studies have shown that medications used to treat ADHD do not increase the risk of future drug and alcohol abuse as the patients who take them grow into early adulthood.

Attention-Deficit/Hyperactivity Disorder (ADHD) is often treated with stimulant medications such as methylphenidate. Ritalin is the best known brand name of methylphenidate. Because these medications belong to a class of drugs often abused on the streets, the fear was that those who took them medicinally as children or adolescents might be more susceptible to drug abuse as young adults.

“These studies say [ADHD medications] don’t have an impact,” says Dr. Alice Charach, head of the neuropsychiatry team in the Department of Psychiatry at Toronto’s SickKids Hospital (SickKids), refering to a child’s future risk of drug abuse. At the same time, parents whose children are taking any medication on a daily basis are right to be concerned and should become informed about the potential long-term impact that medication will have, she says. The first study, published in the American Journal of Psychiatry, shows these fears to be unfounded. Researchers followed up on 112 males ten years after they had first been diagnosed with ADHD and prescribed medications, including Ritalin. At this ten-year mark, the study found no significant increased risk of abuse of drugs, alcohol, or nicotine.

The second study, also published in the American Journal of Psychiatry, also found no link with substance abuse and further concluded that it did not matter when a child was first prescribed stimulants for ADHD, nor how long the child remained on the medication: no association with future drug abuse existed.

“This information is reassuring because it is the first study of its kind to follow young people right through their age of risk,” namely, the late adolescent and early adult years when people are most likely to abuse drugs or alcohol, says Dr. Charach. Previous studies had not tracked patients for such an extended period of time.

“That these medications are linked to drug abuse is a common belief,” Dr. Charach says, adding these beliefs persist due to inaccurate information disseminated through alternative media. At the same time, “[Ritalin] does have some street value for teens and college students,” she admits, which no doubt contributes the negative public perception of these stimulant medications.

Newer, longer- and slower-acting forms of methylphenidates, which are now more commonly prescribed and were included in these studies, make the drug less attractive for those taking it for non-medicinal purposes.

Conduct disorder and future drug abuse
Dr. Charach says while there is no connection between ADHD medication and future drug abuse, the same cannot be said for conduct disorder, the psychological term for chronic bad behaviour. “Many studies have noted that if the child with ADHD has a history of breaking rules, getting into trouble, and hanging out with others who do these things as a group, there is a higher risk for future drug abuse,” she says. “Thankfully, most children with ADHD are not like this. They try very hard and are very motivated to do as they are told. They may be impulsive and have trouble paying attention, but these are now considered separate and distinct difficulties from rule-breaking and other bad behavior.”

Biederman J, Monuteaux MC, Spencer T, Wilens TE, MacPherson HA, Faraone SV. Stimulant therapy and risk for subsequent substance use disorders in male adults with ADHD: A naturalistic controlled 10-year follow-up study. American Journal of Psychiatry. 2008; 165: 597-603

Mannuzza S, Klein RG, Truong NL, Moulton JL 3rd, Roizen ER, Howell KH, Castellanos FX. Age of methylphenidate treatment initiation in children with ADHD and later substance abuse: Prospective follow-up into adulthood. American Journal of Psychiatry. 2008; 165: 604-609

by William Dodson, M.D.
It can be difficult enough to obtain a diagnosis of attention deficit disorder (ADD ADHD), but to complicate matters further, ADHD commonly co-exists with other mental and physical disorders. One review of ADHD adults demonstrated that 42 percent had one other major psychiatric disorder. Therefore, the diagnostic question is not “Is it one or the other?” but rather “Is it both?”

Perhaps the most difficult differential diagnosis to make is between ADHD and Bipolar Mood Disorder (BMD), since they share many symptoms, including mood instability, bursts of energy and restlessness, talkativeness, and impatience. It’s estimated that as many as 20 percent of those diagnosed with ADHD also suffer from a mood disorder on the bipolar spectrum — and correct diagnosis is critical in treating bipolar disorder and ADHD together.
ADHD

ADHD is characterized by significantly higher levels of inattention, distractibility, impulsivity, and/or physical restlessness than would be expected in a person of similar age and development. For a diagnosis of ADHD, such symptoms must be consistently present and impairing. ADHD is about 10 times more common than BMD in the general population.
Bipolar Mood Disorder (BMD)

By diagnostic definition, mood disorders are “disorders of the level or intensity of mood in which the mood has taken on a life of its own, separate from the events of a person’s life and outside of [his] conscious will and control.” In people with BMD, intense feelings of happiness or sadness, high energy (called “mania”), or low energy (called “depression”) shift for no apparent reason over a period of days to weeks, and may persist for weeks or months. Commonly, there are periods of months to years during which the individual experiences no impairment.
Making a diagnosis

Because of the many shared characteristics, there is a substantial risk of either a misdiagnosis or a missed diagnosis. Nonetheless, ADHD and BMD can be distinguished from each other on the basis of these six factors:

1. Age of onset: ADHD is a lifelong condition, with symptoms apparent (although not necessarily impairing) by age seven. While we now recognize that children can develop BMD, this is still considered rare. The majority of people who develop BMD have their first episode of affective illness after age 18, with a mean age of 26 years at diagnosis.

2. Consistency of impairment: ADHD is chronic and always present. BMD comes in episodes that alternate with more or less normal mood levels.

3. Mood triggers: People with ADHD are passionate, and have strong emotional reactions to events, or triggers, in their lives. Happy events result in intensely happy, excited moods. Unhappy events — especially the experience of being rejected, criticized, or teased — elicit intensely sad feelings. With BMD, mood shifts come and go without any connection to life events.

4. Rapidity of mood shift: Because ADHD mood shifts are almost always triggered by life events, the shifts feel instantaneous. They are normal moods in every way, except in their intensity. They’re often called “crashes” or “snaps,” because of the sudden onset. By contrast, the untriggered mood shifts of BMD take hours or days to move from one state to another.

5. Duration of moods: Although responses to severe losses and rejections may last weeks, ADHD mood shifts are usually measured in hours. The mood shifts of BMD, by DSM-IV definition, must be sustained for at least two weeks. For instance, to present “rapid-cycling” bipolar disorder, a person needs to experience only four shifts of mood, from high to low or low to high, in a 12-month period. Many people with ADHD experience that many mood shifts in a single day.

6. Family history: Both disorders run in families, but individuals with ADHD almost always have a family tree with multiple cases of ADHD. Those with BMD are likely to have fewer genetic connections.

Treatment of combined ADHD and BMD

Few articles have been published about the treatment of people who have ADHD and BMD. My clinical experience, having seen more than 100 patients with both disorders, shows that coexisting ADHD and BMD can be treated very well. It’s important to always diagnose and treat the BMD first, as ADHD treatment may precipitate mania or otherwise worsen BMD.

Outcomes for my patients treated for both ADHD and BMD have thus far been good. The majority have been able to return to work. Perhaps more importantly, they report that they feel more “normal” in their moods and in their ability to fulfill their roles as spouses, parents, and employees. It is impossible to determine whether these significantly improved outcomes are due to enhanced mood stability, or whether treatment of ADHD makes for better medication compliance. The key lies in the recognition that both diagnoses are present and that the disorders will respond to independent, but coordinated, treatment.

By Rick Nauert PhDSenior News Editor

Creatine is a naturally occurring amino acid typically associated with providing fuel for intense bursts of energy during high-intensity, short-duration exercises, such as lifting weights or sprinting. A new study finds the dietary supplement may also help women overcome major depression.

In a new study, researchers found that women with major depressive disorder (MDD) — also known as clinical depression — who augmented their daily antidepressant with 5 grams of creatine responded twice as fast and experienced remission of the illness at twice the rate of women who took the antidepressant alone. Researchers say that taking creatine under a doctor’s supervision could provide a relatively inexpensive way for women who haven’t responded well to SSRI (selective serotonin reuptake inhibitor) antidepressants to improve their treatment outcomes.

“If we can get people to feel better more quickly, they’re more likely to stay with treatment and, ultimately, have better outcomes,” said psychiatrist Perry F. Renshaw, M.D., Ph.D., M.B.A, senior author on the study. Although researchers are quick to point out that the findings need to be replicated in larger trials, the benefits of taking creatine could help many Americans battling major depression.

Improving treatment of depression will not only help individuals, but will also provide significant savings in both hospital and ambulatory based care settings. Experts say the economic windfall would bring a significant boost to state and federal coffers. In Utah alone, the state paid an estimated $214 million in depression-related Medicaid and disability insurance in 2008. Add the costs of inpatient and outpatient treatment, medication, and lost productivity in the workplace, and the total price of depression in Utah reached $1.3 billion in 2008, according to the U estimate.

The mechanism by which creatine works against depression is not precisely known, but Renshaw and his colleagues suggest that the pro-energetic effect of creatine supplementation, including the making of more phosphocreatine, may contribute to the earlier and greater response to antidepressants.

The eight-week study included 52 South Korean women, ages 19-65, with major depressive disorder. All the women took the antidepressant Lexapro (escitalopram) during the trial. Twenty-five of the women received creatine with the Lexapro and 27 were given a placebo. Neither the study participants nor the researchers knew who received creatine or placebo.

Eight women in the creatine group and five in the placebo group did not finish the trial, leaving a total of 39 participants. Participants were interviewed at the start of the trial to establish baselines for their depression, and then were checked at two, four, and eight weeks. In the study, researchers used three measures to check the severity of depression, with the primary outcomes being measured by the Hamilton Depression Rating Scale (HDRS), a well-accepted tool.

Investigators discovered that the group that received creatine showed significantly higher improvement rates on the HDRS at two and four weeks (32 percent and 68 percent) compared to the placebo group (3.7 percent and 29 percent). Remarkably, at the end of eight weeks, half of those in the creatine group showed no signs of depression compared with one-quarter in the placebo group. There were no significant adverse side effects associated with creatine.

The findings are important because antidepressants typically don’t start to work until four to six weeks. Still, research suggests that the sooner an antidepressant begins to work, the better the treatment outcome. As a result, Renshaw and his colleagues are excited about the outcomes in this first study. “Getting people to feel better faster is the Holy Grail of treating depression,” he says. Researchers say that future research efforts will test creatine supplements in both men and women. The South Korean University and University of Utah study is published in the American Journal of Psychiatry online.

Source: University of Utah
APA Reference
Nauert PhD, R. (2012). Creatine for Depression?. Psych Central. Retrieved on August 7, 2012, from http://psychcentral.com/news/2012/08/07/creatine-for-depression/42787.html

SUNDAY, Aug. 5 (HealthDay News)By By Barbara Bronson Gray
— For anyone raising teenagers, the idea of helping them feel grateful for everyday things may seem like a long shot; just getting them to mumble a “thank you” every now and then can be a monumental accomplishment.

But a new study suggests that helping teens learn to count their blessings can actually play an important role in positive mental health. As gratitude increases, so do life satisfaction, happiness, positive attitudes, hope and even academic performance.

Giacomo Bono, study author and a professor of psychology at California State University, Dominguez Hills, said it seems there’s not much time these days for teens to pause and consider their appreciation of their friendships, activities they enjoy or even the food on the table.

But among those kids who say they feel grateful for a variety of things in their lives, Bono found an association with critical life skills such as cooperation, a sense of purpose, creativity and persistence.

“Gratefulness allows us to understand what matters most to us and translate that to a broader goal,” said Bono. He is expected to present his research Sunday at the American Psychological Association annual meeting in Orlando, Fla.

The study involved 700 students living in New York, aged 10 to 14. The participants were white (67 percent), Asian American (11 percent), black (10 percent) and Hispanic (1.4 percent), and about 11 percent were other ethnicities or did not identify their race. The researchers took into account for socioeconomic factors and parental educational attainment, but not for religious beliefs.

The study authors defined grateful teens as having a disposition and moods that enabled them to respond positively to the good people and things in their lives, Bono said.

Students completed questionnaires in school at the beginning of the study and then four years later. Bono compared the results from the least grateful to the most grateful. He found those who were among the most grateful gained 15 percent more of a sense of meaning in their lives, became 15 percent more satisfied with their lives overall and became 17 percent more happy and hopeful about their lives. That group also had a 13 percent drop in negative emotions and a 15 percent decrease in symptoms of depression.

Bono said there’s a strong link between having a sense of satisfaction with life and feeling grateful. “People who are grateful are more optimistic and hopeful, feeling they have the resources to be successful in their future,” said Bono.

An expert involved in working with teens said it makes sense that gratitude would increase a teenager’s sense of purpose in life. “I help kids become more aware of what they’re grateful for, not just in treating depression, but in materialistic, busy, media-driven lives,” said Alec Miller, chief of child and adolescent psychology at Montefiore Medical Center in New York City.

Interestingly, socioeconomic status doesn’t appear to be linked to gratefulness. “You don’t have to be rich to feel grateful,” said Bono. “We’ve found poor kids are very appreciative when other people help them out.”

Miller agreed. “I see Medicaid kids and children from wealthy homes in Westchester County, and I don’t see any greater or lesser sense of gratitude from one group or another. It’s fairly low in both groups,” he said. “Unfortunately, our society isn’t focused much on gratefulness; it’s become out of vogue to talk about it,” said Miller. “But I give these researchers credit for reviving interest in the topic.”

Miller said he often asks kids what they’re grateful for. When they can’t identify anything much at all, he sees it as a danger sign of increased risk of severe depression and suicide. But developing a sense of gratitude in kids can help prevent the gradual erosion of self-esteem and build their sense of purpose and ability, he noted.

How can parents help instill a sense of gratitude in their children? Bono suggested parents start paying attention to their own sense of gratefulness and model it. “Talk about what you’re grateful for, and ask your kids what they appreciate,” he said. He also advised mentioning people who have helped in their lives: a teacher who stayed after class, a coach who made a difference. “Talking about gratitude helps guide us all to the things that matter most,” he noted.

Empowering yourself to challenge your inner critic.
Published on April 18, 2012 by Melanie A. Greenberg, Ph.D. in The Mindful Self-Express

The Committees in Our Heads
all have voices inside our heads commenting on our moment-to-moment experiences, the quality of our past decisions, mistakes we could have avoided, and what we should have done differently. For some people, these voices are really mean and make a bad situation infinitely worse. Rather than empathize with our suffering, they criticize, disparage, and beat us down at every opportunity! The voices are often very salient, have a familiar ring to them and convey an emotional urgency that demands our attention. These voices are automatic, fear-based “rules for living” that act like inner bullies, keeping us stuck in the same old cycles and hampering our spontaneous enjoyment of life and our abilities to live and love freely.

Where Do the Voices Come From?
Psychologists believe these voices are residues of childhood experiences—automatic patterns of neural firing stored in our brains and dissociated from the memory of the events they are trying to protect us from. While having fear-based self-protective and self-disciplining rules probably made sense and helped us to survive when we were helpless kids, at the mercy of our parents’ moods, whims, and psychological conflicts, they may no longer be appropriate to our lives as adults. As adults, we have more ability to walk away from unhealthy situations and make conscious choices about our lives and relationships based on our own feelings, needs and interests. Yet, in many cases, we’re so used to living by these unwritten internal rules that we don’t even notice or question them. And we unconsciously distort our view of things so they seem to be necessary and true. Like prisoners with “Stockholm Syndrome,” we have bonded with our captors!

What Happens When the Committee Takes Charge of Our Lives?
If left unchecked, the committees in our heads will take charge of our lives and keep us stuck in mental and behavioral prisons of our own making. Like typical abusers, they scare us into believing that the outside world is dangerous, and that we need to obey their rules for living in order to survive and avoid pain. By following (or rigidly disobeying) these rules, we don’t allow ourselves to adapt our responses to experiences as they naturally unfold. Our behaviors and emotional responses become more a reflection of yesterday’s reality than what is happening today. And we never seem to escape our dysfunctional childhoods.

The Schema Therapy Approach
Psychologist Jeffrey Young and his colleagues call these rigid rules of living and views of the world “schemas.” Based on our earliest experiences with caregivers, schemas contain information about our own abilities to survive independently, how others will treat us, what outcomes we deserve in life, and how safe or dangerous the world is. They can also get in the way of our having healthy relationships in life, work, and love.

How Negative Schemas Affect Our Lives & Relationships

Young suggests that negative schemas limit our lives and relationships in several ways:

(1) We behave in ways that maintain them.

(2) We interpret our experiences in ways that make them seem true, even if they really aren’t.

(3) In efforts to avoid pain, we restrict our lives so we never get to test them out

(4) We sometimes overcompensate and act in just as rigid, oppositional ways that interfere with our relationships.

The Abandonment Schema – Diana’s Story
A woman who we will call Diana has a schema of “Abandonment.” When she was five years old, her father ran off with his secretary and disappeared from her life, not returning until she was a teenager. The pain of being abandoned was so devastating for young Diana that some part of her brain determined that she would never again allow herself to experience this amount of pain. Also, as many children do, she felt deep down that she was to blame; she wasn’t lovable enough, or else her father would have stuck around; a type of ‘Defectiveness” schema.

Once Diana developed this schema, she became very sensitive to rejection, seeing the normal ups and downs of children’s friendships and teenage dating as further proof that she was unlovable and destined to be abandoned. She also tried desperately to cover up for her perceived inadequacies by focusing on pleasing her romantic partners, and making them need her so much that they would never leave her. She felt a special chemistry for distant, commitment-phobic men. When she attracted a partner who was open and authentic, she became so controlling, insecure and needy that, tired of not being believed or trusted, he eventually gave up on the relationship.

Diana’s unspoken rule is that it is not safe to trust people and let relationships naturally unfold; if she relaxes her vigilance for even a moment, the other person may leave. In an effort to rebel against her schema, she also acted in ways that were opposite to how she felt; encouraging her partner to stay after work to hang out with his friends, in an attempt to convince herself (and him) that she was ultra-independent. This led to chronic anger and feelings of dissatisfaction with her partner’s lack of understanding of her needs; she neither understood nor acknowledged her own role in the cycle.

What Can We Do?
Schema Therapy can help Diana (and her partner) understand how their schemas result in ways of relating to self and others that are repetitive, automatic, rigid, and dysfunctional. By acknowledging and empathically connecting with her unresolved fears and unmet needs, Diana can become more flexible and free. These new theories and therapies can help to heal couples conflict and individual problems such as anxiety, depression, personality disorders, grief, and childhood trauma. The schema concept helps us understand how early childhood events continue to influence adult relationships and mental health issues. We need to recognize their influence, pay attention to what our automatic inner voices are saying, and (with professional help, if necessary), begin to free ourselves from their grip.

Resources
Schema Therapy Website: http://www.schematherapy.com/
About The Author

Melanie Greenberg, Ph.D. is a clinical psychologist, life coach, and expert on life change, health psychology, integrative & behavioral medicine, chronic stress and pain, who has published her own research in academic journals. Previously a Professor, she is now an influential practicing psychologist, speaker, and media consultant.

By Chris Iliades, MD
Depression in healthy older people is actually less common than it is in healthy younger people, but depression and aging can be a dangerous mix for seniors dealing with chronic illness, loneliness, or loss of independence. Depression is the most important risk factor for suicide in the elderly, and older white men commit suicide more often than any other group.

Although 80 percent of depression in the elderly can be successfully treated, there are special concerns that the combination of depression and aging present. Here’s what you need to know:

Chronic illness. Diseases of aging like dementia, Alzheimer’s, Parkinson’s, heart disease, stroke, and others may have symptoms that mimic, mask, or make depression worse. These conditions often make the diagnosis and treatment of depression in the elderly more challenging.
Denial. Many elderly people, and even some caregivers, may assume that a certain amount of depression is a normal part of aging. Some elderly people may also think of depression as a weakness and be ashamed to ask for help.
Different response to treatment. Elderly people may be more sensitive to some types of antidepressant medications and may be more likely to experience side effects. On the other hand, they may respond better to simple group therapies that include exercise, and they are more likely to have depression relief through better treatment of their underlying medical conditions.

Treatment of Mild Depression in the Elderly

Depression treatment may begin with an evaluation of the elderly person’s medications. Often, adjusting or stopping certain medications may be helpful. If further treatment is needed, referral to a psychiatrist, psychologist, or other mental health professional is usually the next step:

Psychosocial treatment. Therapy that addresses social interaction is very important for many elderly people. Often, a type of intervention that relieves loneliness goes a long way — a group aerobic exercise session, like walking or swimming, can be very effective.
Talk therapy. Psychotherapy, or talk therapy, may be tried before resorting to medications. Studies show that this type of intervention works as well as medication for mild depression in the elderly. Cognitive behavioral therapy is a type of talk therapy that replaces negative thought patterns and behaviors with positive ones.
Social support. In addition to treatment, establishing a support system is particularly important for seniors. This may include group meals or meals on wheels, arranging for visiting nurses, and encouraging activities like volunteer work that reestablish a sense of purpose and encourage social engagement in elderly people who are able.

Treatment for Moderate or Severe Depression in the Elderly

When social support and talk therapy are not enough, other types of depression treatments that may be effective for depression in the elderly include antidepressant medications and electroconvulsive therapy (ECT). These therapies are almost always used in addition to psychotherapy and support:
Antidepressants. The first antidepressant medications used for depression in the elderly are usually selective serotonin reuptake inhibitors (SSRIs). SSRIs work by increasing brain chemicals that fight depression, but they may also cause thinning of bones and put elderly people at risk for hip fractures. Doctors may need to start these medications at lower doses and increase them more slowly for the elderly.
ECT. Sometimes called shock therapy, this treatment has been shown to be very helpful for severe depression in the elderly when other depression treatments are not enough.. Side effects may include loss of memory. Duration of treatment. For a first episode of depression in the elderly, treatment should continue for six months to one year after symptoms have been relieved. For an elderly person who has had more than one episode of depression, depression treatment may need to be continued for several years.

It is important for elderly persons and their caregivers to understand that symptoms of depression are not a normal part of aging. The combination of depression and aging can make diagnosis and treatment more challenging, but depression in the elderly is just as treatable as depression in other age groups.
Last Updated: 06/07/2012

One of the biggest problems in the treatment of bipolar disorder is that many people aren’t aware they are ill. This lack of awareness, termed anosognosia, can be a major barrier that keeps some people with bipolar disorder from getting the treatment they need. In their minds, they’re not sick, so why take medication?

Anosognosia in Bipolar Disorder

It is estimated that around 40 percent of people who have bipolar disorder also have anosognosia. In fact, anosognosia is the primary reason why those with this disease do not take their bipolar medications. Anosognosia is even more common in people who have delusions or hallucinations associated with their bipolar disorder. When people with anosognosia have a hallucination or delusion, they believe that what they are seeing or thinking is real, and are not convinced that an illness is causing these symptoms.

Many people with bipolar disorder have anosognosia that comes and goes, and anosognosia is often not a problem during periods of bipolar remission. But when a bipolar episode hits, they cannot grasp that they have an illness.

Anosognosia is different from denial, which is a common psychological tool people use to suppress the painful emotions associated with an illness or another stressful event. Instead, anosognosia is thought to be caused by damage to the brain, particularly the frontal and parietal lobes of the brain’s right hemisphere. The right hemisphere of the brain controls thinking skills, and damage can result in a number of problems, including difficulty with reasoning and problem solving.

Anosognosia is not unique to bipolar disorder. It is also seen in schizophrenia, stroke, brain tumor, Alzheimer’s disease, and Huntington’s disease.

Bipolar Disorder and Anosognosia: Coping Tips for Caregivers

As the caregiver for someone with bipolar disorder, you play a major role in your loved one’s life.

The patient “really need[s] to have a reliable care partner,” says Gary Sachs, MD, founder and director of the Bipolar Clinic and Research Program at Massachusetts General Hospital, and associate professor of psychiatry at Harvard Medical School in Boston.

Dr. Sachs says it is critical for someone with bipolar disorder to have somebody who can help the patient follow the treatment plan, especially when he is ill and cannot do it on his own.

Here are some ways to encourage your loved one to stick with prescribed bipolar treatment:

By Krisha McCoy When his mood is stable, tell him that studies show that people with bipolar disorder can improve with medication. Without medication, the odds of him getting sicker increase, which in turn increases the risk of hospitalization, incarceration, suicide, violent behavior, and becoming a victim of violence.
Developing a partnership with the patient is vital. And that means listening to your loved one’s fears, whether those fears revolve around the diagnosis or being hospitalized against his will.
Empathize; don’t dismiss his opinions or emotions. Get the patient to talk about what is going on, person to person.
Pay more attention to what she thinks is important, not what you think. As the caregiver, you might think that the hallucinations are a huge deal, but your loved one might think lack of sleep is the biggest problem. Discuss her problem; it will help develop trust.
Together, plan how to deal with an acute bipolar episode, especially when anosognosia is an issue.
Don’t get discouraged if you cannot convince her that she has an illness. Focus on helping her stick to her prescribed treatment. The patient might take the medications if you help her remember some of the negative experiences that occurred when she skipped medications before.

Positive airway pressure even helps patients who fail to use the treatment as prescribed, study finds.

TUESDAY, June 12 (HealthDay News) — Positive airway pressure, which is used to treat obstructive sleep apnea, may also help ease symptoms of depression among people with the sleep-related breathing disorder, a new study suggests.

Although depression is common among people with sleep apnea, researchers from the Cleveland Clinic Sleep Disorders Center found that patients who used positive airway pressure therapy had fewer depressive symptoms — even if they didn’t follow the treatment exactly as prescribed.

Obstructive sleep apnea occurs when the tissue in the back of the throat blocks the airway, which causes people to stop breathing while they are sleeping. The condition disrupts sleep and can increase the risk of other health problems such as heart disease and stroke. Positive airway pressure therapy helps correct this problem by keeping the airway open with a stream of air. CPAP, or continuous positive airway pressure, is the term commonly used to describe a form of the therapy that is delivered through a mask worn during sleep.

In conducting the study, researchers asked 779 sleep apnea patients to complete a questionnaire, known as PHQ-9, which assessed and scored their symptoms of depression. Following positive airway pressure treatment, the patients repeated the questionnaire. The study revealed that all of the participants reported improvements in their depression symptoms.

Patients using positive airway pressure for more than four hours each night showed more improvement than those who did not adhere to their treatment regimen as strictly.

“The score improvements remained significant even after taking into account whether a patient had a prior diagnosis of depression or was taking an antidepressant,” lead investigator Dr. Charles Bae said in a news release from the American Academy of Sleep Medicine.

“The improvements were greatest in sleepy, adherent patients but even non-adherent patients had better PHQ-9 scores. Another interesting finding was that among patients treated with [positive airway pressure], married patients had a greater decrease in PHQ-9 scores compared to single or divorced patients,” Bae added.

The study was scheduled to be presented Tuesday at the annual meeting of the Associated Professional Sleep Societies in Boston. The data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

More information

The U.S. National Heart, Lung, and Blood Institute has more about sleep apnea.