Monthly Archives: September 2014

When Better is Not Well in Bipolar Disorder and Depression

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bipolarLast week, the Depression and Bipolar Support Alliance (DBSA) hosted a forum entitled “Better is Not Well 2014”, in Chicago, IL.  I do not live in Chicago, so fortunately, they streamed the 90-minute event online where I was able to view it from home.

The purpose of the forum was to discuss the issue of raising treatment expectations; of taking patients from simply “surviving symptoms to creating thriving lives.”  The forum moderator and presenter, Allen Doederlein, opened the discussion by listing some of the negative consequences of living with residual mental illness symptoms.

When we’re not all the way well we are:


– at greater risk of relapse
– at greater functional impairment
– more likely to have co-occurring life-threatening conditions (heart disease, diabetes, etc.)
– at greater risk to die by suicide

So, with these negative risks, why do we settle for better instead of striving for wellness? Panelist, Dr. William S. Gilmer, M.D., Clinical Professor in the Department of Psychiatry at Northwestern University, who has specialized in the treatment of depression and bipolar disorder for more than 24 years, said the following.

We have lower expectations because we:


– feel like we’ve won just because we can get out of bed now
– don’t want to set ourselves up for disappointment
– don’t want to rock the boat or lose what we’ve gained by messing with the current treatment regimen
– see a little bit of mood dysregulation as the “new normal”

What does “better but not well” mean?

Dr. Gilmer suggests that lack of “wellness” means that “subsyndromal symptoms” are present. Subsyndromal symptoms are either one or two severe symptoms OR lots of mild ones. Either way, the symptoms do not meet the threshold of being considered an illness state but they are still there, causing discomfort and some impairment.

“Wellness is not just the absence of sickness.” ~ Panelist, Dr. Judith Cook, PhD, an internationally recognized authority on mental health services research

How do we go from better to well?

Panelists’, including two consumers with bipolar disorder, suggestions include:
– utilization of measurement-based outcomes in symptom evaluation to better track wellness levels
– better optimization of medication dosage and therapy frequencies
– not settling for better; striving for wellness
– discussing wellness with your psychiatrist; if he or she will not listen find a new one

What is your definition of wellness?  What would it look like or does it look like in your life?

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Poetry and Risperidone

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image

These pills are like duct tape across
my mouth, silencing screams
clawing to get out.

Thoughts muted; rainbows
fade to greyscale;
playground ball deflated.

Pen suspended mid-air,
stutters at best.  Spittle
on an anorexic page.

And already…
The End
like premature ejaculation.
I’m so sorry.

Smoking Cessation and Its Effects on Depression

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smoking and depression

I quit smoking seven weeks ago! Seven long weeks ago. It hasn’t been easy. Anyone who has ever kicked the nasty habit can tell you, it down right sucks at times! The physical withdrawals are, of course, at their worst the first week or two, and can play havoc with your moods, causing irritability and the like. But, what about the longer-term effects smoking cessation has on moods? Are there any?

Over at about.com’s Smoking Cessation Forum, members talk about the “Icky Threes” – the first being around day 3 of going through physical withdrawals. The second icky three is around week 3 where the psychological withdrawals begin and we have to “tackle the mental side of nicotine addiction.” Finally, comes the third icky three around 3 months of quitting where the newness of the quit wears off and we start to feel somewhat depressed.

My bipolar depression started a month after quitting, and became increasingly worse as the weeks went by. So, like a good mental health patient I visited my doctor and this is what he had to say:

psychiatrist

“Quitting smoking affects the levels of dopamine in the brain, a neurotransmitter that is responsible for feelings of pleasure and well-being. Quitting smoking also affects how your body metabolizes medication, which could therefore, cause shifts in your mood.”

Makes sense to me.

He went on to say that eventually this tends to all work itself out in most people, but for those of us with mental illnesses, we may need our medication adjusted to make the transition from smoker to non-smoker a bit more tolerable. I agree.

On the other hand, according to a review of the literature done by Ragg, et al, there is almost no published research asserting that people with depression have an increase in symptoms or return of symptoms when they quit smoking. Moreover, they state that quitting smoking may even improve their mood in the long run. (Maybe they all just had their meds adjusted??? Huh? Did the researchers ever think of that?)

Quitting smoking – improving my mood? I will have to see it to believe it. Grrrr…. Stay tuned.

And in the meantime, any former smokers out there, feel free to lay some words of wisdom on me. I will treasure them!