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
More Caffeine Decreases the Risk of Depression
This is one of the most marvellous pieces of mental illness information I have heard in a long time – caffeine (coffee) consumption is inversely related to depression. (More on effects of caffeine on mental illness.) In other words, the more coffee you drink the less likely you are to be depressed! Crazy, no?
Well, I guess no. According to a 10-year study of 50,739 women, the women who drank more caffeine were less likely to be depressed. Compared to depressed women who drink one or less cups of coffee per week:
- The relative risk of depression was 0.85 for women consuming 2-3 cups of coffee per day
- The relative risk of depression was 0.8 for women consuming 5 or more cups of coffee per day
- (No increase or decrease in risk was seen in those who drank decaffeinated coffee.)
Now, I’m not suggesting you buy a Starbucks or anything, but the data is quite incredible. I know one thing, I’m not skipping my morning coffee.
(According to their data, 2,607 cases of depression were identified. That number seems really low so they may have set their bar quite high for what qualifies as “depression” and thus this relationship may really exist between caffeine and severe depression, I’m not sure.)
Real Story Behind Sybil and Multiple Personality Disorder
One the more popular pieces on the Bipolar Burble written by a guest author was Everything You Know About Dissociative Identity Disorder is Wrong by Holly Gray. In this article, Holly exposes some of the myths about dissociative identity disorder – previously known as multiple personality disorder. And, of course, multiple personality disorder was made famous by the book (and movie) Sybil.
As Holly points out, there aren’t really “multiple personalities” or multiple people, inside one person with dissociative identity disorder, so the name was a misnomer and based on some very bad information – much of it from Sybil’s very public case. And A Girl Not Named Sybil in the New York Times aims to explore some of the problems with the story of Sybil, now known to actually be a woman named Shirley Mason.
Among other things, Mason’s therapist prescribes drugs in an unhealthy (addiction promoting) way and repeatedly administers sodium pentothal (truth serum as it has been commonly known). The article seems to suggest that Mason may have been making some things up and her therapist may not have been acting ethically, possibly making Mason actually worse. Do read the article. It goes to show you how one very loud, possibly untrue, case can overshadow reality.
Bipolar Question and Answer Session
Now, really, I’m your question and answer girl. You have questions, I have answers. But perhaps you’d prefer someone with a Phd to talk to. Well then you might try Dr. Rob (yes, I know). He’s hosting a live bipolar question and answer session on October 24th. You can submit confidential questions now or do so during the live session. If I can find the time I might just take a gander myself.
I get asked fairly regularly for insomnia tips or ideas on how to get a good night’s sleep. I actually have quite a bit of knowledge in this area as I’ve written many articles on sleep disorders for other sites. I know many tips and even rules for getting a good night’s sleep.
Recently I read Invisible Tattoos: The stigma of psychiatry by Dr. Henry A. Nasrallah in Current Psychiatry. Invisible Tattoos is an editorial piece on how the stigma of mental illness affects psychiatrists just like it affects the mentally ill. And my reaction?
Oh cry me a freaking river.
I thought the piece was a little whiny and navel-gazing. I mean seriously, these people are respected professionals making lots of money – they don’t have an illness threatening to kill them every day.
But then I got a comment from a medical student and I reconsidered my position. Maybe antipsychiatry poster-boy Tom Cruise doesn’t just fuck around with the way people look at me, maybe he fucks around with the way people look at psychiatrists too. And maybe stigma is difficult for psychiatrists too.
Antipsychiatry vs. Psychiatry
People, mostly antipsychiatrists, tell me I’m evil because I’m a pharma-shill as evidenced by this site. And perhaps more insidiously, others insist I’m really just caught up in a giant web of pharmacology conspiracy and I’m just too stupid and naive to know any better – thus writing me and my opinions off nicely.
This is all falderal, naturally, but the antipsychiatry folks have to have some hatred to hurl at me, I suppose.
But consider for the moment, if I am evil for what I do, how despicable a doctor – someone who prescribes the evil for others – must be.
Psychiatry and Stigma
According to Invisible Tattoos psychiatrists face stigma from their family and friends, just like the mentally ill.
- Stigma: Psychiatrists aren’t “real” doctors.
- Reality: Psychiatrists are not only medical doctors who attended the same medical schools but they attended additional schooling to become a psychiatrist as psychiatry is a further specialty.
- Stigma: Psychiatrists are only money-driven.
- Reality: Psychiatrists make less money than many other specialties and in the US, health insurance companies reimburse at lower rates for psychiatric services than other medical specialties.
- Stigma: Psychiatry treatment is considered a failure.
- Reality: The success rates in psychiatry are virtually the same, and in some cases higher, than other specialties.
Medical Students and Antipsychiatry
And not only do all these ridiculous antipsychiatry statements affect practicing doctors but they also affect medical students considering going into the field of psychiatry as this medical students expresses:
. . . in medical school and in society I keep picking up a negative perception towards mental illness. My family members keep trying to persuade me to pick internal medicine and do cardiology or GI . . . They feel that the good pay is worth it and at least I get respect from society. Even within medicine, other students tell me not to pick Psychiatry as I won’t be paid nearly as much as the more lucrative specialties such as Gastroenterology. And I won’t have to put up with society’s bullshit and demonization.
This makes becoming a psychiatrist a very difficult proposition. Do you willingly become a pariah among your family, friends and colleagues or do you go with a branch of medicine that pays more and people respect?
It’s a wonder anyone becomes a psychiatrist at all.
Why Do People Become Psychiatrists?
Well, as I’m not a psychiatrist, I can’t say for sure, but I believe, hold onto your hats, they do it to help people. That’s right, the evil-pill-pushing monsters are really trying to help people with very severe, possibly lethal, illnesses. Imagine that.
Again, this medical student expresses his reasons,
I came into medical school wanting to do Psychiatry because I particularly enjoyed working closely with patients and people, and personally feel that Mental Illness can be far more devastating than other types of illness . . . some patients may also have heart disease and diabetes, but the schizophrenia when uncontrolled leads to them not taking their pills and a downward spiral culminating in disaster. Then when I see how most patients with mental illness get ripped on by family members and society in general I feel like helping them all the more.
I don’t know the person who left these comments here, but what I do know is we need more people like that in psychiatry. What I know is it’s hard to stand up against antipsychiatry, intolerance and hatred. What I know is there are more sick people than doctors can handle and one more with a good heart can save lives.
And while I have my problems with doctors, medicine, psychiatry and psychiatrists, I will stand behind their work and always say they are doing the best they can to help people that the rest of society would happily write off.
I will never stand behind those who are not good psychiatrists, those who would abuse their power or who don’t care about their patients. But these are not the average psychiatrist. The average psychiatrist is a caring person who sees psychotic patients not because it’s lucrative or fun, but because they honestly want to help better the lives of others.
So please become a psychiatrist and I will stand with you against the hate. You deserve to be respected every bit as much as I do.
Sometimes I get so wrapped up in research, I forget some people are looking for some introductory information like the different between the types of bipolar disorder. Thanks to commenter on my GooglePlus feed, I was reminded of this fact and I decided to answer her question here so I could give her more detail.
Unfortunately, within bipolar terminology resides more bipolar terminology. But don’t be scared, I have information on most terms on my site and I shall try to walk gently into that good encyclopedia.
But let’s try to get rid of the terminology confusion: What is the difference between bipolar type I and bipolar type II?
Part of having a mental illness like bipolar disorder is having a brain that hates you. A brain that overreacts to the slightest perceived imperfection. All it takes is believing that we have done something wrong for our brain to see it as a capital offense and spend hours or days beating ourselves up about it.
This is pretty de rigueur for someone with a mental illness (especially depression or anxiety).
And this morning I got an email from someone in just this situation. This person had spent some time with friends and felt they were overly-anxietious, overly-talkative, overly-hyper and so on. And unfortunately, this person was using this perception to beat themselves up.
This is wrong. Please read my response to this person. I hope it will help anyone in this situation (which includes me, from time to time).
To those who would beat themselves up over a perceived mistake:
First of all, be gentle with yourself. This is a Buddhist concept. You deserve to be treated as well as you treat others. You’re being far too harsh.
You have to understand that your perception of what happened might be skewed. You may not have been nearly as anxious, hyper, talkative, and so on, as you think. And even if you were, others may not have found that a negative.
You’re basically beating yourself up for something that might not have even happened!
Additionally, try to remember that you’re not perfect, none of us are. Even if you weren’t perfect yesterday, that’s OK, because none of us meet that standard. These people care for you and aren’t going to judge you nearly as harshly as you’re judging yourself because they’re not perfect either.
You try your best, every day, which we all do, and that is good enough. Your flaws are OK. Your imperfections are OK. You didn’t do anything wrong or bad it’s just your brain trying to make you think you did. Brains tend to lie. You were just like everyone else. Which is what we all are.
Try to remember to be gentle. It’s rough out there. You deserve to be your own best friend.
Last week I didn’t post three new things but don’t take that to mean I wasn’t learning because I certain was, and always am. For this week I have these three new pieces of information to share:
- Repetitive transcranial magnetic stimulation (rTMS) treatment for depression to be free for (some) Canadians
- Brain changes are noted in depressed females
- Why are some doctors anti-benzodiazepine?
1. Free rTMS in Manitoba (Canada)
RTMS stands for repetitive transcranial magnetic stimulation and is a treatment for treatment-resistant depression. RTMS is considered a neurostimulation therapy, like electroconvulsive therapy (ECT), but is non-invasive. RTMS has its pros and its cons.
- Pros – rTMS is drug-free, has few side-effects and can produce remission from depression in some people
- Cons – rTMS is expensive, intensive and its therapeutic effects are generally temporary
Cost of RTMS
Most people don’t get rTMS due to the cost. Repetitive transcranial magnetic stimulation requires 2 sessions per day for 10 days (weekends off) plus and additional possible 5-10 sessions depending on the reaction to treatment. Needless to say, this is one expensive therapy. In Canada that works out to $5000 – $7500 and in the States lord only knows how much.
And Manitoba is taking the very civilized step forward of offering rTMS as part of the public health care system, which is how it should be. The only reason why it isn’t is cost. You can get rTMS in Canada, but this is the first time I’ve heard of it being free.
Congratulations to Manitoba for taking a step forward in helping people with a mental illness. I hope this is the sign of things to come across the country.
2. Brain Changes Noted in Depressed Females
Women are twice as likely to develop depression as men but no one knows why. This study takes a look at female brains to look for biological identifying markers between depressed brains and well brains.
. . . depressed women had a pattern of reduced expression of certain genes, including the one for brain-derived neurotrophic factor (BDNF), and of genes that are typically present in particular subtypes of brain cells, or neurons, that express the neurotransmitter gamma-aminobutyric acid (GABA.) These findings were observed in the amygdala, which is a brain region that is involved in sensing and expressing emotion.
BDNF and GABA in Depressed Brains of Women
BDNF is something I’ve mentioned before as to a biological cause of depression. Yes, just another fact to chalk up for all the people saying depression is just “in your head.”
And work toward identifying the gene that contributes to depression:
. . . researchers tested mice engineered to carry different mutations in the BDNF gene to see its impact on the GABA cells. They found two mutations that led to the same deficit in the GABA subtype and that also mirrored other changes seen in the human depressed brain.
I keep telling people: We’re getting closer to effective treatments and understanding every day.
3. The Religion of Benzodiazepines – Why Some Doctors Don’t Prescribe Benzos
I’ve taken benzodiazepines (benzos) of one type or another for a decade and never once had a problem with them, but many people do develop tolerance, dependence and drug-seeking behavior around this type of medication.
My opinion is that benzodiazepine medications can be used quite safely when properly handled, but that some people have the tendency to get addicted to medications, and for them, these medications may be contraindicated. In other words, it’s down to the individual and prescription of benzos cannot be characterized as “bad” or “good” in a blanket statement.
I plan on writing a whole article about this, but if you’d like a sneak peek about why some doctors are anti-benzodiazepine, check out this article in Psychiatric Times.
Until next week all, when I shall learn more and do better.
You may not know this, but ecstasy (MDMA) has been studied as a psychiatric medication. Yes, that’s right, that stuff kids take at raves. The stuff that makes you thirsty and fall in love to the person next to you. That stuff. And MDMA was shown effective in several psychiatric uses.
But research on MDMA (ecstasy) was curtailed in 1985 when the US government named it a class 1 drug (like heroin) over the objections of doctors. Psychiatric research on MDMA is gearing up again though and it has shown promise in treating post-traumatic stress disorder (PTSD) and possibly depression and anxiety.
What is Ecstasy (MDMA)?
The active substance in ecstasy is MDMA (3,4-methylenedioxymethamphetamine). However, when ecstasy is purchased on the street, MDMA is common mixed with methamphetamines and other drugs.
So, to be clear, this means that while taking MDMA in a clinical setting may pose limited risk, taking it illicitly is a different risk profile altogether. I do not recommend you buy ecstasy off the street to treat mental illness. (Particularly if you suffer from bipolar 1 or any psychotic symptoms.)
The subjective effects of ecstasy (MDMA) are produced, in part, by a huge release of serotonin. This may be responsible for reducing the perception of threats and of negative emotions in others.
Ecstasy, MDMA, also increases levels of the neurohormones oxytocin, prolactin and cortisol. Oxytocin is thought to reduce feelings of fear and increase social affiliation and trust while cortisol is a stress hormone which may explain why some people experience anxiety while using MDMA.
How is Ecstasy (MDMA) Used in Psychiatry?
Interestingly, ecstasy is being used during psychotherapy and not as a psychopharmacological treatment, per se. MDMA is administered during elongated therapy sessions (8 hours) and patients work through emotions and memories that were impossible to handle beforehand. Two or three MDMA treatment sessions may be done with preparation therapy sessions beforehand and follow-up therapy sessions after.
“. . . enhanced self-understanding [and] insight into personal patterns or problems, greater self-confidence or self-acceptance, lowered defenses [while] undergoing a therapeutic emotional process,” and “less negative thoughts or feelings.”
Studies on MDMA
Right now all the studies are on MDMA-treatment of post-traumatic stress disorder (PTSD) but look for other studies in the future. These studies on PTSD and ecstasy (MDMA) look extremely promising. Right now, several countries have completed phase one research and are onto phase two.
Risks of MDMA in Psychiatry
Risks vary depending on who you ask but in controlled, clinical use the risks of ecstasy (MDMA) appear to be minimal. While some worry about the effects on memory and cognition, some studies have shown there is no effect to these areas. There haven’t been enough participants in studies to make conclusive statements about MDMA risks.
My Thoughts on MDMA in Psychiatry
I’m very interested in such medications. MDMA works on the brain in a powerful way that other drugs do not. In this way ecstasy is unique and is hopeful for people with treatment-resistant disorders. I have a feeling that flooding the brain in this unusual way may be helpful in improving intractable disorders. This is mostly a hunch on my part, but I look forward to seeing what the future holds.
Psychiatric Times, Does MDMA Have a Role in Clinical Psychiatry? By Michael C. Mithoefer, MD, 06 May 2011
Should People with Bipolar Have Kids?
I am now 33. And that’s one of those ages where the biological clock starts to have a deafening ring. But the thing is I can’t get pregnant; I can’t have kids; I have bipolar disorder.
Admit it – you haven’t kept up with your bipolar reading. Come on. I know it. I can barely keep up and I write the bipolar articles.
Luckily for you, I like you a lot, and I’m happy to give you a little cheat sheet on what’s been getting attention at Breaking Bipolar. We’ve got mental illness and higher education, mental illness and physical pain, how to tell if it’s a med side effect and oh so much more.
Articles Breaking Bipolar Over at HealthyPlace
- Is it a Med Side Effect? – What is a medication side effect and what isn’t a med side effect? How can you tell?
- Temperature Dysregulation – Or Why I’m So Cold – Speaking of side effects – did you know psychiatric meds can change how your body temperature feels?
- Yes, You Can Get a Higher Degree With Bipolar Disorder – So many people have written me to say how successful they have been in school. Read this for inspiration and hope. Some people have taken 10 years to get their degree – but they got it. Article includes tips on being successful at school.
- Mental Illness Means Physical Pain Too – People think mental illness is “just” in your head. They would be wrong about that.
- Is It Really Never the Psychiatrist’s Fault? – I’m tired of doctors acting like they never make a mistake.
- Being Thankful Even When Anhedonic – Even when I can’t feel pleasure I can feel grateful for the things that go right in my life.
- How to Keep Going When Medication Doesn’t Work – And for your final dose of hope and encouragement, here are some tips on continuing mental illness treatment even when everything is going wrong.
Popular Articles at the Bipolar Burble
And just in case you haven’t been glued to the Bipolar Burble, here are a few things you should read here:
- Questioning the Evidence of the Efficacy of Therapy for Depression – Interesting information on how evidence-based therapy for depression really is. Less so than I would have thought. And do you think CBT is intellectual and analytical? I do, but a commenter disagrees.
- When to Get Off Antidepressants if You’re Bipolar – The first in a three-part series on getting off of antidepressants.
- Important Safety Warnings for St. John’s Wort – Please read if you’re on or thinking about trying St John’s wort.
- Cutting Supplemental Security Income Hurts Mentally Ill Children – A guest post by Allison Gamble that garnered a lot of reads.
- Psychiatric Myths Dispelled by Doctor – Fighting Antipsychiatry – Have you read this article yet? It garnered more comments than any other at the Burble. It’s always a hot topic.
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?
1. Is Psychotherapy Better Than a Placebo in Treating Depression?
When the study came out a couple of years ago alleging that antidepressants were no better at treating mild-to-moderate depression than a placebo, the antipsychiatry world went crazy (if you will). All their dire claims, it seems, had been proven true.
Well, the sky hasn’t fallen yet, but interestingly the same kind of analysis, when applied to psychotherapy, can also allege that psychotherapy is no better than a placebo too.
Of course, there is no such thing as a placebo in therapy. There is no “inert” counselling session. Scientific literature attempts to compare cognitive behavioural therapy (CBT), interpersonal therapy (IP) and others against wait-listed participants and those who have received therapy not containing the specific therapeutic technique being tested. Basically, they tell a therapist not to therapy. Which is a pretty tough thing to ask a human to do. And naturally, humans aren’t going to do it well.
Does Psychotherapy Work to Treat Depression?
I would say yes, therapy, various types, including cognitive behavioural, interpersonal and supportive therapy, all help treat depression. However, some suggest the jury is still out on how effective therapy really is in treating depression.
2. What Therapy is Best for Depression?
[push]Psychologist Gary Greenberg states CBT is more of an ideology and a “method of indoctrination into the pieties of American optimism.”[/push]
When selecting a therapy for depression one has many choices but the prevailing one in the scientific community right now is cognitive behavioural therapy (CBT). Everybody loves it. It’s the golden child. CBT is a highly intellectual and analytical therapy that is short-term and action-oriented so it’s no wonder that people like it.
In the same article as the one talking about therapy effectiveness in the treatment of depression, they also discuss which therapy is best for depression, and it kind of seems like none of the therapies are best. (This could be because, statistically, some people respond better to one treatment while others respond to other treatments and when you lump them all together, a similar percentage responds to each.)
3. What Does Psychotherapy Do to the Brain?
As I have mentioned several times, depression decreases brain volumes over time – ie, depression shrinks your brain. It does this through decreasing neurogenesis (the creation of new neurons); however, electroconvulsive therapy (ECT) and antidepressants have both been shown to increase neurogenesis and brain volume.
Interestingly, so does psychotherapy.
Until next week all. I’ll learn more and do better.
The Bipolar Burble welcomes today’s guest writer, Allison Gamble. She provides resources about psychology degrees.
Supplemental Security Income, or SSI, is a federal program that supplements income in order to help the elderly and disabled, including those with a mental illness, pay for food, clothing, health care and shelter. [push]Many who receive SSI money are children with diagnosed mental illnesses without any access to health insurance. SSI covers adults with similar conditions.[/push]
Unfortunately, recent economic proposals force many of these individuals to face reduced SSI funds or a complete cessation of aid. This would mean adequate medical and therapeutic treatment would disappear, income support for their families would be gone, and, all in all, this would represent a huge step backwards for those affected by mental illness.
Controversy Over Supplemental Security Income (SSI) Funding
Controversy over SSI funds has been brewing in recent months. Most critics’ main concern centers on aid provided to families who have children qualified to receive SSI moneys. One expose dubbed SSI “the other welfare,” alleging, among other things, that some families are medicating their children not out of medical necessity, but in an effort to obtain government assistance. The incentives to do so are considerable, argue the critics:
- SSI doesn’t come with time limits
- SSI doesn’t require those who receive benefits to be employed or to even be looking for work
- More money is typically available through SSI than through welfare
Cutting Supplemental Security Income (SSI)
[push]People who rely on SSI assistance to provide care for their children are opposing the proposed cuts. Many people on SSI are traveling to Washington to lobby lawmakers and provide testimony about the positive effect receiving SSI funds has had on their children’s quality of life.[/push]
Those who believe families are receiving SSI funding for fraudulent reasons are now looking to slash SSI benefits for everyone. Republicans in Congress have put forth two resolutions seeking such cuts. They claim the government could save considerable money by reducing incentives for parents to place their children in positions to receive SSI funds, believing parents are making their children appear disabled, or more insidiously, disabling their children or putting them on unneeded psychiatric medication, in order to collect benefits.
Effects of Cutting the Supplemental Security Income (SSI)
If the proposed cuts to SSI are approved, they will largely affect children, particularly children with a mental illness. Conditions covered by SSI benefits include:
- Bipolar disorder
- Long-term illness
- Physical disabilities
Most of these children come from families living well below the poverty line and without adequate (or any) health insurance coverage. SSI money may be helping these children receive the specialized care they require to maintain their physical and mental well-being.
How to Protect Your Supplemental Security Income (SSI) Benefits
One of the best ways to spread the word and advocate against SSI cuts is to get in touch with local charitable organizations. Support groups, charities and foundations aimed at providing assistance and advocacy for such mental illness can all be rallied to support SSI. They may also have resources and materials to facilitate advocacy for the need to continue to support SSI even during financially challenging times.
SSI provides a fundamental and necessary service for millions of children across the country. Without it, an entire generation of sick children stands to suffer a reduction in quality of life if they can no longer receive the specialized care they require. Families struggling at or below the poverty line have a legitimate need for this valuable governmental assistance.
About Allison Gamble
Allison Gamble has been a curious student of psychology since high school. She brings her understanding of the mind to work in the weird world of internet marketing with psychologydegree.net.
Or other bothersome antidepressants.
Generally, following the rules I wrote about last week on how to stop antidepressants while minimizing withdrawal work, and most people can successfully withdraw from antidepressants with few side effects.
Some Antidepressants Are Hard to Get Off Of
Unfortunately, some antidepressants are not so easy to get off of no matter what you do. (You can learn more about this through http://drugabuse.com/ and other similar sites.) Some antidepressants:
- Resist a taper strategy
- Have intolerable withdrawal effects anyway *
People Have Trouble Withdrawing from these Antidepressants
Any antidepressant can feel impossible to withdraw from, but the antidepressants people have most trouble withdrawing from are:
- Paroxetine (Paxil)
- Duloxetine (Cymbalta)
- Venlafaxine (Effexor, any version)
- Desvenlafaxine (Pristiq)
But by far, venlafaxine and desvenlafaxine (Effexor and Pristiq) are the ones I hear about. In my opinion, these two drugs are a nightmare to come off of for most people. ^ (I’m not saying everyone has trouble with these antidepressants, just that many do.)
Here are tips on how to get off of horrible~ drugs like venlafaxine (Effexor) and desvenlafaxine (Pristiq).