Category: depression

Bipolar, Schizophrenia and Depression Are Genetically Linked

I know to some people, saying that bipolar, schizophrenia and depression are genetic is like saying the sky is blue. We know that these illnesses are genetic. It’s obvious. It’s also pretty obvious (to, me, anyway) that bipolar disorder, depression and schizophrenia overlap in some ways. Nonetheless, some people require yet more proof. Well, welcome to some more proof. Bipolar disorder, schizophrenia, depression (and actually autism and alcoholism) are genetic and these illnesses’ genes even overlap. Yes, we bipolars are genetically linked to our brothers and sisters with other psychiatric disorders.

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The Separation of Depression and Bipolar in the New DSM-5

The Diagnostic and Statistical Manual of Mental Disorders (the DSM) is frequently called psychiatry’s “bible.” I, however, would not pen it that way. I would suggest that the DSM is simply a guideline for the diagnosis of mental illness. It lists the criteria one has to have in order to be diagnosed with a mental illness.

And, as the name of this post suggests, the DSM is releasing its fifth major version – the DSM-5 – in just a couple of weeks.

Now, the DSM-5 has been controversial from the get-go and I have said that much of this controversy is overstated, but some of the changes do have fundamental nosological implications. In other words, some of the changes in the DSM-5 can change how people fundamentally think of certain mental illnesses.

The DSM-5 Cuts the Chord between Depression and Bipolar

And one of the changes in the DSM-5 is the separation of major depression and bipolar disorder into their own chapters. No longer is there a chapter called “Mood Disorders” with both disorder types listed (Can we still call them mood disorders?). Now they each represent a separate category.

This may seem like a small change, and I’m not going to have a fit over it, but I will say that I think it was the wrong move.

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Why Haven’t You Killed Yourself Already?

Why Depressed People Don’t Kill Themselves

Many people with bipolar depression are suicidal. Not all, of course, but many. Most people with bipolar depression, in fact, most people who are suicidal, do not kill themselves though. In fact, you can live with suicidality for years without ever killing yourself or even attempting to kill yourself.

And while people stay alive for many reasons, I have my own reasons for not killing myself.

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Emotional Overreactions and Depression

Yesterday I was having a good day. This doesn’t happen to me all that often but I was being all productive and downright cheery. Miracles. Every day.

But then something happened. It wasn’t an earth-shattering thing, it was just a thing. A life thing. A thing that your average person would feel bad about but not the end of the world.

Just the end of my world.

Depression

Depression is a funny thing. Not so much funny ha ha but more funny want to slit your throat. Depression makes you believe things that aren’t true. Depression makes you believe that you are lowly, that you are nothing, that you are unlovable, that you are unlikeable, and a host of other things all seemingly designed to tear you to the floor.

And it’s really unfortunate when life events work to confirm, or seemingly confirm, these false beliefs.

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What’s the Worst Mental Illness?

I, as a good little webmistress, keep an eye on my web analytics. So yes, I know some things about my audience, and one of the things I know is what people are searching for when they find me. This sometimes influences what I write about, like today: What is the worst mental illness?

What is the Worst Mental Illness?

That depends on how you judge it. You could judge it by suicide rate, in which case:

  1. Anorexia is the worst with about a 20-25% suicide rate*
  2. Bipolar is second worst with about a 15% suicide rate
  3. Schizophrenia is third worst with about a 10% suicide rate

You could judge the worst mental illness based on disability rates in which case you would probably get:

  1. Schizophrenia as the worst
  2. Bipolar as second worst
  3. Depression as third worst (although more people with depression are on disability overall)

Perhaps schizophrenia is the worst as it’s associated with more psychosis (delusions and hallucination). Perhaps major depression is worst because of the number of treatment-resistant cases.

Or perhaps the answer is simply this: The worst mental illness is the one you have.

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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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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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