Top 10 Bipolar Blogs

John at PsychCentral has created a list of the top 10 blogs on bipolar disorder including bloggers that post on their personal experiences, and those that discuss issues with medications, the latest research and treatments.

Get free help for your depression

The Department of Neuroscience at Columbia University and The New York State Psychiatric Institute is looking for people to participant in mental health research relating to depression, bipolar and PTSD and more.

If you are based in New York you could be eligible to participate in research and receive free outpatient treatment. Check out the current studies on depression and bipolar for more details.

Brain protein that aids breathing may improve sleep, epilepsy and mental illness

For decades, researchers have investigated how the brain "unconsciously" controls breathing, a chemical and electrical process considered automatic in the mammalian world.

Now Biologists at the University of Pennsylvania have found a link between a recently discovered protein in the brain and the nervous system's duty to regulate breathing.

It is already known that breathing is influential on anxiety, sleep and stress related illness so this is a potentially important discovery. The NALCN protein is also found in other brain regions whose irregularities affect those suffering from epilepsy, seizures, depression, bipolar disorders and schizophrenia.

All living beings rely upon the traffic of charged chemicals (normally sodium, potassium or calcium) in the brain to fire neurons, leading to the complex processes that sustain life, among them respiration.

The Penn study demonstrated that NALCN, a substantially uncharacterized member of the sodium/calcium ion channel gene family, plays a key role in respiration by forming a channel in the brain cells that allows a constant, regulated "leak" of the positively charged sodium ions into the neurons. It may be this continual transference of sodium that triggers regular excitement of the brain stem, the portion of the brain associated with a variety of functions including motor control, and respiration.

Testing their findings, Penn researchers genetically mutated mice in the embryonic stem cell phase to prevent their production of NALCN. The resulting specimens experienced severely disrupted respiratory rhythm and died within 24 hours of birth. In addition, brainstem-spinal cord recordings revealed reduced brain activity.

The NALCN channel appears to be a regulating gateway that controls the chemical energy required to fire neurons and thus regulate the breathing required to sustain life.

"Surprisingly, how the neurons generate and control breathing rhythm is poorly understood," said Dejian Ren, assistant professor of biology at Penn's School of Arts and Sciences. "The discovery of this important ion channel may open the door to a further understanding at the molecular level."

The study was conducted by Dejian Ren, Boxun Lu, Yanhua Su, Sudipto Das, Jin Liu and Jongsheng Xia of Penn's Department of Biology and was published in the journal Cell.

The research was supported in part by the American Heart Association and the University of Pennsylvania Research Foundation.

Book review: Living Well with Depression & Bipolar Disorder

John McNanamy is one of the growing number of expert patients who have written about their own health experiences and researched options for treatment.

In his book, Living Well with Depression and Bipolar Disorder, McNanamy details the different types of depression and mania and methods of diagnosis. This book combines his own personal experiences, his interactions with other patients with depression or bipolar, and summarises other literature on the subject of mental health diagnosis and treatment. He takes the time to explain the mechanisms underlying depression and mania, and comorbidity with anxiety, alcoholism and the like.

In Living Well, McManamy draws links between depression and other personality and lifestyle traits. For example, his own small website poll determined that a little over 80% of respondents with depression are introverted. He also discusses the different impact of depression and bipolar on young and old people, men and women.

He then moves on to different treatment options and discusses the pros and cons of medications, talk therapy, complementary treatments (e.g. light boxes, vitamins, minerals, amino acids and other supplements) and lifestyle changes, such as diet and exercise.

This is a great book if you want to understand the causes of depression and bipolar illness, or if you have questions about treatment options. Some people will find the information on antidepressants, antipsychotics and other medications an eye opener. In Living Well, McManamy explains how drug trials work and what the results mean. In short, he debunks the statistics commonly quoted by pharmaceutical companies when describing the effectiveness of medications.

This isn’t to say that meds don’t work, but the number of people that are helped by medications is overstated, and side-effects are minimised. This occurs because the results don’t include patients who don’t complete the trial period, due to unacceptable side-effects. According to McManamy antidepressants reduce depression by half in approximately half the patients. And some of those patients may have naturally improved over this time frame. It’s not entirely encouraging.

However, there are lots of helpful recommendations, including the need to keep taking your meds if they are helpful as this can reduce the risk of relapse. McManamy makes a compelling case for lifestyle changes, such as incorporating more omega 3 fatty acid rich fish, reducing sugar intake, managing sleep and incorporating regular exercise. He also overviews cognitive therapy and the importance of an holistic approach that incorporates changes to lifestyle and mindset to supplement medications.

The book doesn’t give you a prescription for recovery. If you’re looking for a step-by-step solution you may prefer The Chemistry of Joy. However, if you want to understand your illness and all the available options for recovery, then this book lets you choose from the menu of possible solutions.

Should babies be tested for predisposition to disease and illness?

The potential to test babies for predisposition to illness and disease raises interesting ethical issues for parents.

The largest ever study of the genetics behind common diseases such as diabetes, rheumatoid arthritis and coronary heart disease has released its latest findings.

The £9 million study is one of the UK's largest and most successful academic collaborations to date. It has examined DNA samples from 17,000 people across the UK, bringing together 50 leading research groups and 200 scientists in the field of human genetics from dozens of UK institutions. Over two years, they have analysed almost 10 billion pieces of genetic information.

The study has substantially increased the number of genes known to play a role in the development of some of our most common diseases. Many of these genes that have been found are in areas of the genome not previously thought to have been related to the diseases.

The researchers are hoping that these findings will lead to early intervention and treatment of disease, and could potentially be used to allow genetic testing of babies to identify whether they are at risk of Crohn's disease (a type of inflammatory bowel disease), bipolar disorder (manic depression), types 1 and 2 diabetes, coronary-artery disease, or three in rheumatoid arthritis.

While it could be helpful to identify genetic predispositions to these illnesses it also raises ethical concerns. What happens if a toddler is identified as having the genetic markers that predisposes him or her to bipolar disorder? On the plus side the family will be in a position to be aware of early warning signals of manic or depressive episodes and may be able to learn skills to help their child manage episodes.

However there are many dangers to early warning of the possibility of mental illness:

• Insurance companies could refuse to cover the child or raise premiums
• Schools may demand that bipolar children be schooled separately or refuse admission unless they are on medication
• Children may grow up with the stigma of being mentally ill and labelled as being bipolar even when they don’t have symptoms of bipolar disorder
• Friends, family and schools may walk on egg shells around the child or alter their behaviour in ways that are damaging
• If you treat someone as if they have a mental illness, could this belief and the subsequent actions become a self-fulfilling prophecy that creates mental illness?

What do you think? Is forewarned forearmed or is it better not to know the potential illnesses that your child may be predisposed to?

Spring and Summer are Mania Time!

A guest post from Julie Fast of Bipolar Happens

Well, it's mania season again in the Northern Hemisphere. Mania peaks in the spring and summer and many people with bipolar disorder are often caught by surprise and may not take care of the problem before it's too late.

I actually wonder if I've been hypo manic lately. My dear friend Laura asked me if I was when we had lunch yesterday. Laura knows the signs and always says something when she sees them.

I've taught all of my close friends and all of my family members the symptoms of my mania- they have my Health Cards memorized.

When they see signs they ask me questions:

1. Have you been eating?
2. Have you stayed up late?
3. Have you been drinking?
4. Are you making sexual mistakes?
5. Are you spending more money?
6. Does the depression seem a LOT better?
7. Are you having trouble sleeping?
8. Are you agitated or irritated?

They look out for me - because by the time I can answer yes to even a few of these questions, I may not be thinking rationally.

This is because I'm just so darn thankful not to be seriously depressed.

I want my manic feelings to last forever, but they never do. I always go down. So by preventing the mania before it starts or before it goes too far, you can prevent a terrible down swing as well.

My answers to the above questions:

1. I'm definitely eating less (and am VERY happy about it!) This may be a normal fluctuation or a sign of hypomania.
2. I stayed up until 3AM last weekend. This is the first time I have done this in five years. So, this is not a good sign.
3. I did drink on the night I stayed up. I have not had too much to drink in over two years. This is definitely a sign.
4. When you're single it's especially important to look for possibly damaging sexual behavior. I'm being careful about this. Very careful as it has been quite a problem in the past when I get manic.
5. I recently went on an all cash system and this is keeping my spending down. So, this is a no. I always have spending problems when I'm manic.
6. My depression is not serious right now. I woke up depressed this morning. I was feeling better this weekend. A possible sign.
7. I have not had trouble sleeping. This means if I am manic, it is in the beginning stages.
8. I don't have agitated mania. Many of my friends with bipolar disorder do. But this is not an issue with me.

Going In and Out of Mania
Well, when I look at all of this, I can conclude that I'm going in and out of hypomania and will have to be extremely careful in the next few weeks. My family and friends will have to monitor my behavior carefully. And I will have to listen to them, even when I don't want to.

Mania Can Feel So Good!
Yes, mania can feel good. It can be such a relief- especially after a winter depression. But the feelings are false. They're chemically created and must be treating with the same aggressive treatment as you treat depression.

Remember: What goes up because of bipolar disorder ALWAYS comes down.

If you have bipolar disorder, ask yourself the above questions and be honest with yourself. Ask the people in your life to answer them for you. If you love someone with bipolar disorder, think about these questions carefully. Mania can be prevented when you know the signs and use your Health Cards. Mania can be treated successfully even when it has already started. If things are okay right now, ask yourself these questions throughout the summer months.

Staying Healthy
Let's stay healthy this summer. Say no to mania. Take care of yourself. If you love someone with the illness, help take care of them now. Use your Health Cards now and prevent the mania that often comes when the weather changes! It is possible.

Julie A Fast
Author of Loving Someone with Bipolar Disorder and Take Charge of Bipolar Disorder
BipolarHappens.com

Free Bipolar Guide

From The Organization for Bipolar Affective Disorders (OBAD) you can download a free comprehensive 60 page guide to bipolar disorder that includes the history of bipolar disorder, an overview of the condition, how it is diagnosed and options for treatment.

Anti-Depressants - Is the cure worse than the illness? (Part 2 of 2)

Married to antidepressant meds

The author has a wonderful quote on taking meds:

an unexpected relationship will become permanent

He uses this quote (from a fortune cookie) as an analogy to taking meds. He suggests that many people are encouraged to take meds as a temporary measure not realising that for some they will need to be on antidepressants for the rest of their life – either because the illness is too severe or because the withdrawal symptoms of stopping are too painful.

Dr Karp likens the relationship with meds to a marriage:

This process of becoming committed to drugs can be seen as having four stages: desperation, experimentation, engagement and marriage.

I'm not sure I like the analogy, unless you were to describe it is an arranged marriage - for many taking meds is not something they willingly choose.

I can see where he is coming from but I believe the process of becoming wedded to medication is more like that of grieving. Elisabeth Kubler-Ross has defined the five stages of grieving as:

• Denial
• Anger
• Bargaining
• Depression
• Acceptance

I think many depressed people move back and forth between the first four phases before finally reaching acceptance. At that point they acknowledge that they have a psychiatric illness and that medications are a necessary part of the recovery.

For some people acceptance never comes. Instead they form an uneasy alliance with the meds and their health professionals but in their mind it is a temporary arrangement. Even after 15 or 20 years in medications there are many people who long to give them up and fight or question on a regular basis the need for antidepressants.

Doctors encourage patients to take meds likening the antidepressants to treatments for diabetes or headaches. However there is one critical difference - antidepressants are mind altering substances.

In my experience with doctors they are all reading from the same script. They all want you to believe that antidepressants are better than the alternative. I’m not convinced that is always the case. From my own personal experience the side-effects of meds often outweigh the benefits.

Do the drugs really work?

The author points out many of these drugs are relatively new. While they have been tested and found safe this is only within the parameters of their testing. If a drug has only been around for 10 years there is no way to know what it’s long term effect may be on someone who needs to take that med for another 50 years.

For many the improvement from antidepressants is only slightly greater than the placebo effect. According to one study of SSRI antidepressants:

Approximately 80% of the response to medication was duplicated in placebo control groups, and the mean difference between drug and placebo was approximately 2 points on the 17-item (50-point) and 21-item (62-point) Hamilton Depression Scale.

There were many patients interviewed in the book who had little or no relief from the prescribed antidepressants. They also disliked being labelled as someone with a mental illness and found it difficult to tell friends, colleagues and new acquaintances about their diagnosis and the need to take pills.

Dr Karp shines the light on unethical pharmaceutical practises such as:

“commissioning multiple studies to assess a drug’s effectiveness and then reporting only on the research most flattering to their product
“failing to systematically ask study respondents about certain side effects
“Limiting drug trials to short periods of time

He also states that:

rarely does the antidepressant medication far exceed the placebo in effectiveness, and sometimes subjects in the control group actually report greater symptom relief

It makes you wonder why doctors prescribe antidepressants! In reality, I think antidepressants are helpful for many people with depression and anxiety, but for those that don't find them helpful doctors would be wise to stop experimenting and forcing drugs on treatment resistant individuals and focus instead on therapy, cognitive behavioural techniques, positive psychology and lifestyle changes.

What about the side-effects?

Side-effects vary according to the individual biochemistry of the individual taking meds. As we've seen in Part 1, the patient's trust in their doctor is a factor in the efficacy of the meds as well as their attitude towards taking meds for depression.

One of the most contentious risks is the possible increased risk of suicide in children and teens. The US FDA became so concerned about the risk of youth suicide among those taking antidepressants that they asked for a blackbox warning on all antidepressant meds. You can read an analysis of the black box warning issue here

According to the manufacturers of Prozac, the meds may increase the risk of suicidal ideation in children and teens. They also state that there are benefits and risks in using antidepressants.

What are possible side effects of PROZAC?

• Some people experience side effects like nausea, difficulty sleeping, drowsiness, anxiety, nervousness, weakness, loss of appetite, tremors, dry mouth, sweating, decreased sex drive, impotence, or yawning. Most of these tend to go away within a few weeks of starting treatment and, in most cases, aren't serious enough to cause people to stop taking PROZAC.


• PROZAC can cause changes in sexual desire or satisfaction.

Do not drive a car or operate dangerous machinery until you know what effects PROZAC may have on you.

• Contact your doctor or healthcare professional if you get a rash or hives, or other side effects that concern you while taking PROZAC.

While the manufacturers state that ongoing drowsiness and loss of sex drive is relatively uncommon, Dr Karp found in his interviews that the majority of patients experienced these side-effects.

Please don't stop taking your meds without medical supervision

The jury is still out on the effectiveness of antidepressants compared with the placebo effect, and for many the side-effects of meds make them unpalatable. However, the placebo effect does show an improvement, and some patients have found antidepressants a lifeline for depression and anxiety. The results were less clear in the interviews with bipolar patients, possibly due to the fact that many bipolar are prescribed a mix of antidpressants and antipsychotics or mood stabilisers.

If you have any doubts that your meds are working effectively, please see your health professional to fully discuss your options. Sometimes switching to another antidepressant can bring about radical improvements. You may also like to consider therapy and lifestyle changes.

I look forward to your feedback.

Part 2 of our review of Is It Me or My Meds?: Living with Antidepressants by David A. Karp

You can read part 1 here

For help with depression and other emotional issues visit our forum

Anti-Depressants - Is the cure worse than the illness? (Part 1 of 2)

This is the sort of book you wish your doctor would read.

It looks holistically at depression considering the biomedical model (i.e. there is something wrong with your body and in particular your brain) as well as psychosocial factors, lifestyle changes and other environmental influences. Is It Me or My Meds is penned by David Karp, who has long term depression and anxiety. He interviewed 50 people (including teens) with major depression and manic depression to gauge their attitudes about taking antidepressants and dealing with depression and the stigma around it.

Why people take antidepressants

Commonly accepted wisdom is that depression is caused by a biochemical balance in the brain which can be helped by taking antidepressants. Not everyone accepts this hypothesis. Some believe that depression and other mental illnesses can be fixed through meditation, counselling or other types of therapy, dietary changes, exercise or sheer willpower.

According to an anonymous academic who blogs here

Please. There may well be brain issues in people with various “mental illnesses,” but this whole ‘chemical imbalance’ thing is 95% marketing, 5% science. Find a serious scientist who will step up to the mic (sic) and tell us about the definitive chemical imbalance that causes bipolar, schizophrenia, or much of anything else in the mental disorder world.

While there were many people that resisted medication there were some who welcomed it with relief. Many patients were anxious for anything that might grant them some relief from unrelenting feelings of sadness, worthlessness and at times suicidal ideation.

Individuals reported varying degrees of success with antidepressants. For some, taking medications were a lifesaver that enabled them to feel more confident, overcome feelings of hopelessness and get on with life. However large numbers of people reported dissatisfaction with the side-effects of meds, failure of the meds to work effectively, gained only short-term relief from antidepressants or felt ostracised by being labelled as someone who needed to take psychotropic medications.

There were several patients who refused to take meds, or found themselves hopeful that they would one day be able to wean themselves off antidepressants. Overall, the majority of patients interviewed did not like taking meds for depression, bipolar or anxiety.

This attitude is also reflected in the attitude of the author, who has tried unsuccessfully to withdraw from taking antidepressants and antianxiolytic meds.

The people interviewed referred to searching for identity and not knowing whether the self on drugs is the ‘normal’ person or the one off drugs. Many felt pressure to conform to society’s expectation of normalcy.

The book includes a quote from Francis Fukuyama:

There is a disconcerting symmetry between Prozac and Ritalin. The former is prescribed for depressed women lacking in self-esteem; it gives them more of the alpha-le feelings that comes with high serotonin levels.
Ritalin on the other hand, is prescribed largely for young bots who do not want to sit still in class because nature never designed them to behave that way.

How your relationship with your doctor affects you

It was also evident throughout the book that the relationship of the individual to their health professional made a substantial difference. In situations where the individual felt that the health professional listened to their needs and offered trustworthy advice, patients were more likely to take meds and more likely to have success with them.

In this respect the placebo effect of medications was influenced not only by the knowledge that they were taking meds for their depression but also by their trust in the Health Professional prescribing the meds.

Part 1 of our review of Is It Me or My Meds?: Living with Antidepressants by David A. Karp
You can read Part 2 here

~ For help with depression and other emotional issues visit our forum ~

Sunlight reduces Seasonal Affective Disorder but can also induce Mania

Here's an interesting twist on the benefits of sunlight from Julie Fast at Bipolar Happens.

People who experience winter sadness, also known as Seasonal Affective Disorder are very familiar with the benefits of sunshine. Not only does the warmth make you feel good, but the full spectrum light affects your biochemistry triggering feelings of happiness and well-being.

You can increase your exposure to the feel good rays by purchasing light boxes or spending more time in the sun. The light enters through the eyes, either directly or by reflecting off other surfaces.

But apparently for some people too much of a good thing can lead to summertime mania, an abnormally elevated mood accompanied by grandiosity, racing thoughts, increased risk taking and inappropriate behaviours. This probably explains why drinking alcohol in the sunshine appears to potentiate or magnify the effects of the alcohol. A couple of glasses of wine on a sunny day and you start to feel REALLY good!

According to Julie

It often feels so good to finally have some energy and a renewed interest in life once the summer starts, but this good feeling is often the result of mania and has to be monitored carefully. Mania is so tricky. It can sneak up on you in just a few hours and before you know it you’re staying up all night for a week (at the expense of your job and relationships) working on a project you just know will change the world while everyone around you is asking, “What in the heck is wrong with you? Have you lost your mind?”

Julie recommends wearing sunglasses to limit the risk of mania and asking your friends,family and colleagues to be aware of any indications that your mood is excessively elevated.

Talk about bad news! It's our fifth official day of summer here in New Zealand and I have been looking forward to all those feel-good endorphins being stimulated by the longer days. I guess that's another good reason to slip, slop, slap - slip on a shirt, slop on sunscreen, and slap on a hat.