Tag: depression

Bipolar Spectrum Disorders – What is Cyclothymia?

Cyclothymia is neither bipolar depression nor unipolar depression but instead it is an illness that lies somewhere in the middle.

When psychiatric illnesses first started being recognized, some doctors felt that unipolar and bipolar depressions weren’t really the binary options for an illness but really just opposite ends of a spectrum. So then, one would have a spectrum where one could be a 100% bipolar depressive, or 100% unipolar depressive or they could lay somewhere in the middle. However, as illnesses need names and diagnostic criteria and not really vague percentages, bipolar and unipolar depression were defined separately.

Bipolar II – Within the Bipolar Spectrum

DSM-IV Criteria for Cyclothymia

Bipolar 2 though, is recognition of this false dichotomy. Bipolar 2 really sits in between unipolar and bipolar depression as more depressed than bipolar 1 but more hypomanic (emotionally dysregulatory) than unipolar depression. (See the difference between bipolar 1 and bipolar 2 disorders.)

And that’s fine as far as it goes. But there is also recognition from a lot of doctors that other states lie even more in the middle, and cyclothymia is one such disorder.

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Drug Trials, Antidepressants and Placebo Effect – Is it Bad?

When drug trials are conducted, the gold standard (and requirement for FDA approval) is a double-blind placebo-controlled study. In this kind of drug study participants are randomly assigned to receive either the medication or an inert (does nothing) pill known as a placebo. Neither the doctor not the patient knows whether they are getting the placebo or the real drug.

The study then compares what happens to those who received the real drug versus those who received the placebo and determines the efficacy of the real drug.

The Placebo Effect

This is critical because of something known as the “placebo effect.” The placebo effect is this odd scenario where people get better just because you give them a pill, even if the pill does nothing. Doctors and scientists don’t understand the placebo effect but not only will people get better on a placebo, but they will even experience side effects – something that isn’t possible given that the placebo is inert. But the brain is a powerful thing and something we don’t fully understand.

Treatment vs. No Treatment OutcomesAnd one of the problems with antidepressants (and many medications) is that sometimes they aren’t better than the placebo. Additionally, sometimes when they are better than the placebo, it’s only by a small margin. Drug companies have to prove that their drug is statistically significantly better than a placebo in order to get FDA approval but even this statistically significant amount can be very small.

However, this isn’t a piece about how effective are when antidepressants are compared to placebos. This is a piece about how effective antidepressants are compared to no treatment.

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The Daily Athenaeum Response Regarding the Depression Article

Last night I received a response from John Terry, the managing editor at The Daily Athenaeum. While I am rather disappointed to its content as it seems to have missed my points, I do appreciate someone from the paper taking the time to answer my email.

Objection to the Depression Article and Abusive Comments

Depression Article Response

One of the points John makes is that they cut off comments because the comments became “abusive, attacking.” While I don’t agree, the comments seem pretty tame to me, I will say that I do agree with his point that it isn’t acceptable to abuse or attack the author of the article or other commenters. In my opinion, the issue with The Daily Athenaeum’s piece has more to do with editorial permission to publish and less to do with the individual author. Any one person can be ignorant and uninformed but that’s when it’s up to the editor to step up and make sure that such content does not get published.

Moreover, my objection is around the content and the effect it has on others. This takes precedence over even editoral judgement. That multiple people that such stigmatizing and minimizing remarks were acceptable to print at all is the problem, not the individuals, per se.

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Disallowing Depression Misconceptions – Newspaper Response

Disallowing Depression MisconceptionsLast week many people read my article Disallowing Depression Misconceptions containing critical remarks about a piece in West Virginia University’s school paper, The Daily Athenaeum. The piece was entitled Depression can be treated through lifestyle changes and suggested, among other inaccuracies, that all people needed to help depression was, “a walk in the park.”

I found Depression can be treated through lifestyle changes to be stigmatizing and just plain inaccurate and I said so both here at the Bipolar Burble and in the comments on The Daily Athenaeum’s website as well. I’m pleased to say many of my readers also stopped by to express rather notable disapproval of the article.

The Daily Athenaeum’s Response to Criticism

And so what did The Daily Athenaeum do?

They removed all comments from the piece and disallowed new ones.

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Why Aren’t Lifestyle Changes Frontline Treatment for Depression?

Many people complain about overmedication. They lament that the first thing doctors do is prescribe a medication for depression or another mental illness rather than suggest lifestyle changes like exercise and meditation.

This is often true. Doctors, including psychiatrists, often prescribe medication over suggesting lifestyle changes when a mental illness like depression is diagnosed. 

And that’s a completely reasonable thing to do.

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Disallowing Depression Misconceptions

Depression MythsI despise bad reporting and I don’t care if you write for a newspaper with a circulation of 3 people or the New York Times – there is no excuse to report badly on mental illness, there is quality information available everywhere.

Point in case is Depression can be treated through lifestyle changes by Danielle Faipler in West Virginia University’s student paper, The Daily Athenaeum.

Comments on Depression can be treated through lifestyle changes

This article contains some of the most widely-spread mistruths about depression and mental illness and is inexcusable. It doesn’t even pass a sanity check (even by an insane person).

Antidepressants are good for short-term treatment, but they do not facilitate with the long-term changes needed to treat the illness, and they add to the growing prescription drug abuse problem in the U.S.

That is absolutely false and I would enjoy seeing any research that indicates otherwise. As I have shown, depressed people who take antidepressants do better long-term and antidepressants are not addictive. Stating otherwise is ignorant or untruthful.

A side effect of antidepressants is hallucinations, and most of the time, different medication is prescribed to the patient.

If the number of people who experienced hallucinations from taking antidepressants alone were to get together for a party, they could fit in my freaking apartment. Yes, it can happen with some antidepressants, but it’s far from common.

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Coffee Good for Depression. Sybil Revealed. Bipolar Questions Answered. – 3 New Things

Keep up with mental health news. Three new things in mental health to learn this week:

  • The more coffee (caffeine) your drink, the less likely you’ll be depressed
  • Clinical records of real-life Sybil (part of the basis of “multiple personality disorder”) show likely falsehoods and unethical treatment
  • Get your bipolar questions answered by a clinical psychologist

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No Evidence of the Effectiveness of Psychotherapy? – 3 New Things

This week I learned three new things about psychotherapy and depression.

I’m a fan of psychotherapy for everyone. In fact, if we could get the mid-East folks to sit down for some good counselling, I think it would be more effective in bringing peace than anything you can do with a gun.

With that said, there are limitations to therapy and sometimes therapy is not all it’s cracked up to be. So this week, a look at three perspectives on psychotherapy:

  • Psychotherapy is no better than placebo in treating depression?
  • Which type of psychotherapy is better for depression?
  • How does psychotherapy change the brain?

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I write a three-time Web Health Award winning column for HealthyPlace called Breaking Bipolar.

Also, find my writings on The Huffington Post and my work for BPHope (BP Magazine).

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