MentalMeds News
A Newsletter from www.MentalMeds.org
Volume 2

Dear Reader,

Welcome to Volume 2 of MentalMeds news. I want to thank everyone who provided feedback to Volume 1, and I hope you will enjoy this issue.

As always, if you do not wish to receive email from me, please let me know, and I will remove your name from my list.

Please send all correspondence to meds@MentalMeds.org. If you are submitting material for the site or newsletter, include your URL or any other contact information you wish to appear, and I'll include it. (Just be careful to tell me what you want to appear, and what you do not want to appear!)

Kevin Thompson, Ph.D.
Editor


Table of Contents


Calling for Articles

Do you have experiences you would like to share about how you have coped with mental illness? Uplifting stories? Educational stories? Email me with your idea, and if it makes sense, I will be happy to include it in a future issue.

Humor

The Dog and the Sweet Potato

OK, this has nothing to do with mental illness, but it is hysterically funny. Be warned! You will never look at a sweet potato the same way again, if you read the story of the dog and the sweet potato.

Christmas Carols for Mental Illness

Some topical humor from Catdancer

SCHIZOPHRENIA: Do You Hear What I Hear?

MULTIPLE PERSONALITY DISORDER: We Three Kings Disoriented Are

DEMENTIA: I Think I'll Be Home For Christmas

NARCISSISTIC: Hark, the Herald Angels Sing About Me

MANIC: Deck the Halls and Walls and House and Lawn and Streets and
Stores and Office and Town and Cars and Busses and Trucks and Trees
and Fire Hydrants and . . .

PARANOID: Santa Claus Is Coming To Get Me

PERSONALITY DISORDER:
You Better Watch Out, I'm Gonna Cry,
I'm Gonna Pout, Maybe I'll Tell You Why

DEPRESSION:
Silent Anhedonia, Holy Anhedonia,
All Is Flat, All Is Lonely

OBSESSIVE-COMPULSIVE DISORDER:
Jingle Bell, Jingle Bell, Jingle Bell Rock,
Jingle Bell, Jingle Bell, Jingle Bell Rock,
Jingle Bell, Jingle Bell, Jingle Bell Rock,
Jingle Bell, Jingle Bell, Jingle Bell Rock,
Jingle Bell, Jingle Bell, Jingle Bell Rock, ........
(better start again)

PASSIVE-AGGRESSIVE PERSONALITY:
On The First Day of Christmas
My True Love Gave To Me
(and then took it all away)

BORDERLINE PERSONALITY DISORDER: Thoughts of Roasting on an Open Fire.

Send me your favorite joke, funny story, or amusing picture, as long as it is related to mental illness. Keep it upbeat, please! Jokes involving mental illness are welcome, but jokes that demean mental illness are not. If it's appropriate, I'll put it up on the humor page.


Bipolar Disorder: An Illness of Excess

by Kevin Thompson, Ph.D.  Available at BellaOnline, and here.

Bipolar disorder is a condition that is relatively unfamiliar, but surprisingly common.

The National Alliance on Mental Illness (at www.nami.org) puts the number of Americans who have bipolar disorder at 10 million, comparable to the 15 million who have depression, and many more than the 2 million who have schizophrenia. Yet while most people have at least a vague notion of what depression and schizophrenia are, the same is not true for bipolar disorder.

The confusion over just what defines bipolar disorder is probably due to the complexity of the illness, which defies simple description. While all mental illnesses have their complexities, simplified descriptions of depression as "extreme sadness," and schizophrenia as "having hallucinations," do provide basic guidance about core issues of these disorders. However, bipolar disorder is not as easy to summarize.

Psychiatrists and psychologists speak of bipolar disorder as being characterized by two sets of symptoms, labeled mania and depression. Since it is the presence of mania that distinguishes bipolar disorder from ordinary depression, it is important to understand just what is meant by the term.

The symptoms of mania are commonly described as elation, irritability, increased energy, racing thoughts, racing speech, ambition, grandiosity, risk taking, impulsiveness, extravagant spending, sexual indiscretion, alcohol abuse, and insomnia without fatigue. In all cases, these symptoms are more extreme than would be justified by external circumstances.

In the simplest case, manic and depressive episodes alternate, over time scales ranging from months to (in the worst case) hours. Mania and depression can also occur simultaneously (a "mixed state"), in which case the person is depressed and "hyper" at the same time.

The list of symptoms is odd, with some (elation and irritability) contradicting each other. Mania and depression also contradict each other to some extent (elation versus sadness), while the concept of mixed states confuses the picture even more.

It may be easier to understand bipolar disorder as not so much a particular set of symptoms, as an illness characterized by excess.
Thus in short form, bipolar disorder is an illness is characterized by excess, poor judgment, and extreme variability of mood.

The conception of bipolar disorder as an illness of excess suggests that it may arise from some kind of excessive activity in the brain. If so, then treatment might logically be oriented towards dampening excessive activity back to normal levels.

Although this picture is highly simplified, it does have some merit. Some treatments for the disorder (in particular, anti-manic agents, or mood stabilizers) do act to dampen brain activity by strengthening the inhibitory mechanism mediated by the neurotransmitter gamma-aminobutyric acid (GABA). Interestingly, many of these same medications are also used to treat epilepsy and prevent seizures, which suggests that similar mechanisms underlie mania and seizures.

Mood stabilizers are usually not effective in treating the depressive episodes of bipolar disorder (although Lamictal, which is characterized as a mood stabilizer, has been found helpful in this regard). Standard antidepressants (such as Prozac and Wellbutrin) are typically prescribed for this purpose.

However, antidepressants that increase serotonin concentration (which is most of them, including Prozac) must be used with caution, and always with an accompanying mood stabilizer. The reason for this requirement is that a "serotonergic" antidepressant, taken without a mood stabilizer, can trigger or worsen mania in someone who has bipolar disorder.

In fact, anyone who experiences dramatic increases in irritability, or outright mania, from taking one of these antidepressants for depression alone, very likely has bipolar disorder.

The bad news about bipolar disorder is that it can be difficult to diagnose, and is harder to treat than depression alone (because it is a combination of mania and depression). Also, it cannot be treated by therapy alone, and can worsen over time without medical treatment.

The good news about bipolar disorder is that it can be treated successfully in most cases. So if you see yourself in this description, and you have not yet seen a psychiatrist for a diagnosis, now is the time to go.
 
---
Kevin Thompson, Ph.D. is the author of Medicines for Mental Health: The Ultimate Guide to Psychiatric Medication. You can find information about treatments for depression, bipolar disorder, schizophrenia, and sexual problems on his Web site at www.MentalMeds.org.

Why Choose Online Counseling?

by Beth McHugh, Psychologist, B.Sc (Hons),  B.Psych. Dip. Sc.

People sometimes ask me what the differences are between face-to-face and online counseling, and which is better.

My answer is that any form of counseling is beneficial, providing the counselor is effective and the client is willing and able to work on the underlying issues that are driving their distress. However, I also believe that online counseling has many of the benefits of face-to-face counseling but with important advantages of its own. Some of the benefits are obvious: Online counseling is more cost effective and is particularly useful for clients whose work or home commitments prevent them from readily accessing assistance during regular office hours. Online counseling is also a boon to those who live in remote areas where there simply is no counselor available.

Another significant benefit of online counseling is its inherent privacy and anonymity. This aspect is important to many people, especially those in high-profile employment as well as people in small communities who may avoid regular counseling due to the fear of disclosure and the stigma of mental illness.

Many people also find online counseling less confrontational than face-to-face sessions and are therefore prepared to be more honest and open, thus speeding progress. The fact that clients can also choose how often they undertake sessions gives power back to the client as they themselves set the pace of their recovery.

People suffering from a variety of health conditions and who find traveling difficult also benefit from the ready availability of online counseling. In particular, those who experience crippling panic attacks and agoraphobia now have access to formal counseling that once was out of their reach, simply through an inability to travel. Online counseling provides these clients with a support system in the comfort of their homes, through which they can address the issues which have lead them to this point in their lives.

Increased convenience is another aspect of online counseling, as the clients themselves choose the time of their sessions. Regular counseling is renowned for its high cancellation rate, as clients find the process of working through painful issues difficult and often cancel scheduled appointments because they are not feeling strong enough on that particular day. They can then face lengthy delays until their next session. This feature of face-to-face counseling is further compounded by the time restraints of formal 50-minute sessions. In my practice at youronlinecounselor.com, clients have an unlimited word count to describe their problems, feelings and hopes. There is no "I'm sorry, your time is up for this week" at Your Online Counselor.

I am well aware of the effort required to finally make a breakthrough in a regular counseling session, only to have it cut short by the restrictive 50-minute time limit. Often the thread is lost, or the client leaves in a distressed state because of pushing all those emotions down in order to step back out into the "real" world. Online counseling eliminates this frustrating process.

As a psychologist, I find that online counseling actually speeds up the healing process. Because clients are required to write down their thoughts, they focus more fully than when in the therapist's office, where distractions for the client can delay progress. Many counselors must sit and listen to how bad the traffic was this morning as the client slowly eases into the reason while they are really there. With online counseling, these time-wasting behaviors disappear as the client puts their thoughts and feelings to paper in their own time.  The process of having to write down one's problems also helps the client to clarify their situation far better than a disjointed verbal monologue to the therapist, thus speeding recovery.

Finally, the principal benefit of online counseling which regular counseling cannot offer is an actual, black-and-white, concrete record of your progress. Since most therapy occurs over a long period of time, recovery is by necessity slow. Sometimes it can be hard to see the progress that you are actually making, and many people become discouraged, especially when depression is one of the prevailing symptoms. However, by having hard copies of all your sessions, you can readily see how your thinking has changed over time. And when thinking changes, so do your feelings and behavior.  Reading back over older sessions, you can review your progress and clearly view the changes in your beliefs about yourself, your life and the way you view the world and the people in it. It is this feature of online counseling that I find the most rewarding, both for my clients and for me as a therapist.

---
Beth McHugh is the founder and Principal Psychologist of Your Online Counselor. She chose to make a career change, switching from science researcher to psychologist, as a result of encountering life problems of her own. Her personal journey of self-discovery, involvement in support networks and academic training have all made unique contributions to the ideas and methods she employs as a counselor.

You can contact Beth at enquiries@youronlinecounselor.com or visit her website at youronlinecounselor.com.

Site News (and Questions)

The humor and articles sections are up! I want to thank everyone who has provided a joke or funny story (like the songs above). You can even sing along with I am the Very Model of a Psychopharmacologist. (Or is he a "psycho pharmacologist?" You decide!)

I am also adding a link to the new Kindle version of the book (see below).

Visitors to the BellaOnline site's mental health section will be seeing more of my writing soon. My second article has appeared there, and I expect to be writing further columns in the future.

Here are some questions for readers:
  1. I've been thinking about adding a Web log with an RSS feed. Would you find this useful? Would you subscribe to an RSS feed if one were available? Please let me know.
  2. You are seeing a plain-text version of the newsletter. Would you prefer an HTML version, with more attractive fonts and formatting? Or would you rather keep the plain-text version?
Please give me your thoughts, at meds@MentalMeds.org.

Book News

Medicines for Mental Health has been available in printed form, and in a free online form (in HTML) since September 2007. The printed form has the advantage of portability (handy for showing pages to your doctor), while the online form has the advantage of hyperlinks to internal pages, prescribing-information files, and external Web sites.

I'm happy to announce that the book is also available for Amazon.com's new Kindle reader! This version combines the portability of the printed version with the hyperlink and search capabilities of the online version, at a price half that of the printed book. Click the title to find a Kindle version of Medicines for Mental Health.

Spotlight on Resources: CrazyMeds

CrazyMeds was the first Web site to link to mine, back when I was just starting to write my book. This review is more than a belated thank-you, though, because the site is very much worth visiting.

Jerod Poore, who runs CrazyMeds, has assembled a huge amount of information about psychiatric medications, and written about them with accuracy, humor, and a highly idiosyncratic and entertaining style. It is not fair to call him an iconoclast, as his work is very much in the mainstream of medical science, but he shares the modern iconoclast's disdain for nonsense.

CrazyMeds covers antidepressant, anticonvulsant, mood stabilizer, antipsychotic, stimulant, and anxiolytic (anti-anxiety) medications, as well as a scattering of others.

CrazyMeds also provides a companion site, CrazyMedsTalk, which has forums for the different categories of medication (and many for individual medications, as well). It is a terrific resource for those of us who have questions about these medications, as many of the writers have extensive experience in the area.

I you haven't visited CrazyMeds yet, do yourself a favor, and go there now!

Are You Looking for Writers?

If you are looking for articles on mental-health and medication issues, for an online or printed publication, send me a note. I do write for these publications.

MentalMeds News -- Copyright © 2007 by Kevin Thompson
May be freely distributed in whole or in part, provided material is attributed to Kevin Thompson, Ph.D. at www.MentalMeds.org


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