I have never been able to find the short article in the Journal of the American Medical Association that talked about a miraculous treatment for many ailments of the human mind and body… The article was about “hope.” When we have it there is hardly any problem we can’t tackle, and when we lack it every challenge seems insurmountable. This …
Trojan Horse Medications
From time to time we are asked to review the care that people with cycling moods have received, trying to figure out, from a complicated story of medication changes and mood cycles, what to do to get someone out of a period of deep pain and dysfunction. A few years ago I did such a review on a young man …
On the Borderline
I am writing a presentation for the UCSF Bipolar Program on the topic of the relationship between Borderline Personality Disorder and Bipolar Disorder and I thought I would jot down some of my thoughts in a quick post. Borderline personality disorder involves a “pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity” which begins by early adulthood …
Fish Oil Update
Since so many people with bipolar and depression take fish oil we thought we would pass on some information in a summary form from Consumer Labs. The full information is available if you subscribe. Consumer Labs is the only source of reliable information about supplements (the only place that does any testing) and if you take supplements we strongly encourage …
A Protest
So many of us have to deal with things that are not fair – depression, unsupporting spouses, financial reversals, weight gain, etcetera, it can be tempting to launch a protest of some kind against the unfairness. These protest actions don’t have to be obvious at all, but they can have powerful effects, nonetheless. A few women recently told me, “I …
Drug Companies
This blog has mostly not dealt with questions related to medications for treating mood disorders. When we looked around to see what was out there on the Internet, it seemed to us that there was no dearth of information about medications. The problem was finding reliable information about non-medication approaches to living with moods. This morning I met with an …
Mistrust in Action
I was talking to one of my clients, a very bright and wonderful woman, mother of a delightful young girl, and usually one of my favorite people. This visit, however, I began to experience the cycle of mistrust. When she came in I was in a good mood, I smiled and said hello. She looked serious. The last time we …
What If It Works?
For a number of years after I first got started in psychiatry I wrestled with the dilemma of what to do when someone with severe, disabling depression came in for an evaluation, seemed to be an excellent candidate for treatment with an anti-depressant, but was completely preoccupied with potential adverse effects and focused almost entirely on all of the negative …
Stigma and Psychiatry
I ran across an article written by a columnist for the New York Times a couple of days ago about what the columnist felt was psychiatry’s “overreaching” (saying that some people who are bereaved may also have a major depression). The article made reference to Michel Foucault’s view that psychiatry is essentially all about making moral judgments on behalf of …
Tripolar Disorder
For a long time I have been trying to figure out how to convey to the people I work with the view of mental health professionals that a certain type of depression is really a kind of mania, called “mixed mania.” From an “objective” standpoint, this makes a lot of sense. A mixed state generates lots of energy and agitation. …
Mary Poppins: Overcoming the Winter Months
What I most want to have available to me in the long winter months, to help me with my patients with bipolar and depression, is access to someone a lot like Mary Poppins. You may remember that Mary, played by Julie Andrews, was the incredibly cheerful nanny who transformed the unhappy and dysfunctional lives of the family she joined. What …
Feeling Already Full
A wonderful friend sent us a note that this post had been very helpful to him. It is, once again, from the Just One Thing site. The practice is called “Feel already full” and it is a perfectly timed reminder that so much of what we see in life (TV especially) is specifically designed to make us feel unhappy with …
Getting It Done Anyway
From time to time I am inspired to pass on portions of a post from a favorite blog. Today’s Moodscope blog was all about those days when you feel a bit “blah” and what you can do to not get trapped in indecisiveness and time wasting. As it happened this arrived on a day when I was struggling to get …
Crisis – When to Consider Hospitalization
A delightful, funny, smart young man we know called us on Friday to say that he had stopped his medications a few weeks ago, and now he felt he was entering a mania. We did our best over the weekend to patch things up, got him more medications, talked to him every day, worked with him to make sure that …
Take a Chance
If you are feeling depressed or anxious, today’s post from Rick Hanson (part of his Just One Thing blog) may be helpful. If you are already feeling energized, you might not need more encouragement to do something risky/taking a chance… Rick’s post is about how, as children, we learn to avoid certain types of conversations that seem too risky, and …
Running a Marathon
Many of us are strongly motivated by the desire to achieve results, complete tasks and succeed. Often we want to get where we are going quickly. Life is too short. Seize the day. Dealing with moods can be very frustrating. Change may take place slowly. Sometimes you have to put in a fair amount of energy just to hold on …
Parody No More: Mental Health Parity Law
In yesterday’s clinical team meeting we were talking about the mental health parity law, which has been largely ineffective at ensuring access to care. One of the psychologists said, “I call it the mental health parody act,” because it is a parody of meaningful change. That may be changing. President Obama announced that the Sandy Hook school killings had galvanized …
Power out of Depression
It sometimes can be very hard to think of ways of getting out of a lurking depression. A recent email from Moodscope (a site with a mood tracking program that many people find very useful) highlights one very useful strategy: instead of staying stuck in your brain, switch your focus to physical activity. This strategy can be surprisingly effective. If …
Of Two Minds
This morning I was thinking about the relationship between your pre-frontal cortex and your limbic system. I know, it’s a little strange to be having these thoughts while out riding a bicycle in the morning… a hazard of the profession I guess. The reason I was thinking about this subject is that people’s moods appear to be affected by both …
Who’s to Blame?
“Is it my fault?” This is one of those questions that seems to easily dominate conversations between people in a romantic relationship who are having trouble getting along. It is also a question that is usually impossible to answer (who decides? what standards do you use?) and quite unhelpful. I was talking with a recently married woman yesterday about her …