I have spent the last two days mulling over an interaction with a patient and with his therapist. The patient is a brilliant, young man who has somehow entered into a conflictual relationship with me. The nature of that relationship was encapsulated for me in a comment by his therapist. She called to let me know that he was escalating …
Should I Tell My Boss?
One of the hottest topics on our forum is when, and how, to tell people about your depression or bipolar. The question of telling an employer is a particularly tricky one since, on the one hand, sharing information about a “chronic medical condition” allows you to claim certain benefits that are guaranteed by the Americans with Disabilities Act, and on …
Depression and Inflammation
Recently there has been increasing interest in the relationship between depression and chronic overactivity of the body’s biological defense system – inflammation. When we have an infection, or an injury, or almost any other kind of illness, the body activates a series of processes designed to respond to the threat. Unfortunately, the inflammation system, especially if it is turned on …
Acceptance versus Avoidance
Acceptance and Commitment Therapy (ACT) is based on the belief that five fundamental errors are responsible for much of human distress. One of these errors is the tendency to want to avoid painful feelings at all costs. Our addiction to our cell phones can serve as a distraction from the distress of loneliness. Or drinking. Or smoking. A colleague suggested …
Online Resources: Links and Apps Update
The very useful listserve of the Northern California Cognitive Behavioral Therapy association has had a great thread about favorite apps for mental health. We took advantage of the opportunity to update the page entitled “Links and Apps” with some more options. Here is an unedited list of the favorites from that group… note that this list is heavy on iPhone …
My Brain Isn’t Working
Difficulties with cognition and focus are almost universal in folks with moods. In the scientific literature there have been attempts to distinguish between mood related problems and problems that tend to persist regardless of mood state. There is probably nothing that can more profoundly affect our brain’s ability to focus than an episode of depression or mania. These functional brain …
Mood and Gender
A very recently published study in the Journal of Affective Disorders confirmed earlier research showing significant gender differences in symptoms of bipolar type I disorder. Variables examined for gender differences were demographics , illness course , clinical comorbidity, and temperament among a population of 1090 bipolar type I manic inpatients diagnosed according to DSM-IV criteria. Women with bipolar I disorder …
Fair Health
As the result of a bike accident last year we had a chance to experience first hand the crazy world of medical billing and reimbursement. Since then we have been following with greater attention the series of articles in the New York Times that try to explain why things cost so much in this country. A good friend recently suggested …
Child Abuse Update
Twenty years ago the National Research Council (NRC) issued a comprehensive report on child abuse. That report noted that child abuse was much more common than previously thought and called for urgent action. This past week the NRC and the Institute of Medicine (IOM) released an update: New Directions in Child Abuse Research. The good news – physical and sexual …
Antidepressants Help You Focus on the Positive
I am always interested in articles that help us understand how medications work, and perhaps how the brain functions in different mood states. Today I got a copy of a pre-publication article from the American Journal of Psychiatry that confirms other research about antidepressants – antidepressants work, at least in part, by helping us to shift from negative information to positive …
Coffee for Depression?
Feeling down? An article in Psychiatric Times suggests that drinking a couple of cups of coffee in the morning might help your mood. The study they cite found that those people who drank two or three servings of coffee per day (8 ounce cups of drip coffee – or shots of espresso) had a 50% lower rate of suicide compared …
Hormones and Food
In an earlier post we talked about some of the research on appetite. We reviewed some of the peptide hormones that regulate appetite and how the entire system that controls appetite is really designed to cope better with a time of scarcity than a time of plenty. Here I want to talk more specifically about the interplay between other hormone …
Take Action… Why Do I Have to Pick Up My Room?
Sometimes wrestling with depression can seem an awful lot like having to deal with a truculent eight year old. It is 7:00 in the morning, and the alarm goes off. When you aren’t feeling depressed, that means that you get up without thinking about it too much, and take a shower or make some coffee to start the morning. But when you …
Dual Treatment: Medications and Therapy Work Together to Treat Depression
A review in the prestigious journal JAMA Psychiatry suggests that there may be a clear biological explanation of how medications and psychotherapy work together to treat depression. The authors note that recent, unexpected, research findings suggest that antidepressant medications reactivate the brain’s ability to relearn old lessons. The medications allow the brain to modify old neuron connections in a way …
Diagnosis
I just finished updating the “Diagnosis” page under our “Topics” section. Of course, there is much more to be said on this subject, but I hope what I was able to convey was a useful overview of the distinction between unipolar and bipolar depression. I would love to get feedback from you. This topic is one that is especially difficult …
Therapy or Medications for Depression?
A new study published in the most prestigious psychiatric journal (JAMA Psychiatry – see reference below) strongly suggests that a brain scan might be able to help people decide whether therapy or medications are more likely to treat their depression. As background, although some people feel that for more severe depression medications are more effective, the fact is that most …
I Need New Friends
“I thought I needed to replace my friends.” This is how one of our patients described her experience of a several week period of mania last summer. Her friends insisted that she needed to get help and that something had to be done about her energized state. But she had just emerged from a many year depression and felt that …
Men Get Mad Not Sad
There are hundreds of papers written about why it is that women have a much higher rate of depression than men. A new article published in the journal JAMA Psychiatry (August 28, 2013) suggests that some if not all of that difference may have to do with the fact that men express and experience depression differently. The authors of the …
Brain Scan Diagnosis?
A newly developed brain scanning method that measures blood flow to different parts of the brain may help to distinguish between bipolar and unipolar depression, according to a study that got a fair amount of media attention. The study of 54 adult women used a novel way of measuring brain function called arterial spin labeling (ASL). This approach allowed much …
Childhood Trauma – Brain Effects
Experiencing trauma in childhood is associated with changes in the brain during teenage years, according to a study of 117 adolescents using magnetic resonance imaging (MRI). The researchers compared MRI’s from age 12 with MRI’s from age 16. They asked the teenagers about childhood trauma and also did psychiatric diagnostic interviews. There were significant differences in how the brains of teenagers …