JANE'S MHSP ARCHIVES: 2007

Acomplia (rimonabant, manufactured by Sanofi-Aventis) is an anti-obesity drug that was supposed to be a big hit in the U.S. However, earlier this year, U.S. FDA decided not to approve the drug here in the states because the drug was found to increase suicidal thoughts and depression. Acomplia is, however, approved and available in Europe. This week, medical journal The Lancet published a review of clinical trials involving Acomplia to look at the safety and efficacy of this drug.

According to the review analysis (a meta analysis) of 4 past clinical trials involving a total of over 4100 patients, Acomplia did reduce more weight after 1 year of treatment than placebo. However, patients taking Acomplia were more than twice as likely as patients taking placebo to stop treatment because of depression. More anxiety was also seen in the Acomplia treatment group than in placebo. Even though patients with a history or risk of depressive mood were excluded from clinical trials, the observation that depression and anxiety still arose when Acomplia was taken suggests that the drug increases the risk of depression of anxiety. The study researchers suggest that doctors should monitor patients taking Acomplia for these serious psychiatric side effects. Also reported by Reuters.

The Lancet 2007; 370:1706-1713

DOI:10.1016/S0140-6736(07)61721-8

Efficacy and safety of the weight-loss drug rimonabant: a meta-analysis of randomised trials

Robin Christensen MSc a, Pernelle Kruse Kristensen BSc a b, Else Marie Bartels DSc c, Prof Henning Bliddal MD a and Prof Arne Astrup MD email address b Corresponding Author

Since the prevalence of obesity continues to increase, there is a demand for effective and safe anti-obesity agents that can produce and maintain weight loss and improve comorbidity. We did a meta-analysis of all published randomised controlled trials to assess the efficacy and safety of the newly approved anti-obesity agent rimonabant.

Methods

We searched The Cochrane database and Controlled Trials Register, Medline via Pubmed, Embase via WebSpirs, Web of Science, Scopus, and reference lists up to July, 2007. We collected data from four double-blind, randomised controlled trials (including 4105 participants) that compared 20 mg per day rimonabant with placebo.

Findings

Patients given rimonabant had a 4·7 kg (95% CI 4·1–5·3 kg; p<0·0001) greater weight reduction after 1 year than did those given placebo. Rimonabant caused significantly more adverse events than did placebo (OR=1·4; p=0·0007; number needed to harm=25 individuals [95% CI 17–58]), and 1·4 times more serious adverse events (OR=1·4; p=0·03; number needed to harm=59 [27–830]). Patients given rimonabant were 2·5 times more likely to discontinue the treatment because of depressive mood disorders than were those given placebo (OR=2·5; p=0·01; number needed to harm=49 [19–316]). Furthermore, anxiety caused more patients to discontinue treatment in rimonabant groups than in placebo groups (OR=3·0; p=0·03; number needed to harm=166 [47–3716]).

Interpretation

Our findings suggest that 20 mg per day rimonabant increases the risk of psychiatric adverse events—ie, depressed mood disorders and anxiety—despite depressed mood being an exclusion criterion in these trials. Taken together with the recent US Food and Drug Administration finding of increased risk of suicide during treatment with rimonabant, we recommend increased alertness by physicians to these potentially severe psychiatric adverse reactions.

Affiliations

a. The Parker Institute, Musculoskeletal Statistics Unit, Frederiksberg Hospital, Frederiksberg, Denmark

b. The Department of Human Nutrition, Faculty of Life Sciences, University of Copenhagen, Copenhagen, Denmark

c. Copenhagen University Library, Copenhagen, Denmark

Moving Beyond Blue

Therese Borchard at Beliefnet’s Beyond Blue interviewed me in October 2007. She asked many insightful questions including, “how do you think you know when or if you can go off your meds?” and “What did you do when you relapsed?”

I had no idea that my answers were interpreted as controversial based on the comments that flooded the interview!

For the most part, people understood (correctly) that my answer to the first question had to do with my early perception of what I was going through, when I knew just enough to admit that I had a condition that required medical intervention, and when I was still naive to know that depression can return like a vengeance, as I had personally experienced when my depression relapsed in 2001. Did I genuinely believe I could “fix myself” with one year of vigilant medication therapy and psychotherapy back in 1998? Yes, that was my naive personal belief at the time, based on my rudimentary understanding of my own depression, mixed in with a lot of denial that I would be managing the risks for this condition on a life-long basis. Am I saying that this is what people should aim for? NO!

There were some who interpreted my personal experiences and choices with medication as “anti-medication” and therefore expressed concern that I was advocating against medication. This was, of course, neither my intention nor my personal practice or belief. It would be strange for me to be antagonistic in biochemical intervention when I had earned a doctorate in biochemistry and specifically trained in looking at the biochemical basis of living systems. Those who are regular visitors to this website will find that I talk about medications and medication therapy as often as I talk about other complementary therapies (for example: exercise). I have a lot of respect for drugs because I have worked with many of them both in research and in clinical trials during the course of my health care career. I’ve always emphasized (here and on my other sites) that drugs are powerful agents with risks and benefits, and should always be administered judiciously, based on a partnership between doctors and patients.

During my relapse, I immediately went for both routes – the chemical route (antidepressants) and the psychotherapy route – as I had done when I was first seeking help for depression. Unfortunately for me, I tried 3 or 4 antidepressants and the side effects were intolerable. I remember taking two antidepressants made by a drug company that I used to work for; one made me extremely drowsy, the other made me so dizzy and nauseous that I was unable to stand up and walk a straight line.

I was forced to resort to psychotherapy as my main line of treatment, and just to be on the safe side, actually enlisted both a psychologist and a psychiatrist for double dose of psychotherapy weekly. The psychiatrist and I tried to find a drug that would work, but after almost 3 months, ultimately decided that given the suboptimal dose of a SSRI that I could tolerate, I wasn’t getting the therapeutic effects anyway, and we would stop trying to find the med that would work given that I was doing well on psychotherapy. If I wasn’t improving on psychotherapy alone, would I continue trying different medication therapies? You bet. My goal was to get better.

My approach to health – including mental health – is quite simple: I have personal responsibility for my own wellness.

This means I am accountable as a partner with my doctor(s) for my health, and given that I know I have risk factors (depression is one), I have a responsibility to monitor my own mental health so that I can recognize early warning signs before something more serious emerges.

This means I need to educate others around me, especially people close to me, so that they can help me detect abnormalities if I miss the signals.

My goal is to be well and stay well. When warranted, I make sure that the treatment decisions I make with my doctor is based on sound scientific evidence, and I make sure that I do my part in whatever non-medical (i.e. lifestyle) changes I need to make to get better. Read the Interview.

Chantix Early Warning on Suicide Ideation

Chantix (varenicline, manufactured by Pfizer) is a prescription drug to help adults stop smoking. You may have also seen ads during prime time TV. I’ve seen them as sponsors to ABC’s web episodes, which requires you to watch a Chantix ad before you could watch the episode.

According to the FDA website, “An Early Communication reflects FDA’s current analysis of available data concerning these drugs and does not mean that FDA has concluded that there is a causal relationship between the drug and the emerging safety issue.”

From the FDA website:

Based on FDA’s request for information from the manufacturer, Pfizer, Inc., the company recently submitted reports to the agency describing suicidal ideation (thoughts). In the wake of a case report citing erratic behavior in an individual who had used Chantix, FDA has also asked the company for any information on additional cases that may be similar in patients who have taken the drug.

FDA’s Center for Drug Evaluation and Research is working to complete an analysis of the available information and data. When this analysis is completed, FDA will communicate the conclusions and recommendations to the public.

In the meantime, FDA recommends that health care providers monitor patients taking Chantix for behavior and mood changes. Patients taking Chantix should contact their doctors if they experience behavior or mood changes.

FDA also advises that, due to reports of drowsiness, patients should use caution when driving or operating machinery until they know how using Chantix may affect them.

Full text of the Early Communication about the Ongoing Safety Review can be found at: http://www.fda.gov/cder/drug/early_comm/varenicline.htm.

I need a new wardrobe with my medication

Aside from sexual dysfunction, weight gain is another side effect that becomes problematic for patients who need long-term antidepressant therapy. Many patients stop antidepressant therapy on their own, without notifying the physician (“noncompliance”) due to undesirable side effects that further impact their self image or normal daily functioning.

Most Psychotropics Cause Weight Gain

The effects of antidepressant therapy on weight, particularly those within the SSRI (selective serotonin reuptake inhibitors, such as fluoxetine, sertraline, paroxetine, or citalopram) class, have been often debated. Often, early during treatment, SSRI’s have been associated with weight loss due to increased agitation in some patients. However, in the long run, the patient may gain weight due to mechanisms that are still not well understood. Atypical antidepressants such as nefazodone (brand name Serzone) and bupropion (brand name Wellbutrin) are not associated with weight gain, although bupropion appeared to be linked with weight loss. The atypical antidepressant mirtazapine (brand name Remeron) is associated with significant weight gain, which may be an advantage for elderly patients who are often dangerously underweight.

Weight gain may also be a “natural” part of recovering from depression. If a patient loses appetite due to depression and stops eating, recovery will include a desire to eat and therefore regaining of lost weight. Some antidepressants may change appetites or metabolism, and these mechanisms warrant further study.

Many have complained of cravings certain foods (such as carbohydrates) while on antidepressant therapy or mood stabilizers. While patients may not stop therapy due to weight gain, clinicians are beginning to realize that weight gain is not simply a cosmetic issue. Patients who gain a large amount of weight may be less likely to keep complying with therapy (keep taking medication as directed) and their self image will not improve. Recently, weight gain associated with medication therapy had taken on a more insidious nature – accompanied by increased risk for heart disease or diabetes.

Although new drugs in the pipeline for treating depression and mood disorders may have improved side effect profiles and minimize weight gain, for the time being, physicians do not have a many options for treating weight gain cause by medication therapy, other than changing medications or stopping the medication therapy.

Psychological v. Physiological Craving

With my own treatment-induced weight gain experience, my cravings weren’t due to hunger. I would often be full, and still crave sweets. Gorging on sweets was comforting. It was easy to lose control with a gallon of ice cream or a whole pizza pie. I saw this as a psychological side effect rather than being hungry. Since people react to medications differently, what made me gain weight may easily make someone else lose too much weight. Therefore, even testing medications that will help your symptoms improve without too many side effects remains an individual trial and error.

I have been off antidepressant therapy for many years (as of this writing; I got back in low dose fluoxetine in 2017). I was able to take off most of the extra weight through good old fashioned “eating smaller portions” and exercise. I still have carbohydrate cravings – these seemed to not go away. However, a high protein, low carbohydrate diet seemed to help take the edge off the cravings.

In addition, I also get adequate sleep. Studies have shown that lacking sleep can actually contribute to weight gain and obesity, plus other health problems associated with sleep deprivation.

Drinking water and keeping yourself hydrated throughout the day is a simple yet important way to keep your body working properly.

Incorporating weight- or resistance training with regular aerobic exercise is an excellent method to increase metabolism. Muscles require energy and you are able to burn fat even while not aerobically exercising. For women, please do not worry about “buffing up” too much. Unless you were genetically programmed for bulk, regular weight training will tone muscle, not build bulk.

Finally, when the cravings are clearly psychological – when you’re bored, when you’re stressed – keep a list of things to do to distract you from your cravings, or simply remove yourself with a walk down the block or in the park.

I know these aren’t clear-cut solutions, especially if you are still on an antidepressant for managing your depression. Trying many different methods – especially non-medication methods – can maximize your chances of controlling treatment-related weight gain.

Comments

darlene wrote: The weight I gained from SSRI’s is stuck and my metabolism seems ruined…my thyroid must have been affected in some strange way to keep me 25 lbs fatter no matter what I do. Normally with my routine of exercise/weights, eating low and clean I would be l0 lbs lighter now…not l lb. changed in a year. day, May 26, 2006 at 8:24 am

Jane wrote: Hi Darlene, You’re right, what you’re doing would normally help you take off the pounds that you had gained from SSRIs. I’m not sure if you’re still taking meds, including SSRIs, that can affect weight and metabolism. If you suspect that your thyroid has been affected, I encourage you to speak with your doctor and get tested. Friday, May 26, 2006 at 1:11 pm

Anon wrote: I’m a male who was recently treated with fluoxetine. I have always had a fast metabolism, but gained about 8lbs on the drug. I can’t seem to shift it despite a low calorie diet, regular trips to the gym and jogging. In the past, I would have faded away to nothing on this regime. Monday, November 10, 2008 at 3:54 am

Depression: Antenatal Depression Important to Address

We are becoming more aware of postpartum depression – depression that occurs in women after childbirth. However, we know very little about depression that occurs prior to childbirth, at various stages of a woman’s pregnancy. Reuters reported on a study that looks at antenatal depression, and the importance of addressing this type of depression. I’ve included the original study abstract in this post as well, for those of you interested in the scientific citation.

According to the study authors, anxiety and depression can occur during pregnancy and can become associated with postpartum depression, which makes antenatal depression an important condition to treat and to track as a risk factor for postpartum depression. Women who drank and were young when pregnant have higher risks of anxiety and depression during pregnancy. Of course, it will be important for doctors to distinguish between “normal” anxiety and bouts of depression that pregnant women experience as a result of the physico-emotional effects of pregnancy itself from pathological anxiety and depression that warrants medical attention.

Obstetrics & Gynecology 2007;110:1102-1112

Prevalence, Course, and Risk Factors for Antenatal Anxiety and Depression

Antoinette M. Lee, PhD1, Siu Keung Lam, MD3, Stephanie Marie Sze Mun Lau, BsocSc1, Catherine Shiu Yin Chong, MBBS4, Hang Wai Chui, MPH1 and Daniel Yee Tak Fong, PhD2

From the Departments of 1Psychiatry and 2Nursing Studies, LKS Faculty of Medicine, the University of Hong Kong, Hong Kong; 3Department of Obstetrics and Gynaecology, Kwong Wah Hospital, Hong Kong; and 4Pamela Youde Nethersole Eastern Hospital, Hong Kong.

ABSTRACT

OBJECTIVE: To estimate the prevalence and course of antenatal anxiety and depression across different stages of pregnancy, risk factors at each stage, and the relationship between antenatal anxiety and depression and postpartum depression.

METHODS: A consecutive sample of 357 pregnant women in an antenatal clinic in a regional hospital was assessed longitudinally at four stages of pregnancy: first trimester, second trimester, third trimester, and 6 weeks postpartum. The antenatal questionnaire assessed anxiety and depression (using the Hospital Anxiety and Depression Scale) and demographic and psychosocial risk factors. The postpartum questionnaire assessed postpartum depression with the Edinburgh Postnatal Depression Scale.

RESULTS: More than one half (54%) and more than one third (37.1%) of the women had antenatal anxiety and depressive symptoms, respectively, in at least one antenatal assessment. Anxiety was more prevalent than depression at all stages. A mixed-effects model showed that both conditions had a nonlinear changing course (P< .05 for both), with both being more prevalent and severe in the first and third trimesters. Risk factors were slightly different at different stages. Both antenatal anxiety (adjusted odds ratio [OR] 2.66, P=.004 in the first trimester; adjusted OR 3.65, P<.001 in the second trimester; adjusted OR 3.84, P<.001 in the third trimester) and depression (adjusted OR 4.16, P<.001 in the first trimester; adjusted OR 3.35, P=.001 in the second trimester; adjusted OR 2.67, P=.009 in the third trimester) increased the risk of postpartum depression.

CONCLUSION Antenatal anxiety and depression are prevalent and serious problems with changing courses. Continuous assessment over the course of pregnancy is warranted. Identifying and treating these problems is important in preventing postpartum depression.

LEVEL OF EVIDENCE: II

You CAN Get Through This

“Broken” wrote about his experience in the middle of the night, when he described finding himself unable to sleep and have rationale thoughts.

I wanted to share this post because of three things that “Broken” did for himself that probably saved his life:

1. He recognized something wasn’t right, and saw a “danger” signal.

2. He gave himself a change of scenery; in this case, he got himself out of the house.

3. He asked for help, continuously.

Having personally experienced that “bottomless abyss”, I can say that asking for help (#3) was most difficult for me, yet it’s probably the most critical. When the illness disrupts your connection to yourself, sometimes connecting with other people is a round-about way of reconnecting with yourself again. This is why it’s so important to have people who are willing to just listen to you as you purge that tangled mess in your mind.

You CAN get through this. I believe it is just like any skill that we learn and become better with practice; at least, that is what I’ve found true for myself.

Once you’ve pulled yourself through an episode, no matter how dark how frightening how long it seems to last – you realize that you CAN pull through, that you HAVE pulled through, and that you WILL be able to pull through if darkness calls again.

One Comment

broke wrote: Thanks Jane thought you might like to see this: http://www.bbc.co.uk/blogs/ipm/2007/11/blog_therapy.shtml Friday, November 9, 2007 at 3:31 pm

Type 2 Bipolar Disorder, Emotional Resilience, Science, and Humor

Welcome to the October 2, 2007 edition of carnival of depression, bipolar disorder, and mental health journeys.

Deborah’s Bipolar II Misdiagnosis Problem offered me a flash back to the past; she was diagnosed with depression but she suspects that she is suffering from type 2 bipolar disorder. Therefore she has been taking antidepressants but doesn’t seem to have gotten relief for her symptoms. I was misdiagnosed with type 2 bipolar disorder when I actually had depression. Therefore I was prescribed mood stabilizers that offered me no relief. With most mental illnesses, half the battle is a correct diagnosis because the treatment plan that ensues is directly based on the diagnosis.

Dr. Martin shares his hilarious list called The Quicksand Guide To Professional Help to laugh at the ‘experts’ that are meant to help people. My favorite is: Homeopath – “Here is some watered down glue.” (I’m sure the homeopaths out there will take offense to this one).

Dr. Deb wrote a nice article to help you build resiliency: Ten Tips For Building Resiliency. Study after study suggests that a combination of medication therapy and cognitive therapy work well for depression, and part of the goal of cognitive therapy is to help the person become more emotionally resilient.

As always, GrrlScientist shares thoughtful information on depression and bipolar disorder research that are well-referenced so you can check out the study sources and decide for yourself. The first study looks at Running Your Blues Away, where exercise is again shown to improve major depression symptoms. The second study looks at the role of light-based treatment for Bipolar Disorder

Thank you to all those who submitted articles to this edition of my mental health carnival. Congratulations to those whose entries made it into this carnival! Please note that even if your entries were not selected (my selection criteria have become stricter, and I limit each edition to include only 3-4 entries), I personally visit and read each and every one of your submissions.

Comments

Dr Martin Russell wrote: Hi Jane, Good to see a carnival that actually goes for quality rather than quantity, and you add your comments too. Even better! As a result your’s is one of the few times I have ever checked out all your recommendations. And they were all good too. Thanks. Tuesday, October 2, 2007 at 8:32 pm

Deborah Robinson wrote: I agree with Dr Martin Russell, this is a good quality blog carnival with very useful discussion about mood disorders. I am very proud to be associated with this edition. Thank you Jane. Thursday, October 4, 2007 at 1:44 am

Suicide and Self-Harm

Welcome to the October 30, 2007 edition of carnival of depression, bipolar disorder, and mental health journeys.

GrrlScientist looks at a well-covered media topic from a fresh angle: Is There A Genetic Link between SSRIs and Suicidal Ideation? She writes, “A new study provides preliminary data suggesting that a gene variant is linked to suicidal ideation triggered by SSRI treatment in a small subgroup of people taking citalopram (celexa).” The study to observe changes in proteins that affect glutamate signaling. Although this study is preliminary and only limited to one antidepressant within the SSRI class, it suggests at least a couple of things to me: 1) the possibility of using a genetic test to help identify those patients at great risk for developing suicide ideation on SSRI type of antidepressants, thereby helping physicians better manage and monitor for those risks, and 2) the role of glutamate signaling in mental illness, including depression and bipolar disorder. I’ve read years ago about the effects of lithium and valproate (BP drugs) on glutamate signaling.

Isabella’s World Mental Health Day: A Cultural Round-Up was an interesting “mental health tour” around the world, looking specifically at certain cultural groups as well as suicide trends. This was particularly timely, as I had received an email asking for mental health resources relating to Asians, for which there is a lack of information and (in my opinion) support and awareness. In many cultures, depression is still depicted as a character flaw and something to be ashamed about. This fosters continual denial and prevents people from seeking treatment for otherwise manageable diseases.

Megan Bayliss‘s A conversation about self-harm was a very smart way to present a set of frequently asked questions about self-harm. It was presented as a conversation that helps us understand how someone who self harms processes this coping mechanism. For example: Question: As you said, you have a cut to show people how you feel – yet you keep your self-harming behaviour a secret? Answer: To you it doesn’t make sense but to me it makes perfect sense. The cut is a visual display of my pain. I don’t have to share it if I don’t want to but to me it represents everything that is under the skin. And if I really have to show someone how I feel inside I can just show them my cuts.

Marcella Chester covers some recent events surrounding anger and how law enforcement make judgment calls that sometimes may have deadly consequences. One of my friends formed a company specifically to pair law enforcement personnel together with professional actors to help law enforcement better manage situations of mental health crisis.

Fear of Success and How Kids Become Bullies

Therapydoc writes about the fear of success. This was an eerie description how I used to feel:

…if your parents put you down, then you don’t think you’ve got what it takes to be someone. Having a gift at something doesn’t change your mind. Knowing you have certain strengths means nothing… If you’ve been abused then you might develop the fear that if you try to do something fabulous you’ll be PROVEN the idiot you think you are. You’re sure you’ll fail and everyone will KNOW you’re a loser as opposed to just guessing. From Therapydoc’s Tough Neighborhood- Fear of …

Therapydoc then describes what happens to some of the kids who live in an environment of constant put-downs that may be either emotional or physical (usually accompanied by violence). They become bullies and turn on the most vulnerable kids. These vulnerable kids are who the bullies are when the bullies are at home, being bullied by their parents.

These vulnerable kids learn not to draw attention to themselves, and when they become adults, they come to fear success, because it draws attention them. They self-sabotage to keep being invisible.

My question is, What’s a parent to do?

Parents whose children are vulnerable to bullies may want to do something to make the bullying stop, yet by acting, they draw additional attention to their children and adds fuel to the fire in the bullying cycle. But if they do not act, who knows how far some bullies will go, and what parents in their right mind would stand by and do nothing when their children are being tortured on a daily basis?

Do they talk to the bully child’s parents? That may be one approach, but I suspect that the bully child’s parents may often be the very reason why their kid has become a bully. These parents may very well be big bullies themselves, torturing their kid with emotional or physical abuse on a frequent basis.

I don’t know what the answer is, but I’d like to find out what you think may be solutions.

Comments

Julie Curran wrote: When I was in 6th grade,(1976) this girl Kelly wanted to beat me up (or threatened me through my ex-friend Jill) I was very upset about it, so my mother intervened. She called Kelly’s mother and requested about having a “rap session” at my house with refreshments of milk and cookies. Kelly’s mother addressed the problem to Kelly. Kelly re-evaluated her discision to bully me. We became friends, we never did have that “rap session”. But Jill still continued to make prank phone calls to my house and was relentless about it. She also got the whole class to go against me. We did become friends the next year. I forgave her. But I did learn last year (we still keep in touch) that her father used to put her and her brother down and not have any positive feedback as a father would. I can understand now why she did the things she did to me. Thursday, October 9, 2008 at 9:38 am

Jane Chin, Ph.D. wrote: Thank you for sharing your childhood story about Kelly. We don’t often have an opportunity to find out the whole story behind a bully’s story. I’m glad you had the opportunity. Saturday, October 11, 2008 at 1:19 pm

Mental Health: Fixing Yourself and Teen Suicide Increase

Marie sent me a video meditation on all the stuff she’s bought to try to “fix” herself; it was one of the more creative blog entries I’ve received. Here’s the link to Marie’s video meditation and to her blog, Diary of a Bad Buddhist. I don’t know what “dialectical materialism” is, but it makes Marie happy, and at least it only takes up virtual space and not the space in her house!

GrrlScientist is quite prolific and sent me three entries, one relating to mental health research and two relating to suicide trends. In terms of the research material, I’d recently written about the potential utility of the enzyme Protein Kinase C in designing novel drugs for treating the mania phase of bipolar disorder, although I have reservations about the clinical study itself (too few participants). GrrlScientist covers a few other recent developments in bipolar disorder research.

I had seen the recent CDC report on teen suicide and wanted to bring it to your attention. I also remember last year when GrrlScientist wrote about her own suicide attempt and her experiences in the psychiatric ward (and no one taking good care of her parrots!).Thus GrrlScientist can write about suicide prevention from a personal perspective and I encourage you to visit her article.

Part of the speculation around the increase in suicide amongst teens is whether the 2003 mandatory “black box” warning for antidepressants had something to do with this trend. In other words, are teens killing themselves due to depression that is not treated, as doctors have become wary about prescribing SSRI-class of antidepressant drugs to children and teens after numerous reports of SSRI-induced suicidal ideation? GrrlScientist writes about this also.

Last week, I listened to a radio interview with one of the authors of CDC’s suicide trend and this question was raised. The author didn’t directly address it, only emphasizing that suicide is a complex behavior and is contributed by many factors. I think treating teen and child depression can get tricky, and the black box warning serves to make doctors aware of the risks involved when prescribing these drugs off-label (i.e. not approved by the FDA) for such vulnerable population of patients. That’s not to say that a doctor cannot prescribe an SSRI antidepressant for a patient whose condition requires immediate treatment, but the risk warnings caution doctors to carefully watch and monitor that patient if an off-label prescription is given.

How This Shrink Picks Antidepressants

Dinah at Shrink Rap wrote an article about how she chooses antidepressants for patients who come and see her. The factors, which Dinah’s full article elaborates, include: Past history of response, Family history of response, Patient preference, Other Medical Issues, My Best Guess at What Will Help the Target Symptoms, My Best Guess at the Side Effect Profile, and The Patient’s Financial Concerns and What I have Samples of. Dinah also talks about concerns with weight gain on antidepressants, and how this is often a very individual side effect even if the drug “class” itself has been associated (statistically) with weight gain in patients.

One Comment

mliss wrote: My daughter age 20 has been diagnosed as bi-polar, as have I. The problem is I don’t see any mania. It is all depression. Crying, can’t get out of bed, anxiety because she is 20 and afraid to get her driver’s license which makes her feel isolated. She takes 200mg of Lamictal; 200 mg Seroquel and 1 mg of Klonopin. No anti-depressants (I use Prozac). She has tried Prozac, Wellbutrin, Effexor, and some others. I keep hearing about a new kind of anti-depressant that is not an SSRI. Any recommendation? Wednesday, September 26, 2007 at 1:52 pm

Work Place Depression Common in Healthcare Workers

The Office of Applied Studies (OAS) in the US Department of Health and Human Services (HHS) published a study looking at the rate of work place depression from years 2004-2006 in workers ages 18-64. They found that each year, about 7% of full time workers experienced major depression, and the highest rates of depression occurred in those working in the personal care and service industry (10.8%). Healthcare practitioners and technicians came in at 3rd place with a depression rate of 9.6%.

Female workers reported a higher incidence of depression than male workers; this was a trend across the board regardless of occupation type. I found interesting that female workers in management reported 3 times as much depression (9.5%) versus male workers in management (3.3%). Other mental health surveys already suggest a higher rate of depression in females compared with males, and the OAS data does not suggest that there are factors in the workplace specific to females that could have caused a higher incidence of depression in females. However, one may speculate that certain disparities in the workplace may be a factor contributing to depression in female workers.

Depression in the work place is real, and cannot be ignored. Given our love affair with work, it is important to recognize signs of depression early and receive appropriate treatment.

Asians and Mental Health

Recently John asked me about some resources relating to Asians and bipolar disorder. John further says, “I don’t think psychotherapy is prevalent, valued or even understood in Asian cultures.”

John’s observation is unfortunately correct. Although compared with 10 years ago, there is some increased awareness of mental health issues including depression and bipolar disorder among Asian cultures, mental illness is still in large “dealt” through denial and shame. Recently, in Taiwan and Hong Kong, for example, there had been suicides amongst some celebrities, which in turn casts some light on the issues of depression and suicide. In Japan there has been high suicide rates among young people.

However, from my own observation, mental health remains rarely talked about or well understood in Asian cultures. I hope that with the globalization of information, some of the progress we’ve made in the West relating to social perception of mental health can connect with people in other cultures.

Here are some info I’ve shared with John via email (and some I newly added since emailing him) that you may find useful:

Asians and Bipolar disorder – John Mcman’s article

DJ Chuang’s page of resources (not necessarily specific to Asians, but has good references) on bipolar disorder; sometimes written from a religious perspective.

Depression and Minorities – health provider article

japan mental health

NAAPIMHA (might be good to call them and ask for specific resources)

Asian-American mental health

Health: Asians Get Depressed, Too

From my own website: Asian Students, Depression, and Suicide: Begin with the Parents!

Not specific to Asians, but a good backgrounder is the Usernet FAQ List. Here is the index for alt.support FAQ’s.

A troubling piece I found on the Wall Street Journal: “In China, Controversial Brain Surgery for Mental Illness”

Medication: Breast Cancer Drug in Bipolar Mania

Reuters reported on a study by the National Institute of Mental Health that showed breast cancer drug tamoxifen may have an effect on the “manic” symptoms of bipolar disorder. The researchers used tamoxifen because of its effect on protein kinase C (PKC), an enzyme that has many effects on cells, including brain cells. PKC may be overactive in bipolar mania. The study was published in the September 2007 issue of the medical journal, Bipolar Disorders.

My major concern about this study is that it is extremely small: only 16 patients. These 16 patients were then given either tamoxifen or placebo for 3 weeks, and 10 out of the 16 patients had reduced mania symptoms compared with placebo. According to the study, effects were observable within 5 days. According to Reuters, tamoxifen is “too dangerous” of a drug for use in bipolar disorder, and this study is meant to encourage the search for bipolar disorder drugs that target PKC. One of the study investigators believes that targeting PKC may allow for faster effects of antimania drugs.

Zarate Jr CA, Singh JB, Carlson PJ, Quiroz J, Jolkovsky L, Luckenbaugh DA, Manji HK. Efficacy of a protein kinase C inhibitor (tamoxifen) in the treatment of acute mania: a pilot study.

Bipolar Disord 2007: 9: 561–570. © Blackwell Munksgaard, 2007 (free text is available as of September 12, 2007)

Objectives: Considerable preclinical biochemical and behavioral data suggest that protein kinase C inhibition would bring about antimanic effects. Notably, the structurally highly dissimilar antimanic agents lithium and valproate, when administered in therapeutically relevant paradigms, attenuate protein kinase C inhibition function. There is currently only one relatively selective protein kinase C inhibitor that crosses the blood–brain barrier available for human use – tamoxifen. Our group recently conducted a single-blind study with tamoxifen in acute mania and found that it significantly decreased manic symptoms within a short period of time (3–7 days). In this study, we investigated whether antimanic effects can be achieved with a protein kinase C inhibitor in subjects with mania.

Methods: In a double-blind, placebo-controlled study, 16 subjects with bipolar disorder, manic or mixed, with or without psychotic features, were randomly assigned to receive tamoxifen (20–140 mg/day; n = 8 ) or placebo (n = 8 ) for three weeks. Primary efficacy was assessed by the Young Mania Rating Scale.

Results: Subjects on tamoxifen showed significant improvement in mania compared to placebo as early as five days, an effect that remained significant throughout the three-week trial. The effect size for the drug difference was very large (d = 1.08, 95% confidence interval 0.45–1.71) after three weeks (p = 0.001). At study endpoint, response rates were 63% for tamoxifen and 13% for placebo (p = 0.12).

Conclusions: Antimanic effects resulted from a protein kinase C inhibitor; onset occurred within five days. Large, controlled studies with selective protein kinase C inhibitors in acute mania are warranted.

Original source: Reuters Health

First Trimester Pregnancy Use of Antidepressants

Pregnant mothers who have depression or are at the risk of depression are often concerned about the effects of antidepressants on their developing babies. A study published in late June (full abstract is included below) suggested that risks of 3 types of birth defects – craniosynostosis, omphalocele, or heart defects – were not significantly increased with SSRI use overall. However, there appeared to be a slight increase in risk in certain birth defects with certain types of antidepressants: paroxetine (brand name Paxil) and sertraline (brand name Zoloft) were two medications found to have associated increase in certain birth defects. The authors concluded that the absolute risk of birth defects due to antidepressant use during the first trimester of pregnancy is small.

“First-Trimester Use of Selective Serotonin-Reuptake Inhibitors and the Risk of Birth Defects” by Carol Louik, Sc.D., Angela E. Lin, M.D., Martha M. Werler, Sc.D., Sonia Hernández-Díaz, M.D., Sc.D., and Allen A. Mitchell, M.D. Published in New England Journal of Medicine (NEJM) Volume 356:2675-2683, June 28, 2007, Number 26.

ABSTRACT

Background The risk of birth defects after antenatal exposure to selective serotonin-reuptake inhibitors (SSRIs) remains controversial.

Methods We assessed associations between first-trimester maternal use of SSRIs and the risk of birth defects among 9849 infants with and 5860 infants without birth defects participating in the Slone Epidemiology Center Birth Defects Study.

Results In analyses of defects previously associated with SSRI use (involving 42 comparisons), overall use of SSRIs was not associated with significantly increased risks of craniosynostosis (115 subjects, 2 exposed to SSRIs; odds ratio, 0.8; 95% confidence interval [CI], 0.2 to 3.5), omphalocele (127 subjects, 3 exposed; odds ratio, 1.4; 95% CI, 0.4 to 4.5), or heart defects overall (3724 subjects, 100 exposed; odds ratio, 1.2; 95% CI, 0.9 to 1.6). Analyses of the associations between individual SSRIs and specific defects showed significant associations between the use of sertraline and omphalocele (odds ratio, 5.7; 95% CI, 1.6 to 20.7; 3 exposed subjects) and septal defects (odds ratio, 2.0; 95% CI, 1.2 to 4.0; 13 exposed subjects) and between the use of paroxetine and right ventricular outflow tract obstruction defects (odds ratio, 3.3; 95% CI, 1.3 to 8.8; 6 exposed subjects). The risks were not appreciably or significantly increased for other defects or other SSRIs or non-SSRI antidepressants. Exploratory analyses involving 66 comparisons showed possible associations of paroxetine and sertraline with other specific defects.

Conclusions Our findings do not show that there are significantly increased risks of craniosynostosis, omphalocele, or heart defects associated with SSRI use overall. They suggest that individual SSRIs may confer increased risks for some specific defects, but it should be recognized that the specific defects implicated are rare and the absolute risks are small.

You may also read an interpretation of this and other related studies at the Wall Street Journal Health Blog.

8 Comments

Amy wrote: My girlfriend who had been on antidepressants for years prior to conceiving, went off her medications at the advice of her doctor after weighing the possible effects on her child. She would have been at about 10 weeks on Monday, and committed suicide last night. We are all in shock. It seems that the greatest harm to the development of the fetus is the loss of the mother. Low birth weight and a few weeks premature look acceptable to me in light of today’s events. Yours is the first information I read today that has even suggested it is perfectly fine for a mother-to-be to continue her treatment. Please make this side of the arguement be heard with a more powerful voice. Wednesday, November 14, 2007 at 6:34 pm

Jane Chin, Ph.D. wrote: Hi Amy, I’m so sorry to hear about your friend. I’ve been getting more emails relating to the risk/benefit ratio of antidepressants during pregnancy, and in the past I’ve also reviewed a book by a medical doctor who looks at depression before, during, and after pregnancy. Resources for pregnancy and depression remain scarce! It’s very easy to make blanket judgments on ‘stopping all meds’ when a woman is pregnant, yet for some who suffer from clinical depression and become pregnant, the decision is not that simple. It is indeed true that the most harm to the baby occurs when the mother harms herself, and in tragic cases, ends her life due to a very treatable illness. I believe that our doctors – especially ob/gyns who see pregnant women – may need to be more vigilant about looking at individual patients’ risk factors and weigh the risks of depression in the big picture. My condolences, Jane Wednesday, November 14, 2007 at 11:09 pm

adrienne einarson wrote: I just came upon this website as I was looking to see what was on Google regarding the use of antidepressants in pregnancy. I am so sorry to hear about your friend I study the safety of antidepressants in pregnancy(I have published many studies,you can GOOGLE me) and there is no evidence to say that a woman should not be able to take these drugs in pregnancy if she requires treatment. Unfortunately, physicians are not doing their homework by looking in the literature and are giving women incorrect advice, sometimes with tragic consequences like what happened to your friend Tuesday, September 16, 2008 at 10:45 pm

adrienne einarson wrote: There is really a great deal more information than you think regarding depression in pregnancy and the safety of antidepressants. In the scientific literature there is information on thousands of pregnancy outcomes of infants whose mothers took antidepressants in pregnancy with no adverse effects on their babies. Unfortunately, only the few reports of babies who did have problems hits the lay literature and usually the baby does not have the problems because of the drug, although the mother is convinced that it is. No-one mentions that in every pregnancy there is a 1-3% chance of having a baby with a birth defect whether you take a drug or not, this is nature
In addition, reporting is very biased, studies that have shown risk far more frequently get reported than ones who don’t. For instance, I recently published a study in The American Journal of Psychiatry in June of this year, with 1100 women exposed to Paxil and a comparison group of 1100 women who were not exposed and the rates of heart defects was exactly the same in each group. Unfortunately this study was not picked up by the media, so no-one heard about it. If I had found something bad, you can be sure that it would all over the media. This is wrong because women and their health care providers have the right to know if something is safe, just as much as if it is not
You can call Motherisk at 416 813-6780 inToronto, Canada or other organizations like Motherisk in the US, where you can find the numbers to call on the website http://www.otispregnancy.org In addition there is also a group in Europe http://www.entis.org
You will be given all the up to date evidence-based information from proper studies

Depression Caretakers and Bipolar Disorder Myths

James Bishop is becoming one of my favorite mental health bloggers, and that’s not just because he displays the picture of a (smiling?) camel on his “about” page. James consistently writes quality articles on depression and bipolar disorder, and is working on a “health diary” software program to help people track their moods and health.

James’ article, “12 Ways to Care for a Depressed Person” suggests ways that you can help someone you love who is depressed. These 12 steps include: Understand the illness, Seek Appropriate Treatment, Provide Emotional Support, Keep the Illness Separate, Listen Non-Judgmentally, Make a Plan, Look after yourself, Organize their medicines, Support network, Get out and About, Help with daily tasks, and Spend normal time together.

When I was clinically depressed, I was unproductive. Stephen shares “7 Ways to Stay Productive Through Depression“, which include: Share with someone intimately close, Stay with people and try to stay focused on the moment, Avoid all instances of overhyped optimism and feel good inspirationals (this is important if you have a tendency to use anything and everything to figuratively beat yourself up!), Accept it as part of your creative cycle and allow the rest, Look for ways to help others through deep conversations, Tell/ask God, “Screw You!”, “Help Me!”, “This Shit Sucks”, “Whats the Point?”, or anything else on your mind and seek guidance, and Remember that it will pass and look toward the future.

Along a similar vein, Albert Foong a.k.a Urban Monk tackles “taming your monkey mind“. This has little to do with the often superficial hyped up “positive thinking”, and Albert references a prior article on “the dangers” thereof. There are two levels that Albert discusses. While I tend to exclude articles that have been submitted to multiple carnivals (and therefore less unique to my carnival!), I’m going to include this one because the information may be helpful for you.

D Kai Wilson – I know what you mean about being asked questions that you’ve answered repeatedly! It doesn’t really happen here on my mental health website, but it happens a lot on one of my other websites. This is why D Kai posted 8 myths about bipolar disorder and subsequently “busts them” one by one with her responses. So if you are wondering about the following:

Myth: bipolar disorder isn’t manic depression

Myth: You can diagnose bipolar disorder with a blood test

Myth: Bipolar disorder is easy to diagnose

Myth: Bipolars are easy to spot/can’t hold down a job

Myth: Bipolars have an excuse for ‘bad’ behavior.

Myth: Bipolars aren’t aware of how they should behave

Myth: Moods don’t mix and it’s very easy to judge where someone will be based on what they’ve been saying and doing.

Myth: You cannot get pregnant if you are bipolar

Look no further. Your answers are here!

6 Comments

Tom Wootton wrote: In my new book The Depression Advantage is a chapter called Redefining Functionality. It changes the paradigm from an attempt to function the same in all states to one that has state specific functionality. Learning to control mania while retaining some of the advantages is entirely different from gaining insight in depression or functioning while ‘normal.’ The problem in depression is that our limited definition of functionality does not work at all. We need a definition that is specific to the state of depression and allows for functionality in areas outside normal measurements of productivity. The definition must take into account “the purpose that something is designed or expected to fulfill.” Functionality in depression is not measured by how many things we can create. It is measured by what insight we gain and what changes in our behavior are precipitated by that insight. http://www.depressionadvantage.com has more information about the book. Saturday, August 25, 2007 at 9:43 am

Albert | UrbanMonk dot Net wrote: Hi Jane, thanks for including me in this carnival. The other sites you have included are top quality, and it’s great to see my name amongst those. Thanks again! Saturday, August 25, 2007 at 10:25 am

Miracle wrote: Thank you for including my post about being productive. The article was not a typical post in my blog, but I found it at the time important to write. It is still one of my favorites and I’m glad I was able to share it in this carnival. Sunday, August 26, 2007 at 6:44 pm

james wrote: Thanks for including my article in your Carnival, and for your kind words. Tuesday, August 28, 2007 at 11:56 pm

Brenda wrote: My daughter has bipolar disorder and she tries to stay positive. She is more productive when she is stable. When she is in a manic episode she is not very productive. This is because she can work on a hundred different things and not finish even one. When she is stable she can focus on finishing what she starts and this makes her more productive. Thursday, August 30, 2007 at 2:29 pm

Pat Stoiber wrote: My son is bipolar and in a depression. His wife tells him to be himself and not be depressed. She has no patience for this. She thinks it is a weakness. Thursday, February 19, 2009 at 11:10 am

Depression: Constantly Talk About Problems Makes It Worse

I found an interesting report in a current issue of Developmental Psychology that suggests a limitation of constantly talking about your problems with friends – at least if you are a teenager girl. Dr. Amanda Rose studied 813 children and teens for 6 months and saw that girls who spent a lot of time co-ruminating with peers (constantly talk about their problems with friends) are more likely to develop depression and anxiety than those who did not. While it makes sense to talk about problems, there are limitations especially when problems are continually talked about. Dr. Rose suggested that these results may also apply to adults.

It made a lot of sense to me, because constantly talking about your problems becomes a negative reinforcing behavior. If you believe that “what you focus on expands”, as I do, then continually focusing on problems – instead of looking to solutions and ways to move through the problems – trains us to look for more problems to focus on. Over time, it’s no wonder that one begins to develop a pessimistic view and even becomes depressed and anxious. Our brain wirings are “plastic”, which means we can train our brains and even shape how our brains work by what we feed our brains physically and psychologically. Dr. Rose’s study is definitely worth contemplating.

Developmental Psychology (limited time: full PDF of the study)

2007, Vol. 43, No. 4, 1019–1031

Prospective Associations of Co-Rumination With Friendship and Emotional Adjustment: Considering the Socioemotional Trade-Offs of Co-Rumination

Amanda J. Rose, Wendy Carlson, and Erika M. Waller

University of Missouri—Columbia

Co-ruminating, or excessively discussing problems, with friends is proposed to have adjustment tradeoffs. Co-rumination is hypothesized to contribute both to positive friendship adjustment and to problematic emotional adjustment. Previous single-assessment research was consistent with this hypothesis, but whether co-rumination is an antecedent of adjustment changes was unknown. A 6-month longitudinal study with middle childhood to midadolescent youths examined whether co-rumination is simultaneously a risk factor (for depression and anxiety) and a protective factor (for friendship problems). For girls, a reciprocal relationship was found in which co-rumination predicted increased depressive and anxiety symptoms and increased positive friendship quality over time, which, in turn, contributed to greater co-rumination. For boys, having depressive and anxiety symptoms and high-quality friendships also predicted increased co-rumination. However, for boys, co-rumination predicted only increasing positive friendship quality and not increasing depression and anxiety. An implication of this research is that some girls at risk for developing internalizing problems may go undetected because they have seemingly supportive friendships.

One Comment

A. S. Mathew wrote: When we share out burdens and problems with our close friends, we may feel like some heavy load is lifted. On the other hand, the same topics of problems talked repeatedly will cause more burden to our friends, and through the perpetual talking of problems, we are naturally opening wide doors for more problems to land in heads. Problems are negative
waves of life and when we profess that constantly, that will bring us more negative waves in life; on the other hand, positive confessions will bring prositive waves in life. I knew personally many people who were plagued with a negative spirit of failures and they were
talking about that constantly and they all ended up in greater pains and sufferings in life through many unexpected setbacks and tragedies of life. When we have negative thoughts of failures, keep our tongue under chain and lips locked, and we will be winners over the problems of life. Friday, May 3, 2013 at 4:49 pm

Smoking Pot Increases Risk of Developing Schizphrenia

British psychiatrist Stanley Zammit and his colleagues published a study in The Lancet that suggests a link between marijuana (“pot”) use and increased risk of developing psychotic illnesses like schizophrenia by up to 41%. While the marijuana debate has often focused on “medical uses”, this report suggests that new dangers of smoking pot or marijuana. The study was conducted at the University of Bristol and funded by the Department of Health.

On the other hand, a member of the investigators admitted that questions remain whether smoking pot actually causes psychotic illnesses, or whether people who use marijuana may already be predisposed to a psychotic illness. Still, all the studies have found a link between smoking pot and development of psychotic illness, and the researchers believed that a public warning is appropriate.

Issue of The Lancet (requires subscription)

Cannabis increases risk of psychotic illness later in life

Press release issued 27 July 2007

Further evidence that using cannabis could increase the risk of developing a psychotic illness such as schizophrenia, later in life, is revealed today in a study published in The Lancet (27 July).

Cannabis, or marijuana, is the most commonly used illegal substance in most countries, including the UK and USA. About 20 per cent of young people now report using cannabis at least once per week.

Dr Stanley Zammit from Bristol and Cardiff Universities, and colleagues at the universities of Bristol, Cambridge and Imperial College London, analysed 35 studies dated up to 2006. They assessed the strength of evidence for a causal relationship between cannabis use and the occurrence of psychotic or other mental health disorders.

The study, funded by the Department of Health and based in the University of Bristol, found that individuals who used cannabis were 41 per cent more likely to have any psychosis than those who had never used the drug. The risk increased relative to dose, with the most frequent cannabis users more than twice as likely to have a psychotic outcome.

Professor Glyn Lewis from the University of Bristol, and senior author on the paper, said: “It is difficult to be certain about whether cannabis use causes psychotic illnesses such as schizophrenia. It is possible that the people who use cannabis might have other characteristics that themselves increase risk of psychotic illness . However, all the studies have found an association and it seems appropriate to warn members of the public about the possible risk.”

Dr Zammit added: “Policymakers want to provide the public with advice about this widely used drug. However, even if cannabis does cause an increase in risk of developing psychosis most people who use cannabis will not develop such an illness. Nevertheless, we would still advise people to avoid or limit their use of this drug, especially if they start to develop any mental health symptoms or if they have relatives with psychotic illnesses.”

At present, there is little good evidence suggesting that cannabis use increases the risk of depression, suicidal thoughts, and anxiety. Further research could help to decide whether there is a link.

The authors estimate that if cannabis had a causal relationship with psychosis, about 14 per cent of psychotic illnesses in young adults in the UK could be prevented if cannabis were not consumed.

Paper: Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review by Theresa H M Moore (University of Bristol ), Stanley Zammit (Cardiff University & University of Bristol), Anne Lingford-Hughes (University of Bristol), Thomas R E Barnes (Imperial College London), Peter B Jones (University of Cambridge), Margaret Burke (University of Bristol), Glyn Lewis (University of Bristol), is published in The Lancet (July 27).

One Comment

Carol staron wrote: marijuana is a lot like the debate with cigarettes. At one time it was the thing to smoke and now every thing gets blamed on smoking , for instance, lung cancer and I know someone who has lung cancer who never smoked a day in his life. Your surveys don’t prove nothing they all contradict each other’ Saturday, August 25, 2007 at 12:47 pm

Grief, Daffodils, and Self-Esteem

One of the reasons why I enjoy TherapyDoc‘s writings is because she tells stories that bring issues like depression and therapy at a human level. In Can You Cry Too Many Tears?, TherapyDoc begins by describing a tradition that is steeped in tears and the process of grieving in the Jewish culture. She then considers the delicate balance between crying as a natural and normal process, and crying continuously as a sign that someone needs help. Along the theme of grieving, Laura Young shares with permission an article titled “Grief Sucks” by Patrick Weiland, whose sister was murdered last August.

Deb Serani highlights a problem that may get bigger as more soldiers and deployed and may require psychiatric help for what they had endured in war. Her Denying What’s Real: Misdiagnosing for Profit looks at how governmental agencies are deliberately misdiagnosing soldiers who need help to save money.

Dr. Hal encourages us to (symbolic) plant daffodils when we see our life as a barren mountainside. He links to a post that references The Daffodil Garden in Running Springs, Southern California. This is a private garden planted by Gene and Dale Bauer, one daffodil at a time. I’ve read about this garden some years ago and wanted to visit especially when I live in Southern California, but I learned about it when daffodil season was over. Then I forgot about it. One day I’m going to visit The Daffodil Garden, in the meantime – I’m going to remember the lesson, and plant one daffodil at a time in life.

I received two entries that are related: one of self-confidence and the other on self-esteem. In one, Phil B. shares his personal list of how he increased his self confidence, covering topics from physical appearance to speaking to accomplishments to acceptance to gratitude. In another, Edith Yeung shares her Top 7 Ways to Boost Your Self Esteem. I’m going to comment further on the information presented in these articles in the following three paragraphs from the context of this website.

First, this information may be useful information for those whose depression is enhanced by the negative self-talk that came about through years of social conditioning. This information of course, does not preclude the necessity of treatment for depression or an illness that you have requiring medical treatment. On the other hand, part of treatment may require you to change the thoughts you accept and behaviors you exhibit. Those of you looking to implement these tips please remember: it takes time to “learn” new behavior, so be patient with yourself and don’t get discouraged if you “fall off the bandwagon” at the beginning. Just remember to get back on track when you realize you’re off track.

Second, I subscribe to the belief that “what you focus on, expands“. Therefore I do not recommend writing down your obstacles (#1 on Edith’s list), because this would get you focused on your obstacles and beget more obstacles even when your intention is to eliminate them. Instead of writing down obstacles, write out the goal or the end result you want to achieve, as Phil suggests from his list. Edith’s example of her mother not believing she could succeed was one that I can intimately relate to. Those of you familiar with – or dug deep enough through – my website will know that my relationship with my mother was contentious at best and mentally disturbing at worst. My turning point came when I tuned to a Dr. Laura radio show one day in my mid-twenties. A 40-something woman called the show because her alcoholic mother made her life miserable. Dr. Laura told this woman that she could never change her mother no matter how she tried to be a good little girl even into her forties, and that instead of focusing on how her mother continues to manipulate and emotionally abuse her, to start focusing on the people in her life who believed in her, supported her, and loved her for the person she is.

Finally, you don’t need to believe in what you’re saying when you implement #2 on Edith’s list (self talk; telling yourself positive things about yourself) at the beginning for this to work, provided that you also move your thoughts and actions to align with what you are telling yourself. For example, it took me years to finally and totally agree with my “I deserve good things” and “I’m great” self-talk, because in addition to retraining how I talk about myself (mostly in my mind), I was moving my thoughts and behaviors in congruence to that self-image. I believe that human beings need more than just talk for a new reality – we also need movement toward our desired reality. This means helping yourself with both thought movement and actions.

Thank you all for submitting your entries to this edition of my blog carnival. I appreciate the entries, and even though do not publish all submitted, I personally visit and read each submission. To submit an original article or personal story for the next edition, please use this link.

Comments

Ahuli Pitt wrote: When I was working with troubled youth a few years ago, I was given the priviledge of attending a two day workshop on suicide prevention. The main thing I learned was to get said person talking and being a good listener—–reading between the lines, so to speak, as to what the person was Really saying. The Anatomy of Depression Saturday, August 2, 2008 at 8:09 am

Jane Chin, Ph.D. wrote: Thank you for sharing this Ahuli! I visited your site and also found useful your article on family conflicts linked with suicide tendencies in Asian Americans (http://ahuli.info/family-conflicts-dramatically-increase-suicidal-tendencies-among-asian-americans.html). I’ve written elsewhere in this website re: observations of higher suicide rates amongst Asian American students, and no doubt family pressures can contribute. Related articles are: Asian Students, Depression, and Suicide Asians and Mental Health (resources) Thursday, August 21, 2008 at 5:57 am

Child Abuse and Neglect: Another Casualty of War

We’ve been hearing about soldiers suffering from mental health conditions (depression, PTSD) as a result of war deployment. This week’s Journal of American Medical Association (JAMA) published an article on the incidence of child abuse and neglect in families with enlisted soldiers who were deployed for combat.

Almost two thousand families of enlisted soldiers with at least 1 combat deployment between 2001-2004 were studied. Researchers found that the rate of neglecting children by soldier parents were higher during times of deployment (and therefore associated parental stress) than during times of non-deployment while the raet of physical child abuse was lower. On the other hand, the rate of mistreating children by female civilian spouses was four times as great (neglect) and twice as great (physical abuse) when their husbands were deployed.

Child Maltreatment in Enlisted Soldiers’ Families During Combat-Related Deployments

Deborah A. Gibbs, MSPH; Sandra L. Martin, PhD; Lawrence L. Kupper, PhD; Ruby E. Johnson, MS

JAMA. 2007;298:528-535.

Context Parental stress is believed to play a critical role in child maltreatment, and deployment is often stressful for military families.

Objective To examine the association between combat-related deployment and rates of child maltreatment in families of enlisted soldiers in the US Army who had 1 or more substantiated reports of child maltreatment.

Design and Setting Descriptive case series of substantiated incidents of parental child maltreatment in 1771 families of enlisted US Army soldiers who experienced at least 1 combat deployment between September 2001 and December 2004.

Main Outcome Measures Conditional Poisson regression models were used to estimate rate ratios (RRs) that compare rates of substantiated child maltreatment incidents during periods of deployment and nondeployment.

Results A total of 1858 parents in 1771 different families maltreated their children. In these families, the overall rate of child maltreatment was higher during the times when the soldier-parents were deployed compared with the times when they were not deployed (942 incidents and 713 626 days at risk during deployments vs 2392 incidents and 2.6 million days at risk during nondeployment; RR, 1.42 [95% confidence interval {CI}, 1.31-1.54]). During deployment, the rates of moderate or severe maltreatment also were elevated (638 incidents and 447 647 days at risk during deployments vs 1421 incidents and 1.6 million days at risk during nondeployment; RR, 1.61 [95% CI, 1.45-1.77]). The rates of child neglect were nearly twice as great during deployment (761 incidents and 470 657 days at risk during deployments vs 1407 incidents and 1.6 million days at risk during nondeployment; RR, 1.95 [95% CI, 1.77-2.14]); however, the rate of physical abuse was less during deployments (97 incidents and 80 033 days at risk during deployments vs 451 incidents and 318 326 days at risk during nondeployment; RR, 0.76 [95% CI, 0.58-0.93]). Among female civilian spouses, the rate of maltreatment during deployment was more than 3 times greater (783 incidents and 382 480 days at risk during deployments vs 832 incidents and 1.2 million days at risk during nondeployment; RR, 3.33 [95% CI, 2.98-3.67]), the rate of child neglect was almost 4 times greater (666 incidents and 303 555 days at risk during deployments vs 605 incidents and 967 362 days at risk during nondeployment; RR, 3.88 [95% CI, 3.43-4.34]), and the rate of physical abuse was nearly twice as great (73 incidents and 18 316 days at risk during deployments vs 141 incidents and 61 105 days at risk during nondeployment; RR, 1.91 [95% CI, 1.33-2.49]).

Conclusions Among families of enlisted soldiers in the US Army with substantiated reports of child maltreatment, rates of maltreatment are greater when the soldiers are on combat-related deployments. Enhanced support services may be needed for military families during periods of increased stress.

Author Affiliations: Children and Families Program (Ms Gibbs) and Education Research Program (Ms Johnson), RTI International, Research Triangle Park, North Carolina; Departments of Maternal and Child Health and the UNC Injury Prevention Research Center (Dr Martin) and Biostatistics (Dr Kupper), University of North Carolina, Chapel Hill.

One Comment

marj aka thriver wrote: The permalink works now! Thanks for letting us include this awareness-raising post for the BLOG CARNIVAL AGAINST CHILD ABUSE. The carnival will be up at my blog later today. Thanks for joining us! Friday, February 15, 2008 at 9:42 am

Pregnancy and Depression

I have been getting questions and comments from visitors concerned about the effects of antidepressants and psychotropic medications on pregnancy. Thus, I’ve been keeping a watchful eye on new research information published on this concern.

In the August 2007 issue of the American Journal of Psychiatry was a medical education article called, “Antenatal Depression: Navigating the Treatment Dilemmas” by Dr. Marlene P. Freeman, M.D. Dr. Freeman described 2 patient case studies – a 35-year old professional woman with major depression whose illness relapsed when she discontinued her meds after becoming pregnant. Another was a 24-year old mother who became clinical depressed 20 weeks into her pregnancy. Both women posed concerns for the doctor because of the need to weigh the potential risks to the fetus from medication side effects and the risks to the mothers from not receiving medication treatment for their bipolar disorder or depression.

As of this writing, I was able to access the entire article online here. Please feel free to check it out for yourself; however, the article is very technical since it’s geared towards doctors. Dr. Freeman’s conclusions, based on her Summary and Recommendations section, are as follows:

Summary and Recommendations

- Doctors should choose treatment based on how severe the patient’s symptoms are, the patient’s mental health history, and the patient’s preferences in selecting treatment.

- In women with mild depression, nonpharmacological (i.e. non medication) approaches may be useful first-choice treatments.

- In women with moderate to severe depression or a history of previous postpartum depression or recurrent major depression, antidepressants should be strongly considered, alone or in combination with nonpharmacological treatment.

- The risks of antidepressant exposure to the baby are unclear, although some studies have suggested the potential for risks such as cardiac teratogenicity with paroxetine (brand name Paxil or Seroxat, manufactured by GlaxoSmithKline); persistent pulmonary hypertension of the newborn and other adverse outcomes with SSRIs; and preterm birth and lower gestational age at birth with antidepressants in general.

Source: Am J Psychiatry 164:1162-1165, August 2007

doi: 10.1176/appi.ajp.2007.07020341

So what happened to the two women in the article?

The 35-year old professional woman ultimately chose not the be on medication therapy during the course of her pregnancy. Instead, she relied on a dietary supplement alternative, which did not appear to work to improve her depression. She did, however, decide to stop breastfeeding 2 months after delivering her baby to begin medication therapy and experienced full remission from her major depression. Her baby was born normal.

The 24-year old mother and her husband made the decision together that she would start antidepressant therapy, as they both agreed that the risk of not getting treatment for her depression outweighed the potential risk to the baby, especially when she was beginning to feel antagonistic toward her unborn baby. She responded well to antidepressant therapy and also began psychotherapy. She began to feel excited about her baby.

Moral of the stories – When you are pregnant and have a history of depression or begin to experience clinical depression, work with your doctor to discuss all your options as well as your concerns. Your decision will be a very personal one, and the more love and support and accurate information you have about the risks and the benefits of medication treatment for your depression, the better you will be equipped to make the decision that makes the most sense for you during this exciting and challenging time.

Risperdal Approved in U.S. for Schizophrenia and Bipolar Disorder

U.S. Food and Drug Administration (FDA) has approved Risperdal (risperidone) for treating schizophrenia in teenagers ages 13 to 17 and for treating short-term mania or mixed episodes of bipolar disorder type I in children and teens. Currently there are no FDA approved medications for treating schizophrenia in children. Up until now, Lithium was the only drug approved for treating bipolar disorder in adolescents from age 12. Risperdal is currently approved for treating schizophrenia in adults, as well as treating short term mania or mixed episodes in adults with bipolar disorder type I. Risperdal is also approved for treating irritability associated with autistic disorder in children and teens. Common side effects with Risperdal include drowsiness, fatigue, increase in appetite, anxiety, nausea, dizziness, dry mouth, tremor, and rash. Source: FDA.

Wall Street Journal’s Health Blog has an interview about this approval.

Suicide: Boob Jobs and Increased Suicide Risk

I was disturbed to read about a recent article that suggests an unexpected link between women who received cosmetic breast implants and an increased suicide rate. This article looked at 6 clinical studies and found that women who got boob jobs had twice the suicide rate compared with the suicide rate of the general population. The article goes to conclude that more study is warranted specifically looking at this issue, and that cosmetic surgeons who suspect that their prospect breast augmentation patient may be suffering from a mental illness are encouraged to refer their patients for a full mental health consultation before surgery. (abstract follows)

Am J Psychiatry 164:1006-1013, July 2007

Cosmetic Breast Augmentation and Suicide

David B. Sarwer, Ph.D., Gregory K. Brown, Ph.D. and Dwight L. Evans, M.D.

OBJECTIVE: This article discusses the unexpected relationship between cosmetic breast implants and suicide that has been found in six epidemiological investigations completed in the last several years. METHOD: The epidemiological studies are reviewed. RESULTS: Across the six studies, the suicide rate of women who received cosmetic breast implants is approximately twice the expected rate based on estimates of the general population. Although the first study of this issue suggested that the rate of suicide among women with breast implants was greater than that of women who underwent other forms of cosmetic surgery, the largest and most recent investigation in this area found no difference in the rate of suicide between these two groups of women. CONCLUSIONS: The higher-than-expected suicide rate among women with cosmetic breast implants warrants further research. In the absence of additional information on the relationship, women interested in breast augmentation who present with a history of psychopathology or those who are suspected by the plastic surgeon of having some form of psychopathology should undergo a mental health consultation before surgery.

Selenium Supplements and Diabetes

I found this article summary of a study that found that people who took selenium supplementation increased their diabetes risk compared with people who took placebos. In case you’re wondering why you’re reading about selenium supplements and a link to diabetes on a mental health website:

1) There are patient anecdotes on taking selenium to protect against hair loss when taking certain bipolar disorder medications (I was personally given this advice by a patient via discussion group 10 years ago when I was misdiagnosed with BP and taking a BP drug that caused my hair to fall out)

2) There are studies suggesting that certain atypical psychotropic drugs used to treat bipolar disorder are linked with onset of diabetes

For those patients who “self medicate” with supplements including selenium and are taking drugs that may further increase their risk of developing diabetes, you may want to talk with your psychiatrist and make sure you let him or her know all the supplements you are taking.

Medication: EU Acomplia for Patients with Depression

Acomplia (generic name Rimonabant) was not approved in the US because the FDA’s expert panel was concerned about suicidal thoughts that appeared as a treatment side-effect in patients. Acomplia is a drug that was approved in the EU for treatment of weight loss and diabetes. According to Forbes, the European Medicines Agency (EMEA) has updated the drug’s labeling to contraindicate (NOT USE due to dangerous including potentially fatal side effects) the use of this drug for patients who have major depression and/or are receiving ongoing antidepressive treatment. You may also read the company’s PDF press release here.

Depression: ECT Underutilized in Resistant Depression

I just read this interesting piece from WSJ’s Health Blog, reporting on a new commentary published in JAMA on the underutilization of electroconvulsive therapy (ECT) in patients whose depression does not respond to antidepressant treatment. The idea of sending electric currents through a person (some may even liken the procedure to controlled electrocution) has created a stigma of ECT. Doctors often view ECT as a last resort. Yet, for patients whose depression fails to respond to main treatment modalities like medication and psychotherapy, ECT may be a lifesaver.

VA Study Suggests Antidepressants Have Protective Effect on Suicide

The link between suicide and antidepressant (especially SSRI) use has been debated for the past few years, particularly on the potential causative link that antidepressant use may cause suicidal risks in certain patients (pediatric and teens). In the July issue of The American Journal of Psychiatry, a paper titled, “Relationship Between Antidepressants and Suicide Attempts: An Analysis of the Veterans Health Administration Data Sets” was published to look at the relationship of antidepressant use to suicide attempts in adults treated in the veterans administration (VA) system. The abstract follows with link to an online full text editorial.

Study authors: Robert D. Gibbons, Ph.D., C. Hendricks Brown, Ph.D., Kwan Hur, Ph.D., Sue M. Marcus, Ph.D., Dulal K. Bhaumik, Ph.D. and J. John Mann, M.D.

OBJECTIVE: In late 2006, a U.S. Food and Drug Administration advisory committee recommended that the 2004 black box warning regarding suicidality in pediatric patients receiving antidepressants be extended to include young adults. This study examined the relationship between antidepressant treatment and suicide attempts in adult patients in the Veterans Administration health care system.

METHOD: The authors analyzed data on 226,866 veterans who received a diagnosis of depression in 2003 or 2004, had at least 6 months of follow-up, and had no history of depression from 2000 to 2002. Suicide attempt rates overall as well as before and after initiation of antidepressant therapy were compared for patients who received selective serotonin reuptake inhibitors (SSRIs), new-generation non-serotonergic-specific (non-SSRI) antidepressants (bupropion, mirtazapine, nefazodone, and venlafaxine), tricyclic antidepressants, or no antidepressant. Age group analyses were also performed.

RESULTS: Suicide attempt rates were lower among patients who were treated with antidepressants than among those who were not, with a statistically significant odds ratio for SSRIs and tricyclics. For SSRIs versus no antidepressant, this effect was significant in all adult age groups. Suicide attempt rates were also higher prior to treatment than after the start of treatment, with a significant relative risk for SSRIs and for non-SSRIs. For SSRIs, this effect was seen in all adult age groups and was significant in all but the 18–25 group.

CONCLUSIONS: These findings suggest that SSRI treatment has a protective effect in all adult age groups. They do not support the hypothesis that SSRI treatment places patients at greater risk of suicide.

Dr. David Brent’s Editorial, “Antidepressants and Suicidal Behavior: Cause or Cure?“

Relationships, Research, and Resources

Welcome to the June 5, 2007 edition of carnival of depression, bipolar disorder, and mental health journeys.

In the depression category, Angela presents an important topic for women who are pregnant or have just delivered. For more information about this subject, please read my comprehensive review of the book, A Deeper Shade of Blue.

Jeff gives an honest and reflective look at the question, “am I depressed, and is this the kind that requires medication?” I find some of us migrate toward extremes – either denying there is any problem and refusing to seek help – or immediately labeling ourselves with multiple illnesses and begging for pills. We can save ourselves a lot of grief (not to mention risks of side effects) by spending some time asking ourselves some tough questions.

Speaking of extremes, Christian presented a fresh Austrian view on depression, which describes an Austrian diagnostic tool that has interesting implications on the symptoms of depression and perhaps shed some light on potential new cognitive behavioral approaches (my speculation). This is indeed an interesting study and I hope that a larger study is planned to follow up on this one. On the other hand, a sample size of 60 people into 2 groups of 30 in this study is considered a very small sample size, especially in the neuropsych field.

James shares a link to MoodGym, a free online resource that he has personally used even though he suffers from the melancholic type of depression less conductive to cognitive behaviorial therapy (CBT). This is an excellent resource and I highly recommend it, thanks James for sharing it with us.

In the category of mental health, GrrlScientist writes about college students experiencing emotional crises that may contribute to suicide among college students. Grrlscientist’s posts often generate copious comments to her articles, and these comments are often informative and span pages beyond the original article. I was severely depressed when I was in college but I didn’t know it. Also my alma mater Cornell had a “fall break” and rumor has it that this was the time when historically there were lots of student suicides.

In the recovery category, The Junky’s Wife reflected on her habits of mind. This doesn’t really fit into my traditional mental health theme but for some reason this personal story struck me as resonating with the feelings of many caregivers in relationships with those who have mental illnesses that manifest in ways not unlike a drug addicts.

Alvaro posted a study on potential pharmacologic effects of Yoga as it relates to stress management; now there’s an alternative therapy with an excellent side effect profile when compared with medication therapy given the appropriate patient type (i.e. not acutely and severely depressed patients who require immediate medical help).

I found Virginia’s Lessons from Panic both gripping and brutally honest.

In the relationships category, one of my fav psych blogger TherapyDoc writes about Reparations and how some patients in the midst of a manic episode can do things they regret. This post is both about salvaging relationships and an illustration of how no ill you commit is beyond sincere contrition.

Thanks to all of you who submitted for this edition. As always, I may not be able to include everyone’s entries, but personally visit and read each submission. I do favor personal stories and posts that are not already submitted to every other carnival out there (since duplicate entries can waste readers’ time). Please submit your article to the next edition here.

Seasonal Funk, Psych Appointments, Myth of Happy, and Ecotherapy

Welcome to the June 26, 2007 edition of carnival of depression, bipolar disorder, and mental health journeys. Here are my four selections for this edition of the carnival. Entries were chosen based on original content, theme relevance, and “personality”. Congratulations to Mercurial Scribe, BP Professional, Chris614, and James Bishop.

mercurial scribe is not feeling that great due to the seasonal change. Some people are especially prone to seasonal-related mood changes, and for some, symptoms may be triggered by weather changes. I personally love the time when weather becomes warmer and the sun is out earlier and longer, and those who experience symptoms associated with Seasonal Affective Disorder find they may need a certain amount of (sun) light to feel well. For others, like the mercurial scribe, the changing season brings a change in mood that may be dark. Hang tough, mercurial scribe.

BP pro does not enjoy his appointment with the psychiatrist: “Going to the psychiatrist, waiting in line at the pharmacy, setting a new appt and keeping it . . . these things are a drag, but still I do them… eagerly.” This is a short post, but is the reality of managing an illness like bipolar disorder. The alternative, as BP pro alluded to, is worse than the drag of seeing the psychiatrist. For your information, a 5150 refers to the involuntary confinement of a person deemed a danger to himself or herself and/or to others (see more from Wikipedia).

JANE’S PICK I love Chris614's article, I Should Be Happy All The Time! One of the reasons why depressed people tend to be perfectionists (and vice versa) is an all-or-none mentality or a black-and-white mindset in a world that is just plain gray. I tend to have a “black or white” mindset, and this created a lot of upset and angst that did little but to make life miserable for myself and others around me. Thankfully, as I got older, my mind became more open and my mindset less rigid, and this has done wonders for my mental health. Chris shares a detailed article that helps us examine the realities of “being happy all the time”, and how we can adjust our expectations for the world we live in.

James Bishop describes Ecotherapy as “a way to improve mental health, by being active outdoors and in a green environment.” I’m curious to know how many people participated in the first study James mentioned that concluded the benefits of ecotherapy or “green exercise” on depression. Also, without having the original study in front of me, I’m wondering if the authors would note a potential confounding factor: exercise. Studies have shown the benefits of exercise in patients with depression. How would “a walk anywhere” compare with “a walk in the park” for improving depression symptoms? Even with these questions, it makes sense to go outside for a walk – and keep your credit cards at home.

Thank you for contributing to this edition of the carnival. You may submit your personal stories and articles for a future edition here. Until next time!

Mood Spectrum, Internet and College Students, Forgiveness, and Talk Therapy

Welcome to the July 4, 2007 edition of carnival of depression, bipolar disorder, and mental health journeys. Congratulations to those of you whose submissions were accepted to this edition – and thanks to the authors who took the time to submit an entry. Even though I may not be able to include all submissions to this edition, I appreciate your consideration and read each and every entry sent.

If you submit an article that summarizes studies or scientific research: Please include links to references and cite the actual studies so that readers who wish to look at the actual studies may read the original source. I tend to be very strict about citations and source references because 1) this helps me maintain integrity of health information shared on this website esp. given the HONcode accreditation, and 2) my scientific background has made me a stickler for going to original sources whenever possible to look at studies conducted and assumptions made.

I understood Barbara’s argument to teach forgiveness to parents instead of children so that children do not fall to the hands of abuse. However, reality is such that the very people who should learn forgiveness usually end up being the ones who need to be forgiven. In my personal experience, forgiving is letting go of a hatred that consumes and at the same time, letting go of self-loathing that came from “having something bad done to me” when I was a small child and unable to help myself.

mercurial scribe shared a very creative post called, Call it “Covering the Spectrum of the Dwarves” to describe an experience of the spectrum of moods.

I found Brandon‘s Students Should Cut The Net, Not Themselves a sobering article. Even though I was severely depressed as a college student, I didn’t have the internet back then, or I may end up even more isolated than I was. What really helped me was taking up tae kwon do during my senior year in college. The combination of physical exercise, a sense of pride in actually being good at the martial art, and regular interactions with people in class made my senior year most memorable. It was a rare time when I really felt like I had “a college student experience”.

Dave Johnson reminded us that Cognitive Therapy is generally as effective as medication. We’ve been so quick to go to medication that sometimes choosing meds is more a matter of convenience than doing what will ultimately help us get better. I vouch for the benefit for both therapies, although I admit when I first started treatment for depression, my therapy sessions were more productive when the correct meds kicked in (started working). Then, many years later, as I am more familiar with the cognitive tools, I relied only on psychotherapy during a period of depression relapse, because I was not able to tolerate medication side effects.

I’ve gotten a couple of bloggers who have generously reached out to me to help host a future edition of this carnival. Karen will be hosting the July 11th edition, and James is hosting the July 18th edition. You may also submit your articles to the next edition via this link.

For those of you in the U.S., have a joyful and safe July 4th holiday. For those of you in the rest of the world – take good care of yourself. Until Next Time.

Carnival of Depression, Bipolar Disorder, and Mental Health Journeys

I will just be listing the entries that I had selected for this edition, instead of the long-winded commentaries that I’m wont to make in previous editions. I have not been feeling well and have not been at the computer very much these days. Nothing to lose sleep over – I just need to take a protracted rest and get some strength back. Wishing you all well… Jane.

Welcome to the May 22, 2007 edition of carnival of depression, bipolar disorder, and mental health journeys. During my ‘resting period’ I’d like to offer this carnival up for guest hosting. If you want to be a guest host for an upcoming edition of this blog carnival, please email me.

Phil B. presents Reducing Stress. “All to often, I see people around me looking for short term solutions to stress, such as taking ‘must needed’ vacations, and then they go right back to their hectic and stressful schedule immediately afterwards. I equate this with yo-yo dieting that does not work in the long term. Handling stress must be a lifestyle change that minimizes everyday stress.”

Albert Foong presents What your ego is and how to stop it from obscuring your inner peace and unconditional love. “One of the most effective things I’ve ever done in my own conquering of depression: The ego is the source of all unhappiness. All unhappiness. What is it, how does it creep in, and what you can do? This is by far my longest, favourite, and most heartfelt article ever.”

vause presents New Drug Helps Veterans. “This info should help anyone out there that suffers from PTDS”

Janna Seliger presents Emotions. “An emotional day after many days of contentment and what I thought and felt.”

James Bishop presents Dim bulb or bright light?

Barbara presents Stigma and bias shame us all.

GrrlScientist presents Sticks and Stones… “verbal abuse hurts children as badly as sexual abuse.”

Depression: Getting Through Pain and Virginia Tech

Trent announced an interesting article that is published in the May 2007 issue of Harper’s magazine that has a provocative premise: “true depression is actually an extremely rare event and the prevalence of depression in America is manufactured.” Three factors that were listed included 1) people who are melancholic were often diagnosed as depressed, 2) the fallacy of tests currently used to diagnose and measure depression, and 3) an often visible placebo effect in depression treatment when compared with the actual medication treatment.

Trent shares his tips for managing a melancholic state without drugs and much financial investment. For me, medication was an important jump start in my depression treatment, but I have also had subsequent good results with non-medication modalities, and have been doing well over the past few years on a regular routine (sleeping enough, eating regularly, getting enough sun, and having some social interactions all helped me).

Scott writes very thoughtful articles about depression, and his personal experiences give his articles a compassionate tone. In “What to do when it hurts,” Scott remembers a painful experience and how he was able to get through it. Scott also wrote a series on how to tell other people about your mental illness, a timely article given the recent events at Virginia Tech that may have triggered knee jerk reactions from some people toward the mentally ill.

In light of recent campus events, I received several entries relating to the Virginia Tech Massacre. I personally view this event as a mental health “systems failing” rather than an issue of gun control, and while both issues can be controversial, the gun control stance is more sensational and may have gotten most of the attention and debate. In Cho’s case, we may also want to examine cultural attitudes toward mental illness, and how culturally-based stigma can create a situation resembling a ticking time bomb. Being of Asian (Chinese) descent, I know that we culturally are still very uncomfortable talking about mental illness. This must change.

Cynthia shared a series of articles she had written about trauma, including Acute Stress Disorder, Post Traumatic Stress, and Secondary or Vicarious Trauma. Dr. JC tried to put some perspective on these events, and made a poignant and pertinent conclusion: “If I look back in my own past to individuals that I thought were disturbed, troubling, or mentally unstable, I wonder where they are now. At every stage from childhood to college, I do recall people that I didn’t know well that were ‘outsiders’. Most of them slipped through the cracks socially and in school and athletics. Each one of them could have turned out successful and healthy. Or perhaps they could have turned out to be very dangerous people. It’s too bad that I was so self-consumed with my life that I didn’t take time to notice them or reach out a hand.” This puts personal accountability on each one of us to reach out to someone who may be an outsider. We never know when we may be the one to help a person change his or her course of action. GrrlScientist wrote two related articles on the subsequent response (some say overreaction) to what is now considered “disturbing” in the classroom as well as society’s treatment and attitudes toward the mentally ill and mental illness.

This concludes the edition of the mental health journeys carnival. You may submit future carnival entries here. Please keep in mind that I may not be able to include everyone’s entries, but I visit and read each submitted article and appreciate the time and effort you spend to write and submit your articles.

Thinking Blogger Award

Suni at BULLETPROOFsoul awarded this site the Thinking Blogger Award. Thank you, Suni.

This award was created by Ilker over at The Thinking Blog, who said, “Please, remember to tag blogs with real merits, i.e. relative content, and above all – blogs that really get you thinking!” (You can also get the silver version of the TBA at Ilker’s site)

Here are the rules if you’d like to award a deserving blogger the Thinking Blogger Award:

1. If, and only if, you get tagged, write a post with links to 5 blogs that make you think,

2. Link to this post so that people can easily find the exact origin of the meme,

3. Optional: Proudly display the ‘Thinking Blogger Award’ with a link to the post that you wrote (here is an alternative silver version if gold doesn’t fit your blog).

My 5 blog picks are:

1. Therapydoc of Everyone Needs Therapy

2. GrrlScientist of Living the Scientific Life

3. Cheng Leng of Notes from the Heart

4. Albert of Urban Monk

5. Sichitku of SCKU

4 Comments

Tarun wrote: Does this get you thinking Jane? – What is Life? http://hotbacteria.wordpress.com/2008/06/02/who-am-i/ Or this one – Work and Life Balance & Importance of Sleep: http://hotbacteria.wordpress.com/2008/05/22/balanced-life-and-sleep/ Cheers! Saturday, June 21, 2008 at 11:53 pm

Jane Chin, Ph.D. wrote: Indeed it does, as does your blog name Hot Bacteria As for your post, what is life, I respond thus: How about the observation that juxtacrine signaling can be as important to the way a cell makes potential decisions about life and death as endocrine and paracrine signals? Transpose that to the human level and it shows how much we and our society can learn from cellular behavior. Wednesday, June 25, 2008 at 2:33 pm

Tarun Gupta wrote: People used to ask me – Are you gram +ve? Wednesday, July 16, 2008 at 1:26 am

Jane Chin, Ph.D. wrote: How do you respond? I wish I can be thicker cell-walled at times Thursday, August 21, 2008 at 6:02 am

Medication: Suicide Warning for Antidepressant in Young Adults

According to the FDA, it is proposing drug companies to update their antidepressant product labeling to include warnings of increased suicidality, defined as “increased risks of suicidal thinking and behavior” in adults ages 18 to 24 during the first two months of treatment. On the other hand, data suggests that adults ages 65 and older have reduced suicidality with antidepressants. This proposal will affect the entire category of antidepressants, and that available information could not exclude a single medication from this increased suicidality risk.

Here’s what one of my (pharma industry) colleagues Steve thinks about the black box warning.

Mental Illness and Abuse, Suicide, Introversion or Isolation

Talia commented about a woman’s experience with abuse at the hands of a mentally ill sibling, and asked a very good question: “how much sensitivity do the mentally ill deserve?” This and the original article from the abused woman hit home for me, because I know both sides. I have experienced depression, and the type of hurt that I can inflict or have inflicted on people around me when I was knee deep in it. As a small child, I have grown up with the wounds (mostly emotional and an occasional physical trauma like getting my fingers squeezed by a pair of pliers as punishment) of abuse from a mentally ill parent.

I believe that interacting with a mentally ill person requires not sensitivity but understanding of the behaviors that may come from that person in midst of an episode, and with an important caveat – one’s first obligation is the safety of oneself. If at any time you believe that your safety is threatened, your first obligation is to remove yourself physically and immediately from an abusive or dangerous environment. Unfortunately, it is nearly impossible for a child who is vulnerable to do this for himself or herself, which is why it requires adults to take action on the child’s behalf. I feel sad that Leah has gone through what she has gone through with her sister, and I’m outraged at Leah’s parents for allowing this to happen. My comment on the original post is here.

Tim‘s uncle Archie alluded to what Tim called, “the sadness at his center.” I thought this was a poetic description of depression. The biography speaks to Uncle Archie’s different antics and adventures more than his experience with depression, a testimony of how a person is never defined by depression alone.

Many years ago, Lorraine‘s good friend committed suicide. Lorraine said, “He was a friend to everyone. I wish he had been a friend to himself too.” Lorraine wrote this from the perspective of the loved ones of those who may be contemplating suicide. For her, this is not about interference, but compassion and potentially helping someone save his or her own life. Lorraine also contributed another article on a good exercise to do. I’ve actually read about this a long time ago in a study (I can’t remember if it’s a well-powered clinical study) and the results were intriguing. Please try it

Deb writes about taking comfort in online friends at the expense of local (“real life” or offline) friends. I can understand where she is coming from; in my professional circle, people view me as an extrovert since I seem to know many people. In reality, I’m very much the introvert. I need a lot of alone time, even when I’m still getting used to being with myself (some call meditation the art of being with oneself). I’ve always been this way, from the moment I remember being conscious. As long as you are content with the level and depth of relationships you have, that is what counts.

I do notice that I need to at least get some fresh air every day, and connect with at least someone “in real life” at least once a day. When I step outside even for a few minutes, or talk on the phone with someone, or talk with my husband, I feel like I was part of civilization that day and it feels good to me. If I were to use a plant analogy to describe my preference relating with people, I’d say that I’m a shady plant. I don’t need a lot of sun, and I make the best use of whatever sunlight I have to bloom. It is important to make a distinction between being introverted and being isolated. One is a naturally state of being, the other can become a dangerous state of mind.

Finally, Anthony shares his poignant story of visiting a grave and coming to terms with his family history.

This concludes Part 1 of this edition of the carnival. I will write Part 2 later this week. Please stay tuned.

5 Comments

Deb wrote: I enjoyed your comments on my blog post. Thank you for your inclusion. I’m looking forward to reading everyone else’s posts. Kindly, Deb Tuesday, May 1, 2007 at 1:55 pm

Jane Chin, Ph.D. wrote: Thank you for contributing your thoughts here, Deb Tuesday, May 1, 2007 at 6:41 pm

suni wrote: another great carnival. i have to manage to get myself into the next. one. I have also awarded you the Thinking Blogger Award. You deserve it. Thursday, May 3, 2007 at 7:06 am

Jane Chin, Ph.D. wrote: Thank you, Suni Saturday, May 5, 2007 at 11:07 am

Christopher Hassall wrote: Hi there my name is Chris and I live in Sheffield,I need to know if being iserlated from tranining is class as abuse, and why. I have been in the sick for more then 19 years and so called agecies will not help me to get me back into tranining, and the are asking me for refrerance that I have not got, I keep myself to my self, and not talk to anybody that they think that they above the law.
I need to input. thanks chris Saturday, August 16, 2008 at 5:51 pm

Emotional Invalidation, Brands or Generics, Worrying, and More

Barbara‘s article on emotional invalidation has a lot of details to help you recognize emotional invalidation and the many forms it comes in. What I’d like to see is a follow-up article addressing ways to respond within yourself and to the other person when you know you are facing emotional invalidation.

GrrlScientist was recent sent an article on Creating a Mouse Model of Bipolar Disorder to study the manic phase of bipolar disorder. GrrlScientist gave a good background of the biology of bipolar disorder and potential research directions in this area. What’s important to note is that the mouse system did not cycle between mania and depression the way humans do. This underscores the limitations of studying an illness that is often a manifestation of a complex, whole system by 1) picking apart its individual components and 2) using a different system, albeit a whole animal system. One of the limitations of modern medicine has been our fixation on “targeting” specifics, which makes sense on one level, but also means we may often miss unforeseen long term side effects.

Deb described what depression feels like to her. She made an interesting analogy of depression as a visiting “friend.” Recently I heard someone use a similar analogy with fear. What I’m wondering is whether Deb’s lapses of depression may be due to stopping medication after feeling better, but the brain chemistry is still in the process of adjusting. I’m purely speculating here, and Deb’s doctor may understand better why these relapses may happen. However, to use an antibiotics analogy, once you feel better, you still want to take the full course of antibiotics to prevent relapse – which also is accompanied by the real risk of increasing antibiotic resistance as you inadvertently select for bacteria that were stronger than those that were quickly killed during the early rounds of antibiotics. When I was on meds, I was determined to stick with it at least a full year, even after I was feeling better, and in spite of the myriad of side effects I was experiencing, because I wanted to give my system long enough time to fully adjust. On the other hand, this did not prevent a relapse a few years later, although it could be possible that the year long course of medication may have helped delay the onset of a relapse in my case.

Mercurial Scribe found out that generic and brand-name drugs are sometimes not the same, at least for her. I know that generics can be a significant cost savings for people, and that generics do have the same “bioavailable” active ingredient. However, what Mercurial Scribe described may be due to the formulation differences that potentially can have a different effect from individual to individual. She has found that for her at least, to get the same effect as 200 mg of the branded drug, she would need to take 300 mg of the generic drug, which would reduce the cost benefit rather quickly over time. What I’d recommend especially for psychotropic medications is that if you have found a medication that worked well for you, I’d stick with the exact formulation and brand if possible. If cost becomes an issue, see if you can do a “trial dose” with generics, but keep handy your branded medications, and make sure your doctor keeps a close eye on you during the trial dose. If you feel like you’re become symptomatic, you and your doctor can manage it immediately and you would not be left without your original brands.

Dr. JC noted The Mental Health Parity Bill of 2007. One of the major implications of this bill is to treat mental illness at the same level as a physical illness, therefore helping to destigmatize mental illness for patients. Furthermore, this means mental health professionals can be reimbursed for the appropriate, sometimes long term treatment of mental illness, instead of playing “scoring games” with insurance companies and trying to manage mental illness like a bout of bronchitis.

Alvaro’s Brain Exercise FAQs talks about the importance of brain exercise and can be useful for both healthy and “under the weather” brains.

Vahid wants you to stop worrying. I enjoyed this because I understood the experience of chronic worrying. Over the years I learned that if you’re one of those people who wake up in the middle of the night with a start and can’t go back to sleep because you worry, you may be procrastinating during the day, at least that’s the case for me. In the quiet of the night when the daytime distractions are gone, all the things I procrastinated from doing bubble up to the surface. There are also other types of worries – things that “could” happen to you or constantly replaying worst case scenarios. For these types of worries, I remind myself that worrying hasn’t been proven to make things better, and I might as well expend with futilities. It takes effort, but eventually I could convince myself that this is true, and my worries cease.

Madeline wrote an article to answer questions about why you may consider going to a Psychologist. She asked a good question: why should you go to a psychologist instead of reading self help books or going to seminars (like for positive thinking)? Well, for me, I found that self-help books or programs don’t work for people who don’t know how to help themselves, not because they’re not motivated or lazy (I was extremely motivated!), but because their mind perception is warped. It’s like being blind and trying to figure out what color looks like. While medications worked for me, I found that my bond with my therapist “Dr. M” was very important in my healing process. In many ways, I see her as a “helper” sent to guide me along my journey out of the depression abyss. Moreover, when I had a relapse years after completing medication therapy and became intolerant to most psych meds, I relied on cognitive psychotherapy and had good results.

Thank you all for submitting to this edition of the carnival. Share your personal stories to my next edition of carnival of depression, bipolar disorder, and mental health journeys here. Please remember that even though I may not be able to include all entries, I do personally visit and read each submission, and very much appreciate you taking the time to share your stories and insight.

Until Next Time!

2 Comments

Deb wrote: Hi Deb here from your post above. It’s true I stopped taking my medication, but seeing others on medication for years and years, I’m trying not to continue on it for a lifelong course. Many I know have been on meds for more than 10 years. I found once I got off of the meds and adjusted, I’m seeming to do well, and have been medication free since. I enjoyed reading your comments. Tuesday, April 17, 2007 at 6:37 am

suni wrote: “It’s like being blind and trying to figure out what color looks like.” Great analogy. As always, a very informative well thought out carnival. Tuesday, April 17, 2007 at 7:13 am

Zen of Depression, Common Sense, and Trust Your Feelings

JANE’S FEATURED PICK Therese Borchard’s stream of consciousness in “Confessions of a Suicidal Yogi” sums up what I consider to be the zen of dealing with depression: by living through it.

My thoughts have been where Therese’s thoughts have been, and in the depths of depression I had asked those forbidden questions. Why bother? Who cares? What difference does it make? If I disappeared who would notice anyway? From the concerned comments of readers who responded to Therese’s post, I want to emphasize that this was one of Therese’s recollections, as she had followed up in a subsequent post. It is similar to the chronicles of my personal journey through depression; I cringe when I read it, and if you happen to read that page without knowing the context of this being part of my past, you would feel grave concerns (especially around June of 1998). But the only way to deal with pain is to live through it. And the only way to deal with depression is to live through it. Yes, we can run and we can hide and we can numb ourselves in different ways. But the only tried and true method that has always worked in keeping ourselves alive is – living through it.

We could be neighbors, “m”, (for real) and I appreciate you sharing your blog with me. Instead of linking individual entries that you’ve submitted, I’m going to link to your blog so people can bookmark it and visit. Since in my last edition, Therese talked about how she used blogging as a therapeutic tool, I think you’ll too find that blogging is a powerful instrument in your journey through depression.

D. Kai Wilson asked how we could ascribe a movement to proactivism when we’re just exercising common sense. I don’t know… maybe common sense sounds so unglamorous that people would pay more attention to a big word like “proactivism”. My favorite parts of the entry is, “We pay the price of our brilliance in mood swings, and though our currency is tears and days without sleep, I’ll be the first to say that its a good life. It would be better if people would stop asking whether I was normal or not, and wouldn’t I love to function like a ‘normal’ human being.” – beautifully said. Congratulations on publishing your nonfiction book, Kai.

This post from the Positivity Blog is geared toward personal development, and contains useful information for the “cognitive aspect” of managing psychic pain. This is complemented by Alan‘s Stinking Thinking Post.

Shaheen Lakhan always sends brainy entries of the academic kind, and in this edition shared two provocative topics. One is on an antipsychiatry movement, which is not new but has gotten its recent share of celebrity lash-and-backlash (think Tom Cruise v. Brooke Shields). The other is a very valid question of how objective are diagnoses in mental illnesses. John Grohol of PsychCentral fame commented on the subjective nature of most medicines, which I agree. I believe the truth is somewhere in between the extremes: most of us (if not all of us) have some kind of an “imbalance” or another – the life process itself is a physical example in imbalance and nonequilibrium. Mental health diagnoses can help when these enable people who can be treated receive treatment, and can harm when these become labels for people to seek fast fixes to life’s more convoluted problems.

Dr. Deyo wants you to listen to yourself, honor your feelings, and accept even (especially!) the negative ones as a valid and valuable part of you. It all boils down to “love thyself” in all your flawed AND fabulous glory. Dr. Deyo may not be the first one to suggest that you trust your feelings because the Star Wars trilogies have seared that aphorism into our pop culture, yet my Yoda consciousness foresees Dr. Deyo having a great professional career ahead and all the good that she’s going to do, and her future patients will thank her for doing what she does.

Sometimes I get entries that feels like a conversation… here are two. Mercurial scribe is celebrating stability, one moment at a time, which I’m glad to read. Suni asked why she is forced to deal with her own self sabotaging behaviors… my feeling to this is “because you still have some important lessons to learn about yourself, and its a way that you get yourself to pay attention to this learning.”

Wow. Patch Adams calling Nurse Ratched a pill Nazi. I can’t do the story justice so I’ll let Nurse Ratched tell you the story herself.

This concludes this carnival edition. To submit for the next edition, please use this link. Until next time!

3 Comments

M wrote: jane, thanks for the link. it’s so funny because i know who you are! you’re that MSL in MY pharma rep mags! i was in pharma sales too. i’ve ventured to your other site and have enjoyed reading some of your articles. that industry seems so far away but is so close as i still have many friends in it including former accounts who’ve become friends. perhaps we can meet up since we are “neighbors.” you’re very interesting and i’d like to hear more about your entrepreneurial ventures. regards, m Sunday, April 8, 2007 at 8:01 pm

Jane Chin, Ph.D. wrote: thanks for noticing my writing in pharm rep mag and for visiting my other sites; it’s been years since my MSL days, but of course MSLs remain close to my heart given that I provide consulting in that area. sure, let’s meet up; i’m in redondo beach. drop me an email if you’re nearby and feel like chatting over the cuppa tea or coffee. Sunday, April 15, 2007 at 2:52 pm

Elene wrote: I have seen many patients benefit drastically from giving themselves a ‘time out’ time. Meaning, that each day, they set aside time to relax and do something they truly enjoy doing. This is like a release valve for them and if they religiously stick with this plan each day, have improved and have reported they are coping with the depression better. One patient I know went from totally stressed out to managing his depression quite well. Does it eventually rid patients of depression? Time will tell, but from what I’ve seen thus far, is certainly helping. I can suggest doing whatever relaxes oneself, whether playing a game or just sitting in silence, with no distractions. Saturday, September 15, 2007 at 2:50 am

Therapy Appointment Guide by Scott Davis

Jane’s Note: Scott’s website is not accessible when I checked today [August 27th 2010]. I’m not sure whether it is a website problem or if Scott has taken his site offline.

When Scott submitted his article series on therapy appointment to my mental health blog carnival, I excluded his entry from the carnival edition. I wanted to dedicate a post on the article series he had written.

I was impressed by both the comprehensiveness of information Scott shares and the personal approach he takes in writing these articles. Scott’s Finding Your Marbles blog is becoming a unique voice in the mental health blogosphere, and I thank him for sharing his writings with us.

What I’ve done is to give you an outline version of Scott’s article series. You can get an overview of the content that you can expect from each article in the series, and you can visit a specific article that catches your interest.

Choosing A Therapist Finding a Therapist How to Choose A Therapist (You can get a printable version of the checklist in MS/Word format from Scott’s website)

Your First Therapy Appointment Booking Your First Appointment Preparing For Your First Appointment The Session: What to Expect Time Out Beginning Therapy The Therapy Relationship

What do Do After Each Therapy Session First Things First: Unwind Processing Write It Down Talking to Others About Therapy Homework Contacting Your Therapist Be Good To Yourself

Leaving Your Therapist Just Don’t Ask Them on a Date How to Know When It’s Over It’s Been Fun This Isn’t Working Out Dear John… Can We Still be Friends?

Thoughts on Therapy Going Back to Therapy Multiple Therapists Alternative Therapies Be Yourself

If you enjoy what you’ve read, please visit Scott’s website and drop him a note.

Your Responsibility, Marriage, Antidepressants, Anxiety Disorders, and Emoting

I have always seen personal accountability as a self-empowering act and a sign of self-respect. This is often missing in many health situations, where patients too often abdicate their responsibilities or did not dare question their doctors about course of treatment. For Kilroy’s 10 point list that recognizes you as an empowered individual to question and have a proactive role in your own recovery, I am selecting this as my featured post.

JANE’S FEATURED PICK Kilroy_60 distilled a 10 point list of what he had learned “for a person who is preparing to seek treatment for a disease of the brain“: (1) Identify symptoms you are experiencing. (2) Prepare questions prior to your first appointments {with the therapist and psychiatrist} (3) Remember, never forget, you are a person with an illness. You do not BECOME the disease. (4) You will receive a diagnosis or a number of diagnoses. Again, the diagnosis is not what you are. The {or each} diagnosis is a label. (5) Do not become a victim of Sheep Syndrome. (6) Research and learn as much as possible. (7) I believe, although I very well maybe wrong, that many if not most mental illnesses are chronic. You should understand that you will feel “better”, but are likely not to be “cured”. (8) You are RESPONSIBLE. (9) Do Not ISOLATE. (10) Manage your care and stay aware.

Here are two poems that convey different tones of the same mood: Joy Soriano’s “I Will Smile Again” and Suni’s “The dark places“. My challenge to Joy: write another version of this poem in the present tense – i.e. – I AM smiling again, and see what comes up for you. My reminder to Suni: even when depression creates a feeling of darkness within you, remember: you have a bulletproof soul.

Therese Borchard’s “In Sickness and In Health” is a poignant description of the pain that depression causes within and around a person – especially for her loved ones. It makes me appreciate what my husband had gone through and how important his support and patience was in my healing process. I’ve known people who have destroyed themselves – and their families – when they refused to seek help or to stick to a regimen that is helping their condition because they “don’t like the way it feels.” We often forget that unless we live in caves by ourselves, apart from others, our self-destructive acts will have consequences for others as well. Sometimes, when we are still learning how to love ourselves, the act of loving another person can help us make that difficult decision to seek help.

isabella mori wrote a short piece on considerations when using antidepressants.” I agree! Too many people expect a quick fix and don’t realize that medications come with side effects. Taking medication is a sacrifice you decide to make, because you think the tradeoffs (side effects) are worth the potential benefits (getting better). When patients ignore that medications are not just a pill you pop, but powerful chemicals that alter your body in profound ways, they can be mindful of their medication choices, and realistic about their expectations.

Talia Mana asks if you worry too much. She described the GAD-7 questionnaire for screening generalized anxiety disorder (GAD), a condition that may affect one in five people. I think the questionnaire criteria of looking at your symptoms within a 2 week period is very short and can potentially lead to misdiagnosis and overprescribing. Depending on life situation, you can have symptoms that resemble a GAD, without actually having GAD, which subsides once the stressors are removed. I think the period marking the persistence of symptoms should be longer – 4 to 6 weeks instead of 2 weeks – only because I know that in our healthcare system, when you discuss this with doctors, they may hand you a prescription to get you out the door for the next patient.

Scott Lee’s “Get It Out!” is a post on the process of emoting. This can be helpful when considering the cognitive sides of depression and mood. Many people who have mental health conditions also experience anger and rage (depression is supposed to be anger turned inward), and part of changing this condition requires reconditioning of how we deal with anger, both within ourselves and with others. How you do “get it out”, however, requires more thought. All of us have, at one time or another, seen a person who is “getting it out” in an unproductive way.

This concludes this carnival edition. To submit for the next edition, please use this link. Until next time!

Jane Chin

Talia Mana, Centre for Emotional Well-Being wrote: Good point Jane about the criteria for the gneralised anxiety disorder test. I’m guessing the two weeks is used because it is the same period used in depression screening tests, but strictly speaking it should be six months to match with the DSM-IV criteria. Thanks for including my post! Friday, March 23, 2007 at 2:56 am

Neurochemistry of Giving, Suicide, and Mood Triggers

Alvaro shares an essay written by a 15-year old on why “Tis better to give than receive” based on the neurochemicals Oxytocin and Dopamine. I liked the description that Oxytocin is a “cuddle” neurotransmitter. Keep in mind that we can give non-material things that can be just as meaningful – hugs, a smile, an act of kindness. That said, when you’re on the receiving end, accept the gift graciously because for some of us, the lesson we are learning is to accept what is given to us.

TherapyDoc asked, “How many signals does it take for SOMEONE to consider a higher level of care?” She answers the question as “Too many” as described by the suicide of college student Chuck Mahoney. Chuck Mahoney showed many signs of impending suicide, but these signs went unheeded. Signs for help – especially serious signs of suicide – often went unheeded because people did not know what to do. I also found the comment section (almost as long as the post itself) interesting, as it contained points of views toward this article, who’s responsible, what could have been done, and some personal experiences.

In a follow-up article, TherapyDoc talks about triggers that can lead the vulnerable into self-destructive acts. She gave a list of triggers that I think are important in acute management of depression. The reality is that we eventually have to “get out there” and face those triggers and come out of these experiences alive. Then we need a strategy or an action plan to follow when we get a trigger. The caveat is that this depends on ourselves recognizing that our mood function has been “triggered” and that an early warning has been raised. Furthermore it depends on us actually doing something about it, and following through with the action plan.

This concludes this carnival edition. To submit for the next edition, please use this link. Until next time!

Jane Chin

Learning Courage and Changing Minds

Welcome to this installment of the carnival of depression, bipolar disorder, and mental health journeys. I really enjoyed your submissions. I thank you for sending them, and for your passion in what you write about.

JANE’S FEATURE PICK Scott Davis has a mission with his blog: he wants to provide informative, friendly and helpful advice and life tips to people suffering from mental illness. I visited Scott’s website and I love the pictures of the marbles and the honesty that Scott’s writing projects.

Scott’s article, How Winnie the Pooh Taught Me Courage, places our fears in the perspective of a lovable children’s character. Scott thought that by ignoring his fears, he could conquer them, only to realize that it didn’t work. Scott learned as Pooh had learned that courage is about asking for help and talking openly about your fears, and doing things you were afraid of, anyway. Congratulations for being my featured pick, Scott!

Walt said that Pain is a Highly Concentrated Thought and gave some examples of how our pain expands when we focus on the pain: “Think about the last time someone seriously mistreated you unfairly. After they did what they did, what did you do? Then after that? Then after that? I’m pretty sure you consistently thought about what that person did to you. You probably replayed that scene over and over again a countless number of times. Where does it leave you? Nowhere but feeling even more hurt. Any feeling we know comes from a thought first.”

I agree that thoughts are originators. However, a depressed person needs way more help than merely changing his thoughts, even if that person is very determined. In fact, a normal, non-depressed person has challenges changing his thoughts. What form of help a depressed person seeks should be a personal and health related choice, but I wanted to bring to attention that the principle of changing thoughts (“change your thoughts to change the degree of your pain”) is valid, but the actual process of how a person can change his or her thoughts requires a lot of work and discipline.

Along these lines, Talia Mana interviewed Therese Borchard, who blogs at BeliefNet. Therese talked about her experiences with depression, trial and error with scores of medications, and how blogging was helpful for her depression. Therese said, “I think some people make the mistake of not seeking treatment through medication because they feel as though they should be able to think themselves to better health, to control their thoughts. I also think people make a mistake when they expect their medication to do all the work for them.” I wanted to include this because it complements Walt’s entry on pain as a concentrated thought and what I said about principle (that pain is concentrated thought) is not the same as process (how you can change thought).

Therese “had no option but to get well. And to do it fast, because I hated crying and shaking around {my children}.” I enjoyed Therese’s frankness about her experiences with alcoholism and vivid descriptions of her depressive episodes. I also relate to what Therese said about meditation: “The real story: I suck at it. I really don’t like it at all. I try and try and try to just focus on the good, and God, and all my blessings.” I suck at it too. Sometimes I suck so bad that I skip it altogether – like this morning.

J Mitchell Parker wants to build a network of support for men, and his article on depression in men, “He’s Got the Blues – Signs of Depression in Men” is part of this process. Years ago I had reviewed a book on “irritable male syndrome” and the book also talked about how mental health conditions in men tend to get glossed over. If mental illness is linked to social stigma, the pressures for men to keep up a good act when they are battling depression is greater – dare I say – greater sometimes than for women? Depression is not only a health problem, but has social and cultural influences that causes higher hurdles for certain patient populations.

Alvaro Fernandez at Sharp Brains interviewed Professor Bradley Gibson about ADD/ADHD and how training the mind with a non-medication approach shows promise in increasing attention and reducing hyperactivity in 15 children. This would probably be considered a Phase I pilot clinical trial, because the sample size is so small, and the objective of a Phase I trial is usually safety (i.e. approach is safe to use in larger population). Also there was no comparator of non-treated children, which was listed as a study limitation. Still, I was intrigued with the suggestion that plasticity and trainability of the mind opens doors to additional modes of treatment for mental health conditions.

Alvaro also sent an article with his suggestion that learning protects against cognitive decline including dementia. Based on my reading of his summary, I propose that it is not just learning (the intellectual stimulation), but encompasses to “high leisure activities”, which I interpret as having a lot of fun and creativity in your life. Most geniuses are highly creative people and sometimes they can be a bit quirky, but they all immerse themselves in intensely pleasurable activities that for us look like “physics” or “writing music” but for the geniuses are pure joy.

Finally, Vahid Chaychi talks about how dealing with Depression and Cancer. I am not surprised that cancer patients can experience depression because getting a cancer diagnosis takes a person from stages of shock and disbelief to anger and mourning and then acceptance. Still, doctors can be so focused on treating the cancer that sometimes the onset of depression may be missed or perceived as part of the patient’s response to a devastating illness. Vahid reminds us of this important point: Depression is not Normal.

This concludes this carnival edition. To submit for the next edition, please use this link. Until next time!

Jane Chin

Alvaro wrote: Hello Jane, Very good comments. yes, that was a small pilot. See this paper for a real study you can read an interview with Dr. Torkel Klingberg in our blog. Regards Tuesday, February 20, 2007 at 9:09 am

Talia Mana, Centre for Emotional Well-Being wrote: Great selection of articles. I always enjoy your thoughts and comments Tuesday, February 20, 2007 at 8:51 pm

Unsafe Psych Meds from Internet Pharmacies

The FDA is warning consumers about unsafe drugs from internet “pharmacies”. The drugs listed from the FDA alert page includes psychiatric medications like Ambien, Xanax, Lexapro, and Ativan, which were not the drugs that the customer received, but were substances containing a powerful anti-psychotic called haloperidol. This has resulted in ER visits by consumer victims, who suffered from breathing problems, muscle spasms and muscle stiffness. Other haloperidol side effects include agitation, and sedation. Haloperidol is used to treat schizophrenia.

FDA became aware of this problem after a consumer complaint was brought to a U.S. drug company making the branded product. These tablets were packaged with a Greece postmark.

The origin of these tablets is unknown but the packages were postmarked in Greece and looks like this.

Consumers bought these from different websites selling prescription medications.

Source: FDA website

Past Edition for January 23, 2007

Welcome to this blog carnival edition. I’ve already posted one entry that I expanded upon in my post, “I’m Here to Remind You that You Are Not Your Illness.” I thank you who have sent in your entries for this edition, and for upholding my disclaimer that I select entries based on immediate relevance to personal stories about depression, bipolar disorder, and mental health.

D Kai Wilson shared a clinical study abstract that suggests that a successful long term outcome for people suffering from bipolar disorder is not just medication – but “patients that understand their moodswings, their reasonings, their reactions – the underlying chemistry that changes their moods, and their investigation into tailoring their own understanding and treatement of their disorder.”

Dr. Deyo is a predoctoral intern who wrote a very good backgrounder on Cognitive Behavioral Therapy (CBT) and how it works to treat depression. “The idea is that during a depression people have maladaptive or dysfunctional thoughts. These thoughts are not based on reality but rather on the negative self-view or schema.” Dr. Deyo also included a link to a worksheet you can use to track your thinking patterns.

Karen wrote a poignant piece called “the black cave” that started, “There’s been a hard edge to me lately. It’s come out in my writing, and I don’t think I like it.” This piece is a wonderful expression of being in darkness and choosing light even before one has experienced light or even how to get there.

Talia wrote a 2 part review on a book looking at antidepressants, and whether these drugs do more harm than good (part 1, part 2). The review looks at several issues, all of which are complex enough to warrant entire websites and books written about them (doctor-patient relationships, doctor prescribing behavior, the evolution of human behavior, sociology, and pharmaceutical marketing practices). I think one of the key questions that require answering is the placebo effect, especially in mental health studies. Moreover, perhaps a new way to ask an old question would be “how much good and how much harm is this drug” versus “does this drug do more harm than good?” This is because I believe all drugs do both harm and good, which is why drugs require careful deliberation to dispense.

I’m not sure where Scott‘s story fits in here, given it does not deal specifically with depression, but I wanted to include it because I think many readers can relate to aspects of his experiences.

Finally, Vahid shares an article about how to choose the right treatment for anxiety disorders; the article reads more along the lines of choosing the right doctor for your treatment than the right treatment itself. Additionally, the principles of interviewing your doctors applies not only for anxiety disorders but for any health related concerns that require you to see a doctor.

Thank you for sharing your stories. Until Next Time!

Work Place Depression, Pursuit of Money, Loneliness, Exercise Addiction

Welcome to this edition of the mental health carnival. Thank you all for submitting entries and while I cannot include everyone’s submissions, you can be sure that I visit and read all of your entries.

Mother Jones RN shared a touching story of her encounter with a homeless woman who suffered from a mental illness in The Abandoned House and is my featured personal story of this edition. I enjoyed Mother Jones RN’s photographs that accompanied her story as well.

Congratulations, Mother Jones RN!

Isabella’s Mental Illness – It’s Not Talked About reminded me of the time when I was filling out an employment application. There was a line that asked whether I had been treated for a chronic illness (or mental illness, I forget which), and I paused, wondering if my new manager would look at the form and treat me differently. At the end, I wrote down that I had been treated for depression.

Dr. Serani sent a short post about More Celebrities Who Experience Depression, but I’d encourage you to read the comments from readers, who debated whether such celebrity admissions were just another fame-fad, and some realities of the stigma still prevalent in perception of mental illness.

I found Talia’s summary about how pursuit of money has been linked to depression an interesting subject that has gotten a lot of publicity last year in the mainstream media (especially Wall Street Journal), but the angle slightly different. Instead of depression, media looked at some recent studies looking at the correlation between money and happiness. One may assume that if happiness and depression are on somewhat opposite ends of the spectrum – ignoring those people who actually delight in their own suffering from depression – then we could deduce that pursuit of money leads to less happiness. I don’t completely agree with pursuing money = depression, because I’ve been quite poor and depressed.

I liked how Mary deals with an individual aspect of depression: Loneliness and suggests different ways to overcome isolation that exacerbates depression. Angela’s article on communicating with friends with Depression is a perfect accompaniment to Mary’s article, because the truth is, even if I have experienced depression personally, I may not be equipped with the finesse of dealing with a friend’s depression.

Dr. Freedman sent a helpful differentiation between the presentations and prognosticators of depression, because it asks us to take personal accountability to track our own emotions and mood changes. It can be easy to self-label as depression and then seek medication to “fix it”, but more effort to track how we are feeling and responding to different situations.

I’ll admit that I was skeptical of how Reiki healing can work for depression submitted by TC, and even more skeptical of the post title (“reiki healing the best thing for depression”) because this claim was not substantiated beyond anedotes and thus cannot be considered evidence. I’m including the post here because I don’t know enough to discount it, but I know that there is no “best” treatment for depression.

I’ve never met Craig Harper but I consider him a colleague. From Craig’s picture (on his website) he looks tall and in very good shape. Thus I appreciate how open Craig is in sharing his experience with Exercise Addiction. I know what many would think – “that’s a problem I’d love to have” – which is why it was important for Craig to increase awareness of the real consequences that sufferers of exercise addiction faces.

Finally, I want to echo Mary’s sentiments of The Importance of Sleep to Good Mental Health – from my own personal experience!

Thank you all for sending your stories and articles to this edition of the Carnival.

isabella mori wrote: a great carnival, as always! interesting what you have to say about depression and poverty. poverty can definitely be a precursor to depression. i’ve seen that a lot working in an inner-city environment, in vancouver’s downtown eastside. on the other hand, i took a workshop on suicide prevention a few weeks ago, and john banmen from the satir institute of the pacific, who lead the workshop, said that there are more well-off people who commit/attempt suicide than people who are poor because people who are poor tend to have more well-honed coping skills. Tuesday, February 6, 2007 at 8:20 pm

Jane Chin, Ph.D. wrote: interesting about the well off people who commit suicide – I suppose they also have “the means” to carry it through. Tuesday, February 6, 2007 at 10:05 pm

Medication: EU Cipralex for Obsessive Compulsive Disorder

Cipralex (escitalopram, manufactured by Lundbeck; in the US the drug is called Lexapro) has been approved in Europe for treating obsessive-compulsive disorder (OCD). OCD is a chronic disorder characterized by recurrent thoughts and impulses (obsession) and/or repetitive behavior (compulsion). A 24-week study of Cipralex in OCD showed that the 10 mg/day and 20 mg/day dosage of Cipralex were effective in terating OCD. A placebo comparison showed that the 20 mg/day dose of Cipralex showed reduction of symptoms and increase in remission rates. A comparison with paroxetine (brand name Paxil in US and Seroxat in EU) showed that Cipralex had fewer withdrawal symptoms. Given that Cipralex is a member drug of the SSRI class, patients should be aware of the safety profiles and risk relating to this class of drug. Side effects may include nausea, insomnia, problems with ejaculation, somnolence, increased sweating, fatigue, decreased libido, and anorgasmia. Source for side effect information: Cipralex and Lexapro websites.

2 Comments

Ryanne Hall wrote: A word of encouragement to those labeled “O.C.D.” …My sister has long been a poster child for OCD. However, it has recently been discovered that she actually does NOT have Obsessive Compulsive Disorder! She has C.D.O.. What is that, you ask? Well, it is basically the same thing…but in ALPHABETICAL order! Sunday, June 3, 2007 at 9:57 pm

Jane Chin, Ph.D. wrote: That’s funny, Ryanne Tuesday, June 12, 2007 at 4:24 pm

Past Edition for January 10, 2007

Happy new year, everyone. We may be entering a new year, but we don’t need to wait hundreds of days to get that “brand new feeling.” We have a new chance every second and every moment of our lives to renew, to make different choices, and to decide that we deserve a joyful life. May your 2007 – and every moment – be joyful and healthy.

Here are my selections for our first carnival of this new year. I thank all of you who have taken the time to contribute. I also want to thank Marja Flick-Buijs for her lovely photograph you see with this post; it’s called “center abstract”.

Please keep in mind that entries are selected on relevance to the mental health topic – preferably from an individual experience. Starting this year, some entries that are selected for the blog carnival will also be linked from within Jane’s Mental Health Source Page under the appropriate category. This will help visitors find your articles long after the carnival has published.

Linda Freedman‘s Empathy, Boundaries, and Getting Dirty shows us a rare glimpse of what mental health professionals go through when they are helping people. Good therapists make a connection with their clients, so that the clients can speak from a place of trust and get the help they need. This connection can come at a price.

Scott Lee‘s Overcoming Emotional Attachment accomplishes two things: the importance of self-accountability (i.e. I don’t deny the chemical imbalance, and I also don’t deny that I do have choices) and an introduction to the mechanics of “letting go.” We throw “letting go” around like a catchphrase, but many of us don’t actually know how to “let go.” The sedona method can be a good complement to any healing process. I have attended an introductory seminar in the past and have the book and CDs on the method. Thanks for sharing with us, Scott.

Hal Sommerschield, Ph.D.‘s Always Sick At Christmas Is a Signal raises an important question: can an illness become an identity – even a purpose? There are cases where we can grow attached to our labels for one reason or another. One day, we become so used to this attachment that we begin to believe that “we are our sickness.” When that happens, healing can only take place when we get to the core of this phenomena and realize that at some point, we began to believe that having a condition gets us something we deeply want (often love).

GNIF Brain Blogger shared a mother’s relationship both with her son and with other family members whose compassion and patience have bounds. In Staying the Course Prescribed for Major Depressive and Bipolar Disorders: A Family’s Journey Thus Far, Patti Wilson-Herndon talks about her son’s major depressive disorder and possible bipolar disorder condition, and how she has learned not to be as emotionally affected by less-than-understanding family members of her son’s condition. GNIF Brain Blogger also explains THE book in psychiatry: The Diagnostic and Statistical Manual of Mental Disorders, DSM.

I checked out Silent Bipolar Professional‘s blog as soon as I received the post for the carnival. I see a lot of potential in this fledgling blog, and I hope Silent BP continues to share via this blog. Silent BP’s blog remind us that many who suffer from bipolar disorder lead productive lives and make tremendous difference in society. Yet Silent BP believes that anonymity should be encouraged, as our society likes to compartmentalize people, and “There is no reason to expose yourself to the groundless scorn of strangers, co-workers, and the like.” Thanks and keep on writing, Silent Bipolar Professional.

Darren Hayhurst is someone who had experienced depression and wants to share some of the lessons he has learned at The Mind. Darren probably writes as he would converse with you, and you can feel Darren encouraging you to beat depression with “the right help.” This is also a new blog, likely focused on personal development. Similarly, Randy Ynez writes about personal development and shares how anxiety and excitement are both sides of the same coin. Please keep in mind that the article is not discussing anxiety as a medical diagnosis.

Isabella Mori writes wonderful articles on mental health, and her seasonal storms is a gem. I love her analogy of an “emotional storm”. I hope we can take note that self-isolation comes very easily, and sometimes without our noticing it. When I was in the throes of depression, I was isolating myself quite a bit. Isabella shares ways we can “safely” connect with others and extricate ourselves from dangerous isolation.

Lyman Reed decided to go back on antidepressants again. He writes about his decision and how many self-help schools of thought look down upon modern medicine as one big conspiracy. Medications harm as well as help, which is why medications are strong stuff not to be meddled with. I’m as enthusiastic about the laws of attraction as many who love personal development. I’m also trained as a scientist. I find that some celebrity speakers can make gross generalizations about modern medicine as if nothing good as come out of it. This can do harm to those who can be helped by modern medicine but don’t seek help because they follow whatever a “guru” says without critical analysis of all the facts. I have enjoyed many of Wayne Dyer’s books and CDs, but I bet modern medicine saved Dyer’s life when he suffered a heart attack and had to be treated by doctors.

This concludes this edition. Please submit your articles to the next edition here. Please keep in mind that I get overwhelming responses for each carnival, and will enforce selection criteria of relevant topics to mental health (as medically relevant to depression and bipolar disorder and not only positive thinking). I give preference over first-person experiences.

To comment on this carnival, please click on this post’s permalink and scroll down to the comment box. Thank you!

Until Next Time

LInda Freedman (TherapyDoc) wrote: Thanks for including my entry. This is a wonderful group. I’m linking over here and can’t wait to read everything (it’ll take a little time, patience for the comments!) Friday, February 2, 2007 at 7:17 am

In Between Meds, Searching for a Diagnosis, Richard Dadd, and Compassion for Your Self

Welcome to another edition of Jane’s Mental Health Source Page “carnival”, a carnival that reads more like a story (much work but worth your internet reading time) than a list of blog links (easier but so boring). People are finally starting to know that I mean it when I say “top quality posts only, please!” because I’ve received many excellent entries to include in this edition, and only had to exclude about 60% of the posts, as opposed to about 80%-90% of all entries in the past.

Jeannette wrote about a precarious period when you wean yourself off one medication and start a new medication for depression, but this post covered more ground than that. Jeannette knew herself well, and during that “in between time”, she did what she could to get through (remaining alert to her own warning signals, trying acupuncture) although it was tough – it always is. She also knew when it was time to call the psychiatrist’s office and was told she had to wait 2 weeks before she could be seen. I don’t understand why the clinic didn’t immediately give her 3-5 referrals; it’s hard enough to call for mental health help without getting into an appointment bottleneck, but that’s the sad “norm” for our medical clinics today. Thankfully, Jeannette’s new med kicked in the next day. She also likes her psychiatrist once the appointment date came around. “Sure the stress of life gets me down a bit, but being up more than down is so much different than what I have ever experienced. I have hope.” Hang tough, Jeannette!

In contrast to Jeannette’s experience with her psychiatrist, Suni‘s psychiatrist either hasn’t learned how to listen or can’t listen because it conflicts with his perception of his job (I’m guessing “diagnose and prescribe” rather than “sitting down with patient and have a detailed discussion and Q&A to establish rapport”). Suni is questioning her original diagnosis of bipolar disorder, and her psychiatrist appears convinced that bipolar disorder was the correct diagnosis. To be fair, that could be a possibility, but if it was, the psychiatrist did a lousy job of explaining the basis and rationale for his continued belief that she has a form of bipolar disorder.

Readers must understand that the medical community truly isn’t well trained to deal with patients who request “non-medical alternatives”, at least not yet, and the psychiatrist indeed had a point in his argument about “alternative” therapies not being FDA approved. Yes, FDA-regulated drugs can have dangerous side effects as well, but at least what is known is required by law to be spelled out in detail in the package insert (“PI”), while on the other hand, we hear about the (sometimes fatal) side effects that some supplements or alternative approaches have only after the media reports them. Thus, the doctor can only give you lots of pamphlets on things he can talk intelligently with you about, and have scientific data to look into if you ask questions. Still, this doctor could, at minimum, listen to his patient. I wish Suni well on her quest for a better relationship with a healthcare professional, because that makes a huge difference in mental health help.

Therapydoc shared her post about borderline personality disorder, as if in response to Suni’s search for answers regarding her belief that she suffers from BPD rather than from bipolar disorder of any spectrum. Her post includes the current Diagnostic criteria for 301.83 Borderline Personality Disorder, which illustrates why psychiatric diagnoses are so tough. One who suffers from bipolar disorder or depression or another anxiety disorder may identify with many of the symptoms listed in BPD. I can take cold comfort in the reality that our current medication technology for mental illness act like blunt instruments that cover a gamut of mental health symptoms, and medication used for one condition may often be approved for treating another condition. Still, that doesn’t get doctors off the hook for talking with (caring about) a patient who desires clearer answers.

I was struck when reading Isabella‘s 8 points of “emergency preparedness for winter depression” by how big a part “human-to-human interaction” plays in staving off depression. Having some form of daily interaction with another human being makes a big difference in depression no matter what season, at least that’s what I’ve personally found. And no – instant messaging doesn’t count… Skype may be OK, because you get to verbally interact with someone, but nothing beats a real life, interpersonal interaction for the richness of stimuli (sound, sight, smell, even touch) your neurons gain. In fact, human interactions by way of social connectedness has been observed to play an important part in your immune system, as I’ve written about in another weblog.

According to Dr. Vitelli‘s blog bio, he’s “still trying to decide what I want to be when I grow up.” You and me both, Dr. Vitelli, and for now, I’m happy with exploring and blogging along the way (I’m beginning to think that I may never get to the point of having “grown up” but that I’m meant to continue “growing and exploring”). Dr. Vitelli shares a short history of Richard Dadd, a painter who suffered from mental illness but didn’t gain the level of notoriety as, for example, Van Gogh. Still, I was amazed at the level of detail of Dadd’s magnum opus, The Fairy Feller’s Master Stroke. I was fixated on how the ground in this painting appeared to have a physical dimension.

Urban Monk aka Albert writes comprehensive articles on aspects of mental and spiritual perception, and his article, Psychology’s unique contribution to your Compassion and Self-Esteem, may be an eye-opening read for those of you who want to better understand your relationship with yourself – specifically, your perception of who you are. This is a very long read, but worth the investment. Interestingly, I recently just purchased a book by The 14th Dalai Lama called, “How to see yourself as you really are”‘ it’s one of those moments when things happen in my field of consciousness that tells me to pay attention, because “this is important”. When we consider that depression has often been referred to “turning anger inward”, our perception and relationship with ourselves may literally be a defining factor of our management of a depressive condition.

Finally, Suni also submitted a second entry that I will write about in a separate, non-carnival related post, because I received a similar topical question from Quint, and the subject warrants an individual article, which I’ve written here (link is activated 11/22/2007).

Announcement re: carnival editions for December 2007 and January 2008 Thank you all for the many positive and encouraging comments relating to my mental health carnival. I love the fact that you recognize my effort in making these carnivals “different” from the many carnivals you find out there, and that you enjoy my personal commentaries and occasional stories that weave these entries together into a coherent post.

I will be taking a vacation from publishing carnivals and resume carnival editions in February 2008 because I’ll be giving birth to our first child. My husband and I will be learning to be parents and function on very little sleep. I’ll post new articles when I can string thoughts coherently together, but I want to take advantage of this time to do something I’ve wanted to do for a while: republish my favorite posts from the archives and share with you many of my personal writings that’s become buried amongst hundreds of articles on this website.

Until next time

5 Comments

suni wrote: Congratulations on your (soon to be) new motherhood. I wish all the blessings to you that God can afford to grant. You have done a great job in this carnival, as always. I appreciate that you take the time to do what you do here. Looking forward to seeing you again in February. Enjoy your baby!!! Monday, November 19, 2007 at 6:06 pm

Albert | UrbanMonk.Net wrote: Hey Jane, thanks heaps for including my article . You’ve really put a lot of effort into each of your carnivals, and it really makes yours stand out amongst the others. Monday, November 19, 2007 at 7:13 pm

Jane Chin, Ph.D. wrote: Thank you Suni and Albert for your contributions to this carnival and for your kind comments. I’m very much looking forward to this new adventure of human experience that is parenthood Monday, November 19, 2007 at 8:37 pm

Jeannette wrote: Thanks so much for including my story. I hope it helps even one person recognize when it’s time to ask for help. Congratulations on the birth of your new baby. Enjoy it!! Tuesday, November 20, 2007 at 10:02 am

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