My friend Alexandra recently recommended me to be a member on the Young Professionals Board of the Park Center, a local agency that provides opportunities and promotes recovery of persons with mental illness through holistic services that focus on their needs, choices and strengths (See their PSA above). I haven’t been officially ‘inducted’ into the group yet, but with a meeting coming up with their development director in the next week, it’s almost certain that I will soon be on the board of the Park Center in the fall. It’s an incredibly exciting opportunity for me, and I hope that I can gain further insight into the mental health community through being involved with this organization.

I think this commitment will affect this journal/blog in some way, because I’m definitely looking forward to talking about all that the Park Center does, because their gamut of programs, from homeless outreach to pre-employment vocational services, are really amazing. Because I do have this blogosphere platform, I believe I have an obligation to talk more about mental illness beyond my own experiences. While I don’t plan on changing the tone of this journal, I’m sure that, as I become more aware about the projects that they have, I’ll certainly be more inclined to write about them.

My soon-to-be relationship with Park Center will open an amazing new chapter to becoming more than just a blogger about the mental health community, and I’m really looking forward to it!

She was hesitant to take me off of Abilify since the combination that I’m currently on has been fairly well tolerated by me. And with school starting in a few short weeks, she wasn’t sure this was the best time to test out a new mood stabilizer. So, she gave me a choice as to whether I wanted to try something else later or now. I picked now.

Because I’ve been on quite a number of different of meds, the options have dwindled quite a bit. So she thought it’s time to try something new, as in they haven’t even made some animated commercial for it for television yet. It’s called Latuda, and it’s currently been FDA-approved for treatment of schizophrenia. Apparently, it’s supposed to be weight-neutral, but can cause tremors, which I’m not a fan of because of previous experiences with similar issues.

I really hope I lose some weight, but I’m really hoping that Latuda does make a good fit for me.

I posted the animated Abilify commercial on the site in March, and was fascinated with the depression ‘blob’ that follows the depressed woman around. I came across this what I’m guessing is a pretty new commercial for Seroquel XR the other day and noticed that this one features a cloud that follows the depressed people wherever they go.

Apparently, this ‘condition’ could be called hypersomnia (excessive sleepiness, tiredness), and I came across a new study that reported that hypersomnia among bipolar disorder (BD) patients who are in an inter-episode period may predict future depressive symptoms. According to the article in the Journal of Affective Disorders, Allison Harvey (University of California, Berkeley) and team explain that BD patients “in the inter-episode period spend roughly 50% of their time unwell, and these symptoms predict relapse into mania or depression. Hence, there is a critical need to identify aspects of the illness that contribute to inter-episode dysfunction and to relapse.” (Below this post is a shortened version of the article)

So, what am I to do about this? If I fix my sleep issues, would I be able to avoid a possibly incoming depressive episode? This particular study doesn’t answer that question, but I’m hoping that this is the case. If anything, I can go back to getting to sleep around the same time every night and try my hardest to get up at the same time each morning. If that means curing my hypersomniac tendencies as well as ward off future depression, I’m more than willing to follow that rule.

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Hypersomnia in inter-episode bipolar disorder: Does it have prognostic significance?
Katherine A. Kaplan, June Gruber, Polina Eidelman, Lisa S. Talbot and Allison G. Harvey
Journal of Affective Disorders, Volume 132, Issue 3, August 2011, Pages 438-444

Background
Hypersomnia in inter-episode bipolar disorder has been minimally researched. The current study sought to document the prevalence of hypersomnia in a sample of inter-episode patients with bipolar disorder and to examine the relationship between hypersomnia and future bipolar depressive symptoms.

Methods
A total of 56 individuals with bipolar disorder (51 type I + 5 type II) who were currently inter-episode, along with 55 non-psychiatric controls, completed a baseline assessment, including semi-structured interviews for psychiatric diagnoses, sleep disorders, and a battery of indices that included assessment of hypersomnia. Approximately 6 months later, participants were recontacted by telephone and mood was re-evaluated.

Results
Three of six indices suggested that approximately 25% of participants with bipolar disorder endorsed symptoms of hypersomnia in the inter-episode period. Within the bipolar group, hypersomnia in the inter-episode period was associated with future depressive symptoms. This finding was independent of baseline depressive symptoms and medication use.

Limitations
Small sample size and concurrent psychopharmacology in the bipolar sample.

Discussion
Though no gold standard measure for hypersomnia currently exists, this research takes a step towards identifying a clinically and empirically useful hypersomnia assessment. This study demonstrates that hypersomnia in the inter-episode period of bipolar disorder relates to future depressive symptoms, and adds to the growing body of evidence on the importance of inter-episode symptoms predicting bipolar relapse.

I’m not sure this is what I expected. It’s been over two years since my first series of ECT treatments, and I’m still just maintaining, not necessarily thriving. People talk about ECT being a life saver and the ‘magic bullet,’ but as time goes by, I’m not sure if that’s how I would view the experience anymore. Yes, I’m still alive, and that’s (I guess) a good thing, but—-Where would I be  had I not had those shock treatments? Would I be dead, or in a much worse shape than I am in now? Or would I have eventually found my way to this emotional point that I am currently at? I’m still taking mostly the same cocktail of meds. What criteria determines if, and to what degree, I’m doing better?

Perhaps I’m making some logical error in contemplating this whole thing. After all, constant suicidal thoughts did pretty much go away after all the ‘little sparks.’ And wasn’t that the point? Didn’t the treatments accomplish their goal? I may be asking a question that can’t really be answered. I could just as easily ask “what if I had never started taking meds,” but I don’t seem to be doing that. Instead, I keep coming back to whether ECT was the right treatment to have—and still be having.

I seem to give some people the perception that I am obviously an avid endorser of ECT because I have a journal/blog that talks about the subject. But I don’t think that’s what my purpose is in writing on this topic. While I admit that I’m not anti-ECT, I am constantly conflicted about getting this treatment. But maybe I should also be just as conflicted by the medication.

One of the things that binds me and the boyfriend together is our extensive experience with depression. Because of our shared illness, we’ve definitely accumulated some unresolved issues that influence how we think, and ultimately influence how we interact with each other. Nothing is really going wrong in the relationship, but I really felt like our wounds from the past would heal—and thus lead to a better relationship—if we discussed our problems and concerns more openly.

That’s why I asked him to come with me to my therapy sessions. And he agreed.

My therapist also specializes in couples therapy, so we decided to show up together every other session (I still need some time to myself on the other weeks). I don’t really know what I expected, but so far, it’s been a learning experience to have another person incorporated into the session. Yes, I do think that it’s already made our relationship stronger by airing out our laundry in this format, but I also think that I’ve learned something about making a good relationship.

First, you really have to listen to what the other person is saying. I think one aspect of couples therapy that is totally different from individual therapy is that, well, obviously there are two of us (plus the therapist) in the room, and it’s not just you now; you must listen to what your partner is saying. Sometimes it’s easy to tune out the other in an ordinary setting, but therapy teaches you to be attentive to your mate.

Second, you must be ready to respond to what your partner has just said. Listening isn’t enough. I’ve learned that when the boyfriend has brought up a certain issue to the table, it’s my responsibility to react in some way. In order to solve a problem, I can’t just be quiet. It’s no longer my problem or his problem. It’s our problem, and it takes both of us to solve it. And while what the therapist has to say is important, our own feedback is crucial.

Third, you have to learn to communicate clearly. At home if I’m annoyed by something, I could just give a vague reaction. In a therapy setting, I must be able to express what it is that I’m annoyed about. That means digging down and organizing my thoughts about a certain issue before opening my mouth. Therapy teaches me to be precise about how I feel and communicate those feelings to my partner.

Finally (for now), you have to keep talking. I tend to just stop talking if there’s another person in the room that can do the talking. This does not do the relationship any favors. I realized that in bettering communication, I must do the communicating. The fact is that if I don’t say what’s on my mind, I can’t expect the other person to figure it out.

So far, I believe this experience has been a valuable part of building this partnership, and I hope I can keep learning more about creating a better relationship.  But what’s a huge bonus from going to therapy together? There’s a Mexican popsicle shop (Las Paletas) on the same street. Nothing like a post-therapy ice-pop to decompress from an hour-long session.

My friend is an undergraduate student at an university in southeastern United States, and is conducting research into the barriers which people perceive when they try to access mental health services, and whether or not a person’s race influences their perception of those barriers. He is conducting a series of online focus groups. If you are interested, by clicking on the link below (or here: bit.ly/kx3AiE), you will be taken to a prescreening survey where you will answer some basic demographic questions and enter contact information; the survey take less than 5 minutes. He will then email or text you the passcode information for the chat room While the chat sessions will be recorded, no identifying information will be associated with the transcript, and the only people who have access to your name will be him and his faculty advisor.

Because this is a study about racial barriers, you must be willing to identify your ethnicity, so that data can be generated from the sessions. You do not need to have received mental health treatment to join the discussion. If you are not available for any of the chat sessions, please contact him at mattb291@gmail.com and he will attempt to set a time for an interview. Thank you in advance for participating in the discussion about this important topic.

And if possible, please pass this message on to anyone that might be interested!

bit.ly/kx3AiE

IRB#11-338

Patients who use anti-depressants are much more likely to suffer relapses of major depression than those who use no medication at all, according to new research. In an article that is likely to ignite new controversy in the hotly debated field of depression and medication, an evolutionary psychologist concludes that patients who have used anti-depressant medications can be nearly twice as susceptible to future episodes of major depression. (read the story in ScienceDaily)

Below is the abstract for the research which was published in Frontiers in Psychology:

Some evolutionary researchers have argued that current diagnostic criteria for major depressive disorder (MDD) may not accurately distinguish true instances of disorder from a normal, adaptive stress response. According to disorder advocates, neurochemicals like the monoamine neurotransmitters (serotonin, norepinephrine, and dopamine) are dysregulated in major depression. Monoamines are normally under homeostatic control, so the monoamine disorder hypothesis implies a breakdown in homeostatic mechanisms. In contrast, adaptationist hypotheses propose that homeostatic mechanisms are properly functioning in most patients meeting current criteria for MDD. If the homeostatic mechanisms regulating monoamines are functioning properly in these patients, then oppositional tolerance should develop with prolonged antidepressant medication (ADM) therapy. Oppositional tolerance refers to the forces that develop when a homeostatic mechanism has been subject to prolonged pharmacological perturbation that attempt to bring the system back to equilibrium. When pharmacological intervention is discontinued, the oppositional forces cause monoamine levels to overshoot their equilibrium levels. Since depressive symptoms are under monoaminergic control, this overshoot should cause a resurgence of depressive symptoms that is proportional to the perturbational effect of the ADM. We test this prediction by conducting a meta-analysis of ADM discontinuation studies. We find that the risk of relapse after ADM discontinuation is positively associated with the degree to which ADMs enhance serotonin and norepinephrine in prefrontal cortex, after controlling for covariates. The results are consistent with oppositional tolerance, and provide no evidence of malfunction in the monoaminergic regulatory mechanisms in patients meeting current diagnostic criteria for MDD. We discuss the evolutionary and clinical implications of our findings.

Michael C. Neale, Charles O. Gardner, Lisa J. Halberstadt, Susan G. Kornstein, Paul W. Andrews. Blue Again: Perturbational Effects of Antidepressants Suggest Monoaminergic Homeostasis in Major Depression. Frontiers in Psychology, 2011; 2 DOI: 10.3389/fpsyg.2011.00159

I know I’m wasting time feeling sorry for myself (which I’m not sure this is exactly what I’m doing, but I’m sure not helping myself any by feeling this way), and it probably might help to just open up and tell someone how I feel. But if I do pour out all this crap, it’s like I’m exposing someone to a virus, contaminating everything in sight. And the last thing I want to do is hurt other people.

I saw the quote above on a book at West Elm the other day. As much as I thought I agreed with the quote, now I’m not so sure. Right now, I’d really rather have a perfectly kept house so that I didn’t have to show anyone how messed up I am.

Below is their abstract:

Social support is critical for psychological and physical well-being, reflecting the centrality of belongingness in our lives. Human interactions often provide people with considerable social support, but can pets also fulfill one’s social needs? Although there is correlational evidence that pets may help individuals facing significant life stressors, little is known about the well-being benefits of pets for everyday people. Study 1 found in a community sample that pet owners fared better on several well-being (e.g., greater self-esteem, more exercise) and individual-difference (e.g., greater conscientiousness, less fearful attachment) measures. Study 2 assessed a different community sample and found that owners enjoyed better well-being when their pets fulfilled social needs better, and the support that pets provided complemented rather than competed with human sources. Finally, Study 3 brought pet owners into the laboratory and experimentally demonstrated the ability of pets to stave off negativity caused by social rejection. In summary, pets can serve as important sources of social support, providing many positive psychological and physical benefits for their owners.

This research is a pretty big deal considering that most previous research into the benefits of pets has looked only at the relationship between two variables, but didn’t show any real correlations. In addition to the social support provided by the pets, the researchers also found that pet owners were just as close to key people in their lives as to their animals, indicating no evidence that relationships with pets came at the expense of relationships with other people, or that people relied more on pets when their human social support was poorer.

It is a fascinating study, especially since it’s a very quantitative one involving experiments rather than compiling a bunch of anecdotal, qualitative evidence from pet owners.