I have an MD. It stands for manic depression. In January 1999, at age forty-nine, following a series of severe depressions and a lifetime of denial, I was diagnosed with manic depressionās successor label, bipolar disorder, so technically my MD is now BP, which pisses me off no end. After what this illness has done to me, I feel I have every right to call myself an MD.
Screw the medical profession. What do they have on me? Well, they were smart enough to save my life, so I take it back.
My real qualifications are these: I am a former financial journalist with a law degree. My subsequent research into my illness led to me writing about depression for the Web site Suite 101.com, which in turn motivated me to start the only Internet newsletter devoted to depression and bipolar disorder, McManās Depression and Bipolar Weekly. A year and a half after launching my newsletter, I began a Web site, McManās Depression and Bipolar Web (www.mcmanweb.com), which now has more than three hundred articles.
This book draws from more than six years of research that have gone into my newsletter and Web site. It is perhaps the first book on mood disorders that attempts to integrate expert opinion from a wide range of disciplinesāfrom psychiatry and neurology and genetics to nutrition and spirituality. Equally important, this book acknowledges the wisdom and insight of those who have experienced depression and bipolar disorder firsthand. Many of these people have written to me directly. Others have posted comments on my Web site. Perhaps you are one of them.
āPlease,ā writes Brian, āmay I have my life back and start over again?.ā
Forget for the time being whether itās depression or bipolar disorder my readers are talking about. Simply listen.
āItās humiliating to me,ā says Bob, āto have to admit that there is something wrong with me mentally. I hate living this way. I have hope that I can be fixed or healed, but how can I face the people I love and apologize for my behavior and ask for forgiveness?ā
Says Kali:
And from Claire:
Loneliness. The isolation can be worse than the illness. Eleanor writes: āI ended up losing my job, my boyfriend, making my kids feel confused and afraid. I am still trying to recover of all of it and unsure about the future.ā And in a similar vein, a year after his diagnosis, Kyle writes: āI only just about manage to hold a job down. Iām frustrated that my boss and my coworkers are unable to understand how I feel and, as yet, have been unable to tell my family for the same reasonāa lack of comprehension. I would just be told to āpull myself together.ā For the most part I feel lonely, isolated and paranoid of other people.ā
Then there is the uncertainty. The knowledge that one is leaving Planet Normal for a destination unknown weighs heavily on the minds of those considering seeking help. As Leah explains: āI have my first psych appointment on Monday. I am scared, nervous, and freaked out about everything. I feel like everyone around me doesnāt care what I am feeling, especially my husband. I mean, I know he cares, but when I try to discuss things with him it seems like he tunes me out, looks right through me.ā
Meanwhile, the fearsome visage of the beast forces many of us to look away before we are willing to face it head on. In Taliaās words:
Let us not forget the innocent bystanders, the families of those with mental illness. From Anonymous:
Then there is the slow-motion suicide of Michelle: āI am more tearful now than ever before, I see no hope in sight. I really believe that I would be better off dead, yet I am too cowardly to kill myself, so I turn to alcohol and drugs I guess to slowly get rid of myself. I am worried for myself, as well as my children.ā
But Eric, in response to Michelle, offers this valuable insight:
To that I can add the following (from a closing address I made to the 2002 Depression and Bipolar Support Alliance [DBSA] annual conference):
Depression and bipolar disorder can be considered a gift, but only when we are well enough to appreciate the insights we have gained from viewing the world through different and often tortured eyes. So numerous are the artists, writers, musicians, and other bright sparks with depression or bipolar disorder that a shorter list may well be creative people with no mental illness. Think Michelangelo, Beethoven, van Gogh, Tchaikovsky, Lord Byron, Hemingway, and Woolf. Think also how most of them wound up. Would Beethoven have traded in his Ninth to shut down the raging mental storms that tormented him so? What would van Gogh have given up to enjoy but one day of peace and tranquillity? Yes, there are the door prizesāa mystical third eye, creative wings, sparkling wit, moral muscleāand we will be discussing these at length later on. But it is the destructive and incapacitating nature of our illness that demands our immediate attention.
Depression and bipolar disorder are treatable, but getting help is not as straightforward as simply throwing Prozac or lithium down the hatch. If only life were that simple. When I walked into my first support-group meeting not long after I was diagnosed, Moe, who ran the group, told me that meds are only one part of the equation. Getting well and staying well, he said, also involves eating right and sleeping right, diet and exercise, as well as a wide range of intangibles, which may include getting out of the house, volunteer work, spiritual practice, developing a support network, and a whole bag of survival tricks one starts to pick up.
To this day, this is the best advice I have ever received. What we are now learning about the brain is truly mind-boggling, but psychiatry still remains more of an art than a science. Treatments tend to be hit or miss, and patients can endure weeks and months and even years of frustration and heartbreak before striking oil. Compounding matters is that a medical treatment or lifestyle practice that appears to work for others may have no effect on you. Conversely, a much-maligned remedy may be your salvation.
āWhatever worksā is my two-word credo, even if that applies to something that gets only 10 percent of us 10 percent better. For one, you could be one of the lucky 10 percent. For another, a 10 percent improvement may be all that it takes to help you turn the corner to full recovery.
There are two major qualifications to this 10 percent rule. First, it is foolhardy to risk prolonging your suffering and jeopardizing your safety at the outset by rolling the dice on a long-shot treatment. Second, the potential benefits of any treatment need to be carefully weighed against the possible dangers of that same treatment.
But simple math dictates that you will have several āten-percentersā and even āone-percentersā in your arsenal. You may, for instance, find yourself on four different meds, taking a multivitamin, drinking a daily power smoothie, doing yoga and exercise, seeing a talking therapist, attending a support group, pursuing a hobby, and attending religious services.
Add to this the 101 informal things that you find yourself doing every dayāfrom a relaxing soak in the tub to listening to Maria Callas to watching SpongeBob SquarePants to hugging your child, and you can see why there is nothing surgically precise about treating a mood disorder.
Chances are that most of the weapons in your arsenal wonāt even directly relate to mood. One of your meds, for instance, may help you sleep while another serves double duty for depression and anxiety. Your multivitamin may be more relevant to maintaining mental and physical function, the talking therapy may be for coming to terms with earlier trauma, the yoga may be for dealing with stress, while attending religious services may give you a sense of connection to something greater than your individual self.
Then there is the question of timing. One particular antimania med may quickly calm you down, but a different one may better serve you over the long haul. An antidepressant is another long-distance med, while sleep aids tend to be prescribed on an as-needed basis. Good lifestyle choices need to be regarded as constants while SpongeBob is strictly a short-term fix.
Blind faith is your worst enemy. Whether itās the pharmaceutical industry, the psychiatric and talking-therapy professions, or natural-health advocates, all are guilty of overselling their products and services and downplaying their own failings. The negative campaigning that goes on would put a politician to shame.
Yes, we need to listen to the professionals who treat us, but they also need to listen to us. They are the ones with the specialist knowledge, but we are the ones living in our own skins with access to the complete picture.
It is my fervent belief that learning about our illness equates to better outcomes. āKnowledge is necessityā has been my mission since Day One of my newsletter and Web site, and it applies with equal force to this book. The more we know, the better we will understand our illness and the smarter the choices we will make in its management, in partnership with our treating professionals. Patients who are motivated to build partnerships with their doctors have a better chance of achieving a successful outcome. An editorial in the March 27, 2004, issue of the British Medical Journal (BMJ) reports that two Stanford University studies found that so-called expert patients with chronic diseases felt better and had 42 to 44 percent fewer doctor visits than the other patients in the studies.
āPatients who have the resources to find out about their illness and want to take an active part in managing their own care are to be welcomed as allies and partners,ā concludes the BMJ. āLong live [quite literally, one presumes] expert patientsā¦ā
This book is not intended as medical or any other type of professional advice, but it should offer you some insights into working with your psychiatrist or therapist or physician or other professional. Ultimately, though, the responsibility for managing your illness lies with you.
Depression and bipolar disorder are classified as separate illnesses, but psychiatry is increasingly viewing them as part of an overlapping spectrum that also includes anxiety and psychosis. Accordingly, perhaps for the first time, depression and bipolar disorder are allotted equal space in one book. To me, itās a no-brainer: Many patients with bipolar disorder spend much of their lives depressed. Conversely, some people with clinical depression may be bipolar cases waiting to happen. Then there are the tweeners.
The Spectrum Project is an international consortium of academic researchers led by Giovanni Cassano, MD, of the University of Pisa. In the summer of 2004, I sat down with one of Dr. Cassanoās collaborators on the project, Ellen Frank, PhD, professor of psychiatry and psychology at the University of Pittsburgh and director of the Depression and Manic Depression Prevention Program at the Western Psychiatric Institute and Clinic. Says Dr Frank: āWhat weāve been arguing is that even isolated symptoms that donāt cluster together to create episodes may be important.ā
This contrasts to the current approach of assigning clinical significance generally only if a certain number of symptoms are lumped together in a fixed period of time. What tends to distinguish clinical or unipolar depression from bipolar disorder, for example, is an episode of hypomania (think of mania lite, for the time being). Thus, if a person has enough hypomanic symptoms to come to the attention of a clinician, that person is diagnosed as havi...
