Related Articles
These are pertinent articles from various sources.  At the bottom of the page are links to previously posted items that are now archived.

Creating motivation when feeling depressed can be one of the most difficult things a person can do. An episode of depression can be physically and emotionally draining. The simplest of tasks seem to take maximum effort, and sometimes even beyond maximum. Some may feel lethargic. It may be tough make meals, or clean up at home, or take showers, or even get out of bed.

Navigating motivation when depressed can be tough because the instinct is to wait for the energy to return. People who are depressed often fall into the trap of trying to wait it out — that if you give in to the urge to stay in bed for a few days, that you’ll be re-energized and recharged, believing you’ll have exorcised the depression demons by just “going with it”.

Unfortunately, it’s not usually as simple as this. If everybody tried to wait out their depressive episodes, some people would be in bed for 20 years, realizing somewhere along the way that depression actually tends to breed depression if it’s not actively confronted. That’s right, catering to our depressive urges actually reinforces them.


Obviously, actively doing anything doesn’t sound so desirable when feeling depressed, let alone confronting our depressive urges head-on. While it’s important to give depressive symptoms their attention and get to understand and learn about what’s underlying the depressive episode, the concept of “mind over matter” can help create motivation when depressed. I have seen evidence with many people that creating a change in mindset with small, manageable, behavioral steps can change a whole experience of depression. For some it’s brought their symptoms entirely into remission. This doesn’t replace taking the steps to learn more about what’s causing the episodes, but these steps can help us move on with our lives while we continue to work on the underlying issues.

Let’s look at some steps that can help break an episode or a cycle of depression.

1) Opposite Action – In Dialectical-Behavioral Therapy (an offshoot of Cognitive-Behavioral Therapy), Opposite Action is the idea of forcing yourself to do something that you know is good for you, in order to prevent the reinforcement of a bad habit. For example, if you want to stay on the couch and watch tv all day, when realizing this only gives in to depression, opposite action would say to get up and go out, knowing it would be a healthier behavior. It’s very much a “just to the opposite of your unhealthy urge” technique.  In CBT, the principle is that your behaviors can create positive changes in your emotions.

2) Set an Alarm – This isn’t only for getting out of bed. The alarm can be for anything that marks a symptom of depression. You might set an alarm to wake yourself up at a certain time to make sure you get out of bed in the morning; or you might set an alarm to signal a meal time if you’re missing meals, or signal time to do laundry, or run a particular set of errands, and so on. The alarm serves as a cue to draw your attention to a target area where you want to become more active in change.

3) Make Your Bed – Getting out of bed can be very tough with depression. The first step to take is to sit up on the bed, put your feet on the floor, and visualize leaving all of your troubles and thoughts behind you in the bed. Then, get up and nicely make your bed, leaving the troubles behind for the day. Making the bed is essential in this process, as it signals to your brain that there isn’t an option to get back in the bed for the day. As you make your bed, it can also be helpful to imagine the troubles you’re left behind dissipating as the covers are pulled up.

4) Wash Up – The more routine-setting steps you’re able to add on after you make your bed, the better. Try washing your face and brushing your teeth to help wake you up. With these kind of steps you’re training your brain to understand that you’re getting ready for “something,” rather than simply a day laying around.

5) Get Dressed – This is a crucial step in separating from the bed to the day. Sitting around in pajamas on the couch is still possible, even if you escape the bedroom. Getting dressed decreases the urge to lounge, because again you’re reinforcing in your brain that you’re getting ready for something.

6) Go Outside – This can be one of the toughest steps for people who struggle with depression — actually leaving the house. One of the problems with this step is that people are easily held back by not having a place to go. “Okay, I can go outside…..but then what?” So for this step, the idea is to not have a place to go. The goal is going outside, not the particular place you go once you’re outside. Go outside, close the door behind you, and do whatever comes to mind — a walk around the block, down the street, pacing in front of your house, getting in your car and driving on an errand, and so on. It can be anything or nothing at all, but the goal is to spend at least ten minutes outside before going back in.

7) Choose One Exercise – Getting your body moving is a good way to start feeling better. Choose an exercise that works for you: walking, running, swimming, jump-roping, etc. Whatever you choose to do, make it a point to do it every day when you go outside. And if it’s an indoor exercise (like a treadmill), do it before you go outside.

8) Make a List of Activities – Brainstorm activities that you’d enjoy doing. Include things to do at home and out with people. Try to generate a list of things that includes others and that gives you some time to yourself. The activities can be a mix of productive (e.g. work-related) activities, and hobbies, and self-care.

9) Schedule Activities – Schedule the activities throughout the week. Try to plan out either one or two weeks ahead of time and actually write the activities into your calendar with specific days and times. Spread them out as much as possible and make sure to stick to the schedule.

10) Daily Necessity Schedule  – This schedule is if you’re having trouble getting motivated to do your daily activities — such as eating, cooking, showering, or other household chores. For this, you’re creating a daily home schedule. Choose the specific times you’re going to do each activity every day. It can be as specific as you feel you need: time to get dressed, brush your teeth, start cooking, eating, showering, turning off the tv before bed, and so on. This is to help you get your daily necessities actually functioning on a daily basis.

11) See Family and Friends – This one is more about the people than the activity. Being around other people is often helpful for mood improvement. Schedule specific dates and times with friends and family, outside of the house. The more you can remove yourself from the environment of depression (usually the home and bedroom), the better chance of overcoming it.   

12) Psychotherapy – It’s important to keep in mind that the desire to stay inside and and lay around isn’t what causes depression — it is a symptom of depression. Psychotherapy remains a necessary step throughout the process of dealing with depression in order to prevent further episodes, reduce severity, and hopefully be rid of depression altogether. Even if we can resolve some of the motivational issues through pushing ourselves to take behavioral steps, the internal issues that are causing the depression still need to be addressed. Otherwise, when our motivation drops, the depression may return if we don’t have a handle on the underlying issues.

What’s most important to keep in mind is that you’re not going to feel like doing anything discussed above. If you’re going to wait to “feel like it”, then it may not happen. Using opposite action will be the necessary first step to conquering depression — knowing in your mind that it will be good for you to take the steps to move forward, and just doing it. By also engaging in psychotherapy, you’re still able to give appropriate attention to what’s happening inside of you, including if medication therapy may (or may not) also be helpful. You do have the power to increase your motivation and to break out of depression. It may take some effort, but the opportunity is there for you to reclaim your life.





10 Winter Depression Busters for Seasonal Affective Disorder

Associate Editor

10 Winter Depression Busters for Seasonal Affective DisorderWe’ve officially entered the hard months, the “dark ages” as the midshipmen at the Naval Academy say: the time of the year when the sun disappears and the pale complexions of your friends remind you that you had better take your vitamins or else you’ll have a cold to go with your pasty look.

I dread winter each year because many of my depression busters require sunny skies and temperatures in the 70s. What does a girl who kayaks and bikes for sanity do in the winter? Lots of things.

Here are a few of them.

1. Give back.

Ghandi once wrote that “the best way to find yourself is to lose yourself in the service of others.” Positive psychologists like University of Pennsylvania’s Martin Seligman and Dan Baker, Ph.D., director of the Life Enhancement Program at Canyon Ranch, believe that a sense of purpose — committing oneself to a noble mission — and acts of altruism are strong antidotes to depression.

The winter months are a good time to do this because the need is greater, the holiday spirit ideally lasts until February, and you don’t have the excuse of attending family picnics, unless you live in California or Florida.


2. Join the gym.

Don’t let the cold weather be an excuse not to sweat. We have centers today called “gyms” where people exercise inside! Granted, it’s not the same — watching the news or listening to the soundtrack from “Rocky” as you run in place as opposed to jogging along wooded paths with a view of the bay. But you accomplish the goal: a heart rate over 140 beats a minute.

The gym is also a kind of support group for me. These women, I’m guessing, are going after the endorphin buzz just like me because alcohol and recreational drugs don’t do the trick anymore. And, like moi, I suspect that they also have great difficulty meditating. Every time they close their eyes, they have visions of screaming kids, Chuck E. Cheese hell, and the crisis of no thank-you gifts for teachers.

3. Use a light lamp.

Bright-light therapy — involving sitting in front of a fluorescent light box that delivers an intensity of 10,000 lux — can be as effect as antidepressant medication for mild and moderate depression and can yield substantial relief for Seasonal Affective Disorder.
I usually turn on my mammoth HappyLite in November, just after my least favorite day of the year: when Daylight Saving Time ends and we “fall back” an hour, which means that I have about an hour of sunlight to enjoy after I pick up the kids from school.

4. Wear bright colors.

I have no research supporting this theory, but I’m quite convinced there is a link between feeling optimistic and sporting bright colors. It’s in line with “faking it ’til you make it,” desperate attempts to trick your brain into thinking that it’s sunny and beautiful outside–time to celebrate Spring!–even though it’s a blizzard with sleet causing some major traffic jams.

Personally, I tend to wear black everyday in the winter. It’s supposed to make you look thinner. But the result is that I appear as if and feel like I’m going to a funeral every afternoon between the months of November and March. This isn’t good. Not for a person hardwired to stress and worry and get depressed when it’s cold. So I make a conscious effort to wear bright green, purple, blue, and pink, and sometimes — if I’m in a rush — all of them together!

5. Force yourself outside.

I realize that the last thing you want to do when it’s 20 degrees outside and the roads are slushy is to head outside for a leisurely stroll around the neighborhood. It’s much more fun to cuddle up with a good novel or make chocolate chip cookies and enjoy them with a hot cup of Jo.

On many winter days — especially in late January and early February when my brain is done with the darkness–I have to literally force myself outside, however brief. Because even on cloudy and overcast days, your mood can benefit from exposure to sunlight. Midday light, especially, provides Vitamin D to help boost your limbic system, the emotional center of the brain. And there is something so healing about connecting with nature, even if it’s covered in snow.

6. Hang out with friends.

This seems like an obvious depression buster. Of course you get together with your buddies when your mood starts to go south. But that’s exactly when many of us tend to isolate. I believe that it takes a village to keep a person sane and happy. That’s why we need so many support groups today. People need to be validated and encouraged and inspired by persons on the same journey.

And with all the technology today, folks don’t even have to throw on their slippers to get to a support group. Online communities provide a village of friendship right at your computer. Every day I read comments like this one from Beyond Blue member Margaret: “Membership in this club to which we all unwillingly belong isn’t something I would wish on anyone; nonetheless, reading how others have survived specific circumstances has given me hope where I’d lost sight of it and inspired me to keep on keepin’ on even when my feet feel as if they’re encased in buckets of cement and will pull me under the stagnant water in the bottom of the pit.”

7. Head south.

Granted, this solution isn’t free, especially if you live in Maine. But you need not travel like the Kennedys to transplant your body and mind to a sunny spot for a few days. I try to schedule our yearly vacation the last week of January or the first week of February so that it breaks up the winter and so that I have something to look forward to in those depressing weeks following the holidays.

8. Challenge yourself: Take up a project.

There’s no time like winter to start a home project, like de-cluttering the house or purging all the old clothes in your kids’ closets. When a friend of mine was going through a tough time, she painted her entire house–every room downstairs with two different colors. And it looked professional! Not only did it help distract her from her problems, but it provided her with a sense of accomplishment that she desperately needed those months, something to feel good about as she saw other things crumble around her. Projects like organizing bookshelves, shredding old tax returns, and cleaning out the garage are perfect activities for the dreary months of the year. And hey, most of them are free!

My mood can often be lifted by meeting a new challenge — an activity that is formidable enough to keep my attention, but easy enough to do when my brain is muddied. Learning how to record and edit video blogs, for this girl who hates technology, turned out to be great fun. Friends of mine get the same boost by joining Jenny Craig and losing the 25 pounds of baby fat, or exploring a new hobby — like scrapbooking. I try to stretch myself in a small way every winter — whether it be taking a writing class, researching the genetics of mood disorders, or something similar. It keeps my brain from freezing, like the rest of my body.

9. Watch the sugar.

I think our body gets the cue just before Thanksgiving that it will be hibernating for a few months, so it needs to ingest everything edible in sight. And I’m convinced the snow somehow communicates to the human brain the need to consume every kind of chocolate available in the house. We are mammals, yes, so do we think we need an extra layer of fat in the winter to keep us warm? I’m starting to think so.

Depressives and addicts need to be especially careful with sweets because the addiction to sugar and white-flour products is very real and physiological, affecting the same biochemical systems in your body as other drugs like heroin. According to Kathleen DesMaisons, author of “Potatoes Not Prozac”: Your relationship to sweet things is operating on a cellular level. It is more powerful than you have realized… What you eat can have a huge effect on how you feel.”

10. Stock up on Omega-3′s.

During the winter I’m religious about stocking in my medicine cabinet a Noah’s Ark supply of Omega-3 capsules because leading physicians at Harvard Medical School confirmed the positive effects of this natural, anti-inflammatory molecule on emotional health. I treat my brain like royalty — hoping that it will be kind to me in return — so I fork over about $30 a month for the Mac Daddy of the Omega-3s, capsules that contain 70 percent EPA (Eicosapentaenoic acid). One 500mg softgel capsule meets the doctor-formulated 7:1 EPA to DHA ratio, needed to elevate and stabilize mood.


5 Ways to Beat the Winter BlahsCall it the winter blues or blahs or simply seasonal sadness. Whatever term you use, around this time, many of us start to feel our mood sinking. We feel especially tired and sluggish. We might even feel like the walking dead, moping from one task to the next.

That’s because as the days get shorter and colder, we spend more time indoors and are less active, according to Ashley Solomon, PsyD, a clinical psychologist who blogs at Nourishing the Soul. “We tend to be more sedentary, which we know impacts our level of energy and even interest in activities,” she said.

It also doesn’t help that our bodies produce more melatonin when the sun sets, making us sleepy, said Deborah Serani, Psy.D, a clinical psychologist and author of the book Living with Depression. (Interestingly, melatonin is known as “the Dracula of hormones,” because it only comes out at night, according to the National Sleep Foundation.)


Our eating habits also contribute to our sinking mood and energy levels. “We tend to eat warmer, heartier meals because that’s part of our evolutionary survival strategy for staying protected through the winter months,” Solomon said. Eating more sugary foods – which is common from Halloween to New Year’s – also spikes glucose levels, leading to a crash of exhaustion, Serani said.

But that doesn’t mean you’re doomed to a dull and fatigued fall and winter. Here are five ways to lift your energy and mood.

1. Better understand your body clock.

For some of us seasonal changes have a dramatic effect on our bodies. For others, it’s a subtle shift, if there’s one at all. This has to do with our circadian rhythms.

Our circadian rhythm is essentially an internal body clock. “[It] regulates our body with respect to sleeping, feeding and well-being,” Serani said. Circadian rhythms respond to sunlight. With less sun exposure in the fall and winter, many people experience a shift in their circadian rhythm, she said.

How can you tell if you’ve been affected? If you’re sluggish during the times of the day you used to feel energetic or you’re exhausted when you used to be well rested, the seasonal changes might be affecting you, she said.

To reset your clock, on the weekends, when possible, wake up without an alarm so your body gets adequate rest, Serani said. For some, melatonin supplements might improve sleep, she said.

Getting enough sunshine is key. Twenty minutes a day seems to be the magic number, Serani said. You can achieve that by going outside or soaking in the sunshine by a window, she said. Or you can buy a light box, which emits bright artificial light.

(Light therapy is actually very helpful for people with seasonal affective disorder, a form of clinical depression that occurs during the winter. This New York Times article has some good information.)

2. Keep up regular physical activity.

Depending on where you live, you might want to participate in winter activities, such as skiing, snowboarding, snowshoeing, ice-skating or hockey.

But if those aren’t appealing, Solomon said, “even taking a short walk each day or going to an indoor yoga class can help.” Workout DVDs are another option.

If you’re not sure what you like, try a variety of activities that sound like fun. Then pay attention to which activities boost your mood and energy levels.

3. Eat a variety of foods.  

“Make sure you’re eating a variety of foods, including as many fruits and vegetables as you can,” Solomon said. If fresh produce isn’t available, eat foods that are in season, she said.

Also, “Though the colder weather makes us crave sweets and starches, be mindful to keep protein in your diet as a balance,” Serani said. “Protein doesn’t spike your sugar levels, leaving you to feel more satisfied, less irritable and tired than simple carbohydrates and sugars.”

Keep in mind that this isn’t about restricting what you eat or feeling ashamed – or sinful – about eating sugar. (There’s nothing criminal about savoring your favorite desserts.) Rather, it’s about paying attention to how foods affect you, giving your body the nutrients it needs and enjoying what you eat.

4. Socialize.

As the temps take a nosedive, the last thing you might want to do is leave your house. But try. “Schedule regular contact with friends and family, even if it’s via Skype,” Solomon said. Still, make sure you’re also getting out, she stressed.

5. Pamper yourself.

When you think of treating yourself, what comes to mind? For instance, consider taking fragrant baths, drinking hot tea, reading books, lighting candles or cuddling with a loved one, said Serani, who tends to pamper herself more during the fall and wintertime. “These seasonal things raise dopamine, serotonin and oxytocin, feel-good hormones that improve mood,” she said.

Seasonal Affective Disorder (SAD)

If you’re feeling deeply depressed and your daily functioning is impaired, your winter blues might actually be seasonal affective disorder. Learn more about SAD here, and get an evaluation from a mental health professional.



Survey Finds Depression Twice as Common Among the Poor

By Associate News Editor
Reviewed by John M. Grohol, Psy.D. on October 31, 2012

Survey Finds Depression Twice as Common Among the Poor  Americans in poverty struggle with a wide array of health problems, with depression topping the list, according to just released information from the Gallup-Healthways Well-Being Index.

About 31 percent of Americans in poverty say they have at some point been diagnosed with depression compared with 15.8 percent of those not in poverty.

People living in poverty are also more likely to report asthma, diabetes, high blood pressure, and heart attacks — which are likely related to the higher level of obesity found for this group, according to the index.

The researchers note that these differences in chronic disease rates between those living in poverty and those who are not hold true after controlling for age.

Those in poverty report generally worse health habits than adults who are not in poverty, which may be at least partly contributing to the higher levels of chronic diseases among the impoverished, according to the research.

Smoking is the most significant issue — 33 percent of those in poverty smoke compared with nearly 20 percent of those who are not in poverty.

Those in poverty are also less likely to exercise frequently and eat fruits and vegetables regularly.

Americans living in poverty also are significantly less likely to have access to basic health care, according to the research. Nearly four in 10 Americans in poverty lack health insurance, contrasting with the 14.3 percent of Americans who are not in poverty and uninsured — a difference of nearly 24 percentage points.

Those in poverty also were more than twice as likely to say there have been times in the past 12 months when they did not have enough money to pay for the health care or medicine that they or their families needed — 37.8 percent vs. 16.5 percent. Impoverished Americans are also significantly less likely to say they have a personal doctor.

Americans in poverty are more likely to say they have been diagnosed with a chronic health problem, with depression being a “particularly pronounced issue,” according to the researchers.

What is unclear is if there is a relationship between poverty and depression, they said, noting depression could lead to poverty in some circumstances, poverty could lead to depression in others, or some third factor could be causing both.

Th findings are based on more than 288,000 interviews conducted in 2011 with American adults as a part of the Gallup-Healthways Well-Being Index.

Source: Gallup-Healthways Well-Being Index




6 Things That Can Worsen Depression

Associate Editor

6 Things That Can Worsen DepressionThere are many articles about things you can do to improve your depression. But what about staying away from those things that can make it worse?

“There are many things a person who lives with depression needs to be mindful of for better well-being,” according to Deborah Serani, Psy.D, a clinical psychologist and author of the valuable book Living with Depression.

Below, she shared six triggers that can exacerbate depression — and what you can do to minimize or cope with them.


1.  Stress.

A surplus of stress spikes the hormone cortisol, Serani said. “Cortisol keeps us in an ‘emergency ready’ state, with states of arousal and irritability that tax our already fatigued body and mind.” To minimize stress, Serani suggested delegating tasks, dividing projects into digestible parts and learning to say no. “Above all, resist the tendency to take on too much at home, work or school,” she said. Check out these other articles on shrinking stress:

2.  Sleep.

The relationship between sleep and depression is a complicated one. People with depression tend to have disrupted sleep. And people with sleep disorders – specifically insomnia — seem to be more susceptible to depressive symptoms. Too little or too much sleep can aggravate depression.

“Making sure the architecture of your sleep cycle is predicable and sound will help keep depression symptoms from worsening,” Serani said. Consistency is key in enhancing sleep quantity and quality. Go to sleep and wake up around the same time every day, she said. And if you take naps, make sure they don’t sabotage nighttime sleeping, she added.

3. Food.

The relationship between food and mood also is complex. But some studies have suggested that certain foods are associated with depression. For instance, this prospective study found a link between trans unsaturated fatty acids and depression risk. Foods high in sugar or simple carbohydrates can spike glucose levels and mess with mood, Serani said. Alcohol and too much caffeine can make you more irritable and also boost blood sugar levels, she said.

4. Toxic people.

Serani described toxic people as “negative and corrosive.” They don’t grasp how depression actually affects your life, she said. Avoid interacting with these individuals altogether, or at least try to have others around who can temper their toxicity, she said.

And focus on having great people in your life. “Part of living with depression requires you to learn how to reframe negative thoughts into positive ones, so having people in your life that are affirmative, nurturing and accepting of who you are will help ground you in a better healing environment,” Serani said.

5. Media.

Upsetting and disturbing news and stories can exacerbate depression. “I know that my depressive symptoms worsen if I’m exposed to horrifying news, startling stories or dramatic films,” Serani said. She keeps up with current events by reading selective stories. Figure out what medium you’re most comfortable with. And learn your own signs that you’ve absorbed enough information, she said.

6. Anniversary reactions.

Around or on the date of a past traumatic event, some people experience the same distressing symptoms they originally felt. Events that might trigger an anniversary reaction include anything from a loved one’s passing to a stressful doctor’s appointment, Serani said.

She suggested readers “take a look at the dates on the calendar to raise awareness of any emotional days that may be coming up.” Knowing these days are coming up will help you better prepare for them, she said. For instance, let your loved ones know about potentially problematic days, she said. “See if they can check in on you or offer support in some way.”



Why the Supreme Court’s Ruling Matters to the Mentally Ill

By Christine Stapleton

Today’s ruling on what has come to be known as “Obamacare” is extremely good news for those of us with mental illnesses. Discrimination against people with preexisting conditions, whether it is bipolar disorder or cancer, is wrong. Always has been. Always will be.

Insurance companies should be ashamed of themselves for perpetrating this bigotry that has ruined the lives – actually taken the lives – of so many people.

Regardless of whether you watch Fox News or Rachel Maddow, mental illnesses, among the most stigmatized illnesses in our society, can affect anyone. Rich, poor, old, young, male, female, black, white or Hispanic. Clinical depression has become one of the nation’s costliest illnesses, estimated to cost employers tens of billions of dollars every year workplace disability and lost productivity.

Do you know how much medical insurance you could buy with that kind of money? Do you have any idea how much companies could save in lost productivity and sick days if workers with a history of depression had not been denied coverage because of a preexisting condition?

The collateral damage caused by discrimination against preexisting mental illnesses is devastating. I know of people who have medical insurance but are afraid to seek help because they don’t want a diagnosis of depression or bipolar in their medical records. I know of people whose medical insurance covers mental illness but won’t use it and instead pay cash for their prescriptions and therapy so their insurance company will never know about their mental illness.

I know of doctors who have fudged diagnoses to prevent a patient from having a history of mental illness. I know of a man who has been offered a really good job but won’t take it because he will lose the insurance coverage he now has at a job he can’t stand. All this deception and suffering because of discrimination against those with preexisting mental illnesses.

You would think that illnesses that affect so many without regard to race, income, sexual persuasion or political affiliation wouldn’t be the target of this kind of discrimination. But just look at how long and hard former Rep. Patrick Kennedy had to fight for mental health insurance parity – the law that requires insurance companies to cover mental illnesses as they do other physical illnesses.

And look at how hard the insurance companies are trying to dodge the new parity requirements.

When the ban on discrimination against preexisting conditions goes into effect in 2014, I suspect people with illnesses such as cancer will immediately reap the benefits of being able to choose insurance that provides the best coverage. However, it will take time for people with mental illnesses and their physicians to come out of the closet. Because there is so much fear and stigma around mental illnesses, and so many of us have hidden our mental illnesses for so long, it will take time to use our new rights.

But we will. Believe me, we will.




Omega-3s, A Natural Treatment for Bipolar Disorder

Omega-3s are a safe, simple, natural treatment for depression, mental health, and enhancing mood without side effects. Andrew Stoll, a psychiatrist and director of the Psychopharmacology Research Laboratory at McClean Hospital, is author of the book The Omega-3 Connection. The book is designed to educate about benefits of fish oil and help readers restore their natural balance of omega-3 fatty acids, which are found in high concentrations in the brain.

Over the past century, people in the United States have largely eliminated omega-3 fatty acids from their diet, due to the huge consumption of processed foods and a low-fat diet craze.
However, there is reason to be concerned about bad fats. Some fats are absolutely required for good health, while others detrimental. The most dangerous fats are those found in margarines, shortenings, heated oils, cheese, and some meats, but we need the healing fatty acids. Omega-3s are essential for optimal function of every cell in our bodies and we cannot manufacture them internally. They can be obtained only through our diet.

Stoll, on the faculty of Harvard Medical School, was interested in alternatives for bipolar patients. He conducted extensive searches on medical research papers to find substances with properties similar to standard mood stabilizers, lithium and valproate. After he and his colleague, Dr. Emauel Severus, reviewed hundreds of papers, they pulled up one match time and again—common fish oil.
Fish oils are already known for their roll in preventing heart disease, rheumatoid arthritis, and Crohn’s disease. They may also be responsible for protecting against arthritis, diabetes, and some psychiatric disorders. The brain requires more omega-3 and fatty acids than any other system in the body. According to Dr. Stoll, without omega-3s, the brain cannot function normally, so even the most powerful antidepressants will be unable to improve mood. For optimum health, omega-3 and omega-6 fatty acids should be eaten in nearly equal proportions. Omega-6 fatty acids are contained in vegetable and seed oils, including olive oil, sunflower oil, and safflower oils. Omega-3s are more difficult to obtain, and are most often from fish oil. Flax oil and seed contains some Omega-3s.

In addition, omega-3s are safe and effective supplements for pregnancy, nursing mothers, and postpartum depression. Blood levels of omega-3s decrease during the later stages of pregnancy and stay low, because the fetus receives these essential lipids preferentially (especially if there is a shortage). Lack of omega-3s can damage a mothers health after birth and cause major postpartum depression. These fatty acids are so important in cell-signaling pathways, and are vital to the function of many brain systems, including those neural systems regulating mood and emotions. Research indicates that a lack of omega-3s during pregnancy may impair development of the visual system of a fetus, and may also compromise future intelligence.

Evening Primrose is another Omega 3 that is particularly helpful for PMS (premenstrual syndrome), irritability, mood swings, and cramps.

There is some evidence that attention deficit-hyperactivity disorder (ADHD) might be rooted in a deficiency of the omega-3 fatty acids. Researchers noticed that in two groups of children it was found that those who had omega-3 deficiency and ADHD had similarities. Both had excess thirst, greater frequency of dry hair and skin, and an increased need to urinate. When they tested the blood levels of the ADHD subjects they found that 40 percent had low levels of omega-3s.
Dr. Stoll recommends 1 to 3 grams (1000-to 3000 milligrams) of fish oil daily for health, mood, or cognitive improvement.



Depression Linked With More Internet Use

By Candace Czernicki Managing News Editor
Reviewed by John M. Grohol, Psy.D. on May 22, 2012

Can Internet Use Predict Depression?Someday your phone or laptop might truly be smart: It could diagnose your depression based on your Internet surfing patterns.

According to researchers at Missouri University of Science and Technology, people suffering from depression tend to spend more time chatting and sharing files with others.

Two hundred and sixteen undergraduate students were monitored over a month’s time for actual Internet use. Higher scores on depression surveys — which were given at the beginning of the study — correlated with higher use. About 30 percent of the students met the minimum criteria for depression.

Previous research in this area relied on subjects’ memories, which is more imprecise than technology, said study co-author Sriram Chellappan, Ph.D., an assistant professor of computer science at the university.

“If you were asked how many times you looked at your email last month, it would be impossible to give an accurate answer,” Chellappan said.

Study volunteers — who were given pseudonyms at the beginning of the project to protect anonymity — were asked to fill out surveys containing several questions related to depression symptoms. The questions were written to hide the researchers’ interest in depression levels. Researchers then monitored subjects’ activity every time they signed on to the university server.

A paper describing the research, titled “Associating Depressive Symptoms in College Students with Internet Usage Using Real Internet Data,” has been accepted for publication in a future issue of IEEE Technology and Society Magazine.

Source: Missouri University of Science and Technology


9 Best Ways to Support Someone with Depression

By Margarita Tartakovsky, M.S.
Associate Editor

If9 Best Ways to Support Someone with Depression If your loved one is struggling with depression, you may feel confused, frustrated and distraught yourself. Maybe you feel like you’re walking on eggshells because you’re afraid of upsetting them even more. Maybe you’re at such a loss that you’ve adopted the silent approach. Or maybe you keep giving your loved one advice, which they just aren’t taking.

Depression is an insidious, isolating disorder, which can sabotage relationships. And this can make not knowing how to help all the more confusing.

But your support is significant. And you can learn the various ways to best support your loved one. Below, Deborah Serani, PsyD, a psychologist who’s struggled with depression herself, shares nine valuable strategies.


1. Be there.

According to Serani, the best thing you can do for someone with depression is to be there. “When I was struggling with my own depression, the most healing moments came when someone I loved simply sat with me while I cried, or wordlessly held my hand, or spoke warmly to me with statements like ‘You’re so important to me.’ ‘Tell me what I can do to help you.’ ‘We’re going to find a way to help you to feel better.’”

2. Try a small gesture.

If you’re uncomfortable with emotional expression, you can show support in other ways, said Serani, who’s also author of the excellent book Living with Depression.

She suggested everything from sending a card or a text to cooking a meal to leaving a voicemail. “These gestures provide a loving connection [and] they’re also a beacon of light that helps guide your loved one when the darkness lifts.”

3. Don’t judge or criticize.

What you say can have a powerful impact on your loved one. According to Serani, avoid saying statements such as: “You just need to see things as half full, not half empty” or “I think this is really all just in your head. If you got up out of bed and moved around, you’d see things better.”

These words imply “that your loved one has a choice in how they feel – and has chosen, by free will, to be depressed,” Serani said. They’re not only insensitive but can isolate your loved one even more, she added.

4. Avoid the tough-love approach.

Many individuals think that being tough on their loved one will undo their depression or inspire positive behavioral changes, Serani said. For instance, some people might intentionally be impatient with their loved one, push their boundaries, use silence, be callous or even give an ultimatum (e.g., “You better snap out of it or I’m going to leave”), Serani said. But consider that this is as useless, hurtful and harmful as ignoring, pushing away or not helping someone who has cancer.

5. Don’t minimize their pain.

Statements such as“You’re just too thin-skinned” or “Why do you let every little thing bother you?” shame a person with depression, Serani said. It invalidates what they’re experiencing and completely glosses over the fact that they’re struggling with a difficult disorder – not some weakness or personality flaw.

6. Avoid offering advice.

It probably seems natural to share advice with your loved one. Whenever someone we care about is having a tough time, we yearn to fix their heartache.

But Serani cautioned that “While it may be true that the depressed person needs guidance, saying that will make them feel insulted or even more inadequate and detach further.”

What helps instead, Serani said, is to ask, “What can we do to help you feel better?” This gives your love one the opportunity to ask for help. “When a person asks for help they are more inclined to be guided and take direction without feeling insulted,” she said.

7. Avoid making comparisons.

Unless you’ve experienced a depressive episode yourself, saying that you know how a person with depression feels is not helpful, Serani said. While your intention is probably to help your loved one feel less alone in their despair, this can cut short your conversation and minimize their experience.

8. Learn as much as you can about depression.

You can avoid the above missteps and misunderstandings simply by educating yourself about depression. Once you can understand depression’s symptoms, course and consequences, you can better support your loved one, Serani said.

For instance, some people assume that if a person with depression has a good day, they’re cured. According to Serani, “Depression is not a static illness. There is an ebb and flow to symptoms that many non-depressed people misunderstand.” As she explained, an adult who’s feeling hopeless may still laugh at a joke, and a child who’s in despair may still attend class, get good grades and even seem cheerful.

“The truth is that depressive symptoms are lingering elsewhere, hidden or not easy to see, so it’s important to know that depression has a far and often imperceptible range,” Serani said.

9. Be patient.

Serani believes that patience is a pivotal part of supporting your loved one. “When you’re patient with your loved one, you’re letting them know that it doesn’t matter how long this is going to take, or how involved the treatments are going to be, or the difficulties that accompany the passage from symptom onset to recovery, because you will be there,” she said.

And this patience has a powerful result. “With such patience, comes hope,” she said. And when you have depression, hope can be hard to come by.

Sometimes supporting someone with depression may feel like you’re walking a tight rope. What do I say? What do I not say? What do I do? What do I not do?

But remember that just by being there and asking how you can help can be an incredible gift.


Mental Illness Linked to Other Health Problems

By Traci Pedersen Associate News Editor
Reviewed by John M. Grohol, Psy.D. on April 22, 2012

Mental Illness Linked to Other Health ProblemsAdults who had any type of mental illness in the past year were also more likely to have high blood pressure, asthma, diabetes, heart disease and stroke, according to a U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) report released last week.

Specifically, about 22 percent of adults with any type of mental illness in the past year had high blood pressure and almost 16 percent had asthma, compared to 18 percent and 11 percent, respectively, in adults without mental illness.

People with major depression in the past year had higher rates of the following chronic health problems than those without the disorder:

  • High blood pressure (24 percent vs. 20 percent)
  • Asthma (17 percent vs. 11 percent)
  • Diabetes (9 percent vs. 7 percent)
  • Heart disease (7 percent vs. 5 percent)
  • Stroke (3 percent vs. 1 percent).

Individuals suffering from mental illness also had higher rates of emergency department use and hospitalization, according to the report. Rates of emergency department use were nearly 48 percent for people with a serious mental illness compared to 31 percent for those without a serious mental illness.

For those with a serious mental illness, hospitalization rates were more than 20 percent in the past year and less than 12 percent for those without a serious mental illness.

“Promoting health and wellness for individuals, families and communities means treating behavioral health needs with the same commitment and vigor as any other physical health condition,” said SAMHSA administrator Pamela Hyde.  

“Communities, families and individuals cannot achieve health without addressing behavioral health.”

Source:  U.S. Substance Abuse and Mental Health Services Administration



The following article was submitted by a teacher named Heather in California whose class used our website for a project.  One of her class helpers, Michelle, found the article and suggested Heather pass it on to us.  So here it is!  Thanks Heather, Michelle, and the entire Cleary Mountain Class 5-A!!!

Reminding Loved Ones That Life is Precious: Suicide Prevention Resources

Suicide is a very serious issue that can also have serious effects on individuals, their families, and the community. While the causes of suicide are complex and multiple factors may be in play, prevention is the final goal. Simply reducing the factors that increase risk and realizing that the issue can encompass all aspects of a person’s life is a start. Prevention should ideally address all areas of influence. To be effective, prevention should promote awareness and encourage social change.

There are approximately one million people that die from suicide each year globally. That’s one death almost every forty seconds. These figures do not include attempted suicide, which is twenty times more frequent. As times get more difficult in the world, there is concern these numbers could rise. One of the top leading causes of death is suicide. While figures vary for different areas of the world, the overall age groups most at risk are those aged 10 to 44.

Male suicide rates have traditionally been highest, but recently the rate among youths has increased exponentially. This increase now puts this group at the highest rate in one third of developed and developing countries. Europeans and those living in North America are at major risk due to mental disorders, while impulsiveness is the risk factor in Asian countries. There are social, psychological, cultural, biological and even environmental factors at play; it is a complex issue.

There are signs to look for that could reveal someone at risk. Pay extra attention if someone’s behavior is new, if the behavior has increased, or if it appears to be related to loss, change or after a painful event. It may be prudent to seek the help of a mental health professional. For immediate care, there are local and international crisis contacts available in almost all countries and states. If you know someone exhibiting any of the following signs it may be time to intervene.

           • Talking about death, wanting to die or kill themselves.

           • Talking about not having a reason to be alive or an overall feeling of hopelessness.

           • Doing research or Internet searches of weapons, especially guns.

           • Talking about how he or she is a burden to those around them.

           • Talking about having a feeling of being trapped or in pain.

           • More frequent use of drugs and/or alcohol.

           • Spending a lot of time sleeping or not sleeping enough.

           • Feeling isolated or withdrawing from others.

           • Acting recklessly; agitated or anxious.

           • Talking about taking revenge or displaying rage.

           • Uncharacteristic extreme mood swings.

           • A sudden change or disregard for personal hygiene.

Pay even closer attention to these warning signs if the person is bipolar, an alcoholic, or has depression and a past history with attempted suicide. Sometimes one of the most dangerous signs is that of feeling hopeless. Hopelessness can strongly predict suicide. When a person feels there is no future and foresees nothing positive they may feel day-to-day life is unbearable. This feeling can be intensified if there is a family history of suicide, as it may seem that their loved ones also saw no reason to go on.

Someone feeling suicidal might not seek help, but it doesn’t mean help isn’t wanted. Most people in this situation don’t really want to die; they just want the hurt to stop. Prevention begins by recognizing the signs and not ignoring them. If you believe someone in your life is considering suicide, don’t be afraid to talk about it. Simply bringing up the subject could save the person’s life and often prevention begins with the sensitive responses of a loved one. Give your family member or friend alternatives, show them you care, and get a medical professional involved. Your reassurance, understanding and support may help the person conquer their ideas of suicide. If he or she opens up to you with feelings of despair or suicidal thoughts, seek the help of a health professional immediately!

If you find yourself in such a situation, remain calm and be prepared to really listen if the person wants to talk. Be understanding and offer emotional support. This is not a time to be angry with the person or disregard what they are feeling. Talk directly about suicide, most people aren’t sure about their feelings about dying or death and want help. Discuss alternatives and problem-solving ideas. Remember the person is not emotionally in a right place and their thinking may be clouded. Be encouraging, hopeful and confident that you can help to arrange whatever is needed to help.

If you have already lost a young person to suicide, memorials are not recommended. While it seems like the right thing to do, unlike an accidental death, a suicide can create issues for other youth in crisis. The problem is that an accident does not attract the attention or likelihood of another youth dying in the same way. A young person, who is struggling with thoughts of suicide, may see the death of another as a viable option. Research has shown that memorials can create this kind of thinking, especially if it seems that instead of being mourned, the person has been honored for what they have done. The following resources can help provide more information and assistance:

Suicide Prevention Action Network

A page full of national suicide prevention organizations links as well as initiatives and resources.

Canadian Association for Suicide Prevention

Helpful links available for those in crisis now that need immediate help. Information for survivors of suicide who need emotional support services. There are also links for upcoming events and general information.

National Suicide Prevention Lifeline

Includes a crisis hot-line phone number, resource pages on how to get help, and signs of a potential suicide attempt.

Suicide Prevention Spotting the Signs and Helping a Suicidal Person

Find helpful articles for teens and adults on prevention. Also, includes common misconceptions about suicide and a related links section.

Substance Abuse and Mental Health Services Administration

Suicide prevention resources: substance abuse and suicide, prevention lifeline, and suicide prevention resource center.

What is Suicide & How to Intervene

Website includes information on why college students kill themselves, myths and facts, warning signs, and ways to help.

Counseling Center at University of Illinois

Offers basic information on why people kill themselves, myths about suicide, how to help and where to find additional help.

Youth Suicide Prevention Curriculum

Wisconsin Department of Public Instruction offers information on how to educate youth about suicide prevention.

U.S. Air Force Suicide Prevention Program

This site is designed to provide information and tools to members of the Air Force community. Includes: suicide prevention training, videos and more.

Preventing Suicide

The CDC offers helpful information to guide people through the signs and symptoms of suicide.

Why do people take their own lives?

University of New Hampshire counseling offers helpful information on the danger signs of suicide, plus other helpful information.

Suicide Prevention Basics

An introduction to suicide and suicide prevention with an article entitled “The Public Health Approach to Preventing Suicide.”

Virginia Department of Health

Suicide Prevention Program includes contact information and key national resources.

Language Describing Suicidal Behavior

Maine Youth Suicide Prevention Program’s list of behaviors that may lead to suicide attempt or death.

Stop a Suicide Today!

This site offers information on the signs of suicide, how to help a friend, facts on suicide, and suicide and mental illness. Also includes pages for professionals, survivors, and help on how to stop suicide.

U.S. Army Medical Department

This site offers many resources including videos, articles, training, informative tools and much more.

General Information About Suicide

List of risk and protective factors, warning signs, how to help those thinking about suicide, and national statistics on suicide.

How to Answer Questions Teens Ask About Suicide

A Q&A on how to answer specific questions that a youth may have about different topics relating to suicide.




By Karyn Hall, PhD

Grandpa and Dad doing the workWhen people feel alienated and socially excluded, they are at risk for depression and anxiety. When they think that they aren’t part of their community, they may use unhealthy ways to connect or not feel the loneliness.

The more isolated they become the more difficult it is to be around people or reach out. Some may believe that they have nothing to offer. They avoid people despite their loneliness. The more isolated they are and the longer the isolation continues, the more negative their thinking and the more entrenched the avoidance behavior becomes.

What type of  healthy coping skill can help?  It’s not possible to suddenly feel like you have friends or to find a loving partner. You can’t suddenly create a close family. This is the situation that many emotionally sensitive people who suffer from depression may experience.

Volunteering seems to be one of the best activities to overcome isolation and alienation. Volunteering offers a way to feel like a valued member of a community and provides important connections with others. Through volunteering, individuals see that they can make a difference in the lives of others or animals and are needed.

They are connected with others, feel valued, and may develop a greater sense of autonomy. People who volunteer change their views of themselves to a more positive one.  They have an opportunity to learn new social skills and to practice those skills. There may even be positive results in the physical health of those who volunteer.

Depending on the type of volunteering you do, it may also offer a way of having fun. Maybe you could volunteer in an area that you are passionate about. When you are doing an activity that you find interesting, it can increase your energy and replenish your motivation. Some learn business skills that help them in their careers.

Volunteering can offer many benefits. What stops people from participating?

Sometimes there are too many choices. Too many choices can be overwhelming. Web pages listing local opportunities are sometimes very lengthy. Choosing one opportunity from many  can seem too difficult. It’s easier to just give up, especially when you’re having difficulty concentrating anyway.

Change is difficult. I don’t think I can overemphasize how difficult it is to change your behavior. That law in physics that says that an object at rest tends to stay at rest comes to mind. People who are isolated tend to stay in isolation. The energy it takes to do anything different is tremendous and sometimes feels like it’s just too much to attempt. Plus, even though the status quo may not be pleasant, at least you know what it’s like. It’s familiar.  The unknown may be worse. The unknown is frightening.

Fear can stop your best efforts. Fear of rejection, fear of not knowing what to do, fear that you won’t be able to do what is asked of you, fear of people–there are so many fears that can cripple your efforts to take part in an activity that will benefit you. Unfortunately, waiting for the fear to go away is unlikely to work. Overcoming fear of an activity usually means doing the action that scares you.

Fatigue keeps you trapped.  Depression and anxiety zap your energy. You may be feeling chronically tired so that it seems impossible to be active in volunteering. You can’t move off the couch, how could you help repair someone’s house? Becoming more active builds energy and helps you overcome lethargy. But that first step may seem impossible.

Lack of belief and hope.  If you don’t think volunteering will help, then it would be difficult to overcome the fear, lethargy or other concerns that keep you from trying it. Part of the viciousness of mood disorders is that lack of hope.

Perhaps you’ve hoped many times before and been disappointed. This is where making a commitment comes in. Making a commitment, a full-hearted commitment, helps you overcome the obstacles and is a critical part of any recovery.

Going through the motions will not work well, though if that’s all you can do, then that’s a start. If that’s where you are, remember to keep going to the point where you are actively involved in the activity you chose. Being fully committed is necessary to get the results you want.


Note to readers:  If you are emotionally sensitive (whether somewhat or a lot!) please consider taking a brief survey to help us learn more: . Thank you!



Therapy For Your Thoughts: Fact, Fiction And Functioning

By Gabrielle Gawne-Kelnar

Image of fiction bookshelf for therapy article on how your thoughts relate to your feelings, and how to use cognitive behavior therapy to stop a

Have you ever felt anxious about something that turned out to be nothing?

Worried about an event that never ended up happening (except maybe in your own imagination)?

Perhaps you’ve caught yourself planning for trouble before it actually hit.

And feeling the feelings that comes with all of this… 

It can be pretty sickening – a lurch in your gut, a fast-beating heart and sometimes you might even get the sweats. And no wonder. For your thoughts are joined to your feelings – intricately linked. As one moves, the other will probably follow.

So it’s important to keep an eye on your thoughts, to monitor them a bit, so a sudden downward spiral into darker feelings doesn’t catch you unawares. And so you can nip any unnecessary anxiety in the bud if you want to.


Just the other day I caught myself on the brink of one of these spirals – worrying that “the worst” might happen in a situation I faced. The anxiety started wanting to set in (lurch in my gut, faster-beating heart, sense of dread). So I went for a walk to the library just to get out and distract myself and see if I could clear my head a bit.

And there I saw the scene in the photo above:

“Fiction Overflow”

 And I chuckled to myself, because that’s exactly what was going on: in the fiction section of the library, and in the fiction section in my mind…

Cognitive behaviour therapy (CBT) is one way you can question your thoughts and catch any “fiction” at work. It offers a way of spotting the silent, underlying beliefs you might have that drive some of the thoughts (and feelings); thoughts which might not always have a lot to do with what’s actually happening, but they have a real talent for imagining the worst, and then putting it on endless loop in your mind. (Thanks for that…).

But this idea of questioning your thoughts and sort of checking if they’re “fiction” or not, doesn’t belong to CBT alone.

You might also recognise this idea from a saying that gets around:

“Feelings aren’t facts”


Or from some of Radiohead‘s lyrics in their song “There There“:

“Just ’cause you feel it, doesn’t mean it’s there.”


Or even from the Roman Emporer, Marcus Aurelius:

“…the soul is dyed by the color of your thoughts” 


So, what colour are you dying your soul?

If the spiral of darker feelings like worry or anxiety starts to get you down, it can be worth just returning to your thoughts.
Getting to know them.
To see them.
And to get curious enough about them to let yourself question them…


Text and photo copyright: Gabrielle Gawne-Kelnar
Gabrielle Gawne-Kelnar (Grad Dip Counselling & Psychotherapy) is a writer, blogger and Sydney psychotherapist in private practice at One Life Counselling & Psychotherapy. Gabrielle also facilitates telephone support groups for people who are living with cancer, for their carers, and for people who have been bereaved through a cancer experience. She provides regular therapeutic updates on facebook and Twitter @OneLifeTherapy.





Back by popular demand: Bipolar doesn’t make you stupid; you make you stupid.

There were a lot of people who didn’t like the original post, but there were also a lot of people who did. And many of those people do have bipolar disorder themselves.

Granted, I was a bit unwell myself at the time and that translated into one inflammatory post, but I still believe the essence of it is true: Bipolar should not be used as an excuse for rotten behavior. Rather, people need to take measures to try to prevent a bipolar episode that will lead to rotten behavior.

Or, conversely, people need to recognize if they are indeed using their diagnosis as an excuse for their behavior, when in fact they do have control over their behavior. While the majority of people with bipolar, I hope, are people who truly want to be stable and to treat others with care and respect, it is naïve to think that there aren’t people with bipolar disorder using their diagnosis as a means to an end.

It happens in the general population; it’ll happen to the bipolar population, as well.

I have made some tweaks to the original post. Here it is…

What prompted the original post was that my husband’s coworker said it was OK for him to hit his wife during arguments because he has bipolar disorder and was currently in an episode. I say not. Not at all. If hitting people was a symptom of bipolar disorder, it’d be listed as a symptom in the DSM. Bipolar causes lack of insight and impulsivity and terrible errors in judgment, and it can be a reason for hitting people, but it is not an excuse. This man should be feeling great remorse, and then use that guilt as an impetus to getting well. It is never OK to hurt someone, whether or not you have bipolar disorder.

I am sick and tired of people using their diagnosis as an excuse for their rotten behavior. Unless you are currently in the throes of the psychoses of mania or the delusions of depression, you DO have control enough over your behavior to not do something really bad, like hitting your wife. Even if you are depressed or hypomanic, you are still in touch with reality – your impulse control may be well-the-hell off, but you are still “here” enough that you know that you’re breaking a window or abandoning your family or telling your boss to shove it. It’s not like you’re doing something and then later have no idea what you were doing; if that’s the case, then you are in fact psychotic and this article doesn’t pertain to you and you need to see your doctor immediately.

As you’re doing it, if you know inside that your behavior is extreme, you have some control to stop it. You may not be able to stop it while you’re doing it, but you can head it off…you can walk away, stomp out the door in a huff before you put your fist through the wall. You can’t stop the bipolar mood swing, but you can keep yourself from killing people – which means that you do indeed have control. Otherwise, murder – what I would think to be the ultimate in lack of behavior control – would be listed as a symptom for bipolar in the DSM.

If you can stop yourself from killing someone, you have the capability to stop yourself from doing less rotten behavior. It may be difficult, but you’re not too far gone to no longer have free will. Again, if you cannot keep yourself from killing someone, and this includes yourself – if you think about it obsessively – this article does not pertain to you; you need to see your doctor immediately.

While the moods that come with bipolar disorder can make rotten behavior really tempting, that rotten behavior is not in and of itself the symptoms of bipolar. The DSM lists such symptoms as risky behavior, not specifically hitting people. There’s a reason. It’s the moods that make bipolar what it is. It’s what you do because of those moods that ruins your life and signals to you and others that you need to see a doctor or spend some time in the hospital.

Bipolar is a mood disorder, not a self-control problem. True, there are people with bipolar disorder who have self-control problems, such as those with attention deficit disorder, but it is not correct to say that everyone with bipolar disorder has self-control problems. And that’s what this abuser was doing – he said that it was bipolar causing him to hit his wife, when in reality, he is causing himself to hit his wife; bipolar is making it easier for him to make that choice, because hitting his wife is how he is expressing his bipolar symptoms.

Whether or not someone with bipolar disorder has self-control problems, he or she needs to get help if they feel pressure to do extreme, rotten behaviors. Way back when, my husband hit me during a bipolar episode. But then he went and got some help. This is excusable. What is not excusable is to hit someone, say it was because of the bipolar, and then “forget” or refuse to get help. Not caring is not the same as a self-control problem.

In the general population, there are smart people and there are people who do stupid behaviors over and over and someone could label them as stupid. Not that they’re necessarily unintelligent, but that for whatever reason, they are doing stupid things and then not taking action to learn from those mistakes or to prevent them in the future.

It stands to reason that the same case can be found in the bipolar population. If you are bipolar but are using your diagnosis as an excuse to keep on doing rotten behavior, like hitting your wife, you are the bad labels being thrown at you: You are lazy if you choose to keep hitting your wife and not getting help, you are selfish if you choose to keep hitting your wife and not getting help, you are a jerk if you choose to keep hitting your wife and not getting help. You are NOT lazy, selfish, or a jerk if you are bipolar and you’re doing something about it! You may not always be successful in stabilizing your bipolar, but you are trying – and that is what separates you from the people with bipolar who just keep hitting their wives and using bipolar as an excuse.

If you have bipolar but you are continually working to get stable, even if you’re not that successful at it but at least you’re trying – because I’ve talked with people who have tried EVERYTHING out there and nothing works to stabilize them, whether it’s because of sensitivities to meds or just plain resistance to treatments – then this article is not for you.

But if you ride the mood swings with no thought of taking on the work to try something to stop the roller-coaster, if you blame everyone else for your problems (“you made me hit you because you made me mad”), this is who this article is chastising. Those are the types of people with bipolar who are giving everyone else with bipolar a bad name. If you want to get well, even if you’re not right now, you’re with the majority of those with bipolar (at least I hope it’s the majority). I’m talking about those with bipolar who give everyone else a bad name – the people who hit their wives or do some other bad behavior and say, “Well, it’s because I have bipolar. I can’t help it.” Yes, there is something you can do, and should be doing: GO GET HELP!

You are not bipolar. You are you. You just happen to have bipolar. Bipolar makes it a lot harder to live a stable, good life. But bipolar is not your identity. You have the ability to make the choice to try to get better, or to continue doing rotten behavior and using bipolar as an excuse. You may not always be successful – it can years to find the right meds or therapy exercises that will help stabilize you or head off a coming episode, or you may never be all that effective – but at least you care. At least, if you hit your wife, you can feel remorse.

You have the full ability to make choices, even if you have bipolar disorder, and I hope that anyone out there who is hitting his or her spouse takes a page out my husband’s book and makes the resolve to get better…rather than using bipolar as an excuse to keep doing it.

Rita Brhel has been married to her college sweetheart, who has Rapid-Cycling Bipolar Disorder and Attention Deficit Disorder, for 10 years. They are happily married, have three kids, and live in the Midwest, USA.


9 Ways to Take Care of Yourself When You Have Depression

By Margarita Tartakovsky, M.S.
Associate Editor

9 Ways to Take Care of Yourself When You Have DepressionDepression is an illness that requires a good deal of self-care,” writes psychologist Deborah Serani, PsyD, in her excellent book Living with Depression: Why Biology and Biography Matter along the Path to Hope and Healing.

But this might seem easier said than done, because when you have depression, the idea of taking care of anything feels like adding another boulder to your already heavy load. Serani understands firsthand the pain and exhaustion of depression. In addition to helping clients manage their depression, Serani works to manage her own, and shares her experiences in Living with Depression.

If you’re feeling better, you might ditch certain self-care habits, too. Maybe you skip a few therapy sessions, miss your medication or shirk other treatment tools. According to Serani, as some people improve, they get relaxed about their treatment plan, and before they know it are blinded to the warning signs and suffer a relapse.

Because skimping on self-care is a slippery slope to relapse, Serani provides readers with effective tips in her book. As a whole, the best things you can do to stave off relapse are to stick to your treatment plan and create a healthy environment. I’ve summarized her valuable suggestions below.

1. Attend your therapy sessions. As you’re feeling better, you might be tempted to skip a session or two or five. Instead, attend all sessions, and discuss your reluctance with your therapist. If changes are warranted, Serani says, you and your therapist can make the necessary adjustments.

Either way, discussing your reluctance can bring about important insights. As Serani writes:

Personally, the times I skipped sessions with my therapist showed me that I was avoiding profound subjects — or that I was reacting defensively to something in my life. Talking instead of walking showed me how self-defeating patterns were operating and that I needed to address these tendencies.

2. Take your meds as prescribed. Missing a dose can interfere with your medication’s effectiveness, and your symptoms might return. Alcohol and drugs also can mess with your meds. Stopping medication altogether might trigger discontinuation syndrome. If you’d like to stop taking your medication, don’t do it on your own. Talk with your prescribing physician so you can get off your medication slowly and properly.

Serani is diligent about taking her antidepressant medication and talks with her pharmacist frequently to make sure that over-the-counter medicines don’t interfere. With the help of her doctor, Serani was able to stop taking her medication. But her depression eventually returned. She writes:

…At first, it was upsetting to think that my neurobiology required ongoing repair and that I’d be one of the 20 percent of individuals who need medication for the rest of their lives. Over time, I came to view my depression as a chronic condition — one that required me to take medication much like a child with diabetes takes insulin, an adult with epilepsy takes antiseizure medication, or someone with poor eyesight wears glasses…

3. Get enough sleep.  Sleep has a big impact on mood disorders. As Serani explains, too little sleep exacerbates mania and too much sleep worsens depression. So it’s important to keep a consistent sleep and wake cycle along with maintaining healthy sleeping habits.

Sometimes adjusting your medication can help with sleep. Your doctor might prescribe a different dose or have you take your medication at a different time. For instance, when Serani started taking Prozac, one of the side effects was insomnia. Her doctor suggested taking the medication in the morning, and her sleeping problems dissipated.

For Serani, catnaps help with her fatigue. But she caps her naps at 30 minutes. She also doesn’t tackle potentially stressful tasks before bed, such as paying bills or making big decisions.

(If you’re struggling with insomnia, here’s an effective solution, which doesn’t have the side effects of sleep aids.)

4. Get moving. Depression’s debilitating and depleting effects make it difficult to get up and get moving. Serani can relate to these effects. She writes:

The lethargy of depression can make exercise seem like impossibility. I know, I grew roots and collected dust when I was anchored to my depression. I can still recall how getting out of bed was a feat in and of itself. I could barely fight gravity to sit up. My body was so heavy and everything hurt.

But moving helps decrease depression. Instead of feeling overwhelmed, start small with gentle movements like stretching, deep breathing, taking a shower or doing household chores. When you can, add more active activities such as walking, yoga or playing with your kids or whatever it is you enjoy.

It might help to get support, too. For instance, Serani scheduled walking dates with her neighbors. She also prefers to run errands and do household chores every day so she’s moving regularly.

5. Eat well. We know that nourishing our bodies with vitamins and minerals is key to our health. The same is true for depression. Poor nutrition can actually exacerbate exhaustion and impact cognition and mood.

Still, you might be too exhausted to shop for groceries or make meals. Serani suggests checking out online shopping options. Some local markets and stores will offer delivery services. Or you can ask your loved ones to cook a few meals for you. Another option is Meals-on-Wheels, which some religious and community organizations offer.

6. Know your triggers. In order to prevent relapse, it’s important to know what pushes your buttons and worsens your functioning. For instance, Serani is selective with the people she lets into her life, makes sure to keep a balanced calendar, doesn’t watch violent or abuse-laden films (the movie “Sophie’s Choice” sidelined her for weeks) and has a tough time tolerating loud or excessively stimulating environments.

Once you pinpoint your triggers, express them to others so your boundaries are honored.

7. Avoid people who are toxic. Toxic individuals are like emotional vampires, who “suck the life out of you,” according to Serani. They may be envious, judgmental and competitive. If you can’t stop seeing these people in general, limit your exposure and try having healthier individuals around when you’re hanging out with the toxic ones.

8. Stay connected with others. Social isolation, Serani writes, is your worst enemy. She schedules plans with friends, tries to go places she truly enjoys and has resources on hand when she’s somewhere potentially uncomfortable, such as books and crossword puzzles.

If you’re having a difficult time connecting with others, volunteer, join a support group or find like-minded people online on blogs and social media sites, she suggests. You also can ask loved ones to encourage you to socialize when you need it.

Living with Depression9. Create a healthy space. According to Serani, “… research says that creating a nurturing space can help you revitalize your mind, body and soul.” She suggests opening the shades and letting sunlight in. There’s also evidence that scent can minimize stress, improve sleep and boost immunity. Lemon and lavender have been shown to improve depression.

Serani says that you can use everything from essential oils to candles to soap to incense. She prefers lavender, lilac, vanilla and mango. If you’re sensitive to fragrance, she recommends diluting essential oils, buying flowers or even using dried fruit.

You also can listen to music, meditate, use guided imagery, practice yoga and even de-clutter parts of your home a little each time.

Serani’s last point involves empowering yourself and becoming resilient. She writes:

By learning about your biology and biography, following your treatment plan, and creating a healthy environment, you don’t allow anyone to minimize you or your depression. Instead of avoiding struggles, you learn from them. You trust your own instincts and abilities because they are uniquely yours. If you experience a setback, you summon learned skills and seek help from others to get back on-point. If a person’s ignorance on mental illness presents itself in the form of a joke or stigma, you clear the air with your knowledge of neurobiology and psychology.


Not Making a Resolution This Year? Don’t Feel Bad About It

By Summer Beretsky

Not Making a Resolution This Year? Don't Feel Bad About It

I won’t lie: I’ve never followed through on a single New Year’s resolution.

Despite having promised myself many times, I’ve never started exercising consistently. I’ve never followed up and joined a gym. I’ve never started reading more novels. I’ve never done this; I’ve never done that.

I guess I’m not one for resolutions. They’re big. They’re bulky. They’re heavy. Even though “resolution” is an abstract concept, it carries weight. It carries mass.

And I get overwhelmed just thinking about the gravity of creating one.

Now, let me be clear: I’ve definitely dropped bad habits before. I’ve also picked up good habits. But it happened in July. And September. And March.

It happens when I’m truly motivated — not in late December or early January when the calendar suggests I ought to be motivated.

After getting 12 cavities filled within one month (July), I resolved to start flossing my teeth on a daily basis. My flossing had been sporadic at best, and I sure as hell paid for my laziness with every turn of the dentist’s drill. It’s been two and a half years since that cavity-filled month — and now, flossing my teeth is such a habit that I often don’t realize that I’ve even begun flossing until I’m tossing the used string into the bathroom garbage can.

And let’s not forget that time when I gave up meat and became a vegetarian for a period of time. It wasn’t a new year that drove me to change my eating habits — it was a high school friend who knew I loved fast-food hamburgers. She bet me a few bucks that I couldn’t go a year without eating meat.

“Oh yeah? Well, I’ll show you!” I probably said. (I always love a good challenge. Also, I won. Two years of a meat-free lifestyle.)

My point is this: great changes in habit will come when we are most motivated. If you’re motivated — truly motivated, right now — to join that gym or lose that weight or quit those cigarettes, then do it.

But if you’re not, then don’t worry. The turning of the year does not demand anything of you. Except, maybe, the purchase of a new wall calendar for your kitchen — but that’s all.

Creative Commons License photo credit: hownowdesign





Anxiety and OCD Exposed

Panic During the Holidays

By Laura L. Smith, Ph.D.

It’s not uncommon for people with anxiety disorders to have episodes of panic. A panic attack is defined as a period of time when a person experiences intense discomfort or fear. Along with that feeling, there is a biological response such as a pounding heart, trembling, dizziness, sweating, nausea, trouble breathing, or chills.

People who have panic attacks frequently describe their experiences as horrible. Some say that they felt like they were dying; others say they thought they were going crazy; some say that they worried about losing control of themselves; still others report that they felt like they were outside of their bodies. It is quite understandable that, after experiencing a panic attack, people want to avoid another one.

But, it’s that attempt to avoid panic that actually makes panic grow. When people with panic avoid going places that might be associated with their panic attacks, they experience relief. Feeling relief for avoiding something makes it more difficult to either imagine or actually go to those places. As panic grows, more and more places are avoided.

The holiday season can be tough on those who experience panic attacks. People with panic often fear going out in crowded places or driving on busy roads. Yet, crowds and traffic can be rather hard to avoid during the holidays. Here’s an example of how one panic attack can become a major issue during the holiday season.

Jamie is shopping for Christmas presents for her kids early in the morning on black Friday. The mall is packed with people. Jamie tries to get to the counter to buy a toy car for her son when a man walks right in front of her. He rudely pushes her aside and Jamie almost falls down. Jamie feels a flush of anger and her face gets hot. She’s about to say something to the man when he abruptly leaves the store. Suddenly, Jamie can’t catch her breath. She’s feeling faint and nauseous. A tremendous feeling of dread overwhelms her. She puts down the toy and staggers out of the store. She finds a seat in the middle of the mall and fumbles for her cell phone in her purse. She calls her best friend, “I can’t breathe,” she says, “help me.”

Her friend calls 911 and Jamie is rushed to the hospital. After many hours in the ER, she feels better. The doctor tells her she must have become overheated and stressed out by the holiday crowds. He can’t find anything wrong with her. He tells Jamie to rest and drink lots of fluids.

After an uneventful week, Jamie decides to return to the mall to start her Christmas shopping. But the minute she decides, her stomach starts to churn, her heart pounds, and she begins to sweat. Frightened, she calls her friend to ask her for a ride to the urgent care center. She’s sure that she must be very sick to feel this bad. The urgent care center is packed with people. Jamie and her friend wait almost two hours. Again, the doctor says that everything checks out. He encourages Jamie to get more rest and drink lots of water.

Instead of going to the mall again, Jamie orders all of her gifts online. Jamie may be in the early stages of developing a panic disorder. Her initial bout was likely caused by a combination of stress, crowding, anger, and fear. Panic starts small and grows. If Jamie keeps on avoiding what is causing her distress, her fears will only grow. Tune in later to read about the treatment of panic disorders.




A Mindful Way Through Depression

By Elisha Goldstein, Ph.D.

Depression is one of the most profound challenges of our time. We know that 25% of women and up to 12% of men will suffer a clinical depression in their lifetime and many more will suffer with mild depression. Author and professional blog writer, Therese Borchard writes a wonderful blog about personal experiences with depression. Whether you or someone you know is suffering from depression or some psychological pain like sorrow or grief, it can feel like a burden on the mind and heart. Maybe we hold the feeling in and we become numb, walking around like a zombie, or maybe we feel like if we actually let the tears flow they would never end. Perhaps there is another way, a more gentle way to approach the pain inside.

In an earlier blog I mentioned a way we can work with the tormented mind through acknowledging the reality of the present moment and then sending a message internally to calm the distressed mind.  For example, the mind can seem fragmented, thrashing, anxious, fuzzy, numb, or any number of other ways. These states of mind can be uncomfortable and our automatic struggle with them or judgments of them only serves to feed the depression. The problem is, this struggle and avoidance of it leads to disconnection of what we are truly feeling and so the mind begins to get the better of us.

Here is another approach:

When we notice the struggle, we want to breathe in and acknowledge the mind and while we breathe out we can say to ourselves “It’s Ok.” So if the mind is anxious, just breathing in and saying “anxious mind”, breathing out “it’s ok”.

As you do this the mind may eventually change to a different feeling. See if you can notice this and then shift with it. It may start feeling fuzzy and so you can switch now to “breathing in, fuzzy, breathing out, it’s ok.”

Tip: Notice any judgments arising right now when reading this, “this will never work for me” or “nothing is going to change how I feel, how stupid.” These judgments are likely well known to you and have become automatic. If they arise, just see if you can acknowledge them as just thoughts, let them be, and gently bring your attention back to the page. If this happens while you practicing, again, just ackowledge the thoughts as thoughts, let them be, and come back to the practice.

To deepen: When practicing, you may or may not notice tears come. However, you may feel a sense that tears are about to come, but there is a holding back. If you feel safe enough, see if you can tell yourself “Whatever is here is ok…let me feel it.” You can do this with the practice by saying “breathing in, acknowledging what is here, breathing out, let me feel it.” As the feeling comes, just continue to breathe with it and let it be. Let your body lead, if it feels like moving to the bed or laying on the couch, go ahead and do that and just stay with it, without judgment.

You can tell yourself that you can be with these emotions and “this too shall pass.” Sometimes allowing our true emotions to arise, allowing them to be, and letting them come and go can have profound implications on the safety we feel with them and ourselves.  This way of relating to our pain differently is not meant to be a panacea for depression, but is mean to change the way we relate to our pain and plant the seeds of recovery. The more we practice the more we sew these seeds. However, don’t take my word for it, please, try it for yourself.

May you be safe, healthy, happy, and free from fear.




Social Security disability on verge of insolvency

WASHINGTON (AP) — Laid-off workers and aging baby boomers are flooding Social Security's disability program with benefit claims, pushing the financially strapped system toward the brink of insolvency.

Applications are up nearly 50 percent over a decade ago as people with disabilities lose their jobs and can't find new ones in an economy that has shed nearly 7 million jobs.

The stampede for benefits is adding to a growing backlog of applicants — many wait two years or more before their cases are resolved — and worsening the financial problems of a program that's been running in the red for years.

New congressional estimates say the trust fund that supports Social Security disability will run out of money by 2017, leaving the program unable to pay full benefits, unless Congress acts. About two decades later, Social Security's much larger retirement fund is projected to run dry, too, leaving it unable to pay full benefits as well.

Much of the focus in Washington has been on fixing Social Security's retirement system. Proposals range from raising the retirement age to means-testing benefits for wealthy retirees. But the disability system is in much worse shape and its problems defy easy solutions.

The trustees who oversee Social Security are urging Congress to shore up the disability system by reallocating money from the retirement program, just as lawmakers did in 1994. If Congress does not act, the disability program will collect only enough payroll taxes to pay about 85 percent of benefits after the trust fund is exhausted in 2017.

Even if Congress does act, the combined retirement and disability trust funds are projected to run out of money in 2036, the trustees say. The new congressional report estimates the combined fund would run out of money in 2038. At that point, the combined programs would collect enough in payroll taxes to pay about three-fourths of benefits.

Claims for disability benefits typically increase in a bad economy because many disabled people get laid off and can't find a new job. This year, about 3.3 million people are expected to apply for federal disability benefits. That's 700,000 more than in 2008 and 1 million more than a decade ago.

"It's primarily economic desperation," Social Security Commissioner Michael Astrue said in an interview. "People on the margins who get bad news in terms of a layoff and have no other place to go and they take a shot at disability,"

The disability program is also being hit by an aging population — disability rates rise as people get older — as well as a system that encourages people to apply for more generous disability benefits rather than waiting until they qualify for retirement.

Retirees can get full Social Security benefits at age 66, a threshold gradually rising to 67. Early retirees can get reduced benefits at 62. However, if you qualify for disability, you can get full benefits, based on your work history, even before 62.

Also, people who qualify for Social Security disability automatically get Medicare after two years, even if they are younger than 65, the age when other retirees qualify for the government-run health insurance program.

Congress tried to rein in the disability program in the late 1970s by making it tougher to qualify. The number of people receiving benefits declined for a few years, even during a recession in the early 1980s. Congress, however, reversed course and loosened the criteria, and the rolls were growing again by 1984.

The disability program "got into trouble first because of liberalization of eligibility standards in the 1980s," said Charles Blahous, one of the public trustees who oversee Social Security. "Then it got another shove into bigger trouble during the recent recession."

Today, about 13.6 million people receive disability benefits through Social Security or Supplemental Security Income. Social Security is for people with substantial work histories, and monthly disability payments average $927. Supplemental Security Income does not require a work history but it has strict limits on income and assets. Monthly SSI payments average $500.

As policymakers work to improve the disability system, they are faced with two major issues: Legitimate applicants often have to wait years to get benefits while many others get payments they don't deserve.

Last year, Social Security detected $1.4 billion in overpayments to disability beneficiaries, mostly to people who got jobs and no longer qualified, according to a recent report by the Government Accountability Office, the investigative arm of Congress.

Congress is targeting overpayments.

The deficit reduction package enacted this month would allow Congress to boost Social Security's budget by about $4 billion over the next decade to invest in programs that identify people who no longer qualify for disability benefits. The Congressional Budget Office estimates that increased enforcement would save nearly $12 billion over the next decade.

At the same time, the application process can be a nightmare for legitimate applicants. About two-thirds of initial applications are rejected. Most of these people drop their claims, but for those willing go through an appeals process that can take two years or more, chances are good they eventually will get benefits.

Astrue has pledged to reduce processing times for applicants' appeals, and he has had some success, even as the number of claims skyrockets. The number of people waiting for decisions has increased, but their wait times are going down.

"It's ludicrous to say that the backlog problem is getting worse," Astrue said. "The backlog problem has gotten dramatically better."

Patricia L. Foster said she was working as a nurse in a hospital in Columbia, S.C., in 2005 when she was attacked by a patient who was suffering from a mental illness. Foster, 64, said she injured her neck so bad she had a plate inserted. She said she also suffers from post-traumatic stress disorder.

Foster was turned down twice for Social Security disability benefits before finally getting them in 2009, after hiring an Illinois-based company, Allsup, to represent her. She said she was awarded retroactive benefits, though the process was demeaning.

"I have to tell you, when you're told you cannot return to nursing because of your disability, you don't know how long I cried about that," Foster said. "And then Social Security says, 'Oh no, you don't qualify.' You don't know what that does to you emotionally. You have no idea."



Federal disability programs:

Congressional Budget Office projections:

Government Accountability Office report:




6 Bipolar Rules for Eating

By Therese J. Borchard
Associate Editor

6 Bipolar Rules for EatingThe following post is by Hilary Smith, author of “Welcome to the Jungle: Everything You Ever Wanted to Know About Bipolar But Were Too Freaked Out to Ask” (Conari Press, 2010) as well as a cool blog to go with it, Welcome to the Jungle.

We’ve all heard about “mood foods” that can promote wellness for people with bipolar and depression–fish oil for brain health, oatmeal for stable blood sugar, chocolate for, well, chocolateness. But it’s also important to think about how we eat. How we eat can have just as big an impact on our mood as what we eat, yet it often gets neglected in conversations about bipolar and food. Here are some tips for maintaining a healthy mood through mindful eating practices.


1. Make eating an art.

How you eat is sometimes a reflection of how you feel. Are you rushed? Distracted? Frustrated? It’ll show by the way you act around food. Similarly, the way you eat can help you change how you feel. When you slow down, prepare yourself a beautiful meal, and savor every bite, you might find yourself feeling calmer, happier, and less stressed out. Mindfulness about the way you eat can be a good starting place for learning mindfulness in other areas of your life, which can go a long way in alleviating the symptoms of depression and bipolar.

2. Know thy meds.

Are your meds supposed to be taken with food or on an empty stomach? Is it OK to drink grapefruit juice while you’re taking them? Have you checked lately? Some foods can interact with your meds in funny ways, or even stop them from working. For example, if you’re taking lithium, it’s important to watch your sodium intake, and many psychotropic medications become downright dangerous if you drink alcohol while taking them. If you haven’t checked the PI sheet for your medication in a while, have a look. There might be a food-related instruction you’ve been forgetting.

3. Know thy eating habits.

Do you start living on Skittles when you’re heading towards a manic episode, and eat nothing but dry toast and coffee when you’re getting depressed? Does your mood dip if you skip breakfast? Do you have a hard time sleeping if you eat too late at night? Being aware of how your eating habits correlate to your mood can be extremely helpful in heading off bipolar symptoms. If you’ve never given much thought to it before, try keeping a food journal for several weeks. Keep a record of when you ate, what you ate, and how you felt throughout the day. After a month or so of record-keeping, you might discover patterns you didn’t know were there.

4. Depression is not an excuse to binge on ice cream.

While chowing down on junk food might distract you from depression for a few minutes, the resulting feelings of guilt and low self-esteem can make the depression worse (not to mention the sugar crash an hour later). When you’re depressed, the best way to eat is to sit down, take your time, and have healthy meals at regular intervals. Not only will this keep your blood sugar more stable throughout the day, but it can give you a sense of well-being and self-worth that you just don’t get from snarfling cookies right out of the box. Not that there’s anything wrong with eating a cookie.

5. Weight gain? Be kind to yourself.

Many psychotropic drugs have the unfortunate side effect of weight gain, and that can be hard on your self-esteem. It’s common to feel angry, frustrated or embarrassed about your appearance, especially when friends and relatives comment on the change. But if you react to meds-related weight gain by trying to starve yourself, you’re only going to make it worse. Instead, be kind to yourself. If you want to lose weight, make a sensible plan with your doctor, and don’t punish yourself with draconian diets. Find a gentle way to love the body you have right now, even when its size fluctuates because of your medication.

6. Rhythm is king.

It’s much easier to keep bipolar under control when your life has a steady rhythm. We all know about the importance of going to sleep at a regular time, but how many of us pay attention to meal times? Eating at regular times keeps your body energized throughout the day and your blood sugar levels stable, which in turn can help you keep a stable mood. Keeping regular mealtimes is especially important if you’re experiencing depression or mania/hypomania, when the temptation to skip meals can make your symptoms worse.

By making a few easy changes to the way you eat, you can help yourself keep a stable mood and healthy body. Eating right is an important part of the bipolar picture, and by paying attention to how we do it, we can be happier, healthier, and feel better about our bodies too.



What the Debt Limit Agreement Means for People Living With Serious Mental Illness

August 1, 2011

This week a major economic catastrophe was averted through the agreement put together by President Obama and congressional leaders to increase the current debt limit and bring about significant deficit reduction over the coming decade.  As is being widely reported in the press, the agreement will increase the debt ceiling by $2.1 trillion and allow the government to continue meeting all current obligations.  The agreement also includes a 10-year cap on discretionary spending and formation of a new bipartisan congressional committee charged with identifying an additional $1.5 trillion in deficit reduction through changes in entitlement programs and reforms to the tax code.

Debt Limit Increase Removes Threat to Current Entitlement Payments

In terms of assessing the impact of this agreement on people with mental illness, it is important to note that the increase in the government’s borrowing authority will ensure NO interruption critical safety net benefits such as monthly cash assistance under the SSI and SSDI disability benefits.  While media coverage was largely focused on a government default and protecting AAA bond ratings, failure to raise the debt limit would likely have placed these cash benefit programs at risk.  In addition, the higher debt limit will ensure that quarterly matching payments to state Medicaid agencies and payments to housing agencies for rental assistance programs (tenant-based and project-based Section 8) will continue uninterrupted.  Even a short-term disruption to these programs would have had a dramatic impact on people living with mental illness who depend on these programs (SSI, SSDI, Section 8, etc.) for basic supports.

Some Protections from Future Cuts to Medicaid

As noted above, the agreement creates a new 12-member bipartisan joint House-Senate Committee that will be charged with identifying $1.5 trillion in additional deficit reduction over the next decade.  This panel will be on a fast track and must produce recommendations by November 23, 2011, with a required "up or down" votes in the House and Senate by December 23. 

This $1.5 trillion in savings will come from changes in entitlement programs and reforms to the tax code. This new special congressional committee will be made up equally of Democrats and Republicans from the House and the Senate. As a result, few expect the committee to come to an agreement on cuts to major entitlement programs before November. Therefore, the "sequestration" enforcement mechanism becomes critical and it is here that critical protections for Medicaid will kick in.

So, in the strong likelihood that Congress fails to approve the committee’s recommendations (or if the recommendations fall short of the $1.5 trillion goal), the agreement contains an "enforcement mechanism" designed to impose automatic cuts, known as a "sequester."  This "trigger" mechanism for spending reductions would begin in 2013 and would split reductions evenly between defense and non-defense programs.  If this automatic "trigger" mechanism is imposed, it would exempt from reductions Medicaid and Social Security (including SSI and SSDI).  As with the new special congressional committee, the "trigger" mechanism can limit payments to Medicare providers (health plans and hospitals), but not Medicare benefits or cost sharing.  In addition, any reductions in payments to Medicare providers are limited to 2% of total Medicare spending.

Bottom line: The agreement decreases the possibility of deep cuts to Medicaid, the largest source of funding for treatment and supportive services for people living with serious mental illness.    At one point during the difficult negotiations over the past month, as much as $1.2 trillion in cuts to Medicaid over the next decade were under discussion.  Exempting Medicaid from cuts--through the "sequestration trigger"--will help ensure that this agreement meets the test of protecting the most vulnerable.  

New Limits on Discretionary Spending

The agreement does impose new constraints on the growth of federal discretionary programs that Congress funds through annual spending bills.  Imposition of a 10-year limit on federal discretionary spending will generate as much as $900 billion in savings over the next decade – that is, $917 billion below the baseline established by the Congressional Budget Office (CBO).  This will reduce discretionary spending to its lowest level since the Eisenhower Administration.  While President Obama had proposed freezing discretionary spending for 2012 and 2013, this new agreement puts these limits in statute and extends them through 2021.

The agreement does impose "firewall" protections between defense and domestic discretionary programs.  It also walls off "homeland security" spending that will not be subject to the discretionary spending limit.  This means that Congress will not be able to raid domestic discretionary programs to fund critical defense, homeland security and veterans medical care needs.  For FY 2012 and FY 2013, the agreement puts into place discretionary limits of $1.043 trillion and $1.047 trillion respectively. 

For NAMI’s priority discretionary programs, this could have far reaching implications.  Keeping current funding levels in place for a decade will mean that mental illness research, services and housing programs are almost certain to stay in place.  In order for Congress to increase funding for a domestic discretionary priority, a corresponding equal reduction must be made in another program(s) in order to avoid breaching the cap.  Fortunately, homeland security (including veterans medical care) are exempt from the cap.   

At the same time, keeping a tight enforceable limit on discretionary spending will have significant consequences for NAMI priorities:

Mental Illness Research  

The current (FY 2011) budget for the NIMH is $1.477 billion (.9% below FY 2010 level).  Keeping this level in place for the coming decade would seriously erode the capacity of the NIMH to invest in "new and competing" grants, while still maintaining "out year" commitments to large scale clinical trials and longitudinal studies that take years to design, recruit and complete.  Each year that the NIMH budget is frozen in place, the capacity of the agency to undertake new studies and clinical trials will be eroded as "biomedical research inflation" (the annual increase in the cost of research) means fewer and fewer new grants.  This year, the NIMH "pay line" (the percentage of accepted and validated grant proposals the agency can fund) is at risk of dipping below 15%.  In other words, 85% of the proposals and applications NIMH will receive in 2011 that meet standards for sound and valid scientific discovery will not be funded.  Level funding NIMH over the coming decade will inevitably send that "pay line" even lower.

Mental Illness Services

As noted above, the vast majority of publicly funded mental health services are financed by the Medicaid program, a joint state-federal entitlement program that operates outside of the new 10-year cap on discretionary spending.  There are now a range of smaller discretionary services programs operated by SAMSHA (the Substance Abuse and Mental Health Services Administration) that will be subject to the discretionary cap.  These include:

  • Mental Health Block Grant - $421 million,
  • PATH (outreach and engagement services to homeless people with mental illness) - $65 million,
  • Childrens Mental Health - $121 million, and
  • Projects of Regional and National Significance (various discretionary grants and demonstration programs) - $361 million.


A 10-year cap on overall discretionary spending will likely have a dramatic impact on HUD’s rental assistance programs.  These programs, including Section 8, Section 811 and permanent housing programs under the McKinney-Vento Homeless Assistance Act depend on the discretionary budget for ongoing renewal of existing rental and operating assistance.  The out year costs of these programs are driven by a complex set of factors such as tenant income and rental markets.  Any increase in these costs is certain to erode the capacity of HUD to invest in development of new supportive housing units that serve people with disabilities (including serious mental illness).  This is especially the case with McKinney-Vento and Section 811.


The agreement follows the Obama Administration’s definition of "homeland security" funding that is exempt from the 10-year discretionary funding cap.  This means that veterans medical care will not be subject to the discretionary spending limit.  However, other functions of the VA, including medical research will be subject to the cap.



Social Security Disability Claim Denied? Hire A Lawyer

By Joe Kraynak

social security claim denialIf you think you qualify for Social Security Disability benefits, consider taking the following steps to pursue a claim:

  1. See a doctor for your condition if you have not done so already. Without documented medical evidence, you have little chance to qualify as disabled.
  2. Apply for disability at your local Social Security Administration office or apply online. If you’re currently unable to do it yourself, get a close friend or relative to assist you. This should take about three to four hours.
  3. If you’re denied, contact an attorney who specializes in Social Security Disability benefits.

Do you qualify as disabled?


To qualify as disabled you must meet the following conditions:

  • You can’t do the work you did prior to becoming disabled.
  • You’re unable to do any substantial/gainful activity – that is, any job in which you can earn $1,000 per month or more.
  • Your disability has lasted or is expected to last for at least one year.

These are general guidelines. Each case is unique, so if you think you qualify, consult an attorney who specializes in Social Security Disability benefits.

Why hire an attorney?

An attorney costs money, but many people have misconceptions about how much it costs, how and when the attorney gets paid, and what they can expect to receive in return. A qualified attorney…

  • prescreens your situation to determine your chances of winning an appeal
  • helps you establish realistic expectations
  • gathers your medical records and reviews them for evidence to support your claim
  • makes sure you meet SSA deadlines
  • presents your case in a way that gives it the best chance to succeed
  • knows how to cross-examine expert witnesses who may question your inability to work
  • typically works on contingency – the attorney gets paid only if successful, and:
    • SSA limits attorney compensation to no more than 25% of back payments due and caps the amount at $6,000 – you pay the lesser of the two amounts
    • the attorney does not receive any percentage of future disability benefits
  • may be able to streamline the process to get you your first check sooner
  • may recommend other benefits to file for that you’re unaware of

Hiring the right attorney

Following are some guidelines for hiring a qualified attorney:

  • Look for someone local. Local attorneys are more likely to meet with you individually and work with you to prepare your case and prepare you for your hearing.
  • Choose an attorney who specializes in Social Security Disability benefits. Someone who specializes in this area knows not only the law but also a lot about medicine and what qualifies a claimant as unable to work. 50–75% of the attorney’s cases should be in Social Security Disability. (Call several attorneys in your area to find out which attorneys specialize in Social Security Disability. If you call an attorney who doesn’t specialize in this area, ask who they would recommend.)
  • Meet with a couple attorneys on your list. Many attorneys offer a free consultation. Meet with two or three attorneys to get a sense of which one you feel is most qualified and that you’re most confortable with.




Using Mindfulness for Bipolar Disorder

By Bipolar Beat

By Shamash Alidina, author of Mindfulness For Dummies

Mindfulness For Dummies cover imageMindfulness is a meditation therapy that uses self-control techniques to overcome negative thoughts and emotions and achieve a calmer, more focused state of mind – a moment-to-moment awareness with qualities of kindness, curiosity, and acceptance.

Mindfulness was originally an ancient eastern approach to wellbeing that has been found, through recent psychological research, to be a powerful way of managing a range of mental health conditions.

The great thing about mindfulness is that it’s not only a technique you practice now or then, but a way of living your whole life, moment by moment. People who practice mindfulness regularly find they are more focused, calm, and better able to cope with the challenges of life.

Observing thoughts instead of reacting to them

In mindfulness, you learn to see thoughts as just thoughts rather than as facts or situations you must react to. Thoughts commonly come and go in the mind, and if you treat all thoughts as true and assign them all the same level of importance, you’re more prone to feel down in the midst of negative or self-judgmental thoughts and highly elated in the midst of positive thoughts. This rollercoaster ride of emotions and energy often seems to trace the same path as bipolar disorder’s ups and downs.

By practicing mindfulness, you notice that both types of thoughts are just thoughts, and you don’t need to react to them or even give them your full attention. After all, thoughts arise merely out of your perception of reality or are borne out of your own thought process. You’re not required to give them the full status of being true. Mindfulness involves watching thoughts and stepping back from them – like watching clouds passing through the sky. This enables you to become a disinterested observer, and thoughts lose some of their control over your emotions.

Switching modes of mind

Mindfulness also emphasizes learning to switch modes of mind. Normally you operate in “doing mode,” which is all about setting goals and trying to achieve them. Many people get stuck in this mode and never realize they have the option of shifting to “being mode,” which is all about allowing and accepting things just as they are, rather than working hard to change them.

Being mode is particularly helpful in the realm of emotions. If you’re feeling sad and don’t accept it, you can end up fighting to change the experience. This can lead to a deeper feeling of sadness and trigger a negative thought cycle. By being with the experience and mindfully accepting the emotion, you allow the feeling to dissipate in its own time.

Mindfulness-based cognitive therapy (MBCT) for depression

Mindfulness-based cognitive therapy (MBCT) was developed about 10 years ago as a treatment for recurring depression. MBCT teaches participants the skills that enable them to be more aware of their thoughts without judgment, viewing negative (as well as positive and neutral) thoughts as passing mental events rather than as facts. Research found that an eight-week course in MBCT resulted in a 50 percent reduction in depressive relapse (compared to treatment as usual) for those who had three or more previous episodes of depression. As a result, the National Health Service in the UK now recommends MBCT as the treatment of choice for those who have suffered from three or more depressive episodes.

MBCT is now being rapidly researched for a range of different mental health conditions, including bipolar disorder. Preliminary research published in 2008 by Professor Mark Williams, one of the developers of MBCT, has shown promising results. Researchers studied a small randomized group of people with bipolar disorder in remission. They found an immediate reduction in levels of anxiety for the group compared to those who didn’t receive the MBCT training. Also both bipolar and unipolar participants with MBCT had a reduction in symptoms of depression compared to those who didn’t.

Another experiment on MBCT for bipolar was carried out on 2 groups at Oxford University, UK, and 2 groups at the University of Colorado, USA. These were small groups but again results were promising, showing reduction in depressive symptoms and thoughts about suicide, and to a lesser extent, a reduction in anxiety and manic symptoms.

Mindfulness in managing bipolar disorder

Mindfulness looks like a potentially effective way of managing bipolar disorder, especially the depressive pole, which may be the most difficult to treat with medication alone. Mindfulness exercises and meditations are useful for people with bipolar disorder (manic depression) because mindfulness:

  • Decreases the relapse rate for depression.
  • Reduces stress and anxiety, which contribute significantly to the onset of both mania and depression and may worsen the course of the illness.
  • Improves a person’s ability to manage thoughts and feelings and increases awareness of the way the person tends to internalize external stimuli.

Mindfulness exercises include guided body scan meditation, mindful walking, mindfulness of breath, and mindfulness of thoughts and feelings. All of these exercises are on the audio CD that comes with the book Mindfulness For Dummies.

If you’ve had any sort of mindfulness training, please share your experiences and insights.

Learn more about mindfulness

To find out more, you can read my book, Mindfulness For Dummies, which comes with over one hour of guided mindfulness exercises on CD. Order on





A Whole New Light on the Bipolar / Violence Connection

By  Marcia Purse, Guide  April 11, 2011


Having bipolar disorder by itself does not increase the risk of violent behavior. Yes, you heard that right, all you crime drama writers and finger-pointers. Sorry, but you'll have to find another explanation.

Researchers from Oxford University and the Karolinska Institutet in Sweden looked at 3,700 hospitalized patients with bipolar disorder, 4,000 of their siblings, and 37,000 people from the general public. The rate of violent crime in the control group was 3%, in the siblings 5%, and in the bipolar group 5% - or 21%.

Yes, that's right. A rate of 5% for bipolar patients without substance abuse problems - and 21% for those diagnosed with severe substance abuse in addition to bipolar. Similar results were found for people with schizophrenia. And rates of violent crime among substance abusers who are not mentally ill are 6-8 times as likely as non-abusers to commit violent crimes.

In other words - it's alcohol and drug abuse - not bipolar disorder and schizophrenia alone - that lead to violent crimes.

Of course, there's a catch: people with severe mental illnesses are far more likely to be substance abusers in the first place than others. Researchers have found that from 30-60% of bipolar people are also substance abusers.

One of the study leaders summed it up beautifully: "Substance abuse is really the key mediator of violent crime. If you take away the substance abuse, the contribution of the very minimal," said Seena Fazel of Oxford University's department of psychiatry.

"It is probably more dangerous to be walking outside a pub on a late night that it is to be walking outside a hospital where mental health patients are being released."



10 Winter Depression Busters for Groundhog Day

By Therese J. Borchard

On Groundhog Day: 12 Winter Depression BustersI don’t really care if that bloody woodchuck emerges from its hole to see its shadow or not today (Ed. – He did not, so an early spring is predicted). History tells this depressed person that we still have a good 30 to 40 days to endure really crappy weather, during which we should employ every sanity exercise available. Let’s call a spade a spade: winter sucks for some of us.

So, little marmot, I don’t care what you do. I don’t care if you get yourself a nice rat for dinner, I’m sticking to these techniques regardless!

Here are a few of my favorite winter depression busters…

1. Watch the sugar.

I think our body gets the cue just before Thanksgiving that it will be hibernating for a few months, so it needs to ingest everything edible in sight. And I’m convinced the snow somehow communicates to the human brain the need to consume every kind of chocolate available in the house. We are mammals, yes, so do we think we need an extra layer of fat in the winter to keep us warm? I’m starting to think so.

People with depression and addicts need to be especially careful with sweets because the addiction to sugar and white-flour products is very real and physiological, affecting the same biochemical systems in your body as other drugs like heroin. According to Kathleen DesMaisons, author of “Potatoes Not Prozac”: Your relationship to sweet things is operating on a cellular level. It is more powerful than you have realized…. What you eat can have a huge effect on how you feel.”


2. Stock up on Omega-3s.

During the winter I’m religious about stocking in my medicine cabinet a Noah’s Ark supply of Omega-3 capsules because leading physicians at Harvard Medical School confirmed the positive effects of this natural, anti-inflammatory molecule on emotional health. I treat my brain like royalty–hoping that it will be kind to me in return–so I fork over about $30 a month for the Mac Daddy of the Omega-3s, capsules that contain 70 percent EPA (Eicosapentaenoic acid). One 500mg softgel capsule meets the doctor-formulated 7:1 EPA to DHA ratio, needed to elevate and stabilize mood.

3. Give back.

Ghandi once wrote that “the best way to find yourself is to lose yourself in the service of others.” Positive psychologists like University of Pennsylvania’s Martin Seligman and Dan Baker, Ph.D., director of the Life Enhancement Program at Canyon Ranch, believe that a sense of purpose–committing oneself to a noble mission–and acts of altruism are strong antidotes to depression.

The winter months are a good time to do this because the need is greater, the holiday spirit ideally lasts until February, and you don’t have the excuse of attending family picnics, unless you live in California or Florida.

4. Join the gym.

Don’t let the cold weather be an excuse not to sweat. We have centers today called “gyms” where people exercise inside! Granted, it’s not the same–watching the news or listening to the soundtrack from “Rocky” as you run in place as opposed to jogging along wooded paths with a view of the bay. But you accomplish the goal: a heart rate over 140 beats a minute.

The gym is also a kind of support group for me. These women, I’m guessing, are going after the endorphin buzz just like me because alcohol and recreational drugs don’t do the trick anymore. And, like moi, I suspect that they also have great difficulty meditating. Every time they close their eyes, they have visions of screaming kids, Chuck E. Cheese hell, and the crisis of no thank-you gifts for teachers.

5. Use a light lamp.

Bright-light therapy — involving sitting in front of a fluorescent light box that delivers an intensity of 10,000 lux — can be as effect as antidepressant medication for mild and moderate depression and can yield substantial relief for Seasonal Affective Disorder.

I usually turn on my mammoth HappyLite in November, just after my least favorite day of the year: when Daylight Saving Time ends and we “fall back” an hour, which means that I have about an hour of sunlight to enjoy after I pick up the kids from school.

6. Wear bright colors.

I have no research supporting this theory, but I’m quite convinced there is a link between feeling optimistic and sporting bright colors. It’s in line with “faking it ’til you make it,” desperate attempts to trick your brain into thinking that it’s sunny and beautiful outside–time to celebrate Spring!–even though it’s a blizzard with sleet causing some major traffic jams.

Personally, I tend to wear black everyday in the winter. It’s supposed to make you look thinner. But the result is that I appear as if and feel like I’m going to a funeral every afternoon between the months of November and March. This isn’t good. Not for a person hardwired to stress and worry and get depressed when it’s cold. So I make a conscious effort to wear bright green, purple, blue, and pink, and sometimes–if I’m in a rush–all of them together!

7. Force yourself outside.

I realize that the last thing you want to do when it’s 20 degrees outside and the roads are slushy is to head outside for a leisurely stroll around the neighborhood. It’s much more fun to cuddle up with a good novel or make chocolate chip cookies and enjoy them with a hot cup of Jo.

On many winter days–especially in late January and early February when my brain is done with the darkness–I have to literally force myself outside, however brief. Because even on cloudy and overcast days, your mood can benefit from exposure to sunlight. Midday light, especially, provides Vitamin D to help boost your limbic system, the emotional center of the brain. And there is something so healing about connecting with nature, even if it’s covered in snow.

8. Hang out with friends.

This seems like an obvious depression buster. Of course you get together with your buddies when your mood starts to go south. But that’s exactly when many of us tend to isolate. I believe that it takes a village to keep a person sane and happy. That’s why we need so many support groups today. People need to be validated and encouraged and inspired by persons on the same journey.

And with all the technology today, folks don’t even have to throw on their slippers to get to a support group. Online communities provide a village of friendship right at your computer. Every day I read comments like this one from Beyond Blue member Margaret: “Membership in this club to which we all unwillingly belong isn’t something I would wish on anyone; nonetheless, reading how others have survived specific circumstances has given me hope where I’d lost sight of it and inspired me to keep on keepin’ on even when my feet feel as if they’re encased in buckets of cement and will pull me under the stagnant water in the bottom of the pit.”

9. Head south.

Granted, this solution isn’t free, especially if you live in Maine. But you need not travel like the Kennedys to transplant your body and mind to a sunny spot for a few days. I try to schedule our yearly vacation the last week of January or the first week of February so that it breaks up the winter and so that I have something to look forward to in those depressing weeks following the holidays.

10. Take up a project and challenge yourself.

There’s no time like winter to start a home project, like de-cluttering the house or purging all the old clothes in your kids’ closets. When a friend of mine was going through a tough time, she painted her entire house–every room downstairs with two different colors. And it looked professional! Not only did it help distract her from her problems, but it provided her with a sense of accomplishment that she desperately needed those months, something to feel good about as she saw other things crumble around her. Projects like organizing bookshelves, shredding old tax returns, and cleaning out the garage are perfect activities for the dreary months of the year. And hey, most of them are free!

My mood can also often be lifted by meeting a new challenge — an activity that is formidable enough to keep my attention, but easy enough to do when my brain is muddied. Learning how to record and edit video blogs, for this girl who hates technology, turned out to be great fun. Friends of mine get the same boost by joining Jenny Craig and losing the 25 pounds of baby fat, or exploring a new hobby — like scrapbooking. I try to stretch myself in a small way every winter–whether it be taking a writing class, researching the genetics of mood disorders, or trying to build myself a website. It keeps my brain from freezing, like the rest of my body.




Emerging Bipolar Therapies

By Jane Collingwood

Researchers around the world currently are exploring a wide range of possible new treatments for bipolar disorder.

Bipolar disorder, formerly called manic-depression, involves episodes of extreme mood disturbance ranging from deep depression to unrestrained mania. It affects an estimated four percent of the US population. Sufferers typically alternate between these extreme states, with normal mood states in-between.

Lithium, a central treatment of bipolar disorder, was discovered more than 50 years ago. Since that time, some additional medications have also been approved and are successfully helping people with bipolar disorder. Lamictal, an anticonvulsant originally approved for the treatment of convulsive disorders such as epilepsy, was approved by the FDA for bipolar treatment in 2003. Lamictal is particularly helpful for the depression side.

Abilify, a drug that was originally approved to treat schizophrenia, was approved for use in the treatment of bipolar disorder in 2005.

A range of other drugs have been tried with limited success. Sodium valproate (Depakote in the United Statess), an anticonvulsant, often is used to stabilize mood. Certain antipsychotic medications, including chlorpromazine (Thorazine in the United States), also are used for agitation in acute manic episodes. But antidepressants usually are ineffective for the depression stage of bipolar disorder.

A 2006 study found that only half of patients remained well two years after starting treatment. So scientists remain on the lookout for improved therapies for the mood swings of bipolar disorder.

Dr. Husseini Manji of the National Institute of Mental Health (NIMH) in Bethesda, Md., explains that current medications for bipolar disorder “certainly reduce symptoms but don’t do a good enough job. Many patients are helped, but they’re not well.” Dr. Andrea Fagiolini of the University of Pittsburgh adds: “What’s more, many patients can’t tolerate current bipolar medications because of side-effects like weight gain, sleepiness, tremor, and the sense of feeling ‘drugged’.”

Recently, researchers from NIMH have investigated the use of an anti-seasickness drug called scopolamine. In a study of 18 patients with bipolar disorder or major depressive disorder, Drs. Maura Furey and Wayne Drevets found that “rapid, robust antidepressant responses to scopolamine occurred in currently depressed patients who predominantly had poor prognoses.”

“In many cases that improvement persisted for weeks or even months,” Dr. Drevets said. He now is experimenting with scopolamine in patch form. The experts hit upon this effect of scopolamine when testing the drug for its effects on memory and attention.

Another possible new treatment also was discovered by accident. In late 2003, scientists at McLean Hospital in Belmont, Mass. noticed that depressed bipolar patients improved following brain scans called echo-planar magnetic resonance spectroscopic imaging (EP-MRSI). “Several subjects finished the EP-MRSI exam with obvious mood improvement,” they report.

Researchers carried out a study comparing EP-MRSI against standard magnetic resonance imaging (MRI) scans. Seventy-seven percent of patients showed an improvement on a structured mood rating scale following EP-MRSI, compared with 30 percent with MRI. The researchers suggest the benefit comes from specific electric fields induced by the scan, and added that patients who were not on medication fared even better.

Attempts now are being made at NIMH to incorporate scanning into a possible treatment. Another type of scan, transcranial magnetic stimulation, is also being studied.

Riluzole, a drug often used for Lou Gehrig’s disease, also is a potential candidate for bipolar disorder therapy. Riluzole has been shown to have antidepressant properties in a number of recent studies of mood and anxiety disorders.

Riluzole was tested for bipolar depression by Dr. Husseini Manji and colleagues. They gave the drug to 14 acutely depressed bipolar patients alongside lithium for eight weeks. A significant improvement was found, with no evidence of a switch into mania. “These results suggest that riluzole might indeed have antidepressant efficacy in subjects with bipolar depression,” say the team.

Dr. Manji also is looking at the effectiveness of tamoxifen, a breast cancer drug, for bipolar disorder. His recent findings suggest that it rapidly reduces mania. However, he is searching for another drug with similar action, as tamoxifen is linked to possible long term side-effects at the high doses required to treat mania. But the knowledge that tamoxifen is beneficial helps towards a better understanding of the condition. “We’re close to answering some very fundamental and important questions about the illness,” commented Dr. Manji.

Current advances in DNA research allow experts access to the genetic secrets of bipolar disorder. The technology to scan entire genomes already has highlighted several genetic variants linked to bipolar disorder.

A study from August 2007 presents “the largest database of phenotypic variables yet assembled for bipolar disorder.” Researchers from Johns Hopkins School of Medicine in Baltimore, Md. said the data is reliable enough to “detect even modest genetic effects in bipolar disorder.”





Women and Bipolar Disorder

By Psych Central Staff

While bipolar disorder affects both men and women, how the disorder is experienced and treated in both genders varies greatly. Women, for example, tend to experience more of the “rapid cycling” type of bipolar disorder.

Why is it that rapid cycling occurs more often in women? What other issues do women have to face with regards to having bipolar disorder? What should be the course of action for women (with bipolar disorder) who are contemplating pregnancy?

Types of Bipolar Disorder

There are several types of bipolar disorder. The main types include bipolar type I disorder, bipolar type II disorder, and cyclothymic disorder. Bipolar type I disorder is the “classic” form, and patients often experience at least one full or mixed episodes with major depressive episodes. Bipolar type II disorder is where patients have at least one milder form of mania and one major depressive episode. However, they never get a full manic or mixed episode. Bipolar II is more difficult to diagnose because some symptoms of hypomania may not be as apparent. Hypomania is described as a milder form of mania with less severe symptoms. The basic distinction between mania and hypomania is that mania can prevent a person from functioning on a day to day basis. That’s why it is so easy to overlook and misdiagnose a person as without bipolar disorder. Moreover, there are never any delusions in a hypomanic state. Lastly, in cyclothymic type of bipolar disorder, individuals suffer from many hypomanic and depressive symptoms (over 2 years, at least). It is interesting, however, that these symptoms are not severe enough or do not last long enough to be considered as a mood episode.

As told in its name, people with bipolar disorder have mood episodes that fall into two general categories: symptoms of mania and symptoms of depression. However, people diagnosed with bipolar disorder do not need to have symptoms of depression. In fact, people are often misdiagnosed with depression when bipolar disorder is actually the culprit. Thus, the symptoms of mania are key to the definition of having bipolar disorder. Symptoms of mania alone would be sufficient in diagnosing a person with bipolar disorder. The symptoms of mania include increased energy, activity, restlessness, racing thoughts, and rapid speech. The list continues with additional mania symptoms, such as excessive euphoria, extreme irritability and distractibility, decreased sleep requirement, uncharacteristically poor judgement, increased sexual drive, denial, and risky behavior. The symptoms of depression are also just as lengthy. These include persistent sad or empty mood, feelings of hopelessness, pessimism, guilt, worthlessness or hopelessness. Depression is also described as having decreased energy and thoughts of death or suicide. Overall, the specific symptoms and the severity of these mood episodes vary between individuals.

Bipolar Rapid Cycling in Women

Although bipolar illness is equally prevalent in both men and women, the course of the illness differs greatly between the sexes. This is especially true for conception and pregnancy, which affects both the course of the illness and the “treatment decisions that are made at various points in a woman’s life” (Leibenluft, 1997). A primary example of such a gender difference occurs with rapid cycling. As previously mentioned, rapid cycling is more prevalent in women. It is approximately three times more common in women than in men. Rapid cycling describes incidences where a bipolar patient experiences four or more episodes of mania, hypomania, or depression within a time period of a year (Leibenluft, 1997).

Why is rapid cycling bipolar disorder more common in women than in men? Three potential hypotheses to explain the higher prevalence of rapid cycling in women are hypothyroidism incidence, specific gonadal steroid effects, and the use of anti-depressant medications. First, more women encounter hypothyroidism than men do; however, there is not a general consensus on it being a primary cause of increased rapid cycling. Second, gonadal steroids, such as estrogen and progesterone, fluctuate throughout the menstrual cycle. Sixty-six percent of bipolar type I women had regular mood changes during either their menstrual or premenstrual phase of their cycle. They were more irritable and had increased anger outbursts (Blehar et al., 1998). These may set up women to frequent mood changes (especially prior to the menstrual cycle, as noted in the term “premenstrual syndrome”). Increased estrogen may cause women to develop hypercortisolism, which may increase the risk of depression. Stress levels are associated with cortisol level, so this may possibly be the reason for increased risk for depression.

People with bipolar disorder generally do not respond well to anti-depressant medications as the sole treatment. In fact, if taken alone, anti-depressant medications such as selective serotonin re-uptake inhibitors, tricyclics and monoamine oxidase inhibitors, may increase the manic episodes. They help alleviate the depression, but do not help the manic phases. Studies indicate that serotonin reuptake inhibitors and monoamine oxidase inhibitors are less likely to cause mania side effects, as compared with tricyclic antidepressants. Yet another study suggests that manic episodes caused by antidepressants are more moderate compared to those caused spontaneously. In addition, manic episodes caused by monoamine oxidase inhibitors are much milder than those caused by tricyclics or fluoxetine, also known as Prozac antidepressant (Leibenluft, 1998). This indicates that if a patient wanted to take antidepressants, then monoamine oxidases may be a better option. Again, there has not been enough evidence to suggest that any of the three hypotheses presented above is the absolute reason for increased rapid cycling in women with bipolar disorder. The treatments must be taken especially carefully, in order to account for all of the factors discussed.

The treatment of rapid cycling bipolar disorder is especially difficult. As mentioned above, treatment with anti-depressants may precipitate a switch to mania, but may also increase cycle frequency (Leibenluft, 1997). There needs to be more studies done in this area to confirm and treat these problems. However, the most helpful of all treatments is document daily what the moods are upon taking the appropriate drugs (anti-depressant/ antimanic). This will aid in the search for a better cure or prevention for both the short- and long-term treatment. It is probably best to minimize the use of anti-depressants and to maximize the use of mood-stabilizing agents. Mood-stabilizing agents are used to treat manic, hypomanic and mixed episodes and are used to prevent more mood episodes. This is not the absolute way, remember, because the use of mood-stabilizing agents is used primarily to treat mania. As with the problem of taking primarily anti-depressants, rapid cycling bipolar patients who use mainly mood-stabilizing agents will have severe depressive episodes. There is a trade-off between the use of either mood-stabilizing agents or anti-depressant drugs. Both decreases one problem while enhancing another. The absolute cure is still unknown.

Risks Associated with Bipolar Disorder in Women

Perhaps more significant a gender difference lies in the fact that women can give birth. Relatively little study has been done regarding the risks of bipolar disorder in the period during pregnancy. Sometimes it is difficult to distinguish bipolar symptoms from regular pregnancy symptoms. Pregnant women often do suffer from depression, depending on their environment and stresses. Nonetheless, it is unclear as to whether or not pregnancy increases or decreases bipolar symptoms. Some studies suggest that pregnancy may lessen symptoms: “In one study, 800f patients with affective illness (predominantly bipolar) experienced an improvement or a diminution of symptoms of their mood disorder during pregnancy” (Altshuler et al. 1998). At the same time, these studies are contradicted by other studies. For instance, in a study involving women with bipolar type I disorder, “…women reported manic mood changes, in each case occurring during pregnancy” (Blehar et al., 1998). Manic episodes and cycling seemed to occur exclusively during pregnancy.

Although the reason for this point is unclear, it is apparent pregnancy also poses a question of relapse, which has an important effect on women and the fetus that they are carrying. The fetus can be at risk due to lack of attention to prenatal care, if the woman is not treated for the psychiatric illness. Precipitated episodes in the absence of treatment may be very detrimental to both parties involved. Secondly, the woman would be at risk because with each successive episode, the length of time to following episodes gets smaller. That is, the woman could have manic and depressive episodes more often. This would neither be beneficial to the woman or her child. The effect on the fetus due to many mood episodes is unclear (Viguera et al., 1998). “During pregnancy, a woman’s glomerular filtration rate increases” (Llewellyn et al., 1998). This means that any medication that she takes, such as lithium (discussed below), will be excreted more rapidly. This is very dangerous because if she does not have enough medication in her system, she can fall into relapse. A dilemma arises in that if she increases her medication amount, she may be exposing her fetus to grave side effects and even danger (discussed below). Moreover, during labor, it is important that women remain fully hydrated. Since the period of time for delivery varies with each individual, a pregnant woman can become very dehydrated. When a woman gets dehydrated, the serum medication concentrations will increase (Llewellyn et al., 1998). This is the opposite effect of the increase in glomerulus filtration. Nonetheless, both situations are dangerous and can be very toxic to the woman and indirectly to the fetus.

As varying as the symptoms of bipolar disorder, per individual, so are the treatments. It is very important that bipolar pregnant women get the appropriate care and treatment that they need, in order to properly care for themselves as well as for the child that they are carrying. In treating pregnant women who have bipolar disorder, there exist several clinical problems. There are several drugs or chemicals that are used to treat bipolar disorder. However, such drugs have been shown to cause clinical problems. Drugs that are antimanic agents, such as lithium, valproic acid, and carbamazepine, all have teratogenic effects. Prenatal exposure to lithium increases risk for cardiovascular malformations (Viguera et al., 1998; Llewellyn et al., 1998). With lithium use, cardiovascular abnormalities such as Ebstein’s anomaly may result. This risk in the infant is “400 more common if the mother was being treated with lithium during pregnancy” (WWW1). Ebstein’s anomaly is a cardiovascular malformation where the right ventricle has hypoplasia and there is downward placement of the tricuspid valve into the right ventricle (Viguera et al., 1998). In addition, lithium use during the first trimester of pregnancy increases the risk for Ebstein’s anomaly dramatically. Since lithium can cross the placenta, it is particularly risky because fetal serum concentration is similar to that of the mother (Llewellyn et al., 1998). Moreover, lithium can also cause cardiac arrhythmia, where the heart beats are asynchronous, irregular, or especially slow. Often physicians will counsel their patients to terminate the pregnancy.

Early reports urged the change from lithium use to that of carbamazepine and valproic acid. However, these carbamazepine and valproic acid have been shown to cause defects in the fetus. They have teratogenic effects. Rates of neural tube defects due to carbamazepine and valproic acid exposure has been estimated to be about 1 percent and 3-5%, respectively (Viguera et al., 1998). Studies now suggest that carbamazepine and valproic acid treatment for pregnant bipolar patients may cause even more severe fetal defects than lithium. In addition to the neural defects, carbamazepine and valproic acid exposure to the fetus is associated with craniofacial abnormalities and cognitive dysfunction, if given late in pregnancy. At least with the damage caused by lithium, early detection and surgery can repair the effects. Another study believes that giving pregnant women folate reduces the neural tube defects (Viguera et al., 1998). Nonetheless, studies now show that lithium may be the lesser harmful of the three.

Other treatments are now being discovered to treat bipolar disorder. Yet, newer anticonvulsant agents such as gabapentin and lamotrigine seem to have contradicting effects. Newer antidepressants, such as bupropion, supposedly have good response rates and low risk for manic episodes or rapid cycling. However, as with all new medications, bupropion studies have been met with mixed results (Leibenluft, 1998). Apparently, patients had to discontinue use of bupropion because upon its use, patients occasionally switched to hypomania. Another possible treatment for bipolar disorder is electroconvulsive therapy. This should be considered for as an alternative medication for bipolar depression. In comparison of medication effectiveness, specifically that of monoamine oxidase inhibitors and tricyclics, electroconvulsive therapy seems to be more effective. Five out of seven studies show that electroconvulsive therapy is more useful (Leibenluft, 1998). As with all treatments so far discussed, there exists a drawback in using electroconvulsive therapy. It seems that electroconvulsive therapy is capable of alleviating depression symptoms of bipolar disorder, but there is a possibility that patients will switch into mania or hypomania.

In the use of anti-manic treatment, some studies suggest periodic use and disuse of drugs for pregnant women. For example, some women discontinue taking these drugs for the first trimester of pregnancy. This may decrease the defects mentioned above. These women then use the drugs in later trimesters. How exactly does this work? Data shows that there is increased risk for relapse upon abrupt discontinuation of medications. Gradual, as opposed to rapid, discontinuation may have a more positive effect for pregnant women with respect to relapse. However, although gradual discontinuation is most ideal for pregnant women, the fetus may be exposed to these antimanic agents for a longer period of time–a time that is critical for organogenesis, or the development of the organs. Teratogenic risks are also quite high at this time. The risk of relapse is especially high in women with a greater number of prior mood episodes. Low lithium circulation also increases the risk of relapse; thereafter, there is an increased suicide risk (Viguera et al., 1998).

Viguera et al. (1998) also describes possible treatment guidelines for women with varying episodes. Bipolar patients with a history of one episode of mania and usually function well should be able to discontinue lithium before conception. Those who have moderate illness (2-3 episodes) could take either of two paths. First, the patient may choose to gradually discontinue lithium before conception. If they find that they are unable to handle this, lithium may be easily resumed. Or, they could wait until they find out that they are pregnant. This way, the patient minimizes exposure during placental implantation. Thus, these critical factors must be considered before beginning treatment of pregnant women suffering from bipolar disorder. Women with the most severe forms of bipolar disorder (i.e. more than four episodes) should continue to use lithium throughout the first and second trimesters. They should use lithium treatment before as well as during pregnancy. This is because they are most prone to have severe manic-depressive episodes in the absence of medication treatment. As emphasized before, this would be very detrimental to both the mother and fetus. In general, all women who use lithium during the first trimester of pregnancy should get a level II ultrasound at 18 to 20 weeks gestation (Llewellyn et al., 1998). This is to check for cardiac abnormalities.

An even more critical period in a pregnant woman’s life is during the postpartum period, after the woman has given birth. This is because the postpartum period of a woman’s life is one of especially high risk. Relatively more studies have been done on bipolar disorder during the postpartum period as opposed to during the actual pregnancy. The relapse from bipolar disorder during the postpartum period has been estimated between 33% (Altshuler et al., 1998). Since some women do suffer from depression after giving birth, it is especially crucial to be aware of the possibility of elevated depression. During the postpartum period, women often feel the need to commit suicide, because the depressive episodes seem to dominate (Blehar et al., 1997). Postpartum psychotic episodes vary and they can be very severe. This has to be noted in order to prevent the mother’s suicide or infanticide of the newborn. Moreover, postpartum relapse can be greatly decreased by five-fold when lithium is taken right before birth (within 48 hours of delivery) and continued throughout the postpartum period (Viguera et al., 1998).





6 Ways to Open Up and Talk in Therapy

By John M Grohol PsyD

6 Ways to Open Up and Talk in Therapy“I’ve shared more in my blog than I could ever tell my therapist.”

“I wish my therapist could read this online support group. Then they might begin to understand what I’m really going through.”

You’ve gathered up the energy and resources to start psychotherapy. It’s a big step and you’re excited to begin. But you find yourself unable to talk in therapy. What’s the point of talk therapy without the talking? We find it so incredibly easy to open up online, but when we’re in the therapy office, we become suddenly mute.

There are many strategies to help “open up” and be able to talk more freely while in psychotherapy. Here are a few.

1. Write it down.

One of the easiest ways to help overcome your fear or inability to talk in therapy is to write down some things that are important to you to talk about before session. Jot it down on a piece of paper, or keep a “therapy journal” even of topics or areas of your life that you want to talk about, you just find it difficult. Bring it to session, open it up, and pick a topic for that session.


2. Let the therapist guide you.

A psychotherapist’s main job is to act as a guide in your recovery and healing process. They are not there to necessarily give you all the answers, but help you find your own way to those answers (often with specific skills and techniques they can teach to help you better understand your interconnected moods and thoughts).

3. Reset your expectations.

Some people believe you need to go into your weekly therapy session with a “topic” to discuss. While sometimes that may indeed be the case — especially if the therapist has given you “homework” on a specific topic — it may also be that each session may already be full. Therapy would be of little benefit if you go into every session and talk non-stop for 50 minutes.

Remember, you’re not there to entertain your therapist, or to tell stories to maintain their interest. You’re there to do real work, some of which is going to involve talking about the past week in your life, but not to such an extent or in so much detail it overshadows the reason you’re in therapy to begin with.

4. Prepare for each session.

Sometimes people put off preparing for each therapy session. Either it becomes too unwieldy, or it becomes too much like real work. Well, psychotherapy is real work and is often hard. If you prepare for each session beforehand, you’re more likely to be ready to have a topic to talk about.

Not preparing for a therapy session or waiting until the last minute may inadvertently make it more difficult to talk. Imagine going to a conference or big meeting where are you the main speaker, and you only prepare your speech minutes beforehand. Naturally you’re going to be more flustered and less likely to speak well. Preparation is key. Not just for speeches or meetings, but for anything worthwhile in life.

5. Think of your therapist as the closest confidante you can ever share anything with.

In childhood, we often have a best friend or two we felt like we could share anything with. Sometimes we maintain these friendships, and other times they fade away for whatever reasons.

Therapists are your adult equivalent of someone you can share almost anything with (except for some things that are illegal, like murder, or suicide). That is a part of the special joy of a psychotherapy relationship. Here is a person who can tell them anything you want about yourself, and they won’t judge, they won’t insult or berate, and they won’t just leave you unexpectedly (within their abilities, anyway). It’s such a valuable and unique relationship that’s to your benefit to take advantage of as much as possible.

6. Ask your therapist to read your online blog entry, Facebook page, or support group posting.

I would do this very rarely indeed, but it’s okay to share the occasional blog entry or support group posting, if you feel like it indeed puts into words you can’t bring yourself to verbalize in session. Keep in mind that most psychotherapists are fairly busy — as is anyone in a full-time job — so they’re not going to have time to read all of your blog entries dating back from 5 years ago.

However, if you pick out one entry or one posting that really expresses how you feel or what you’re grappling with at that moment, that’s fine. Most therapists appreciate that additional insight into their patient, especially for one who may be having trouble talking or opening up in therapy.

* * *

As I’ve written previously about, though, don’t open up just to lie to your therapist. Little benefit comes from lying about your true feelings or how well you’re actually doing (versus the mask you may put on for your therapist).

One last thing — silence is okay once in awhile too. Although for most of us, an extended silence between two people engaged in a conversation can be uncomfortable, it’s something you can learn to become comfortable with in time. Therapists often won’t rush in to fill the silence, because most are comfortable with it. Don’t feel the need to say something just to fill the void, either. Give it some time, and perhaps the words will find themselves.





Texting, ADHD, Kids and Driving: A Killing Combination and Proposed Solution

By Kathryn Goetzke

I’ve written recently about the issues that those with ADHD have with texting, including myself, and have been reading some startling statistics about texting and driving that must be shared.

As those with ADHD have increased distractibility, I think it’s especially important that us ADHDers know this startling statistic and take serious note; Research shows that texting and driving can actually be worse than drinking and driving, and laws banning texting is doing little about saving lives.

I’ve always known it isn’t exactly safe, but until it was put in that context it didn’t register with me just how great the potential to destroy lives really is.  I’ve done things like limit my texting to when I am on the highway and at stoplights, readily making excuses for why I can afford to look away a few more seconds on long stretches and when I’m stopped.  But invariably my few seconds at the stop light turns into just one more after I’ve started, and before you know it those very restrictions I have put in place are over ruled by my impulsivity, excuses and justifications.

I’ve quit drinking and am the first to try to stop anyone that has been drinking from driving, and encourage stricter laws for those that do it.  I feel blessed I did not kill anyone while I was drinking and driving back in the day, and am glad it is one of the few lessons I did not learn the hard way, as I don’t need someone in my family to be killed by a drunk driver to know that I think it is wrong.

I already know how it feels, to lose someone close to me for reasons that I think were preventable.  So even after I didn’t drink much, my ability to control impulses isn’t great, so my rule was simply NO alcohol while driving.

My solution for myself with regards to texting is now simple and clear.  NO phone use in the car unless I am stopped with the car off.  I’m not perfect, but reading articles like this remind me of why I need to try harder be perfect.  Why would I want to wait until I destroyed my life or another’s to learn the forever-altering lesson that texting can kill?

How do I enforce this?  I tell those I love what I am trying to do, and to bust me when I am not doing it, and that helps.  I practice mindfulness.  I read about texting and driving, and stories that have changed lives.  I am not perfect, and know that I can’t do things alone, but when I ask for support from those around me I am all the more likely to be successful.

Kids, thankfully, have parents that can enforce rules to prepare them for being in the real world.  Parents can:

  • Ban cell phone texting / calling in the car completely.
  • Take away phones from kids that don’t follow this rule.
  • Check cell phones to see when the kids have been texting.
  • Don’t simply create a rule, but let the child experience the feelings of why the rule is created in the first place.  Watch drunk driving videos as a family.  As the kids to write a paper on how they would feel if someone in the family was killed by a texter.
  • Lead by example.

That may seem harsh, but think about how how harsh it is to wind up in jail for life, to have your child kill someone because they are texting, or get killed because someone’s parent thought that conversation was too harsh.

Do we really need to wait to experience something before we are willing to do something about it? We want to shield our kids from these types of feelings, but by doing this we also prevent them from understanding the lessons others are learning the hard way.  We don’t want our kids in fear, but it is important that they understand the dangers of life and develop healthy behaviors to protect themselves.

It doesn’t surprise me that the laws don’t work, it is easy to get around and difficult to catch people in the act.  We don’t need to rely on the police for preventing this – we need to rely on ourselves and the help of others around us to encourage us to lead healthier lives.





Strategies for Overcoming Depression

By Jane Framingham, Ph.D.

Strategies for Overcoming DepressionThere are a lot of articles on the Internet about overcoming depression. They suggest things such as changing your thinking, changing your mood, and voilà! — changing your life. But overcoming depression is not something you do in the blink of an eye. And no article is going to tell you how you can simply “overcome” depression in a few minutes of reading.

Depression is a serious mood disorder that affects millions of people each year. Sadly, most people who suffer from depression never seek treatment for it, fearing about what others may think of them or not having the courage to face change on their own. There remain a lot of misconceptions about depression treatment, how long effective treatment takes, and whether it’s all worth it.

What this article will cover are common themes in effective depression treatment, and some theories on how you can speed the process of depression recovery.

What is Depression?

Since you’re already reading this article, it’s likely you already suffer from depression or know someone who is, so we’ll keep this brief. Depression is just not the occasional feelings of sadness that we all experience from time to time. Instead, it’s a persistent feeling of overwhelming sadness for at least 2 weeks (and usually much longer). It’s the inability to take pleasure in almost any of life’s activities, and feeling run down or lacking the normal energy you had before depression set in. People with clinical depression also often suffer from problems with sleep and eating — physical symptoms that have been going on for as long as the depression itself. There is also an overwhelming sense of hopelessness for most people who experience depression — like this is not simply ever going to get better. Ever.

It’s no wonder a person with depression can’t see overcoming it. It seems hopeless. You talk negatively all the time, not just about yourself, but about others too. It’s not just the blues — it feels like someone has grayed out the world altogether.

Helping Yourself Overcome Depression

So what can you do about it?

In a very positive book about depression, Dr. Michael Yapko persuasively argues in Depression is Contagious that the cornerstone of the majority of people’s depression today is about relationships — or the lack of healthy, good, close relationships in our life. If we have many, close healthy relationships in our lives, it’s hard to be and stay depressed. (In the book, he also discusses the skills a person can learn to improve existing relationships, and find new healthy ones.)

Relationships just don’t fall into our laps, but when we’re depressed, we may specifically isolate ourselves from our existing and new relationships. This is a symptom of the depression. Relationships can help us pull ourselves out of the deepest throes of depression. Finding ways to build our relationship skills and engage with those around us who love us is one key way to overcome depression.

Our thoughts shape our behaviors, not the other way around. How and what we think directly impact how we behave, and many would argue, how we feel. If we feel depressed, it may be because we are often thinking depressing thoughts. You can’t just stop thinking such thoughts, but you can learn to identify the thoughts as they occur. As you track your thoughts throughout the day, you can also learn ways of evaluating them, and answering them back when they are unhealthy or irrational. This exercise forms the basis of cognitive-behavioral therapy, but the joy of this therapeutic technique in treating depression is that you can learn it all on your own, outside of a therapy relationship.

Skills building isn’t something you can do only with relationships. It’s something you can do with a lot of areas in your life. Such as combatting negative thinking or coping with stressful in more positive ways. Humans don’t come pre-built with these skills in place, and most of us never formally learn how to do these things successfully — such as enhancing our relationships and nurturing our positive emotions. That’s okay, because these things can be easily learned, as long as you open your mind up to the possibilities. Including the need for real change in your life.

Remember that there are a lot of ways you can learn these new skills. You can learn a lot by simply doing Internet searches on specific skills you want to enhance or learn anew, such as building a healthy relationship with a family member or loved one, finding new friends, or how to stop isolating yourself. You can find skills-building exercises in many self-help books written about depression as well. Online support groups offer a third simple and free option for finding and sharing skills with others like yourself.

Of course, some people who suffer from depression seek treatment, usually from their primary care physician or family doctor. That’s a good start, but it should only be the start. Family doctors and primary care physicians aren’t specialists in mental health treatment — psychologists, psychiatrists and other mental health professionals are. Seek a referral to one immediately, before even starting medication. Why?

Because the choice of medication and dose should be decided by you in conjunction with a doctor specifically trained in psychiatric medication prescribing — psychiatrists. Some doctors and therapists might even recommend against medication as your initial treatment, as it might be more appropriate to start with psychotherapy instead.

Taking Baby Steps

There’s a reason that most therapists suggest taking it slow when trying to treat depression. If you feel good one day, and decide to try and start a new business or make a new friend and you fail, it could be a forceful setback in overcoming depression. Instead, try things out slowly, and experiment with change one step at a time (save the leaps for when you’re feeling fully recovered!).

As you do take steps into the future, trying out new behavior strategies or relationship skills, reward yourself for your successes. We all too often are quick to compliment others for doing something nice, but are loathe to compliment ourselves. Give yourself a compliment and a reward for accomplishing some goal you’ve set for yourself in your depression recovery.

All journeys are not a straight line forward. There will be setbacks in your journey recovering from depression, no matter if you focus on going it alone (e.g., without seeking formal treatment), or even if you are in treatment with an antidepressant or psychotherapy. Take the setbacks in stride, though, and keep them in perspective — it wouldn’t be work if it was simple to recover from depression. Depression recovery is a process that will take time, but as long as you stick with the goal of change, you can overcome depression in due time.

Remember, hope is one of the things that leaves when a person is depressed. But hope can be reignited through small successes along the way, reinvigorating the memory of better times — times that can be just around the corner as you begin to win the battle over depression.





Borderline Personality and Bipolar Disorder Differences Part I: Diagnosis

By Candida Fink, MD

Bipolar disorder and borderline personality disorder often share many of the same symptoms – mood shifts, emotion dysregulation, impulsivity. In “Is Bipolar Disorder Overdiagnosed in Adults?” I cited a study suggesting that a number of people diagnosed with bipolar disorder actually meet criteria for borderline personality disorder, instead.

So what’s the difference? It’s a complicated discussion. Although some overlap may exist, important distinctions separate the two conditions, yet some researchers believe both conditions are likely a part of a continuum and are, in fact, related to one another.

In this part of a two-part series, I highlight the diagnostic differences between bipolar disorder and borderline personality disorder. In Part II, I focus on differences in treatment for the two conditions.

Development/Nature of the Illness

Borderline personality disorder is a type of “personality disorder” which essentially means that it is a developmental condition – something that has evolved through the entire development of a person’s emotional/behavioral infrastructure.

Bipolar disorder is an illness that presents acutely or subacutely (less than acute) sometime in a person’s life and is not, at least as we define it now, a condition that is part of a person’s core personality structure.

Course/Presentation of Symptoms

Borderline symptoms are present as a person’s baseline– their difficulties with mood regulation and impulsivity, their ups and downs, are part of their life all the time. They are always up and down.

Bipolar symptoms present in episodes that must be a change from the person’s baseline – that is part of the diagnostic definition. Their episodes of depression or mania are a change from who they are when they are feeling well.

Onset and Duration of Mood Episodes

Borderline mood episodes are shorter and more frequent and most often triggered by an event. These mood episodes are described as reactivity – a loss, a perceived rejection, a frustration, like an overflow of emotional response well out of proportion to the triggering event. During these episodes, an individual may appear angry or depressed or feel some degree of anxious irritability, and episodes last only a few hours to, at most (and rarely), a few days.

Bipolar mood episodes are more discrete and longer acting and can often present without any obvious trigger. A depressive episode must exist for at least two weeks. Mania must last seven days, and hypomanias must last five days – even for rapid cycling bipolar disorder, these duration criteria are still required. The irritable or angry mood symptoms are also part of either depressed or manic/hypomanic/mixed episodes and not required to be part of the person’s everyday personality.

Impulsive Behaviors Present Differently

Borderline: Impulsivity in borderline personality disorder is part of the chronic baseline – there is a chronic pattern of difficulty with impulsive and damaging patterns of behaviors.

Bipolar: Impulsivity in bipolar disorder is characteristic of the manic or hypomanic period only. That is a core part of the manic state, and it is different from a person’s baseline personality.

Psychosis Presents Differently

Borderline: In borderline personality disorder, sometimes people become transiently paranoid or feel as though they have dissociated, but they do not typically develop sustained delusions or hallucinations.

Bipolar: True delusions and hallucinations are possible in in any type of episode – depressed, manic, or mixed – though not in hypomania.

Borderline Requires Symptoms beyond Mood and Impulsivity

The borderline diagnosis requires at least five core symptoms out of a list of nine in the DSM IV. Only three of those have any possible overlap with bipolar disorder and in fact are quite different from bipolar symptoms as described above. The three symptoms that may be considered to overlap in bipolar and borderline are as follows:

  • Affective instability
  • Impulsivity
  • Inappropriate, intense anger

A borderline personality disorder diagnosis requires at least two other symptoms, such as the following:

  • Frantic efforts to avoid being alone, chronic feelings of emptiness
  • Patterns of unstable/intense interpersonal relationships, disturbance in core sense of self and identity
  • Recurrent suicidal behavior, threats, gestures, or self-mutilating behavior

None of these symptoms is required in bipolar disorder, and if they are present they are typically part of a mood episode and not part of the individual’s baseline behavior.

Borderline Personality and Bipolar Disorder on the Same Spectrum?

A group of researchers who study mood disorders have presented the idea that the rapid and constant mood dysregulation of borderline personality disorder is actually on a continuum with bipolar disorder. They use the term Bipolar Disorder Not Otherwise Specified to describe this clinical picture.

They describe a bipolar spectrum and would consider many of the borderline features part of that spectrum. Supporting this theory is a concept of ultra-rapid cycling bipolar disorder, which is different from the well defined rapid cycling bipolar disorder in the DSM IV that is characterized by four or more mood episodes per year.

This ultra rapid cycling concept can look a lot like the mood reactivity of borderline, with multiple mood changes per day, but the definition is not consistent among researchers and so is difficult to rely on clinically.





Spending Sprees in Bipolar Disorder

By Jane Collingwood

Spending Sprees in Bipolar Disorder
People with bipolar disorder experience severe mood swings which can last several weeks or months. These include feelings of intense depression and despair, manic feelings of extreme happiness, and mixed moods such as depression with restlessness and overactivity.

The disorder can also lead to impulsive spending sprees, usually during manic episodes. These can extend to cars, holidays and computers, costing thousands of dollars, as irrational decision-making takes hold. It may be wild “self-medicating” shopping sprees, unwise investments, extravagant gifts to family, friends or charity, or spending a fortune on gambling.

People with mental health problems are already more likely to be debt-ridden than the general population, and the number is even higher among those with bipolar disorder. Financial troubles can lead to problems such as stress, anxiety, depression and suicide even among those not officially diagnosed with a mental illness.

Can’t Find Money To Eat

The UK mental health charity Mind says debt is leaving thousands of people with bipolar disorder struggling to find money to eat, stay warm and pay the rent. They wrote a report stating, “People who have been diagnosed with bipolar disorder may have particular problems managing their finances. During a manic, or ‘high’ phase, people can feel euphoric, brimming with ambitious schemes or ideas, their confidence excessively high. They may reach financial decisions that seem sensible to them at the time but which, in retrospect, are not. People may spend extravagantly and build up considerable debts.

“After a high phase is over, they are often shocked at what they have done and by the consequences they face. This spirals out of control very quickly and can be very daunting.” During a low phase, the person may feel so depressed they are unable to leave the house or even answer the phone. Unopened bills can pile up.

Comedian and writer Stephen Fry spoke out about his experiences on behalf of the charity Mind. He said: “My own bipolar condition has caused me to go on plenty of giddy spending sprees. Because so much stigma still surrounds mental health, many people can’t get a job, are on the poverty line, and can’t get credit from anyone but doorstep lenders charging up to 400 percent interest.”

Mind’s chief executive, Paul Farmer, adds that people with bipolar disorder can become trapped in a spiral of debt that further compounds their mental health problems. He believes that procedures need to be put in place that allow people to protect their finances while still retaining autonomy. Customers with mental health problems should be able to ask their bank to monitor their account for unusual spending patterns, and should be treated appropriately if they miss repayments.

Getting Out of Debt While Bipolar

Mental health professionals can sometimes offer advice and help individuals set a realistic budget. They may be able to help set up a repayment plan to creditors and teach financial management skills.

Friends and family may be able to assist by creating checks and balances to prevent manic spending sprees. If in agreement, they could monitor the individual’s money from a distance. Psychoeducation could also be a good idea. This is teaching people with bipolar disorder about the illness, its treatment and how to recognize triggers which might cause relapse so that early intervention can be sought before a full-blown illness episode occurs. The approach may also be helpful for family members.

In addition, there are support groups available for patients and their family members to help them talk openly about the condition. Studies suggest that the availability of social support increases the chances of employment in patients with bipolar disorder compared with those patients without support.

As always in bipolar disorder, lifestyle decisions such as exercising and eating well can help avoid problems. Keeping regular sleeping patterns is thought to be helpful in preventing episodes, as is avoiding excessive stimulation such as caffeine or stressful social events during the onset of a possible manic episode.

When tempted to make a large purchase, people with bipolar disorder might feel able to alert their spouse, partner or friend in time to discuss the purchase. There may also be the possibility of delayed order processing which needs a second approval at the end of a cooling off period before final confirmation.

Whether it is repairing the damage caused by excessive spending during manic episodes, dealing with loss of earnings as a result of illness, or taking steps to prevent future problems, financial health is a top priority. It can be as important a factor in staying well as any other form of help, treatment and support.



Dialectical Behavior Therapy: Radical Acceptance

By Christy Matta, MA

For many, reality is hard to accept. Unexpected and overwhelming events like lost jobs, physical illness and financial problems can make us want to give up or refuse to acknowledge the realities of our circumstances.

In Dialectical Behavior Therapy, the ability to accept life, the reality of circumstances in which we find ourselves and the painful events that each of us must endure is taught as a skill.

These skills can be difficult to teach and learn because the ability to respond to the world as it is, is an underlying attitude towards life. These skills, taught in the Distress Tolerance Module of the skills training group, include strategies to get both our bodies and our minds into more accepting attitudes.

Below are a few exercises on acceptance:

Body Awareness

To cultivate a more accepting state of mind, increase awareness of your body. Start by simply bringing your awareness to the position of your body. This can be done any time and any place. Whether you are walking, standing or sitting, notice your position. Become aware of the purpose of your position. For example, are you folding your arms across your chest in a defensive stance or are you tapping your foot in anxiety. If you notice that your mind has drifted, bring your attention back to your breath. It can be helpful to practice breathing exercises, such as counting each breath or saying “in” with each inhale and “out” with each exhale.

Turn Your Mind

Acceptance requires a choice. You have to turn your mind towards accepting reality, rather than rejecting and judging reality. You must commit to accepting the current situation and reality over and over. Each time your mind tells you it’s unfair or shouldn’t be as it is, you must turn your mind towards acceptance.

Be Willing

When the world seems unfair and you’re feeling stuck, depressed or frantic, it’s natural to want to give up, try to fix what can’t be fixed, or simply refuse to tolerate the situation. Instead of trying to impose your will on reality, focus on doing what works. Do just what is needed in each situation. Your job is to simply do your best, whatever the world throws at you.

Accepting reality can become a habit. If done regularly, it can reduce stress and anxiety and improve your ability to identify and solve the problems in your life.   What helps you accept life as it is?



Know Your Triggers

Often we get caught up in life and forget that it's often our life styles that lead to bipolar disorder symptoms.

 If you've been ill lately and can't seem to find relief, there are specific areas you can look at and make changes. I know this because I need to do the same for myself these days.

The following list will help you examine where your life is today and how your behavior and the behavior of those around you might be making you ill.

Doing too Much: Is there any chance you're doing too much these days? Or maybe there is simply too much going around you that you can't change. I remember when I was in the process of selling my house, sending my second book to publishers, going through a break-up and trying to be there for a family member who is getting a divorce. It's too much. I could personally can handle it, but my bipolar disorder brain could not. Period. I had to get some help. So, I explained that others would have to help me with the move. I was simply not in a position to deal with all that was going on. I told the family member that I cared about him very much and that I was here for him, but I couldn't really get involved in his situation. This may be similar to your life these days. If you're taking on too much and simply can't stay stable, it's ok to back down and say, I can't do it all. It doesn't make you weak. It just means you're taking care of yourself. This can be especially difficult if the doing too much is caused by your work, but once again. If you don't take care of the problem now, it might really affect your work adversely in the future. It's always a balance.

Here are some ideas for what you can do if there's too much going on in life:

- Choose one project only. The others will have to wait. Be honest with people and tell them that you want to get stable and this means you can't be everywhere all of the time and you can't be the person that everyone turns to if they have a problem.
- Remind yourself to treat bipolar disorder first. The whole point of management is to use the tools you have to stay stable. If you stop using them, the illness will take over.
- Take a break for a few days and don't do anything. I know this helps me, even though it's hard to do.

When I read the above list I think, sure Julie. This sounds good on paper, but it's hard in real life. Yes, that's true. But I know that if I don't take care of myself the depression will get worse, the psychosis will return and the mania just might pay me a little visit. I want to prevent mood swings instead of being in constant crisis control.

Relationships: Is there someone in your life whose behavior makes you ill? Maybe they're always telling you what's wrong in their lives. Maybe they tell you what they think is wrong with you! Maybe they try to change you. Is there someone in your life who likes to pick fights? Do you have a relationship with someone who is verbally or physically abusive? I know from personal experience that our bipolar brains simply can't handle abuse. Ever. We will get sick if someone abuses us. Even if it has nothing to do with us. Even if it's a stranger - and es pecially if it's someone we love. I've always felt that we get enough abuse from the illness itself. We certainly don't need abuse from someone on the outside. I don't stay in abusive relationships. Period. I can't. I will end up in the hospital. And no person is worth that. If I know someone who literally tells me all that is going wrong with them every time we meet, I don't see them. If I do have to see them, I don't participate in the conversation. Or I lead it in a different direction by saying, "Tell me what's going well for you right now. I'm interested." If I know someone who for years has complained about their lives and never done anything about it. I don't hang around that person. Yes, even if it's a family member. This has nothing to do with love. It's protection.

If someone is cruel to me, it's my obligation to take care of myself by leaving. If you're in this situation right now, you know how hard this is. If we love someone and they hurt us, leaving seems impossible. But I can tell you it is possible. It's painful and it's sad, but it's better than being suicidal or out of control manic.

As my book for couples states in the triggers chapter, stressful relationships are one of the main triggers of bipolar disorder mood swings. It's up to us to do something about them. Here are some tips:

- If you have a stressful relationship with someone at work, try to limit contact or make it strictly business at all times. If it's too much for you, get help. Nothing is worth having to work with a jerk all day.
- Cultivate relationships with positive people. It takes time, but it is possible. I would say it took me about one year of living in my new city to really find positive, proactive, supportive people I can trust. Now I treat them like gold, because they are gold to me!
- Set limits with the people in your life and let them know you're doing this in order to stay stable.
- Read my book for couples. There are a lot of relationship tips in the book even if you're not in a relationship with someone who has bipolar disorder.
- Remember that you are precious. As new agey as that sounds. You matter and the people you hang out with are a reflection of what you think about yourself.


I hope this helps. These are just two areas you can look at if you're having mood swings these days. Of course, checking your meds helps as well. I know that I get so tired of having to manage this illness, but it's a reality of our lives if we have bipolar disorder. If you're a friend or family member of someone with bipolar disorder, please know that your help means so much. The more stable and supportive you are, the more stable and supportive we can be. Of course this can be hard if the person you love is going through mood swings, but if you can remember it's not on purpose: it's an illness! Maybe this will help you get through the tough times.

from Julie Fast's newsletter


Man Gets Kicks Convincing Depressed People To Commit Suicide In Chat Rooms

MINNEAPOLIS — A nurse who authorities say got his kicks by visiting Internet suicide chat rooms and encouraging depressed people to kill themselves is under investigation in at least two deaths and could face criminal charges that could test the  of the First Amendment.

Investigators said William Melchert-Dinkel, 47, feigned compassion for those he chatted with, while offering step-by-step instructions on how to take their lives.

 By his own admission, William Melchert-Dinkel had a problem: He liked watching people kill themselves. He trolled suicide Web sites and chat rooms starting in 2005, posing as a 29-year-old female nurse who sympathized with depressed people and then offered 'expert knowledge' on the most effective way to commit suicide. At least two people did, say Minnesota authorities _ an 18-year-old college student in Canada and 32-year-old Mark Drybrough. (AP Photo)

"Most importatn is the placement of the noose on the neck ... Knot behind the left ear and rope across the carotid is very important for instant unconciousness and death," he allegedly wrote in one Web chat.

He is under investigation in the suicides of Mark Drybrough, 32, who hanged himself at his home in Coventry, England, in 2005, and Nadia Kajouji, an 18-year-old from Brampton, Ontario, who drowned in a river in Ottawa, where she was  at Carleton University.

While the victims' families are frustrated that no charges have been filed, legal experts said prosecuting such a case would be  because Melchert-Dinkel didn't physically help kill them. In the meantime, he has been stripped of his nursing license.

"Nothing is going to come of it," Melchert-Dinkel said of the allegations during a brief interview with The Associated Press. "I've moved on with my life, and that's it."

The case came to the attention of Minnesota authorities in March 2008 when an anti-suicide activist in Britain alerted them that someone in the state was using the Internet to manipulate people into killing themselves.

Last May, a Minnesota task force on Internet crimes  Melchert-Dinkel's computer and found a Web chat between him and the young Canadian woman describing the best way to tie knots. In their search warrant, investigators said Melchert-Dinkel "admitted he has asked persons to watch their suicide via webcam but has not done so."

Authorities said he used such online aliases as "Li Dao," "Cami" and "Falcon Girl."

The Minnesota Board of Nursing, which revoked his license in June, said he encouraged numerous people to commit suicide and told at least one person that his job as a nurse made him an expert on the most effective way to do it.

The report also said Melchert-Dinkel checked himself into a hospital in January. A nurse's assessment said he had a "suicide fetish" and had formed suicide pacts online that he didn't intend to carry out.

In excerpts of a Web chat between Kajouji and Melchert-Dinkel, provided by Kajouji's mother, he allegedly gave the young woman both emotional support and technical advice on hanging.

"im just tryin to help you do what is best for you not me," one message said, posted using the alias "Cami." Kajouji's mother said she was given a transcript by Ottawa police.

In another exchange, "Cami" tried to persuade Kajouji to hang herself instead of jumping into a freezing river: "if you wanted to do hanging we could have done it together on line so it would not have been so scary for you"


Bipolar Disorder and Coffee

CoffeeI Love Coffee, but my anxiety hates it…

Why does caffeinated coffee taste so good? I am not someone who likes caffeine. It actually makes me feel quite awful. But I love the taste of coffee. I know that I should only have decaf. It tastes ok and doesn’t make me anxious.

But regular coffee just tastes SO much better. I find that I let my guard down in order to have real iced coffee. Not the decaf Americano iced coffee, but the kind of coffee that is cold brewed and wonderful. And it’s only available as regular coffee.

Is it worth it? No. It takes at the most 10 minutes to sit and drink an iced coffee while I work. I can then have HOURS of anxiety from just one drink. In fact, once the anxiety starts, it can affect me all day. I know that if I have an iced coffee about once a month, and I have it on a day where I’m not anxious, I can handle it. But if I drink coffee a few times a week, the caffeine accumulates in my body and my anxiety gets much, much worse.

My coauthor Dr. John Preston always tells his clients to carefully watch their caffeine consumption. I have to agree with him. For those of us with anxiety, no caffeine is the ONLY way to go. My friend Sherri is on Zyprexa and if she makes the mistake of having regular coffee, the caffeine and Zyprexa interact and make her really anxious and shaky. Also, be careful at the coffee shop. Starbucks has messed up my order many, many times. I always know if it’s real coffee though- by the taste! I take it back and say, “Are you sure this is decaf?” And they will say, “No! I missed that one.” Just great.
Are you anxious? Do you drink coffee? Switching to decaf is not that hard. You just have to give up some taste to reduce your anxiety. I prefer the lower anxiety.

from Julie Fast's newsletter

Childhood Abuse Linked to Migraines and Depression

By Rick Nauert PhD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on September 5, 2007

WomanAdult health problems among women may be traced to childhood abuse. According to a new study, a history of childhood abuse is more common in women with migraines who suffer depression than in women with migraines alone.

The study is published in the journal Neurology®, the medical journal of the American Academy of Neurology.

“This study confirms adverse experiences, particularly childhood abuse, predispose women to health problems later in life, possibly by altering neurobiological systems,” said study author Gretchen Tietjen, MD, with the University of Toledo-Health Science Campus and a member of the American Academy of Neurology.

Researchers surveyed 949 women with migraines about their history of abuse, depression and headache characteristics. Forty percent of the women had chronic headache, more than 15 headaches a month, and 72 percent reported very severe headache-related disability. Physical or sexual abuse was reported in 38 percent of the women and 12 percent reported both physical and sexual abuse in the past. These results for abuse are similar to what’s been reported in the general population.

The association between migraines and depression is well established, but the mechanism is uncertain. The study found women with migraines who had major depression were twice as likely as those with migraines alone to report being sexually abused as a child. If the abuse continued past age 12, the women with migraines were five times more likely to report depression.

“The finding that a variety of somatic symptoms were also more common in people with migraine who had a history of abuse suggests that childhood maltreatment may lead to a spectrum of disorders, which have been linked to serotonin dysfunction,” said Tietjen.

“Our findings contribute to the mounting data that show abuse in childhood has a powerful effect on adult health disorders and the effect intensifies when abuse lasts a long time or continues into adulthood,” said Tietjen.

“The findings also support research suggesting that sexual abuse may have more impact on health than physical abuse and that childhood sexual abuse victims, in particular, are more likely to be adversely affected.”

The study also found women with depression and migraines were twice as likely to report multiple types of abuse as a child compared to those without depression, including physical abuse, fear for life, and being in a home with an adult who abused alcohol or drugs.

“Despite the high prevalence of abuse and the increased health costs associated with it, few physicians routinely ask migraine patients about abuse history,” said Tietjen.

“By questioning women about their abuse history we’ll be able to better identify those women with migraine at increased risk for depression.”

Source: American Academy of Neurology



Despite Abuse, Women Stand by Their Man

By Rick Nauert PhD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on April 13, 2010

Despite Abuse, Women Stand by Their Man A new study seeks to determine insights into the behavior of women entrenched in an abusive relationship with their male partner.

Researchers discovered that many who live with chronic psychological abuse still see certain positive traits in their abusers — such as dependability and being affectionate — which may partly explain why they stay.

“We wanted to see whether survey information from women who were not currently seeking treatment or counseling for relationship abuse could be a reliable source for identifying specific types of male abusers,” says Patricia O’Campo, a social epidemiologist and director of the Centre for Research on Inner City Health at St. Michael’s Hospital in Toronto.

She adds that past research has underscored abused women’s personal evaluations of their intimate relationships — specifically, their commitment to the relationships and positive feelings about the abuser or the relationship — as critical in their decisions to continue or terminate abusive relationships.

“We wanted to learn more,” says Dr. O’Campo, who co-authored the study with researchers from Adelphi University.

Using survey data from a project funded by the U.S. National Institute of Mental Health, the researchers explored the experiences of 611 urban-dwelling, low-income American women.

  • Overall, 42.8 percent of those surveyed said they had been abused by their intimate male partners in the year preceding the survey.
  • Psychological abuse was significantly more of an ongoing problem than physical abuse, while sexual abuse was reported as least common.
  • A relatively small number of women (2.3 percent) perceived their partners as extremely controlling, while 1.2 percent reported that their partners engaged in extreme generally violent behaviors.

But a considerable number of women felt their abusive male partners still possessed some good qualities: More than half (54 percent) saw their partners as highly dependable, while one in five (21 percent) felt the men in their lives possessed significant positive traits (i.e., being affectionate).

Based on the survey findings, the researchers divided the male abusers into three groups: “Dependable, yet abusive” men (44 percent of the sample) had the lowest scores for controlling and generally violent behaviors, and the highest scores for dependability and positive traits.

“Positive and controlling” men (38 percent of the sample) had moderately high scores for violence and also for dependability and positive traits. However, they were more controlling than men in the first group, displaying significantly higher levels of generally violent behaviors.

“Dangerously abusive” men (18 percent of the sample) had the highest scores for violence, controlling behavior and legal problems and the lowest scores for dependability and positive traits.

The researchers say their findings suggest there is value in studying the problem of male violence through the perceptions of abused women, including those who are currently “outside” the social services and legal systems designed to help them.

“The importance of listening to women’s voices cannot be highlighted enough and needs further exploration,” says O’Campo.

“This is just one step toward potentially increasing our understanding of how to find additional ways to improve women’s safety.”

Source: St. Michael’s Hospital
How To Improve Medication Compliance

By Rick Nauert PhD Senior News Editor
Reviewed by John M. Grohol, Psy.D. on March 31, 2010

How To Improve Medication ComplianceTaking a daily medication can literally mean the difference between life and death — yet people forget to take their meds all the time.

A new study has found that changes in daily behavior have a significant effect on whether we remember to take our medication, and that these changes influence older and younger adults differently.

“We’ve found that it is not just differences between people, but differences in what we do each day, that affect our ability to remember to take medication,” says Dr. Shevaun Neupert, lead author of a paper describing the research.

That’s good news, because it means there’s something we can do about it.

“This is the first time anyone has looked at the effect daily changes in how busy we are affects our ability to remember medications. We also learned that these changes in daily behavior affect different age groups in different ways. For example, young people do the best job of remembering to take their medication on days when they are busier than usual,” Neupert says. “But older adults do a better job of remembering their medication on days when they are less busy.”

The researchers evaluated study participants who were on prescribed daily medications. The participants were divided into two groups: younger adults (between the ages of 18 and 20) and older adults (between the ages of 60 and 89).

For both age groups, the researchers found that participants were more likely to remember to take their medications on days when they performed better than usual on “cognition” tests, which evaluate memory and critical thinking.

“We found that cognition is an important factor in remembering medications,” Neupert says, “but that how busy we are is also important.”

This has very real applications for helping people remember to take medications that can be essential to their health and well-being.

“We’ve found such a disparity between young and old adults, that it’s clear we need to tailor our messages to these two groups,” Neupert says.

“For example, it is important for young people to stay busy and be active. That will help them remember to take their medications. However, we need to let older adults know that need to be particularly vigilant about remembering medication on days when they expect to be busier than usual.”

The study, “Age Differences in Daily Predictors of Forgetting to Take Medication: The Importance of Context and Cognition,” will be published in a forthcoming issue of Experimental Aging Research.

Source: North Carolina State University


Depression or Bipolar?

By Kristina Randle, Ph.D., LCSW

I’m not really sure where to start. For about 4-5 years I’ve alternated between depression and a very hyper and (usually) happy mood. The depression usually lasts a few weeks, sometimes a month or so. The hyper mood rarely lasts as long, usually a week or two.

I usually think about suicide a little when I’m depressed, and seriously consider it every few months but talk myself out of it because I know I’ll feel better eventually. (I also know I’ll get depressed again, but I don’t think about that when I feel that way.) Occasionally it will seem like I’m sort of disconnected from everything, like everthing is hazy, like in a dream although I know what’s real and whats not. Once it got so bad that I started to believe my mom was keeping me at home forever (I’m homeschooled) and would kill me if I tried to escape or found out about her “plan”, and that my brother was part of it(not true at all by the way). Other than that I don’t know what else to say about it, I guess it’s mostly just typical depression. Now I’ll explain the hyper mood.
It starts with me not being tired at all and just feeling silly.

I can sleep 0-5 hours a night for several days and still not be tired. It seems like I do everything faster, and after a little while it gets annoying because everything else seems too slow and starts to get boring/frustrating. I get distracted almost constantly by how fast I think. My thoughts are loosely connected by one detail of each thought, or I make up conversations I’d like to have with people (almost like daydreaming). It used to get so weird that I would start to believe impossible or nearly impossible things. When I was about 13 I learned one song on guitar and believed i would be the most famous guitarist in the world by the time I turned 14. I once believed invisible cameras were following me and somehow recording what I did then to be used in interview or something in the future when I would be on TV. Similar things like that happened alot until I was about 15, I still daydream like that alot but never believe it as much as I used to. Colors seem brighter and its like I’m aware of everything. Sounds, smells, peoples conversations, basically everything becomes clearer. Recently its been more anger and anxiety than happiness, especially after several days of it. That’s all I can think of for explaining that part.

Ive occasionally heard things in either/both moods. Usually just noises or my name. Sometimes I get really angry, sometimes over very little things. When I was younger I would throw/break things when I got really mad, after awhile my mom nearly made me go to therapy so I learned to stop throwing/breaking things but I still get just as mad. It usually feels like I can’t control it, like the anger takes over me completely.
My family history:

Ive occasionally heard it mentioned that my dad is bipolar, but I dont know for sure because I havent asked him.
grandma, aunt and uncle on antidepressants (dont know exactly why)
Cousin that attemped suicide once (also dont know why)
other cousin that was kicked out of the coast gurd for some mental or emotional issue (again dont know exactly what/why)
grandmas brother that was severely depressed almost his whole life
Thats all I remember.

Because of my dad I’ve taken the bipolar quiz on this site and I scored a 43, but I’m not taking it too seriously because its just a quiz.
Well thats it, sorry its really long but I tried to put as much detail as possible. Thanks for reading this.

A. If you are a regular reader of my column then you know that it is difficult for me to give an individual a reliable diagnosis over the Internet. Based on your letter it is possible that you have bipolar disorder. You have described periods of depression and mania. What you describe as being “a hyper mood” is fairly consistent with the description of mania. If you would like to read more about the signs and symptoms of bipolar disorder please click this link.

What can and should you do? Make an appointment with a mental health professional. He or she could help you determine if you meet the criteria for a diagnosis of bipolar disorder. You may want to choose a mental health professional who specializes in the treatment of bipolar disorder.

After you have been evaluated discuss with the clinician what type of treatment would be best for you. I would not recommend ignoring your symptoms. Aside from the fact that you may have bipolar disorder my concern is that you have suicidal thoughts. Individuals with bipolar disorder are more likely to attempt and complete suicide. This potentially places you at a higher risk for suicide. Suicidal thoughts need to be taken very seriously. I would advise anyone who is having thoughts of suicide to see a mental health professional immediately.

Writing a letter is a starting point but more needs to be done. I hope you will follow through and make an appointment with a mental health professional. If you have any further questions, please do not hesitate to write back. Lastly, here is a link to the Psychology Today website where you can search for a therapist in your community. I wish you well.


Ten things friends and family members NEED to know about those of us with bipolar disorder.

10. If you blame us or put us down or get impatient or angry with us for bipolar disorder
behavior it simply makes us sicker!

Impatience never got us out of bed or made us less depressed. Anger never made us stop spending
when we are manic. Kind and realistic rules and limits do help. Telling us that you will not and cannot
live with us if we don't treat bipolar disorder first does help. But helping us help ourselves is the best
gift you can give us. The Health Cards can help you figure out what part of our behavior is bipolar
disorder and what part is just us. If you know what behavior is a symptom of the illness, you can then
treat the illness to help the behavior instead of getting so upset with us all of the time.
(We are upset enough with ourselves, believe me!)

9. Understand that we cannot always help you do things when we are sick. You may need help
around the house, with the kids, the bills, the laundry, etc. Deep down we know that, but sometimes we
are just too sick to do anything. Help us get well and then we can help you around the house more. Help us
get well and we will be a good friend, partner, daughter, son, grandson, granddaughter and parent. If you
expect us to be able to do normal things when we are sick, then you will only get more upset with us. If you
expect us to treat bipolar disorder first- that is reasonable and something we can work on together! Then we
can do the laundry and the dishes with pleasure. We can have fun in life.

8.  Depression is very motivated. I don't know if there is a more successful illness in the world. It is a champ,
a winner! It sets goals and follows through with its goals. "I want Julie to be really sick and down on herself today.
I want her to stay in bed, eat junk and cry buckets of tears."  And it sure does do a good job! Depression is serious
and motivated and strong. Without the right tools it is impossible for us to fight it. WE ARE NOT LAZY! WE ARE
NOT SLACKERS! WE ARE NOT DUMB, WEAK OR FAILURES! We are sick. Learn our individual signs of depression
by using the Health Cards and help us fight it. If depression is motivated and successful, then we all have to get
motivated and successful. If you see us sitting on the couch doing nothing day after day- don't get on our case
for being on the couch. Get some tools to help us get off the darn couch! Get motivated, serious and strong, just
like depression. Then teach us how to do this. Help us find the right mix of medications, alternative treatments and
lifestyle changes that make depression the failure instead of making us look like failures. We need your help to fight
this illness. We need your love to beat depression.

7. What you do in YOUR life makes a huge difference in how we experience our bipolar disorder
in OUR lives
This is not fair on you, but it is a reality. It should be that you can do what you want and we can lead our own lives
and let you be you - but people with bipolar disorder cannot simply separate themselves from the things you do.
If you are stressed and unhappy and unhealthy, you have to know that it affects us greatly.

6.  Bipolar disorder is a disability. It is not really recognized in that way right now, but it will be more so in the future-
many of us are dis-abled from leading the life we want and you want us to lead. We simply can't function like other
people can function. We can't snap out of it, therapy our way out of it or just get on with it- whatever the "it" is you
want us to do. WE HAVE TO LEARN WHAT WE CAN DO AND WE NEED YOUR HELP! Please know that stress makes
us sick- good stress, bad stress, stress that is none of our business- all stress makes us sick. Can you look at us differently? Can you see us as people who have an illness that often makes us unable to be "normal"? Can you hug us, love us and help us even when we make you scared, angry and embarrassed? Please help us turn a disability into an opportunity.

5. This illness is not about you. We are not trying to punish you or ruin your life. We do not want to treat you badly. It is a side effect of bipolar disorder when we change our moods. This does not make it ok- and it does not mean that it will not cause huge problems for you, but it is not about YOU at all.

4. If we are manic, spending money seems like a good idea. It is part of the illness. It is a proven symptom of
mania. We need your help in creating checks and balances so that we can prevent manic spending sprees. If you are
blind to what we are spending when we are well and then suddenly notice the $5000 we spend during a manic episode
and then get angry, it is not fair. Please be consistent and help us monitor our money at all times so no one is caught
unaware again. You can use the Health Cards to help us prevent manic spending sprees. We can't do it alone.

3. Medication side effects really, really suck. They often make us fat, tired, sick, scared, suicidal, seemingly stupid
and angry. We need help in adjusting our meds and telling the doctors what we need. It is not ok to have these side
effects and when we are in the middle of them and a doctor is telling us just to "wait and see how things go," we feel
helpless and want to give up. Help us find different medications and comprehensive treatments that do not have so
many side effects. Advocate for us if we are intimidated by our doctors.

2. Some of us with bipolar disorder cannot work like "normal" people. We cannot go to the office or keep a 9-5 job. It simply makes us too sick to function. Many of us have had a different job every year because we want so badly to fit in and be like everyone else. The reality is that we may need to find alternative ways to support ourselves and we truly need your help. Please understand that we WANT to be productive- we just have to find a different way of being productive. Going to an office really is not everything. If we need disability, help us get disability and understand that it is so very humiliating for intelligent people like us to have to get help from the government because we can't work. Never, ever make us feel guilty because we can't work! Help us find work that is non stressful, fun and helps us be independent. And if you are supporting us because we can't work- thank you so very, very much.

1.  People with bipolar disorder are intelligent, funny, creative, free thinkers, different, loving and kind -

People with bipolar disorder are demanding, sad, annoying, scary, self centered, all over the place, uncaring, dangerous, and crazy - WHEN THEY ARE SICK. In order to help us be all of the good things, bipolar disorder must be treated first. Use the Health Cards and any other books you may have to help us treat the illness first - for the rest of our lives. This is the ONLY way for us to have a good relationship. Because bipolar disorder does not want any of us to be happy. Friends and family are so important in the lives of people with bipolar disorder. We do not need you to take care of u s- not at all- we need you to help us take care of ourselves: Take care of yourself first, get the right
tools and then show us that you are willing to join us in our goal for a stable life. Always take care of yourself, but NEVER GIVE UP ON US!



33 Tips and Tricks . . .

For Managing Bipolar Disorder

by Julie A. Fast

1. I check my moods daily. I try not to let an episode sneak up on me.
2. I know the absolute first signs of a swing and I take action at the beginning.
3. I educate the people in my life about the illness and how they can best help me. 
4. I am now able to see who can help and who can't. I don't ask for help from the wrong people.
5. I try to accept my limitations.
6. When I am ill - I stop everything and do anything to get better, because I know that I don't have a real life when I am in the jaws of bipolar disorder.
7. I learn from others, but I try to learn to listen to myself as well. I know what works and what doesn't.
8. I use the Health Cards and I teach everyone I can how to use the Health Cards so that they are ready when I get sick.
9. I now know that making a spur of the moment change is not a solution for bipolar disorder. I have to be happy where I am before I can ever be happy anywhere else.
10. Impetuous decisions are a sign that I am not well.
11. If I'm in a situation I can't control, I have to say - it is not my ?Issue ?Battle ?Business ?And then I have to let it go!
12. If someone upsets me every time I see them and I have a mood swing every time I see them, it is up to me to completely change the interaction or not see that person at all.
13. Nothing is worth getting sick over--no one is worth a downswing.
14. Suicidal thoughts are normal because I have bipolar disorder. Knowing this helps me know that I need to work to get better instead of trying to figure out why I am having suicidal thoughts.
15. Voices that tell me lies are simply a part of bipolar disorder. I can totally talk back to these voices and tell them to leave me the hell alone.
16. If someone mistreats me, they are creating bipolar symptoms. I tell them to stop or I leave them.
17. Mood swings are normal because I have bipolar disorder, but they are not really acceptable. I have learned to do everything possible to prevent mood swings.
18. Medicines can often have side effects worse than the illness. I have the right and the obligation to search for meds that work for me and I have the right a nd obligation to supplement western treatments with holistic treatments such as the Health Cards that help me get better so that I can take less meds.
19. Living with bipolar is like being a chameleon- I never know if I am green or brown- well, chameleons live with this and I can too- I have learned to work with the illness.
20. I do not make life decisions when I am ill.
21. I do not make phone calls or send emails to friends when I am paranoid.
22. I know that psych medications can affect my driving. I am careful not to drive when I am on strong meds.
23. I make rules about my behavior and I stick to them, such as I WILL NOT CANCEL APPOINTMENTS.
24. If something makes me uncomfortable, I walk away--and I do not have to apologize or explain myself--I just walk.
25. I do not get involved in ANYTHING that does not dir ectly involve me such as a friend's relationship problems and I know that when I do get over involved that I may get sick and that I need to work to stay well.
26. No rubber necking. I really do not need to know what happened in an accident on the street or an argument in a restaurant.
27. I often do embarrassing things when I am ill. I accept that this is part of bipolar disorder and I try to learn from my mistakes.
28. I turned off the tv and kept it off until I was well enough to be selective (this took three years). This is one of the absolute best treatments for depression
29. If people helped me a certain way in the past and it no longer works, it is ok to say- thank you so much for your help, but this is what I need from you right now.
30. I turned my focus from being sick to getting well and now that I am better, I focus on staying well. My manage ment never ends.
31. I take care of my friendships and educate my friends. Bipolar is known to leave a trail of wrecked relationships. I try not to let that happen anymore, but if it does, I learn from it and move on. It hurts and I cry, but I survive. 
32. I listen to my inner voice and not the voice of bipolar. Do you know what your inner voice really says? I do- sometimes it's just a whisper, but it's the real me.
33. I never, ever, ever give up hope. Bipolar disorder is an illness - not my life. I can and will get better if I manage the illness daily. 
You've just read an excerpt of the book Bipolar Happens!.  If you have found this helpful, I encourage you to get your copy of the complete book by following the link below. 
Bipolar Happens! provides hope and inspiration for those with bipolar disorder as well as invaluable information for families. Written with stark and riveting honesty as only a person with the illness can do, you'll gain a deep understanding of what it is like to live with this illness and find practical steps for managing bipolar disorder.  

Order your copy of Bipolar Happens! today -



Do You Have Borderline Personality Disorder?

By Charles H. Elliott, Ph.D.

In the past several decades, we’ve watched the treatment of Borderline Personality Disorder (BPD) evolve from a virtually hopeless status with no clear answers as to what may work, to a far more sophisticated and hopeful array of possibilities (see our earlier blog on Increasing Hope for the Treatment of Borderline Personality Disorder). Have you ever wondered or worried that you might have BPD? The actual, current approach to diagnosing BPD is quite complex, but the four components that most folks with BPD demonstrate include:

  • Mood instability: A person with BPD may flip from feelings of joy to despair, sadness to profound anxiety, or affection to rage within minutes or hours. Sometimes these shifts occur many times throughout a given day. People with Bipolar Disorder, on the other hand, tend to have somewhat longer lasting moods though they also may demonstrate frequent shifts in mood.
  • Impulsivity: People with BPD tend to do things without thinking about the consequences first. Perhaps not surprisingly, this tendency often lands them in trouble. People with BPD also speak without thinking. They may lie to get out of trouble, exaggerate reality, or to lash out at others.
  • Disturbances in Thinking: We’re not talking about psychosis here although people with BPD do sometimes experience fleeting departures from reality. Rather, the more common disturbances in thinking that they have involve tendencies to see things in all or not, black and white terms with no shades of gray. Sometimes they are also inclined to having somewhat paranoid thoughts and see other people as maliciously motivated (though this “paranoia” does not reach psychotic levels very often).
  • Unstable Relationships: People with BPD are notorious for having struggles with interpersonal relationships. They get drawn into conflicts with other people and feel exquisitely hyper-sensitive to criticism or rejection.

If this description seems to fit you, please see a licensed mental health professional for a diagnosis. Although we see the mental health diagnostic system as highly flawed, there’s enough value in understanding the nature of your problems that we do recommend you get yourself checked out.

But if you discover that you have something like BPD, what should you do next? First, try not to blame yourself. BPD has a wide variety of causes including genetic, learning history, family issues, and traumas among others. No one asks to get BPD and frankly, BPD causes serious hurt and anguish to those who are afflicted with it. So what you do next is seek treatment, preferably from someone skilled in treating BPD with an approach that’s supported in the empirical literature. As we blogged previously, the primary approaches that have shown real promise in that literature include:

Dialectical Behavior Therapy (DBT)
Mentalization-Based Therapy (MBT)
Transference-Focused Psychotherapy (TFP)
Schema Therapy (ST)
Cognitive Behavioral Therapy (CBT) tailored specifically to BPD

Although DBT has the most support at this time, the others have been receiving increasing scrutiny and have exciting potential. Interestingly, they also do not seem especially incompatible with one another. One approach we’ve found particularly exciting is Schema Therapy, developed by Jeffrey Young, Ph.D. We’ll discuss that therapy in a later blog.




Why Women Stay with Controlling Men

By Marie Hartwell-Walker, Ed.D.

Why would a woman stay in a relationship with a guy who puts her down, hems her in, and perhaps even physically abuses her? Why would a woman hold down two jobs to keep the rent paid and food on the table while her boyfriend sits around smoking weed all day? Why oh why would a woman allow herself to be emotionally blackmailed by her boyfriend’s threats that he will kill himself or her or both if she even talks about leaving a relationship that is going nowhere?

There’s no easy answer. Often it’s a complicated mix of a number of answers. If you wonder why on earth you stay with the guy who keeps hurting you in spite of promises to do better, in spite of protestations that he loves you, in spite of your obvious distress about how things are going, see if you recognize yourself in any of these common reasons.

But please be careful not to jump to conclusions based on a list. It’s not at all uncommon for relationships to have some challenging times. Reasons for staying become problems when they become excuses or ways we fool ourselves into believing that things aren’t that bad when in fact they are. If you keep getting hurt; if you know in your heart that the relationship is diminishing you but you still keep going back for more, it may be time for you to get into therapy or to find the resources in your community that help women extricate themselves from a controlling or abusive relationship.

8 Bad Reasons Women Stay in Painful Relationships

  1. Because being someone’s everything is intoxicating stuff – at least at first. When you met, he only had eyes for you. He called to say good morning. He called to say “I love you” at lunch. He wanted to be the last voice you heard before you went to sleep. When you left work or your last class for the day, there he was - waiting for you. If another guy even looked at you, he put his arm protectively around you. If a guy friend called you up, he pouted. He wanted all your attention. In exchange, he gave you attention as no one ever had before. He wined you and dined you (or at least took you out for pizza and a beer several times a week) and made you feel like a princess. Sounds like any romantic beginning, doesn’t it?

    If your guy is so insecure that he needs control, his attention gradually became claustrophobic. Over time, his demands for all your attention all the time hemmed you in. You found yourself frantically explaining your every move that didn’t involve him. Staying a bit late for work, a girls’ night out, even a visit to your mother on a Saturday morning became grounds for a fight. What started out as wonderful attention became not so wonderful control.

  2. Because these guys can be absolutely charming. You didn’t fall in love with your boyfriend for no good reason. He can be charming. He can be romantic. He can say the things that every woman would like to hear. Sometimes he lets you see a sweet vulnerability that melts your heart. He seems to feel genuinely terrible after the two of you have had a big fight. He brings apologies and flowers. He promises he’ll be less jealous. He says you really are his everything. Lovemaking at times like these is delicious. He says all the right things to make you want to give him another chance. Things are wonderful for awhile. But then it starts all over again. You come home a little late and his eyes look stormy. You make a phone call and he has to know just who you’re talking to. Pretty soon, you’re feeling hemmed in again and you know that there’s going to be another blow-out…
  3. Because you don’t feel you deserve any better. Maybe you grew up in a family where you were told that you were no good, ugly, clumsy, or incompetent. Maybe your father or mother even told you “No one will ever love you.” Perhaps you were an ugly duckling in high school who never had a date or you were never accepted by the people you wished were your friends. Maybe you’ve had a series of disastrous relationships or no relationships at all. Your self-esteem is in the cellar. Even though a part of you knows that your family should have treated you better; even though you understand that high school is harsh for a lot of people, there’s an even bigger part of you that feels that maybe all the people who rejected you were right - you really are a loser. You’ve become convinced you should be grateful for any smidgen of caring your boyfriend provides - even if it is painful.
  4. Because you don’t know any better. All the women you grew up with were in abusive, difficult relationships. All your girlfriends complain about men who don’t do their share and who stopped being “Mr. Wonderful” long ago. Lacking role models for positive, loving relationships, you think good relationships only happen in the movies. Although you can agree in theory that women deserve to be treated with consideration and respect by the men who love them, you’ve never seen such a relationship up close and personal.
  5. Because he scares you or manipulates you. There are men who aren’t a bit subtle about their need for control. Try to leave and they threaten to hurt you or your kids or other people you care about. He may have even grabbed you too hard or hit you or locked you in a room or waved a gun around. When he goes into a rage, there’s no telling what he might do. So you do everything you can to prevent it – including staying.

    The manipulators are equally effective in trapping their women. They say they will commit suicide if you leave – and it will be all your fault. They are masters at making you feel guilty even when you don’t have a clue what you are guilty for. Fights inevitably shift to all the things you’ve done wrong – or at least wronger than him. You end up staying to make amends and make it right or because you can’t bear the idea of living with the guilt if he hurts himself.

  6. Because you truly believe you can change him. Because the relationship started out so wonderfully and because he can be so terrific after a fight, you hold onto the idea that you can bring out the best in him. All you have to do is find the right words and behave in the right way, and you’ll have the man of your dreams. Love conquers all, right? Wrong. No one can make another person be anything. He has to want it. He has to be willing to work on it. He has to want to change because it will make him a better person, not because he made an insincere promise in order to make up after a fight. Even though you know all this, you convince yourself that you’re an exception. You’re going to find a way.
  7. Because you are more afraid of being alone again than of being in a painful relationship. You’ve been alone and it’s lonely. You want someone to talk to in the evening, to cuddle up to at night, to at least once in awhile take the kids. Even picking up his laundry, cooking meals he doesn’t appreciate, and fighting with him is more appealing than coming home to an empty house. If he does help pay the bills and do a few chores (and especially if he pays most of the bills and can be counted on to do some of the heavy work), it’s even harder to think about going it alone. Supporting a family and doing everything to maintain a household as a single person is really, really hard. Maintaining the fiction that you have a partner feels better than dealing with the reality of going it alone.
  8. Because you love him. The most common answer I get when I ask women why they stay in bad relationships is “because I love him.” Love isn’t always rational, it’s true. There’s no accounting for chemistry. But the fact is that love, especially one-sided love, isn’t enough to sustain a relationship. It’s like one hand clapping.

If you are always on the giving end in the relationship; if you’ve accepted indifference, abuse, or manipulation because you don’t believe you deserve or can get better, it’s time to take charge of your life and to make some changes. If your guy will agree, try out couples therapy. Couples can and do change with commitment to the process and love for each other. If your boyfriend won’t join you in the project, get some therapy for yourself. Build up your self-esteem, develop the skills you need to be successful in the world, and increase your confidence in yourself. A stronger you will be able to hold out for the loving relationship that you deserve.




Bipolar Disorder Medications and Weight Issues
Many of us with bipolar disorder have trouble with weight gain due to medications. For others, eating enough is a problem and serious weight loss can be a result. No wonder weight issues are one of the main reasons people stop medications.


 My Story

by Julie Fast


As many you know, after three years of constant medications from 1995-1998, I gained over 80 pounds. I don't know the exact amount because after a certain point I was so profoundly depressed and upset by this weight gain that I stopped getting on the scale. I simply had an out of control appetite for three years. I couldn't stop. I know I weighed over 250 in 1998.


I asked for help from the doctors and the only reply I received was, "We will deal with the weight gain when the mood swings are under control."  I was so naïve back then. I thought I had to only LISTEN to doctors. I know now that I have to WORK with doctors as a team. There is a lot more awareness today regarding the potential for weight gain, but as the medications haven't changed much, knowledge is not enough to deal with the problem.  Gaining or losing too much weight needs to be addressed from the minute a person starts bipolar disorder drugs, especially as many of the mood stabilizers and antipsychotics used to treat bipolar disorder cause well documented weight gain.



What Causes the Weight Problems?

No one seems to be quite sure why people gain weight on medications.

The main reason seems to be that drugs themselves cause weight gain that is completely separate from a person’s diet and exercise level. This is especially true with antipsychotics where the weight goes to the belly area and is related to insulin and a diabetes risk. I know from a great deal of experience that some drugs used to treat bipolar disorder stimulate the hunger portion of the brain to the point that we no longer have a good sense of when we are full. (This is now backed with emerging research.) I have also had food hallucinations when I'm on certain meds. I actually hear voices that say, "You are going to eat until you are sick." No kidding! On the other side, a friend of mine took an anti depressant and AHDH medication and he has lost almost all of his body fat. Hey! Why didn't that happen to me! I should note that he has depression and not bipolar disorder. We tend to gain more weight.


I'm always amazed at how quickly my appetite changes when I take medications.

I sometimes take an anti psychotic when the psychosis gets bad and within hours I'm craving junk. I crave it like I'm starving. I get images of cake, cookies, ice cream and candy. I think about it and fantasize about it. I want to eat big spaghetti dinners with a lot of bread and could literally drink Coke at every meal. 

 My friend Sherri, who is obviously much healthier food wise than I am, once ate a can of garbanzo beans late at night- right out of the can! She takes Zyprexa.


 It's almost exactly like the food cravings caused by marijuana. (Before anyone writes me, I don't use marijuana to treat bipolar disorder. It messes up the brain and I can't risk that but I did use marijuana before I was diagnosed.) It's an odd phenomenon. I also remember taking Prozac in the 90's- (this was before doctors realized that no one with bipolar disorder should take an anti depressant without extensive questioning from an experienced mental health professional beforehand) and my appetite was simply gone. I used to walk into the kitchen and the thought of eating made me feel nauseas.



There are Solutions


I've lost a lot of the weight I gained in the 90's. It hasn't been easy. I've found that consistent exercise with a lot of weight training and walking is the best way to keep my body healthy, but it has not been effective for weight loss unless I combine it with dietary changes. I know that if I approach losing weight as something I HAVE to do, I will rebel and eat junk just to feel better. Instead, I approach it as just another tool to add to my Health Cards. If I see eating healthy as a way to reducing weight gains caused by meds, I am more likely to think before I put a lot of junk in my mouth. I know that eating sugar is not my best food choice. I would eat it for every meal if I let myself.  I'm lucky now that I don't need to take the meds that cause so much weight gain, but I still have to deal with the weight I gained so long ago. It's crazy!

This Doesn't Always Work


A friend of mine has been on Zyprexa for a year. It has saved her life. She stays out of the hospital and is able to work more consistently. The problem is that she gained 30 pounds the first three months she was on the Zyprexa. She didn't change her eating and often walked miles a day and she still gained the weight and can't keep it off. What can a person do? Luckily the weight gain stopped at 30 pounds. Mine just kept on going. Our bodies are so different. She and I talked a lot about her dilemma. Her clothes no longer fit at all. She is depressed about the weight gain and she wants to stop the med. But her doctor doesn't think she is stable enough. When she lowers the Zyprexa, she starts to get psychotic again.

It's so unfair. She made a decision to stay on the Zyprexa despite the weight gain. It's all about weighing options. Weighing options- get it!


Her goal was to switch from the Zyprexa to Abilify as it has few weight gain problems. Unfortunately, it didn’t work as well as the Zyprexa.  I'm just so thankful she's stable and of course her weight gain has no bearing on our friendship. Her partner is okay with it as well, but that is not much of a help when you can't wear your clothes and don’t like to look at yourself in the mirror! But you can adapt.


Are You Getting Too Skinny?


I can joke that I wish I could take a medication that made me lose weight, but if you're thin already this can truly be a problem. Often the restless energy caused by meds takes your appetite or you simply lose all desire and pleasure in eating. If you're in this situation, you have to treat eating as a task instead of waiting to be hungry. Even if the thought of eating makes you feel sick. Some meds can cause a drug induced anorexia feeling. So this is serious stuff. Remember, you don't have to want to eat in order to eat. Eat foods with a higher fat content. Eat yogurt and good cheese. Have some meat. Eat tortillas and tofu. Apples and bananas are good fillers. If you're stacking on carrots and celery, low fat foods or junk, your body will literally just burn it up. For you, eating has to be scheduled and required.




Walk. This is absolutely the best way to stay healthy and get the sunlight your brain needs. As you read this, maybe you're thinking- gosh, I'm so tired of reading all this information on how I need to walk. I don't have energy to walk! Well, guess what. You will definitely gain weight if you don't exercise when you're on weight gaining meds.

You can join a walking group if you won't walk alone. Make it something you want to do, not something you have to do. In the US there is a program called USA Fit. It starts in the spring and teaches people how to walk a marathon. I'm sure that no matter where you live, there are places to walk and people to walk with. This really can make a difference with bipolar disorder. Many people never start a walking program because they are waiting for the DESIRE to walk. The truth is you don't have to want to do something in order to do it. Depression will tell you it's pointless anyway. You simply have to say to yourself, I am going to walk and then wait for the good feelings that come regarding your body after the walk is over.


- Hire a trainer.

- Eat a protein breakfast or skip breakfast!

- Talk to your Health Care Professional about changing your meds:


Here is Some Encouragement


If I can go from an overmedicated, sick and despondent 250+  pound woman to someone who is at least healthy, alive and kicking and getting on with her life, you can do it as well. Give it time. This has been a seven year odyssey for me. The Health Cards gave me my life back, but now I have to use them daily to stay well. This means I can take less meds. I still get into the why me? Mode. But the reality is that my life is about managing bipolar disorder. This is an everyday process. I don't get a break. This goes for my eating as well. Do you sometimes feel it's too hard to deal with all of this? Well, you are not alone. It is very hard, but it can be done. And like me, you can be in a different place regarding your weight next year than you are now.


Julie Fast



I now take Lamictal (Lamotrigine). I'm lucky that weight gain is not a side effect, because I simply don't know what I would do. I know I will NEVER be 80 pounds overweight again. I took Serequel a few months ago and gained 26 pounds in less than three months. I had to stop it for that reason. And yet, another friend of mine takes Zyprexa and has had no weight gain. You have to keep trying different meds and talk with your doctor about your options. I say that gaining more than 20 pounds is a PROBLEM that must be addressed. If you're losing too much weight, eat eggs with some meat, toast and fruit for breakfast.


You don't have to eat a ton, but get all of those food groups in there.  This is not too hard to do and can make a real difference with your blood sugar. I know that I feel so much better if I have long periods between eating.  It all depends on if you're overweight or underweight. If you have the money, hire a good personal trainer. A Pilates trainer, a professional body builder (natural, not one who uses steroids) or a really dynamic private yoga teacher can make all of the difference. When you pay good money for something there is a chance you will take advantage of it more than if you just have a monthly membership to a gym.


If you don't have the money for this, find your least expensive local gym and see what they have to offer -then really take advantage of their services. Become a regular at your favorite class and meet others who want to stay in shape.


And then get a training partner. It's too hard to stay in shape alone for most people. We need help and encouragement from someone. And most importantly, hang out with people who are healthy. If we are with those who like to eat for recreation, we will eat for recreation. If we are with those who actually think that recreation is a walk- we will walk!





 Holidays are supposed to be such a wonderful experience. Television tells us this all of the time!
And yet for those of us with bipolar disorder- as well as those who love us- holidays can be very
stressful and ultimately unsatisfying for many reasons. This newsletter will cover some of the potential problems you may face in the next few months and then offer suggestions to help you manage and ultimately create a stable and loving environment so that you truly can experience the rewards of the holiday season.


I guess the holidays sneak up on all of us no matter what part of the world we live in. In the states, we are getting
ready for Thanksgiving, Christmas, Hanukkah, and much more. It can be a very, very stressful time. Suicide is at its peak in the holiday season as well - while the excitement and travel associated with the holidays can send a person into mania overnight.

The Holiday Rush

Now is the time to get ready for the holiday rush. So many people with bipolar disorder either become overly stressed, irritated or manic from all the seasonal requirements or severely depressed during this 'cheerful' season. Let's make this year different. You can create a plan now for dealing with the holidays before the decorations and obligations take over your life and make you sick.

Think Ahead

What are your plans for the holidays? Have you thought about how the next months will affect your bipolar disorder symptoms? Maybe now is a good time to think seriously about what you need to do in order to stay healthy and stable during this frantic time.

The first step is to check in and determine how you currently feel:

- How are you doing right now?
- Where is your bipolar disorder on a scale from 1-10?
- Are you stable?
- Is there an upcoming event that causes anxiety just thinking about it?

Sometimes we get so caught up in life that our symptoms creep up on us and we're soon too sick to do anything.

Family and Friends Are Affected As Well

If you're a friend or family member of someone with bipolar disorder, you can ask yourself the same questions. How is my loved one? Is she stable? Is he doing too much? What can I do to make things easier? Does the person I love go through a tough period because of t he holidays? How can I help this year?

You Already Have the Tools

The good news is that learning to stop bipolar disorder mood swings is not always about learning something new. It's often about stopping something you're already doing. This is a simple way to get some stability in your life before the hectic holiday season starts. Personally, I'm going to do absolutely
as little as possible this holiday season. I will go to friends' houses and let them cook! I'm creating checks and balances now that will make sure that my time with friends and family over the holidays will be
relaxed and fun. I no longer buy presents and am very careful to be ready for family stress.

What Can You Do Now?

Is there anything you can stop now in order to prevent bipolar disorder mood swings over the holidays? Have you thought of what's coming up and how you will deal with the shopping, food and family obligations? It may b e a good time to add a holiday card to your Health Cards or ask someone for help in planning events. It's also a good time to reread any of my books you may have! If you're already depressed, you have to treat depression first and then get ready for the holidays. Waiting for the
holidays to make you feel better may not work as well as you would like it to. But feeling better before
the holidays will make a difference.

Tips for Staying Stable

Mania, anxiety and depression are serious problems during the holidays. It's important that you're ready with a plan before the symptoms start.

* Be very careful about sleep changes due to travel. Time changes are triggers of bipolar mood swings and we all have to be careful when we travel . One secret is to start the time change weeks before you actually leave. For example, if I'm traveling to a place with an eight hour time change, I will slowly make the change in the weeks before I leave so that I'm on the destination's schedule before I even get on the plane. This can prevent the mood swings that can really wreck vacations.

* Holiday parties are fun, but they sure are stimulating. There's lot of fun food and alcohol and many people see it as a time to let go. This can be over stimulating for those of us with bipolar disorder. You need to think carefully of what you can and can't do. Start to think now about the checks and balances you can set up in order to stay well. For example, limit the alcohol and junk food, go to the parties but leave early if you have to, and ask for help from friends and family.

* Say no without guilt. I really mean this. Just say no if you know that something is going to make you ill. Remember, you don't have to explain yourself to anyone and if cooking a holiday turkey (or whatever special holiday dinner you have in your country) is too much for you, then just say no. If decorating the house for the holidays is too much, then don't do it. You really do have the final say on what you do and don't do. Take advantage of this power and SAY NO! This may break a tradition at first, but if you explain the reasons, people often understand- at least they will when you do the same the next year!

* Families! Well, it can be pretty stressful for families during the holidays. Take your Health Cards with
you to family gatherings and use this time as a way to introduce your family to your management plan. Make a decision before you go to any get-together that you absolutely will not get into stressful discussions no matter how hard someone baits you. Picture yourself walking away and then do it if and when things get heated. Another solution is to have a holiday season away from your family. You have so many more choices than you think you have. Always make the choice that keeps you healthy. If you do find yourself in a contentious situation and you start to cry or have a panic attack, remove yourself from the situation and do everything you can to get back on track and join the party again.

* Spending is such a big issue during the holidays. When I first started using the Health Cards it became very obvious that the emphasis on spending had ruined the holidays for me. So I made a decision- I stopped giving presents completely and asked others not to give me presents. The relief was enormous and the holiday time became about family and friends again instead of rushing around in over stimulating shopping malls buying things that no one needed any way. I read a book called 'Unplug the Christmas Machine' and stopped seeing Christmas as a spending orgy and decided it was more about family. If you are religious, then this may be a good time to rediscover what the holidays mean to you outside of shopping. Whether it's Christmas, Hanukkah or the particular holiday your country celebrates, try to make this year the year you change the focus from things to people. It's a lot less stressful and very
few people ever became manic from a family hug! Believe it or not, just reading what I wrote here
makes me feel a little stressed. The holidays really can be overwhelming. I'm glad I'm thinking ahead.

* Try the daily check in. At a certain time every day, check in and ask yourself how you are on a scale of one to ten. This can help you slow down and see if a mood swing is starting. If you feel a symptom, go to the Health Cards and look in the What I Can Do column and stop the swing before it goes too far. I often set the beeper on my watch t o remind me to do a check in during stressful times.

* Loneliness. I've had quite a few letters from people who say they are very lonely during the holidays as bipolar disorder has taken most of their friendships. This is often a reality of this illness. As many of you know, I also lost most of my friends when I was ill. There are many things you can do to make these holidays less lonely, but over all I still suggest that working on becoming a good friend by stabilizing your bipolar disorder with the Health Cards is the first step in taking care of the problem. Here are some suggestions for making the holidays happy and fun when you're lonely:

- Volunteer to help others on the major holidays. Believe me, people in a homeless shelter, battered women's shelter, youth home, or hospital would love your company. Make it a goal to help others this holiday season and make sure you do the following: Don't talk about your problems and your illness when yo u do this work. This puts people off and is a barrier to new friendship. Try to get outside of this illness and be the real you. Listen to what others have to say and get interested in something besides your own mood swings. And yes, you can get out and do things even when you're depressed.

- If you have the money, go to a singles event for the holidays. Go there with the idea of making friends and being social. Make it a goal to listen to others and hear about their lives. Keep talk of yourself to a minimum and work on listening to what other people have to say. I emphasize the listening part because I know that when I was sick and lonely, I tended to talk about my problems constantly instead of
opening myself to learning about other people.

- Get back in touch with any family members you may have alienated when you were ill. Tell them about the Health Cards and ask them to work with you. It never hurts to try.

- Make it a goal that b y this time next year you will be healthy and stable enough to have strong and loving friendships. Do the work on yourself now so that you don't have to be lonely during the holidays ever again. If I can do it, you can do it too.

No matter what, if the holidays are important to you and you don't have any plans - now is the time to make plans. You don't want to be alone and depressed when everyone on TV is having so much fun. I've been through this and it's not nice. There is always somewhere to go and someone to see if you
plan far enough in advance. If you're already having suicidal thoughts, it's time to do something about them before they take over completely. Use the Health Cards, go see your doctor and get some help.
As you have heard me say many times, suicidal thoughts are a normal part of bipolar disorder but they have to be treated quickly and effectively so that you can get back to your normal life.

There is an event group throughout the United States called This group offers events throughout the holidays. The group is expanding to other countries as well. I have been a member for over a year and love it. You can also look for groups and events on

*Think about the holidays before you simply rush into them.*

Start Your Plan Now

Hopefully these tips will help you to stop and take a look at yourself today, before the mad rush begins. This is the time of year I tell people with bipolar disorder to watch their stress levels very carefully. It
really is ok to say no to people and events if it means you can spend stable quality time with the people you love. Think about the holidays now and create a plan. That is what I'm going to do. I know you can do it as well. Make this a time to appreciate what you have and how far you have come, despite bipolar disorder. The holidays are not only about gifts or dinner parties, they are about people. And the best gift you can give anyone is your own health.


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It's easy, you are charged $ 92.00 now, we ship your full package of books and provide you your immediate download links. You will be charged the second installment in 30 days.  A simple and an affordable solution for the holiday budget.

The Full Package is perfect for spouses, parents, siblings, Health Care Providers, friends, family and of course, your loved one with bipolar disorder. Were so sure that this package provides you with what you need to manage bipolar disorder that we have added no hidden costs or fees in our payment plan. You can visit the web site
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Happy Holidays!

Remember Bipolar disorder is an illness-
Not your life.
You can get better. 




Actress Glenn Close talks about her personal interest in mental health





Sleep Issues

Regulate Your Sleep
To sleep, perchance to dream.............

Sleep is taken for granted by many people- but not for those of us with bipolar disorder! If you're the partner or parent of someone with bipolar disorder, you've certainly seen the problems we all have. The illness truly can cause TONS of sleep issues - some of these issues are caused by the illness, while others are controlled by the person with the illness. It's a pretty vicious cycle. The good news is that with just a few tips you can dramatically improve your sleep situation. It takes a lot of observation and sacrifice, but it can be done.

The Chicken and the Egg- is it you or is it bipolar disorder?

One of the main obstacles a person with bipolar disorder faces is the chicken and egg nature of the illness. If you can't sleep at night, is that because you're manic, wired from medications or is it a reaction to a decision you made the day before that affected your brain chemicals? These are important questions. There are two steps you will need to take to stop the chicken from laying the egg that created the chicken that.....: You will have to manage the illness successfully so that the mood swings reduce and don't affect your sleep as strongly and then identify, monitor and ultimately stop your own behaviors that cause sleep problems. I have many tips on how to reduce mood swings in my books. This newsletter will cover personal behaviors that cause sleep issues as they are easier to change! And of course, as you do this, the bipolar gets better and you really are managing bipolar disorder more successfully which leads to regulated sleep! This is a sweet, non vicious cycle ;)

What is Regulated Sleep?

When you go to sleep easily, sleep and dream deeply and wake up refreshed on a set schedule every night, you're experiencing regulated sleep. (How often do you get to experience this!) This type of sleep lets the brain send out the chemicals that control emotions on a set schedule. To put it simply, regulated sleep stabilizes the brain chemicals that control emotions. So, it makes a lot of sense that the more regulated sleep you can get, the more stable you can be.

The Role of Your Circadian Rhythm

Our bodies work on a 24 hour biological clock called a circadian rhythm. If you have bipolar disorder, this is a process you need to understand very clearly. The circadian rhythm of your body determines when you need sleep and when you need to wake. It is through this rhythm that your body knows when to start and stop certain chemicals such as serotonin. This is a natural clock- the problem is that busy lives often make it difficult for people without bipolar disorder to sleep according to their circadian rhythm. When you add bipolar disorder to the problem, disruptions to the cycle can be VERY destabilizing.

You Can Control Your Rhythm

The more you upset this rhythm by working odd hours, staying out late and partying, ignoring what you put in your body, cultivating stress, or watching upsetting tv before bed for example - the less likely you are to find stability. As you read this you may think, but I have to work these hours! I have to take care of my kids! I have to have coffee in the morning! Well, some of these behaviors may be exactly what you have to change in order to kick your circadian rhythm in gear so that you can sleep better and get your brain working more effectively.

Common Barriers to Regulated Sleep

- Shift work or work that upsets your sleep patterns such as an ever changing schedule
- Travel to different time zones
- Drugs and alcohol
- Medications
- Anything new- new baby, new job, loss of a job, new city, etc
- Caffeine!
- Stress
- Bright light before bed

This list is pretty endless isn't it! I could write 100 more barriers and still not get to them all - and yet everything on the list would have one thing in common- an upset circadian rhythm.

This newsletter will focus on three off the list: caffeine, stressful situations and bright light at night. Just working on these areas can improve your sleep immediately.

Sleep Stressor #1 Caffeine

Ah, as many of you know, I had a little iced coffee habit this summer due to the amazing coffee at the restaurant where I sit and write. I knew it was bad for me, but I kept thinking- just one more time and then I'll stop! I eventually had to stop when I realized the coffee that I drank in less than 15 minutes was literally affecting my sleep nightly. It was not worth it in any way. I have enough bipolar disorder sleep problems as it is- adding caffeine to the mix is just stupid. I have a friend who is a very no nonsense person. When I tell her about one of my bad habits, she very kindly and humorously says- "Well Julie! That's just stupid!" In other words, why on earth would I do something to undermine the work I do daily to stay stable?

Limit Your Caffeine!
My coauthor Dr. John Preston is on a caffeine awareness crusade. He suggests that a person with bipolar disorder limit caffeine consumption to 250 mg or less a day. Considering that a 12 oz Starbucks coffee has 260 mg- this can be a problem! (Decaf has about 10mg.) I started to drink iced tea when I went out. Then I realized that a few glasses of tea at 50mg a glass could cause problems as well. Is there no justice! Lucking I like decaf and it doesn't bother my sleep at all.

A New Caffeine Threat....
What is it? Energy drinks like Red Bull! People drink these sugary, caffeine drinks without thinking of their effect on mood swings. Red Bull has 80 mg of caffeine and lots of sugar. The combination is a brief high followed by a low. Just like a candy bar and a coffee. I've seen a lot of teenagers drinking energy drinks as they are considered cool. I like to be cool- but these days I prefer being stable.

It's your choice. Only you know if caffeine is disrupting your circadian rhythm and causing mood swings. I know that decaf is my only option if I want to curb anxiety and sleep better at night.

Sleep Stressor #2 Stress!

Stress is an outcome of a behavior - either yours or that of someone else. This means that 50% of stress is in your control! Over the years, I've systematically removed the major stressors that cause sleep trouble. I really limit going out for late nights. I know that if I stay out at karaoke past midnight I simply will not get to sleep. I still do this once in a while- but know I will have to take sleep meds. Staying out every night like I used to is simply impossible. I also worked on the relationships in my life that used to cause stress to the point that I went over the problems in my head when I tried to sleep. This was a process of course. Some of these people are family members. I can't change them, but I learned not to set up or walk into stress traps. For example, my brother and I love each other greatly, but I can't be in his life the way I would like to right now- it's too stressful. Fighting with him upsets me for hours- so I don't do it. It's the same with my mot her. There are things we discuss and things we don't. She loves me and I love her, but there is no reason for us to cause each other stress. Our whole family dynamic is so much better now and I think we all sleep better.

Work Stress
I can't work a 9-5 job. I realized this a long time ago. I can remember coming home from work after having trouble with a colleague and talking about it all evening and then not being able to sleep from worry. It's as though the conversation continued even when I was asleep. I can't do this anymore. It's a loss as I really want to work with other people. Does your work cause you so much stress that it affects your sleep? If this is the case, you have to decide what you can and can't change. You can make it a goal to sleep better at night no matter what it takes. For some it means changing jobs- especially if the hours are crazy. You have a lot more control over stress than you think. It's ok not to be passive and let the world make it hard for you to sleep.
If I have trouble getting to sleep, wake up at night or wake up too early in the morning and then sit there and get worried about a stressor in my life, I am going to change that stressor. My sleep is too important.

Sleep Stressor #3 Blue Light at Night

I recently met with a psychiatrist friend who is very interested in the effects of blue light on people with bipolar disorder. Apparently, certain parts of the light spectrum affect people in different ways. For a long time, the idea was that light in general was the culprit when it came to mania and agitation, but new research suggests that it might be the blue light alone that causes the problem. What is the biggest source of blue light in most American households? The television. If this blue light is stimulating, it makes sense that watching TV, DVDs and playing video games at night can over stimulate the brain and make it very difficult for you to get regulated sleep. He suggests wearing special blue light blocking glasses at night to block the blue light so that your circadian rhythm can kick in on a more natural schedule.

What! No TV!
As most of us don't have these glasses, the main solution to the problem is to stop exposure to blue light a few hours before bed. This means turning off the TV and reading, talking, doing crafts, family time, games, books on CD, writing or just relaxing as opposed to sitting in front of a television before going to bed. Hmm.. I've done it. I go to my room and read, write in my journal and listen to music. There is absolutely no question that this helps my sleep. The problem is that it feels a bit lonely and boring sometimes. It's always a trade off isn't it? Going out and meeting friends at karaoke versus going to bed early and waking up more refreshed. I've learned to compromise by going out, coming home earlier than I used to and then sitting in my room relaxing before I turn off the light. What will work for you?

Never Give Up!
There will always be situations where you can't control your sleep situation. I went to visit friends in a city a few hours away last weekend and ended up sleeping in two different beds as I moved around town. I didn't have my own pillow- it was too quiet- I was worried about being somewhere new, it was daylights saving time, etc. etc. I went into a down swing when I got home. I've decided that sleeping somewhere comfortable when I travel is the best way to insure that I have a good trip. This means a hotel room or planning ahead a bit more to find out my sleeping situation. It's that serious for me. What a bother- I want to have fun, but my body wants regular sleep. I want make the right sleep choices for the rest of my life as I don't want my life to be ruined by mood swings! I won't give up on regulated sleep- the more I learn about my body, the better choices I can make. You can do the same.

A Simple Goal
My goal is to help people throughout the world find a plan that works for them. If every person on this newsletter mailing list learns to manage this illness more effectively, it's a really great start. I use the Health Cards for Bipolar Disorder and the tips in my books to stay stable. All of my books have information for family and friends as well. Remember, educate yourself, take your meds, learn what works for you, teach others what you need and always know that bipolar disorder is a treatable illness. :)



© Julie A. Fast - All Rights Reserved



Straight Talk About Psychosis

I like to talk about psychosis- I want people to see that it has been around forever and that it's a very normal part of many mental illnesses, especially bipolar disorder- and yet it freaks people out. If you've ever been psychotic, it freaks you out too!

Here is a brief definition.

Psychosis is defined as a loss of contact or break with reality, which shows itself in a number of different ways including the following: paranoid thoughts- is someone talking about me, looking at me funny or following me? Hallucinations- where you see, hear or smell something that isn't there. Such as a rat running around a chair or hearing a voice that says, "Julie, you need to get out of this store!" Suicidal thought such as, 'Take that gun and kill yourself," are psychotic. I had my first psychotic thoughts in the form of hallucinations- when I got stressed and I was standing on a street corner- actually that doesn't sound too good- when I was waiting for a cross walk light- I saw myself walk into the street- and get hit by a car. My body would fly in the air and land right on the street in front of me. It scared me a lot. I used to call these visions 'death images' because I didn't know what they were. I thought everyone had them. I used to see a lot of dead bodies and severed hands when I walked in the woods too. That is just one symptom I had. These are all psychotic hallucinations.

Then there are delusions- where you have very unrealistic or even bizarre beliefs. I once drove by a beer commercial billboard and thought, "Is that a message for me? Did I do something wrong with that beer last night?' I would never drink that nasty beer anyway- but it seemed real. Psychosis is basically your brain going wonky- all of the chemicals and neurons that normally process information correctly start to process information both internally and externally falsely. What is hard to explain if you've never been psychotic is how real it feels. For example, when I get paranoid, I really believe it. Even if there is absolutely no information to prove that the feelings are real. Paranoia was always really bad for me in a classroom setting.

I've learned to manage my psychosis by keeping away from my triggers such as large groups, arguments and messing with my meds. I know the first signs that I'm getting sick and I talk myself out of it. If a voice tells me I have to leave somewhere, I say to myself, "Actually, I don't. That is just a voice and I'm not listening." I can work around it now- and I always know that when I get psychotic, I'm doing too much.

Mild psychosis can be self  treated and major psychosis can be prevented by knowing the signs it's starting and getting help immediately. This may sound unrealistic, considering how serious psychosis can get, but there is usually a treatment window.


best selling author of Take Charge of Bipolar Disorder and Loving Someone with Bipolar Disorder and Get It Done When You're Depressed is a critically acclaimed six-time author, award winning bipolar disorder advice columnist, national speaker, and sought after expert in the fields of bipolar disorder and depression. Julie's work specializes in helping people manage all aspects of their daily lives -despite the complications that bipolar disorder creates. To learn how to personalize a plan to help yourself or a loved one find and create stability that ensures the quality of life that we all deserve, visit:





What is Schizoaffective Disorder?


Bipolar Disorder Symptoms + Schizophrenia Symptoms = Schizoaffective Disorder

There is a lot of confusion surrounding Schizoaffective disorder.  This is probably because schizophrenia itself is so hard to understand when you only have knowledge of bipolar disorder.

What is the difference between bipolar disorder and schizophrenia?

There is a big difference between bipolar disorder and schizophrenia. Bipolar disorder is a mood disorder where a person has trouble regulating their emotions. It's episode, which means it can come and go- some people have chronic symptoms as I do- others can literally go for years without an episode. For example, my former partner Ivan who has bipolar I (one) went 12 years between manic episodes. Stress is often a factor in when a person has episodes. Bipolar disorder can definitely have psychosis- but it is not usually chronic. And most importantly, psychosis with bipolar disorder almost always comes with other mood swings such as psychotic depression or psychotic mania.

Schizophrenia is a psychotic disorder which means its main symptom is psychosis. People with schizophrenia can be chronically psychotic or experience episodes, but the psychosis is persistent if a person doesn't get medication treatment. 

Both illness are difficult to treat- but schizophrenia is more difficult as there is not enough information on how it affects the brain- which means the medications are more limited.  Bipolar disorder treatment focuses on mood stabilizer medications where the focus for schizophrenia is antipsychotics.

And now, to answer the question-  What is Schizo-Affective Disorder?

The schizoaffective disorder diagnosis means that a person has bipolar disorder mood swings along with discrete psychosis. In other words, the psychosis can be present with mood swings, but it can also exist alone.  This is not the case with bipolar disorder where the psychosis almost always attaches itself to a mood swing. This is why is why a different diagnosis is used for people who have the symptoms of  bipolar disorder combined with the more chronic psychosis of schizophrenia.  Schizo affective disorder is naturally much more difficult to treat than bipolar disorder.  But there is hope as new medications come on the market and the illness is more researched and understood.


Julie Fast

P.O. Box 86728
Portland, OR




It's often difficult to know the difference between the two main types of bipolar disorder. It can even be difficult for health care professionals to explain unless they have had special training on the topic. When you know the facts, you can see that the difference between the two is actually quite simple. 

Bipolar I and Bipolar II (two) have the exact same symptoms in terms of depression and both have mania. The difference between the two diagnoses is the type of mania a person experiences. Bipolar I (one) has full blown mania while Bipolar I has hypomania. 

What is the difference between full blown mania and hypomania you may wonder? The difference is intensity. 

Full blown mania if untreated usually leads to a hospital stay- especially if it's someone's first episode. This episode usually starts around the age of 20. The mania can start off mildly with a sense of creativity and then spin out of control very quickly. When my partner Ivan had his first full blown episode it started with agitation and confusion, then moved into a complete behavioral change as he started to talk more than usual and couldn't hold a coherent thought. The night before he went into the hospital, he wasn't able to remember how to write a check or even have a normal conversation. He was seemingly very creative, but it was agitated and not fun and very scattered. He talked over people and moved around very rapidly. His face looked different and he talked with a different voice. He had what is called dysphoric mania- in other words he didn't feel very well! This mania was accompanied by severe psychosis. 

Euphoric mania is the opposite of dysphoric mania. When it's full blown, it's very dangerous as it feels so good. The person almost always refuses help when they are really euphoric. When a person has euphoric mania, they feel no pain and have no reasoning ability- and most importantly, they can't see the consequences of their behaviors as they feel invincible. This is very, very dangerous mania as it can just seem like excessive enthusiasm, creativity and charisma from the outside. 

All full blown manias lead to disasters and most people go into a deep depression if medications are not used successfully. 


Hypomania is much less intense and doesn't put a person into the hospital. As with full blown mania, a person can have euphoric and dysphoric hypomania. Extreme psychosis is rare with hypomania- though it's common to have grandiose thoughts as well as negative thoughts. I get euphoric mania at the beginning of my hypomanias. Nothing feels as good as euphoric mania- absolutely nothing- but I always do something stupid and I always crash. I work very hard at preventing hypomania. 

As I say in my book Take Charge of Bipolar Disorder, it's essential that you have a distinct diagnosis of either Bipolar I or Bipolar II as the treatments for the two can be quite different! You have to know if you have full blown mania or hypomania. No matter what form you have, the mania is serious- you can make horrible and life altering decisions when you're full blown manic or even hypomanic. Prevention is the only way to make sure this doesn't happen. 


Julie Fast

P.O. Box 86728
Portland, OR


Borderline Relationship Recovery 101

Whether you have Borderline Personality Disorder (BPD) or love someone who does, one of the enormous benefits we derive from recovery is improving our relationships.

In my coaching practice, I'd say difficulties with relationships are the number one reason why folks voluntarily seek counsel and guidance. When I see strained, chaotic interactions morph into calm, cooperative, and mutually supportive partnerships, is one of the most joyous things I get to experience. 

If it is your desire to have meaningful, fulfilling relationships, you can have them. You can even repair mistakes you made before you knew better.

And there are also times when those you wish to be close to have other plans, and just aren't interested in working on the relationship.

To be certain, the hardest relationships to rebuild are those where there is no longer any contact. But even in those circumstances, there are things you can do. Here are my top ten things to do to improve/win back/find the relationship you want:

1. Learn to tolerate distress a little better. Some conflict and difficult circumstances and discussions are a part of a normal, healthy relationship. If you can keep that in perspective, and not blow them up further, then these occurrences will just come and go. They can also serve as a time to develop intimacy, problem solve, and to learn to trust and support one another more.

2. Work on your sense of self worth. Other than learning how to tolerate distress, there is nothing that has improved my relationships more than this one. Why? Because now that I have a strong sense of who I am, I am not nearly as bothered that someone may be judging, leaving or criticizing me when they offer their perspective. I value (for the most part!) others input, can consider it, but it does not have to define me or my worth.

3. Improve your validation skills. Validating is a communication skill where you non-judgmentally listen to someone and let them know that their experience is real and understandable. This does not mean you agree with their position. This skill is very helpful in de-escalating strong emotions in another, and in delivering an assertive request, or denial to a request.

4. Ask yourself, "so what?" Is being right, or having things done perfectly really worth losing the relationship? Really? If it is, then go ahead and assert yourself. But the next time a task isn't done exactly right, ask yourself, "so what?" Is it really that important?

5. Learn how to skillfully ask for your own needs to be met. This requires skill in balancing your request with firmness and gentleness, being clear, and making it about you, not their deficiencies. Being able to clearly articulate the reward to them for granting your request is also very important.

6. Practice saying "no." Actually, being able to say "no" without apology can help strengthen your relationship. You will feel stronger and more satisfied, and your partner will feel like they can count on you to do the right thing, no matter how much they push against you.

7. Experience gratitude and show it. Make lists of the things you value and appreciate about those you love and express your gratitude to them for these specific things often. Very often.

8. Learn how to be a giving person. This is very different than being a resentful door-mat. What I am talking about is being able to observe needs in others, and meet them without being asked, and without expecting something specific in return. And also be a vessel to receive love.

9. Appreciate differences. We were made to be inter-dependent with others. Those of us with BPD really love being in relationships and are not usually made to be "an island unto ourselves." Celebrate this fact, and celebrate that we do really complete one another. Show this by liberally allowing others to make their own choices and be their own selves, and reap the rewards of the wonderful new things they bring to our lives.

10. Practice compassion and take a non-judgmental stance with others. If you really have these two things down, then true recovery is yours.


Preventing Mania


 April 21, 2009


In This Issue

Preventing Mania
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Develop your plan and create peace of mind. 

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You can learn to manage your life with bipolar disorder. 

Medications alone are not enough.

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best selling author of Take Charge of Bipolar Disorder and Loving Someone with Bipolar Disorder and Get It Done When You're Depressed is a critically acclaimed six-time author, award winning bipolar disorder advice columnist, national speaker, and sought after expert in the fields of bipolar disorder and depression. Julie's work specializes in helping people manage all aspects of their daily lives -despite the complications that bipolar disorder creates. To learn how to personalize a plan to help yourself or a loved one find and create stability that ensures the quality of life that we all deserve, visit:


Knowledge about bipolar disorder

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Oh no, here Julie goes again! All about mania- all of the time!

Well, tis the season. I have started rapid cycling at night. It's frustrating as I really need to sleep. I haven't had caffeine or done anything stupid such as getting into stressful situations, but I'm still going up.

I can joke about it in the blog, but mania is a super serious and dangerous part of bipolar disorder. As I always say, depression has a large treatment window. Mania's treatment window can close within a few hours. It can be like a tornado. And yet, there are signs that you're moving towards mania. If you know the signs, you can get help and prevent mistakes.

Here are some tips:

Know who you are when you're not manic in relation to the following areas:

Substance wise- such as drugs and alcohol
Energy level
Sleep habits

And then write down what you're like in these areas when you're manic.


There are not many items on the list, but they are SO important when it comes to mania prevention. Here is how you use this technique to prevent mania from going too far:

Normal Sexuality: The normal me likes guys and wants a partner. I find men handsome. I tend to be rather antisocial around guys in public and don't meet men in social settings very often. Can you believe it! I have a lot of trouble even looking at guys sometimes. I'm not shy, but I can't flirt very well! I always worry about my weight when I'm not manic.

Oh boy, it's different when the mania starts!

Manic sexuality: Men start to look abnormally good. I stare at them and have thoughts like, "He has FABULOUS eyes." My vision is clearer. All men look good. I have sexual thoughts about them that are very strong. I also become more aware of the looks of women. I notice their hair and clothes. I have thoughts such as, "Wow, that is a really gorgeous woman!" I am not usually sexually attracted to women, but it happened once when I was really manic. I lose most of my inhibitions and don't worry as much about my weight and definitely can't see the consequences of my actions.

Notice the contrast. I now know that the minute my mind becomes a man radar and that they all look good, I have to examine my mood, get out my Health Cards, report the potential mania to my mother, friends or therapist and do what needs to be done. Of course it's hard! I would much rather feel these fun and sexy feelings, but they aren't real and they get me into big trouble. Darn it!

I can't emphasize enough how the Health Cards help my mother when it comes to my mania. She has to know even the smallest signs and there is no way she can memorize them. She now reads them regularly and often sees the mania before I do.

This is all hard. Bipolar disorder is a very tricky illness. You HAVE to be prepared before the mood swings start.

Never forget: Mania averages spike in spring and summer. Always.




Social Security clogged with disability claims

TAMPA, Fla. (AP) — For all the talk of an impending crisis in Social Security, one already exists: The system is clogged with hundreds of thousands of disputed disability claims, a backlog so big that some people wait years for a hearing.

Social Security officials blame underfunding, understaffing, a dramatic rise in cases and an increasing number of claims involving hard-to-prove ailments, such as back pain, depression and anxiety.

Even with a $500 million infusion from the federal stimulus program, it could take years to clear the backlog. In the meantime, many of those who have applied for benefits struggle to make ends meet.

"I keep thinking every month I'll hear something," said 56-year-old Tampa resident Karen Slater Chambers, who quit her job driving a delivery truck after a series of accidents and injuries. She applied for disability four years ago, was turned down and is now awaiting an appeal hearing.

Social Security benefits are available to people who can no longer work because of a disability, regardless of whether it was suffered on the job or off. The monthly checks average $1,063.

Someone seeking benefits must first send an application and wait an average of 106 days for a decision, according to the Social Security Administration. The agency denies nearly two-thirds of the applicants, who then can request a hearing to appeal.

Then the real wait begins. Those who received a hearing last fiscal year had waited nearly a year and half on average — twice the wait time in 2000, according to the SSA. More than 765,000 people — about double the number in 1998 — are now waiting for a hearing.

Sixty-one percent of applicants who go through an appeal hearing are ultimately approved for disability benefits.

Since 1990, the number of Americans receiving Social Security disability has more than doubled, to 7.4 million, while the number of staffers to process the claims — and sort out the fakers from the truly disabled — has dropped by around 5 percent.

"Workloads have gone up, resources did not go up proportionately, and the agency was too slow to embrace new technologies," said Social Security Commissioner Michael Astrue, explaining the backlog. "It's a combination of all those things."

Also, Astrue noted that at the start of the disability program in 1957, the vast majority of applicants were blue-collar workers, generally with a single disability from a traumatic accident. That is no longer the case.

Recipients receive benefits if they are deemed mentally or physically unable to work and the condition is expected to last at least a year or will lead to the person's death.

People injured on the job can often collect workers' compensation, though it generally runs out after a certain amount of time, while Social Security benefits continue as long as the disability persists. In Slater Chambers' case, she opted against workers' compensation by settling with her employer. But the settlement money is long gone.

Rep. Kathy Castor, D-Fla., introduced a bill that would require a hearing be held no more than 75 days from the time it is requested, and a final verdict no more than 15 days after that.

Castor represents Tampa, one area where the backlog has been particularly bad. "It's crushing, especially during the economic crisis," she said.

Astrue said Castor's proposal does not take into account the time applicants need to prepare their cases. He has set a goal of a nine-month maximum wait for a hearing.

"The long waits aren't acceptable," Astrue said. "But it's not something you can fix overnight."

Applicants increasingly have found they are unable to navigate the system on their own — 85 percent of them, by Astrue's estimation, hire a lawyer or obtain other representation to help prepare their paperwork, gather medical records and ready them for a hearing.

Dorothy Garcia filed for benefits in 2005 after a brain aneurysm and a series of mini-strokes, but two years later was still waiting. She agreed to give up a portion of her initial payout to someone who could expedite the process. The 53-year-old from Gibsonton, Fla., said the help was worth the price: Within 11 months of hiring claims services company Allsup, she was approved.

"If the disability system worked the way it should, we wouldn't be in business," said Dan Allsup, an executive with the Belleville, Ill., business.

The Social Security Administration is approaching the problem from multiple angles — experimenting with electronic records to speed up medical reviews, hiring more judges and other staff, and adding offices — but the efforts only go as far as the funding.

The recently passed budget gave the Social Security Administration $126.5 million more than President Barack Obama requested, and many see the increase, combined with the stimulus relief, as the best chance the agency has had to relieve the backlog.

Slater Chambers said she has constant pain in her neck and back and her hands go numb, making it hard to grasp things. She said she cannot even win an arm-wrestling match with her 6-year-old granddaughter.

She is struggling to pay her bills. Her boyfriend and children give her money for a $547 monthly mortgage payment and other expenses, and she gets help from her mother and grandmother, who are on Social Security themselves and are in their 70s and 90s.

"Why would I put myself through four years of not knowing if I could keep a house or food?" Slater Chambers asked. "It's like they don't realize that I just can't. If I could work, why wouldn't I?"



12 Depression Busters

By Therese J. Borchard
March 16, 2009


My therapist helped me to build a personalized “toolbox”: a list of a dozen depression busters to direct me toward mental health, and an emergency lifeline in case I get lost along the way. I consult these 12 techniques when I panic, when I get pulled into addictive behaviors, and as armor in my ongoing war against negative thoughts. Here they are: twelve strategies to take us all to the promised land of recovery from depression.

1. Get Some Buddies

It works for Girl Scouts, depressives, and addicts of all kinds. I remember having to wake up my buddy to go pee in the middle of the night at Girl Scout camp. That was right before she rolled off her cot, out of the tent and down the hill, almost into the creek.

Our job as buddies is to help each other not roll out of the tent and into the stream, and to keep each other safe during midnight bathroom runs. My buddies are the six numbers programmed into my cell phone, the voices that remind me sometimes as many as five times a day: “It will get better.”

2. Read Away the Craving

Books can be buddies too! And when you are afraid of imposing on others like I am, they serve as wonderful reminders to stay on course. When I’m in a weak spot, especially with regard to addictive temptations, I place a book next to my addiction object: the Big Book (the Bible) goes next to the liquor cabinet; some 12-step pamphlet gets clipped to the freezer (home to frozen Kit Kats, Twix, and dark chocolate Hershey bars); and I’ll get out Melody Beattie before e-mailing an apology to someone who just screwed me over.

3. Be Accountable to Someone

In the professional world, what is the strongest motivator for peak performance? The annual review (or notification of the pink slip). Twelve-step groups use this method–called accountability–to keep people sober and on the recovery wagon. Everyone has a sponsor, a mentor to teach them the program, to guide them toward physical, mental, and spiritual health.

Today several people together serve as my emotional “sponsor,” keeping me accountable for my actions: Mike (my writing mentor), my therapist, my doctor, Fr. Dave, Deacon Moore, Eric, and my mom. Having these folks around to divulge my misdeeds to is like confession–it keeps the list of sins from getting too long.

4. Predict Your Weak Spots

When I quit smoking, it was helpful to identify the danger zones–those times I most enjoying firing up lung rockets: in the morning with my java, in the afternoon with my java, in the car (if you’ve been my passenger you know why), and in the evening with my java and a Twix bar.

I jotted these times down in my “dysfunction journal” with suggestions of activities to replace the smokes: In the morning I began eating eggs and grapefruit, which don’t blend well with cigs. I bought a tape to listen to in the car. An afternoon walk replaced the 3:00 smoke break. And I tried to read at night, which didn’t happen (eating chocolate is more soothing).

5. Distract Yourself

Any addict would benefit from a long list of “distractions,” activities than can take her mind off of a cig, a glass of Merlot, or a suicidal plot (during a severe depression). Some good ones: crossword puzzles, novels, Sudoku, e-mails, reading Beyond Blue (a must!); walking the dog (pets are wonderful “buddies” and can improve mental health), card games, movies, “American Idol” (as long as you don’t make fun of the contestants…bad for your depression, as it attracts bad karma); sports, decluttering the house (cleaning out a drawer, a file, or the garage…or just stuffing it with more stuff); crafts; gardening (even pulling weeds, which you can visualize as the marketing director that you hate working with); exercise; nature (just sitting by the water); and music (even Yanni works, but I’d go classical).

6. Sweat

Working out is technically an addiction for me (according to some lame article I read), and I guess I do have to be careful with it since I have a history of an eating disorder (who doesn’t?). But there is no depression buster as effective for me than exercise. An aerobic workout not only provides an antidepressant effect, but you look pretty stupid lighting up after a run (trust me, I used to do it all the time and the stares weren’t friendly) or pounding a few beers before the gym. I don’t know if it’s the endorphins or what, but I just think–even pray–much better and feel better with sweat dripping down my face.

7. Start a Project

Here’s a valuable tip I learned in the psych ward–the fastest way to get out of your head is to put it in a new project–compiling a family album, knitting a blanket, coaching Little League, heading a civic association, planning an Earth Day festival, auditioning for the local theatre, taking a course at the community college.

I went to Michael’s (the arts and crafts store) and bought 20 different kinds of candles to place around the house, five picture boxes for all the loose photos I have bagged underneath the piano, and two dozen frames. Two years later, all of it is still there, bagged and stored in the garage.

However, I also signed up for a tennis class, because I’m thinking ahead and when the kids go off to college, Eric and I will need another pastime in addition to reading about our kids on Facebook.

8. Keep a Record

One definition of suffering is doing the same thing over and over again, each time expecting different results. It’s so easy to see this pattern in others: “Katherine, for God’s sake, Barbie doesn’t fit down in the drain (it’s not a water slide)” or the alcoholic who swears she will be able to control her drinking once she finds the right job. But I can be so blind to my own attempts at disguising self-destructive behavior in a web of lies and rationalizations.

That’s why, when I’m in enough pain, I write everything down–so I can read for myself exactly how I felt after I had lunch with the person who likes to beat me up as a hobby, or after eight weeks of a Marlboro binge, or after two weeks on a Hershey-Starbucks diet. Maybe it’s the journalist in me, but the case for breaking a certain addiction, or stopping a behavior contributing to depression, is much stronger once you can read the evidence provided from the past.

9. Be the Expert

The quickest way you learn material is by being forced to teach it. I adamantly believe that you have to fake it ’til you make it. And I always feel less depressed after I have helped someone who is struggling with sadness. It’s the twelfth step of the twelve-step program, and a cornerstone of recovery. Give and you shall receive. The best thing I can do for my brain is to find a person in greater pain than myself and to offer her my hand. If she takes it, I’m inspired to stand strong, so I can pull her out of her funk. And in that process, I am often pulled out of mine.

10. Grab Your Security Item

Everyone needs a blankie. Okay, not everyone. Mentally ill recovering addicts like myself need a blankie, a security object to hold when they get scared or turned around. Mine is a medal of St. Therese that I carry in my purse or in pocket. I’m a bit of a scrupulous, superstitious Catholic (I fit the religious OCD profile), but my medal (and St. Therese herself) give me consolation, so she’s staying in my pocket or purse. She reminds me that the most important things are sometimes invisible to the eye: like faith, hope, and love. When I doubt all goodness in the world–and accuse God of a bad creation job–I simply close my eyes and squeeze the medal.

11. Get on Your Knees

Some holy folks would put this first, not second to last, and it would be followed by instructions on how to pray the rosary or say the Stations of the Cross. But I think that the true addict or depressive need only utter a variation of these two simple prayers: “Help!” and “Take the bloody thing from me, now!”

12. Do Nothing

If you do nada, that means you’re not getting worse, and that is perfectly acceptable most days. After all, tomorrow is another day.

Bipolar Disorder and Exercise. Why it helps.

There are a few technical reasons:

1. It increases serotonin
2. It creates endorphins

There are also tons of health reasons that I'm sure you know.

But did you know that exercise helps depression for one psychological reason?

When you get one thing done, such as taking a short walk, your brain finds it a lot easier to get the next thing done. Exercise cuts down on depression brain resistance! How can your brain tell you that you never get anything done and that you're a failure if you just exercised! You have duped the brain and that is a secret to managing the illness.

I have 50 ways to get things done in my book Get it Done When You're Depressed. I use them all. That is how I write my books even when I'm crying from the stress. We can get things done when we're depressed, we just have to bypass our ill brains and exercise is one of the best ways to do this.

One of my favorite strategies in the book is to Think Like an Athlete. I use that tip a lot! I just wrote a blog about exercise and how it helped me manage a pretty bad anxiety mood swing!

Julie Fast


best selling author of Take Charge of Bipolar Disorder and Loving Someone with Bipolar Disorder and Get It Done When You're Depressed is a critically acclaimed six-time author, award winning bipolar disorder advice columnist, national speaker, and sought after expert in the fields of bipolar disorder and depression. Julie's work specializes in helping people manage all aspects of their daily lives -despite the complications that bipolar disorder creates. To learn how to personalize a plan to help yourself or a loved one find and create stability that ensures the quality of life that we all deserve, visit:

Copyright (c) 2000 - 2009 Julie Fast. All Rights Reserved.



Bipolar Mania: What is the difference between the 'real' person and the 'manic' person?

There is a simple test you can do to differentiate between manic behavior and 'normal' behavior.

- Is the manic behavior sudden and completely out of character? For example, when I got very hypomanic for three months in 1987- years before I was diagnosed, everyone said, "What is Julie doing? What is wrong with her? I'm so shocked at her behavior!"

- Is the manic behavior dangerous and the person who is manic can't see it at all- even when you show them evidence?

- Is the person spending huge amounts of money on trivial things? I know someone who paid tens of thousands of dollars on paintings because she was sure the artist would be famous one day. Lucky artist- unlucky person with mania when she comes out of the episode and sees the bill!

And finally, does the behavior end when the manic mood swing ends? If so, this is almost always mania and not the 'real' person.

There are so many ways for family members- and the person with bipolar disorder to see the mania once it's over- the trick to managing this illness is to use this information to prevent mania in the future. This is why I created the Health Cards. I don't ever want another summer of destructive hypomania.  You can read my hypomania Health Card in the sample cards. It's an interesting card as anyone with mania who reads it says- I had no idea there were other people like me!

Julie Fast


best selling author of Take Charge of Bipolar Disorder and Loving Someone with Bipolar Disorder and Get It Done When You're Depressed is a critically acclaimed six-time author, award winning bipolar disorder advice columnist, national speaker, and sought after expert in the fields of bipolar disorder and depression. Julie's work specializes in helping people manage all aspects of their daily lives -despite the complications that bipolar disorder creates. To learn how to personalize a plan to help yourself or a loved one find and create stability that ensures the quality of life that we all deserve, visit:

Copyright (c) 2000 - 2009 Julie Fast. All Rights Reserved.

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