   I've often pondered....
i've often pondered the fact that i can't recall ever saying
out loud to anyone, "I'm very fortunate..." about anything. i can recall, more times than i care to admit, many times i have
said, "i can't believe that i only have...." this or that. i've almost never said that I'm "fortunate" for anything that i
obviously take for granted.
it wasn't until i began to come out of my very deep intense depression that i began to feel anything. i
had numbed myself to everything. i was fearful of everything and nothing.
it wasn't until i began studying emotions and feelings that i began to realize that i had limited myself
to feeling a few common emotions that most of us are concerned about; but mostly negative emotions and feelings came to my
mind. i could tell you what i felt in the depths of depression. i could tell you about hopelessness, helplessness and about
feeling like i was made of nothingness.
i spent many many days and nights focusing only on the horrible things that people had done to me, what
i had allowed to happen to me in my grief, my depression and my sorrow. i had lost control of my life, myself and my sanity,
or so it seemed.
when you begin to ponder, reflect, or study your own life, your own being, your own sense of self - you
begin to realize more than you ever believed that you knew. what i realized about myself was that i never felt fortunate although
i knew i had been in times of my life. i knew that after survivng the worst of times, i felt fortunate to be away from those
horrible days, i felt fortunate to be alive.
an idea came upon me, much like the sun, dawning upon the horizon, rising up above the treeline, creeping
at the slowest pace, amazingly perfect, amazingly brilliant..... i really was much more fortuante in my life than cursed.
if i looked honestly at all my years living upon this earth, i was truly blessed, not suffering some of the most horrendous
of situations i could think of.
none of my children had even been terribly sick or injured. that was such a huge blessing and for God's
great grace upon me, and them, they were all alive, not deceased. it came to my mind, the infinite suffering those parents
had endured who had lost children to death or watched their child suffering with some disease like cancer, cerebal palsy,
multiple schlerosis or lifelong disability. i was infinitely fortunate for this, i thanked god.
although i had experienced some misfortune in my own physical health, just recently recovering from breaking
my leg, living fourteen months in a wheel chair, being unable to live normally for about two years, i was so fortunate to
have finally healed. i was fortunate to have avoided infection, which was very common with injuries like mine, and even
more fortunate to have avoided amputation which had always been a possibility. i was fortunate to have use of my hands, to
have been able to see, hear, taste and feel everything around me.
realizing these unattractive facts about myself, i thought of those living in poverty in the United States
and then around the world. i realized that those people never were fortunate enough to live in a house, have food, water and
a family. i realized that there were parentless children that didn't have anyone to love them. i felt truly repentent of always
thinking of my misfortunes instead of what i took for granted -to be truly fortunate for what i've had in my life.
as i realized how fortunate i truly was in this world we live in, i began to think on... to a higher level.
what had i ever done to help someone who was less fortunate than i? where was my sense of responsibility to help anyone who
i came into contact with who was less fortunate than i? why did i waste so much time dwelling on the negative aspects of my
life, leading me into such deep depression that i could not function? it seemed like a simple answer to a simple question...
i must have spent my life being so self absorbed that i made myself miserable.
sounds like a horrible thing to think about yourself, doesn't it? "sometimes the truth hurts," i've heard
other say. i let myself feel my thoughts. i let myself sit in the realization of that moment. touching upon my feelings of
self pity, depression and intense fears - i flinched in my seat as if to jump out of the way of those feelings. they were
dark and cold. they were agonizing. sadness in the true sense of the world. those things that happened to me were sad, horrible
and gut wrenching. they were, that's a fact, and i sat there.... for a long time in my memories of my misfortunes.... merging
into agony, sadness, and hopelessness, my mind and body went there to feel it, really feel it.
i didn't try to analyze anything, i didn't try to blame or feel regret; i just felt the pain.
unfortunately, i had to do this a large number of times to
begin to let it go. but fortunately, once i did experience the different feelings that i had been avoiding for decades, i
began to feel better. "nothing worthwhile happens quickly," i've heard people say. no one can tell you how long you have to
sit with those horrible feelings that have been lying just below your depression. you just have to feel them. you just have
to do it and see how it goes. there is no "get better quick fix." it took me forty-seven years to get to this point and it
certainly wasn't going to get better overnight. i would take time and i had to realize that i was fortunate to be feeling
better with every day that passed.
while i've been sitting here remembering those days... those
precious moments... i've been semi-listening to tom brokaw narrate the harrowing story of a young man who was a hiker that
ran into a horrible dilemma. he had to cut off his own arm. i know how fortunate he was to have survived that ordeal, but
i also knew how much more fortunate i was for never being faced with that same situation.
i adopted a new outlook on life after those days.... when i was feeling sad, i would sit and feel it. i'd
write about what i was feeling and thinking. i'd just let the sadness sit with me. i'd talk to it. i acknowleged my sadness.
knowing it better each time it came to me, i allowed myself to absorb it, taste it, listen to it, and to intimately know it.
and what do you know? after i welcomed sadness to sit with me... it would up and leave so much more quickly than before. how
fortunate is that?
i think now of how fortunate i am on on regular basis. i receive email from those of you that visit the
site, wondering - pondering - about why you're feeling certain feelings and emotions.... why you are sitting in envy, or dissatisfaction
with life, or with feeling selfishness; and i write back, immediately, and offer the things i have learned the hard way........
ponder upon poverty, homelessness, domestic violence, and think about what you can do to help someone experiencing
those horrible misfortunes. ponder upon what makes you heart soar... and think of those who aren't so blessed.... how
can you share your soaring thoughts of hopefulness with unfortunate people - how can you help them to reach out and grab
a sparkling glimpse of hope from you?
then act upon it. do it. sign up, call someone who needs something and offer your help. do what it
takes to find what you you're good at and contribute your good fortune by sharing your knowledge of it. stop being self absorbed.
stop feeling sorry for yourself. stop wondering what you can do and just do something. it doesn't matter what it is. go to
a public school and sign up to help a child to learn how to read. go to a homeless shelter to donate your slightly
used clothing and bedding. write a check to a charity if that's all you can think of doing. just do something. realize
how fortunate you are.
write about it then read it back - out loud to yourself. where have you traveled to? how fortunate were you
to have learned how to ice skate? how fortunate are you to love to cook? cook something and take it to a sick friend
or a depressed neighbor. reflect upon your good fortunes when you are feeling low.... you won't feel low for long.
pray for those less fortunate. praying is free. you can always think of just something to do if you try
hard enough......
accept your good fortune and pass it on... let someone else feel fortunate for knowing you.
kathleen
Bipolar Disorder
Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in a person's mood, energy &
ability to function.
Different
from the normal ups & downs that everyone goes thru, the symptoms of bipolar disorder are severe. They can result in damaged relationships, poor job or school performance & even suicide. But there's good news: bipolar disorder can be treated & people with this illness can lead full & productive lives.
More than
2 million American adults, or about 1% of the population age 18 & older in any given year, have bipolar disorder. Bipolar disorder typically develops in late adolescence or early adulthood.
However,
some people have their first symptoms during childhood & some develop them late in life. It's often not recognized as
an illness & people may suffer for years before it's properly diagnosed & treated.
Like diabetes
or heart disease, bipolar disorder is a long-term illness that must be carefully managed throughout a person's life.
"Manic-depression
distorts moods & thoughts, incites dreadful behaviors, destroys the basis of rational thought & too often erodes the
desire & will to live. It's an illness that's biological in its origins, yet one that feels psychological in the experience
of it; an illness that is unique in conferring advantage & pleasure, yet one that brings in its wake almost unendurable
suffering & not infrequently, suicide.
"I am fortunate that I haven't died from my illness, fortunate
in having received the best medical care available & fortunate
in having the friends, colleagues & family that I do."
Kay Redfield Jamison, Ph.D., An Unquiet Mind, 1995, p. 6.
(Reprinted
with permission from Alfred A. Knopf, a division of Random House, Inc.)
What Are the Symptoms
of Bipolar Disorder? Bipolar disorder causes dramatic mood swings from
overly "high" &/or irritable to sad & hopeless & then back again, often with periods of normal mood in between. Severe changes in energy & behavior go along with
these changes in mood. The periods of highs & lows are called episodes of mania & depression.
Signs & symptoms of mania (or
a manic episode) include:
- Increased energy, activity & restlessness
- Excessively "high," overly good, euphoric mood
- Extreme irritability
- Racing thoughts & talking very fast, jumping from one idea
to another
- Distractibility, can't concentrate well
- Little sleep needed
- Unrealistic beliefs in one's abilities & powers
- Poor judgment
- Spending sprees
- A lasting period of behavior that's different from usual
- Increased sexual drive
- Abuse of drugs, particularly cocaine, alcohol & sleeping
medications
- Provocative, intrusive or aggressive
behavior
- Denial that anything is wrong
- A manic episode is diagnosed if elevated mood occurs with 3
or more of the other symptoms most of the day, nearly every day, for 1 week or longer. If the mood is
irritable, 4 additional symptoms must be present.
Signs & symptoms of depression (or
a depressive episode) include:
- Lasting sad, anxious,
or empty mood
- Feelings of hopelessness or pessimism
- Feelings of guilt, worthlessness or helplessness
- Loss of interest or pleasure in
activities once enjoyed, including sex
- Decreased energy, a feeling of fatigue
or of being "slowed down"
- Difficulty concentrating, remembering, making decisions
- Restlessness or irritability
- Sleeping too much, or can't sleep
- Change in appetite and/or unintended weight loss or gain
- Chronic pain or other persistent bodily symptoms that aren't
caused by physical illness or injury
- Thoughts of death or suicide, or suicide attempts
- A depressive episode is diagnosed
if 5 or more of these symptoms last most of the day, nearly every day, for a period of 2 weeks or longer.
A mild to moderate level of
mania is called hypomania. Hypomania may feel good to the person who
experiences it & may even be associated with good functioning & enhanced productivity.
Thus even when family &
friends learn to recognize the mood swings as possible bipolar disorder, the person may deny that
anything is wrong. Without proper treatment, however, hypomania can become severe mania in some people or can switch into
depression.
Sometimes, severe episodes
of mania or depression include symptoms of psychosis (or psychotic symptoms).
Common psychotic symptoms are:
- hallucinations (hearing, seeing, or otherwise sensing the presence of things not actually there)
- delusions (false, strongly held beliefs not influenced by logical reasoning or explained by a person's usual cultural concepts).
Psychotic symptoms in bipolar disorder tend to reflect the extreme mood state at the time.
For example:
- delusions of grandiosity,
such as believing one is the President or has special powers or wealth, may occur during mania
- delusions of guilt
or worthlessness, such as believing that one is ruined & penniless or has committed
some terrible crime, may appear during depression
People with bipolar disorder who have these symptoms are sometimes incorrectly diagnosed as having schizophrenia, another severe mental illness.
It may be helpful to think of the various mood states in bipolar disorder as a spectrum or continuous range. At one end is severe depression, above which is moderate depression & then mild low mood, which many people call "the blues" when it is short-lived but is
termed "dysthymia" when it is chronic. Then there is normal or balanced
mood, above which comes hypomania (mild to moderate mania) &
then severe mania.
In some people, however, symptoms
of mania & depression may occur together in what is called a mixed
bipolar state.
Symptoms of a mixed state often include:
- agitation
- trouble sleeping
- significant change in appetite
- psychosis
- suicidal thinking
A person may have a very sad, hopeless mood while at the same time feeling extremely energized.
Bipolar disorder may appear to be a problem other than mental illness - i.e., alcohol or drug abuse, poor school
or work performance, or strained interpersonal relationships. Such problems in fact may be signs of an underlying mood disorder.
Diagnosis of
Bipolar Disorder
Like other mental illnesses, bipolar disorder can't yet be identified physiologically; i.e., thru a blood test or a brain scan. Therefore, a diagnosis of bipolar disorder is made on the basis of symptoms, course of illness &
when available, family history.
The diagnostic criteria
for bipolar disorder are described in the Diagnostic & Statistical Manual for Mental Disorders, fourth edition (DSM-IV).
Descriptions offered by people
with bipolar disorder give valuable insights into the various mood states associated with the illness:
Depression: I
doubt completely my ability to do anything well. It seems as though my mind has slowed down &
burned out to the point of being virtually useless…. [I am] haunt[ed]… with the total,
the desperate hopelessness of it all…. Others say, "It's only temporary, it'll pass, you'll
get over it," but of course they haven't any idea of how I feel, although they are certain they do. If I can't feel, move,
think or care, then what on earth is the point?
Hypomania:
At first when I'm high, it's tremendous… ideas are fast… like shooting stars you follow until brighter ones appear….
All shyness disappears, the right words & gestures are suddenly there… uninteresting
people, things become intensely interesting.
Sensuality is
pervasive, the desire to seduce & be seduced is irresistible. Your
marrow is infused w/ unbelievable feelings of ease, power, well-being,
omnipotence, euphoria… you can do anything… but, somewhere this changes.
Mania:
The fast ideas become too fast & there are far too many… overwhelming confusion replaces
clarity… you stop keeping up w/it, memory goes. Infectious humor
ceases to amuse. Your friends become frightened…. everything is
now against the grain… you're irritable, angry, frightened, uncontrollable &
trapped.
Suicide
Some
people w/ bipolar disorder become suicidal. Anyone who's thinking about committing suicide needs immediate
attention, preferably from a mental health professional or a physician.
Anyone who talks about suicide should be taken seriously.
Risk for suicide appears to be higher earlier in the course of the illness. Therefore, recognizing bipolar disorder early
& learning how best to manage it may decrease the risk of death by suicide.
Signs & symptoms that may accompany suicidal feelings include:
- talking about feeling suicidal or wanting to die
- feeling hopeless, that nothing will ever change or get better
- feeling helpless, that nothing one does makes any difference
- feeling like a burden to family & friends
- abusing alcohol or drugs
- putting affairs in order (e.g.,
organizing finances or giving away possessions to prepare for one's death)
- writing a suicide note
- putting oneself in harm's way, or in situations where there's
a danger of being killed
If you are feeling suicidal or know someone who is:
- call a doctor, emergency room, or 911 right away to get immediate
help
- make sure you, or the suicidal person, are not left alone
- make sure that access is prevented to large amounts of medication,
weapons, or other items that could be used for self-harm
While some suicide attempts are carefully
planned over time, others are impulsive acts that haven't been well thought out; thus, the final point in the box above may be a valuable
long-term strategy for people w/ bipolar disorder.
Either way, it's important to understand that suicidal feelings & actions are symptoms of an illness that can be treated.
With proper treatment, suicidal feelings can be overcome.
What Is the Course of Bipolar Disorder?
Episodes
of mania & depression typically recur across the life span. Between episodes, most people w/
bipolar disorder are free of symptoms, but as many as 1/3 of people have some residual symptoms. A small percentage of people experience chronic unremitting
symptoms despite treatment.
The classic form of the illness, which involves recurrent episodes
of mania & depression, is called bipolar I disorder.
Some people, however, never develop severe mania but instead
experience milder episodes of hypomania that alternate w/depression; this form of the illness is called bipolar
II disorder.
When 4 or more episodes of illness occur within a 12-month period,
a person is said to have rapid-cycling bipolar disorder. Some people experience multiple episodes
within a single week, or even within a single day. Rapid cycling tends to develop later in the course of illness & is
more common among women than among men.
People w/ bipolar disorder can lead healthy & productive
lives when the illness is effectively treated (see below—"How Is Bipolar Disorder Treated?").
Without treatment, however, the natural course of bipolar disorder tends to worsen. Over time a person may suffer more frequent
(more rapid-cycling) & more severe manic & depressive episodes than those experienced
when the illness first appeared.
But in most cases, proper treatment can help reduce the frequency
& severity of episodes & can help people w/ bipolar disorder maintain good quality of life.
Can Children & Adolescents
Have Bipolar Disorder?
Both children & adolescents can develop bipolar disorder. It's more likely to
affect the children of parents who have the illness.
Unlike many adults w/ bipolar disorder, whose episodes tend
to be more clearly defined, children & young adolescents w/ the illness often experience very fast mood swings between
depression & mania many times within a day.
Children w/ mania are more likely to be irritable & prone to destructive tantrums than to be overly happy & elated. Mixed symptoms also are common in youths w/ bipolar disorder. Older adolescents who develop the
illness may have more classic, adult-type episodes & symptoms.
Bipolar disorder in children & adolescents can be hard to
tell apart from other problems that may occur in these age groups. For example, while irritability & aggressiveness can indicate bipolar disorder, they also can be symptoms of:
- attention deficit hyperactivity disorder
- conduct disorder
- oppositional defiant disorder
- other types of mental disorders more common among adults such
as major depression or schizophrenia
Drug abuse
also may lead to such symptoms.
For any illness, however, effective treatment depends on appropriate
diagnosis. Children or adolescents w/ emotional & behavioral symptoms should be carefully evaluated by a mental health
professional.
Any child or adolescent who has suicidal feelings, talks about
suicide, or attempts suicide should be taken seriously & should receive immediate help from a mental health specialist.
What Causes Bipolar
Disorder?
Scientists are learning about the possible causes of bipolar disorder thru several kinds of studies.
Most scientists now agree that there's no single cause for bipolar disorder; rather, many factors act together to produce
the illness.
Because bipolar disorder tends to run in families, researchers
have been searching for specific genes, the microscopic "building blocks" of DNA inside all cells that influence how the body
& mind work & grow, passed down thru generations that may increase a person's chance of developing the illness.
But genes aren't the whole story. Studies of identical twins,
who share all the same genes, indicate that both genes & other factors play a role in bipolar disorder. If bipolar disorder
were caused entirely by genes, then the identical twin of someone w/ the illness would always develop the illness & research
has shown that this is not the case.
But if one twin has bipolar disorder, the other twin is more
likely to develop the illness than is another sibling.7
In addition, findings from gene research suggest that bipolar
disorder, like other mental illnesses, doesn't occur because of a single gene. It appears likely that many different genes
act together & in combination w/other factors of the person or the person's environment, to cause bipolar disorder.
Finding these genes, each of which contributes only a small
amount toward the vulnerability to bipolar disorder, has been extremely difficult. But scientists expect that the advanced research tools now being used will lead to these discoveries & to new &
better treatments for bipolar disorder.
Brain-imaging studies are helping scientists learn what goes
wrong in the brain to produce bipolar disorder & other mental illnesses. New brain-imaging techniques allow researchers
to take pictures of the living brain at work, to examine its structure & activity, without the need for surgery or other
invasive procedures.
These techniques include magnetic resonance imaging (MRI), positron
emission tomography (PET) & functional magnetic resonance imaging (fMRI). There's evidence from imaging studies that the
brains of people w/ bipolar disorder may differ from the brains of healthy individuals.
As the differences are more clearly identified & defined
thru research, scientists will gain a better understanding of the underlying causes of the illness
& eventually may be able to predict which types of treatment will work most effectively.
How Is Bipolar Disorder
Treated?
Most people w/ bipolar disorder, even those w/ the most severe forms, can achieve substantial
stabilization of their mood swings & related symptoms w/ proper treatment. Because bipolar disorder is a recurrent illness,
long-term preventive treatment is strongly recommended & almost always indicated.
A strategy that combines medication & psychosocial
treatment is optimal for managing the disorder over time.
In most cases, bipolar disorder is much better
controlled if treatment is continuous than if it is on & off. But even when there are no breaks in treatment, mood
changes can occur & should be reported immediately to your doctor.
The doctor may be able to prevent a full-blown episode by making
adjustments to the treatment plan. Working closely w/ the doctor & communicating openly about treatment concerns &
options can make a difference in treatment effectiveness.
In addition, keeping a chart of daily mood symptoms, treatments,
sleep patterns & life events may help people w/ bipolar disorder & their families to better understand
the illness. This chart also can help the doctor track & treat the illness most effectively.
Medications
Medications for bipolar
disorder are prescribed by psychiatrists, medical doctors (M.D.) w/ expertise in the diagnosis & treatment of mental disorders.
While primary care physicians who don't specialize in psychiatry also may prescribe these medications, it's recommended that
people w/bipolar disorder see a psychiatrist for treatment.
Medications known as "mood stabilizers" usually are prescribed
to help control bipolar disorder. Several different types of mood stabilizers are available. In general, people w/ bipolar
disorder continue treatment w/ mood stabilizers for extended periods of time (years).
Other medications are added when necessary, typically for shorter
periods, to treat episodes of mania or depression that break thru despite the mood stabilizer.
Lithium, the first mood-stabilizing medication approved by the
U.S. Food & Drug Administration (FDA) for treatment of mania, is often very effective in controlling mania & preventing
the recurrence of both manic & depressive episodes.
Anticonvulsant medications, such as valproate (Depakote®) or
carbamazepine (Tegretol®), also can have mood-stabilizing effects & may be especially useful for difficult-to-treat bipolar
episodes. Valproate was FDA-approved in 1995 for treatment of mania.
Newer anticonvulsant medications, including lamotrigine (Lamictal®),
gabapentin (Neurontin®) & topiramate (Topamax®), are being studied to determine how well they work in stabilizing mood
cycles.
Anticonvulsant medications may be combined w/ lithium, or w/
each other, for maximum effect.
Children & adolescents w/ bipolar disorder generally are
treated w/ lithium, but valproate & carbamazepine also are used. Researchers are evaluating the safety & efficacy
of these & other psychotropic medications in children & adolescents.
There's some evidence that valproate may lead to adverse hormone
changes in teenage girls & polycystic ovary syndrome in women who began taking the medication before age Therefore, young
female patients taking valproate should be monitored carefully by a physician.
Women w/ bipolar disorder who wish to conceive, or who become
pregnant, face special challenges due to the possible harmful effects of existing mood stabilizing medications on the developing
fetus & the nursing infant.15
Therefore, the benefits & risks of all available treatment
options should be discussed w/ a clinician skilled in this area. New treatments w/ reduced risks during pregnancy & lactation
are under study.
Treatment of Bipolar
Depression
Research has shown that people w/ bipolar disorder are at risk of switching into mania or hypomania,
or of developing rapid cycling, during treatment w/ antidepressant medication. Therefore, "mood-stabilizing" medications generally
are required, alone or in combination w/ antidepressants, to protect people w/ bipolar disorder from this switch.
Lithium & valproate are the most commonly used
mood-stabilizing drugs today. However, research studies continue to evaluate the potential mood-stabilizing effects of newer
medications.
Atypical antipsychotic medications, including clozapine (Clozaril®),
olanzapine (Zyprexa®), risperidone (Risperdal®), quetiapine (Seroquel®) & ziprasidone (Geodon®), are being studied as
possible treatments for bipolar disorder. Evidence suggests clozapine may be helpful as a mood stabilizer for people who don't respond to lithium or anticonvulsants.
Other research has supported the efficacy of olanzapine for
acute mania, an indication that has recently received FDA approval.18 Olanzapine may also help relieve
psychotic depression.
If insomnia is a problem, a high-potency benzodiazepine medication
such as clonazepam (Klonopin®) or lorazepam (Ativan®) may be helpful to promote better sleep. However, since these medications
may be habit-forming, theyre best prescribed on a short-term basis.
Other types of sedative medications, such as zolpidem (Ambien®),
are sometimes used instead.
Changes to the treatment plan may be needed at various times
during the course of bipolar disorder to manage the illness most effectively. A psychiatrist should guide any changes in type
or dose of medication.
Be sure to tell the psychiatrist about all other prescription
drugs, over-the-counter medications, or natural supplements you may be taking. This is important because certain medications
& supplements taken together may cause adverse reactions.
To reduce the chance of relapse or of developing a new episode,
it's important to stick to the treatment plan. Talk to your doctor if you have any concerns about the medications.
Thyroid Function
People
w/ bipolar disorder often have abnormal thyroid gland function. Because too much or too little
thyroid hormone alone can lead to mood & energy changes, it's important that thyroid levels are carefully monitored by
a physician.
People w/ rapid cycling tend to have co-occurring thyroid problems &
may need to take thyroid pills in addition to their medications for bipolar disorder. Also, lithium treatment may cause low
thyroid levels in some people, resulting in the need for thyroid supplementation.
Medication Side Effects
Before
starting a new medication for bipolar disorder, always talk w/ your psychiatrist and/or pharmacist about possible side effects.
Depending on the medication, side effects may include:
- weight gain
- nausea
- tremor
- reduced sexual drive or performance
- anxiety
- hair loss
- movement problems
- dry mouth
Be sure to tell the doctor about all side effects
you notice during treatment. He or she may be able to change the dose or offer a different medication to relieve them. Your
medication should not be changed or stopped w/out the psychiatrist's guidance.
Psychosocial Treatments
As
an addition to medication, psychosocial treatments including certain forms of psychotherapy (or "talk" therapy) are helpful in providing support, education & guidance to people w/ bipolar disorder & their families.
Studies have shown that psychosocial interventions
can lead to increased mood stability, fewer hospitalizations & improved functioning in several areas. A licensed psychologist,
social worker, or counselor typically provides these therapies & often works together w/the psychiatrist to monitor a
patient's progress.
The number, frequency & type of sessions should
be based on the treatment needs of each person.
Psychosocial interventions commonly used for bipolar disorder
are:
- cognitive behavioral therapy
- psychoeducation
- family therapy
- a newer technique, interpersonal & social rhythm therapy
NIMH researchers are studying how these interventions compare
to one another when added to medication treatment for bipolar disorder.
Cognitive behavioral therapy
helps people w/ bipolar disorder learn to change inappropriate or negative thought patterns &
behaviors associated w/ the illness.
Psychoeducation involves teaching
people w/ bipolar disorder about the illness & its treatment & how to recognize signs of relapse so that early intervention
can be sought before a full-blown illness episode occurs. Psychoeducation also may be helpful for
family members.
Family therapy uses strategies
to reduce the level of distress within the family that may either contribute to or result from
the ill person's symptoms.
Interpersonal & social rhythm
therapy helps people with bipolar disorder both to improve interpersonal relationships & to regularize their daily routines.
Regular daily routines & sleep schedules may help protect against manic episodes.
As w/medication, it's important to follow the treatment plan
for any psychosocial intervention to achieve the greatest benefit.
Other Treatments
In
situations where medication, psychosocial treatment & the combination of these interventions prove ineffective, or work
too slowly to relieve severe symptoms such as psychosis or suicidality, electroconvulsive therapy
(ECT) may be considered.
ECT may also be considered to treat acute episodes
when medical conditions, including pregnancy, make the use of medications too risky. ECT is a highly effective treatment for
severe depressive, manic, and/or mixed episodes.
The possibility of long-lasting memory problems,
although a concern in the past, has been significantly reduced w/ modern ECT techniques. However, the potential benefits &
risks of ECT & of available alternative interventions, should be carefully reviewed & discussed w/individuals considering
this treatment & where appropriate, w/family or friends.20
Herbal or natural supplements, such as St. John's
wort (Hypericum perforatum), haven't been well studied & little is known about their effects on bipolar disorder.
Because the FDA doesn't regulate their production,
different brands of these supplements can contain different amounts of active ingredient. Before trying herbal or natural
supplements, it's important to discuss them w/your doctor.
There's evidence that St. John's wort can reduce
the effectiveness of certain medications (see http://www.nimh.nih.gov/events/stjohnwort.cfm). 21
In addition, like prescription antidepressants,
St. John's wort may cause a switch into mania in some individuals w/ bipolar disorder, especially if no mood stabilizer is
being taken.22
Omega-3 fatty acids found in fish oil are being
studied to determine their usefulness, alone & when added to conventional medications, for long-term treatment of bipolar
disorder.
A Long-Term Illness
That Can Be Effectively Treated
Even though episodes of mania & depression naturally come & go,
it's important to understand that bipolar disorder is a long-term illness that currently has no cure. Staying on treatment,
even during well times, can help keep the disease under control & reduce the chance of having recurrent, worsening episodes.
Do Other Illnesses Co-occur
w/ Bipolar Disorder?
Alcohol & drug abuse are very common among people w/ bipolar disorder. Research
findings suggest that many factors may contribute to these substance abuse problems, including self-medication of symptoms,
mood symptoms either brought on or perpetuated by substance abuse & risk factors that may influence the occurrence of
both bipolar disorder & substance use disorders.
Treatment for co-occurring substance abuse, when
present, is an important part of the overall treatment plan.
Anxiety disorders, such as post-traumatic stress disorder &
obsessive-compulsive disorder, also may be common in people w/ bipolar disorder.
Co-occurring anxiety disorders may respond to the treatments
used for bipolar disorder, or they may require separate treatment. For more information on anxiety disorders, contact NIMH
(see below).
How Can Individuals &
Families Get Help for Bipolar Disorder?
Anyone w/ bipolar disorder should be under the care of a psychiatrist
skilled in the diagnosis & treatment of this disease. Other mental health professionals, such as psychologists, psychiatric
social workers & psychiatric nurses, can assist in providing the person & family with additional approaches to treatment.
Help can be found at:
University—or medical school—affiliated programs
Hospital departments of psychiatry
Private psychiatric offices and clinics
Health maintenance organizations (HMOs)
Offices of family physicians, internists, and pediatricians
Public community mental health centers
People with
bipolar disorder may need help to get help.
Often people w/ bipolar disorder do not realize how impaired
they are, or they blame their problems on some cause other than mental illness. A person w/ bipolar
disorder may need strong encouragement from family & friends to seek treatment.
Family physicians can play an important role in providing referral
to a mental health professional. Sometimes a family member or friend may need to take the person w/ bipolar disorder
for proper mental health evaluation & treatment.
A person who is in the midst of a severe episode may need to
be hospitalized for his or her own protection & for much-needed treatment. There may be times when the person must be
hospitalized against his or her wishes.
Ongoing encouragement & support are needed after a person obtains treatment, because it may take a while to find the best treatment
plan for each individual. In some cases, individuals w/ bipolar disorder may agree, when the disorder is under good control,
to a preferred course of action in the event of a future manic or depressive relapse.
Like other serious illnesses, bipolar disorder is also hard
on spouses, family members, friends & employers. Family members of someone w/ bipolar disorder often have to cope w/ the
person's serious behavioral problems, such as:
- wild spending sprees during mania
- extreme withdrawal from others during depression
- the lasting consequences of these behaviors
|
 |
|
Love + Loving = Better Health by Nina Amir Lacey Conscious Choice,
February 1999
Love. We search, hunger, pray for this too often elusive emotion. When we experience it, we revel in the bliss love elicits & bask in the warmth that blankets us with caring, gratitude, comfort & a sense of all-around well being.
Little have we known
that this wonderful feeling we call love does, indeed, create well-being. In fact, feeling love sets forth a complex series of events within our bodies that generally bring about better health.
Before entering into a discussion about love, a distinction must be made between "falling in love" & "being in love" or feeling love in general.
Simply defined, falling in love is part of the initial stage of a relationship, in which we feel strong passionate feelings of attraction, both emotional & physical, to another person.
If we're
fortunate, this stage leads to being in love, a deeper devotion & affection, which may develop & deepen over time.
Feeling love is much like being in love. However, we can feel love for someone who isn't a romantic partner; in fact, we more often feel love without "being in love." We frequently extend the more general kind of love to relatives, friends, even pets.
Numerous studies prove that love does, indeed, improve our health. These studies look at love not only in the context of male-female primary relationships, such as marriage, but also in the context of a person's general
social support & connection to others.
In other words, these
studies examine both relationships where participants are "in love" & those in which we feel love for someone.
Dean Ornish, M.D., has served as a pioneer in this work. In his book,
Love and Survival, the Scientific Basis for the Healing Power of Intimacy (HarperCollins,
1998), he reports on many such studies.
For example, he helped
conduct a study at Yale that involved 119 men & 40 women undergoing coronary angiography. Those who felt the most loved & supported had substantially less blockages in their heart arteries than the other subjects.
In a related study,
researchers looked at almost 10 thousand married men with no prior history of angina. These men had high levels of risk factors,
such as elevated cholesterol, high blood pressure, diabetes & electrocardiogram abnormalities.
Those
who felt their wives didn't show them love experienced almost twice as much angina as the first group, who felt their wives did show them love.
While
feeling loved appears to benefit our heart's health, giving love seems to do the same for our aging process. The results of a study of more than 700 elderly adults showed that the
effects of aging were influenced more by what the participants contributed to their social support network than what they
received from it. In other words, the more love & support they gave, the more they benefited.
Social ties with friends, family,
workers & community that involve love & intimacy of any type also may help protect against infectious diseases.
In a study of 276 healthy
volunteers ranging in age from 18 to 55, all participants received nasal drops containing rhinovirus, which causes the common
cold. Researchers assessed subjects on 12 types of relationships, including relationship with spouse, parents, parents-in-law,
children & other close family members, neighbors, friends, co-workers schoolmates & member of various groups.
They scored a point
for each type of relationship if they spoke to a person in that category at least once every 2 weeks. While almost all of
the people exposed to the cold virus were infected, not everyone developed the signs & symptoms of a cold.
The participants
who reported only 1 to 3 types of relationships had more than 4 times the risk of developing a cold than those reporting 6
or more types of relationships.
"When you feel loved, nurtured, cared for, supported & intimate, you're much more likely to be happier & healthier. You have a much lower risk of getting sick & if you do, a much greater chance
of surviving," Ornish concludes in his book.
New studies being conducted at the Institute
for HeartMath in Boulder Creek, California, confirm the health-improving & life-affirming effects of love on the human body.
By studying the heart's
rhythms, researchers there have discovered that when we feel love, or any positive emotion such as compassion, caring, or gratitude, the heart sends messages to the brain & secretes hormones that positively affect our health.
"Our heart rate changes with every heartbeat," Rollin McCraty, director of research at the Institute
of HeartMath, explains. "It creates patterns we call heart rhythms."
Researchers see the
difference in heart rhythms easily when study participants wear portable recorders that allow researchers to monitor their
heart rhythms as they go about their day.
These rhythms
provide "a window" into the inner workings of the communication system between the heart & the brain.
McCraty believes the heart actually monitors the blood stream for hormones & translates the hormonal information
into neurological information, which cascades up into the higher brain centers, like the cortex.
"When we get stressed out or mad or worried, the bottom line is that the heart's rhythmic beating pattern becomes very incoherent &
that has the effect of inhibiting the brain's cortex," McCraty explains.
"When we feel emotions
like love & appreciation the heart switches into a very rhythmic, coherent, beating pattern that facilitates cortical function."
These coherent heart rhythms, he says, cause an "inner synchronization" of the systems in our body, which then affects how
we think, function & fight off disease.
Not only does the heart communicate
with the brain via the nervous system, its rhythms affect the functioning of the nervous system itself. The autonomic nervous
system is divided into 2 branches, one that speeds things up & another that slows things down.
"When we're in
a non-loving state, when we're angry at someone, the 2 halves of the nervous system get out of sync with one another.
It's like they're fighting each other: one tries to speed the heart up as the other tries to slow it down.
This is what
creates this very erratic heart rhythm.
"When we're in a loving state, our hearts go into coherent heart rhythms," says McCraty. "This is because the 2 halves of the nervous system
are in sync & operating much more efficiently together. That allows the body to go thru its natural regenerative process,"
he explains.
"If we feel love & compassion, that boosts our immune system."
The effect of which McCraty
speaks showed up in a study documented by Doc Childre, architect of the HeartMath program. When subjects of the experiment
felt angry for one 5 minute period, their cortisol levels increased.
Cortisol, known as the
stress hormone, suppresses the immune system. Thus, these subjects experienced suppressed secretory immunoglobulin A (IgA), an antibody,
for up to 6 hours after feeling angry for only 5 minutes.
Secretory IgA serves as the human body's first line of
defense against disease. Thus, lower than normal levels of IgA, leave us more susceptible to colds, flu & respiratory
disease. When the subjects of this study felt love & appreciation for just one 5 minute period, their secretory Iga rose significantly.
While the rise
in IgA spikes after feeling love for 5 minutes & then drops off, it then begins a slow rise that continues for many hours afterward.
A few years ago researchers at the Institute of HeartMath used their tools to teach 30 people how to feel love in a conscious manner. One month later, they measured the study subjects' levels of both cortisol & DHEA, known as the
anti-aging hormone.
They found
that the cortisol levels for the whole group had decreased 23 % while the group's DHEA levels increased 100% across the board.
"The measurement of those two hormones is considered by many, including myself,
to be a very good measure of stress & aging" says McCraty. "If they're out of balance, such as high cortisol, low DHEA, that basically is rapid aging.
Learning to love or to love more consciously, more of the time, brings those hormones into balance. This is a very direct pathway to see how love affects health."
Cardiologist Bruce Wilson, chairman of the Medical Education Committee
at Columbia Hospital in Milwaukee, WI, found that many of his patients suffer not from the 5 identifiable risk factors for
heart disease, which are:
- family history
- cholesterol elevation
- smoking
- diabetes
- hypertension
but from the effects of a stressful life.
In his work as both a doctor & a HeartMath trainer, Wilson reports that he has seen people shift their heart rhythms from
anger or stress to love & benefit from the physiology.
Another body of work sheds light on the health
benefits of love by looking at the makeup of emotions. Candace Pert, Ph.D., research professor at Georgetown University Medical Center in
Washington, D.C., & author of Molecules of Emotion, Why You Feel the Way You Do (Scribner,
1997), reports that endorphins, which are associated with the feeling of bliss, help us "bond" with other people.
In other words, they
help us form loving relationships. Endorphins are "natural endogenous morphine-like substances that we produce in our brain, sex organs, gut,
immune system & heart," says Pert.
"Certainly the data
would suggest that endorphins are involved" when we feel love. Endorphins are known not only to create a positive, bliss-like feeling - which we definitely associate with love - but also to stimulate the special immune system cells, called Natural Killer cells, which fight cancer. In addition, they
improve digestion & elimination.
While the fact that love improves our health may be good news for people in an intimate primary relationship, it may appear just the opposite for
those who aren't. However, to reap the benefits of love you need not have a lover or spouse. The love you feel can be for a co-worker, a parent, a child, or a sibling.
In fact, it can even
be for your dog, cat, fish, or plants. "Somebody could be flooded with love for their pet or their God & get just as much of a boost...as someone who just started going out with someone new," comments
Pert.
There are
numerous studies illustrating the fact that people live healthier lives & heal better after a major illness or
surgery if they own a pet. In particular, many such studies have shown that the elderly fare better if they own pets.
For those
who still feel doubt about the power of love to improve their lives, yet one more hope exists. Wilson suggests that people can apply HeartMath techniques to the deep gratitude or appreciation you feel toward a movie, a concerto, or another activity or event that fosters in you
positive feelings.
"One step in this technique
has to do with focusing very hard on one moment of sincere appreciation," Wilson explains. He conjures up a sunset in Cancun,
though your own chosen focus may be closer to home. "You call up one of your many images, think of that special moment, center
yourself in your heart & access this physiology.
Then these changes in
physiology totally change how you're interacting with your environment. They change your internal physiology. They change
the balance in your autonomic nervous system. Literally," he concludes.
One question still
remains unanswered: Is falling in love better for our health than being in love or feeling love? While McCraty feels that truly falling in love can boost health, he notes that dating & the insecurity that can go with looking for new relationships can involve a
fair amount of stress.
Pert agrees:
"We could speculate that in the beginning stages of love there's more of an excitement factor, which would produce some of the classical neurotransmitters, like norepinephrine & dopamine, which are involved
with excitement," she explains."
If you're actually
flooded with norepinephrine, viruses have a hard time getting in." But Pert urges us to "celebrate old love as well." She adds, "Maybe as [love] becomes richer & deeper & different...then additional chemicals come into play."
In any case, we
can all be reassured that the more we love & are loved, the healthier we become.
Nina Amir Lacey is a freelance writer living in Batavia,
Illinois.
|
|
|
|
|
|
|
|
|
|
|
|
