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.
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.
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
Carols for Mental Illness
Some topical humor from
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
You Better Watch Out, I'm Gonna Cry,
I'm Gonna Pout, Maybe I'll Tell You Why
Silent Anhedonia, Holy Anhedonia,
All Is Flat, All Is Lonely
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)
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.
Illness of Excess
Bipolar disorder is a condition that is relatively unfamiliar, but
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
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.
- Feelings and behaviors range far outside the bounds of
- Mood runs from elation to depression, and energy from
hyperactivity to lethargy.
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
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
can find information about treatments for depression, bipolar disorder,
schizophrenia, and sexual problems on his Web site at www.MentalMeds.org
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.
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
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 firstname.lastname@example.org
or visit her website at youronlinecounselor.com.
News (and Questions)
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
Visitors to the BellaOnline
site's mental health section
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:
- I've been thinking about adding a Web log with an RSS feed.
you find this useful? Would you subscribe to an RSS feed if one were
available? Please let me know.
- You are seeing a plain-text version of the newsletter.
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
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
on Resources: 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
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
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