Advice from Dr. Steven A. Weisblatt

Dr. Steven A. Weisblatt, MD, a clinical assistant professor of psychiatry at S.U.N.Y. Downstate Medical Center who also has private practices in New York and Pennsylvania, recently wrote the following article for  bp Hope Magazine.  He is a leading consultant regarding accurate psychiatric diagnoses and effective treatments.

“Treating someone with bipolar disorder without meds is as primitive as treating a patient with a seizure disorder without medication. If anyone advises you to avoid medication, run-don’t merely walk away-from such dangerous counsel. Although not by any means the only ingredient in a comprehensive strategy to live a life free of any bipolar symptoms, it is an essential and necessary component. What follows are some answers to common questions about medication treatment that may make your path to remission faster and more comfortable:

What is the goal of treatment with meds?
Optimally, the goal is getting rid of all your symptoms over the long term (remission), while having no adverse effects. Meds may give you partial relief from symptoms within several days or weeks, but full remission can take months or even years of active treatment.

What if my meds don’t work?
If you feel this way, rest assured it’s not usually because your disorder is failing to respond to appropriate treatment. More often, I see the problems as being misdiagnoses, clinicians who may be unfamiliar with specifically helpful combinations of meds, and patients who are challenged in their ability or willingness to follow through with treatment.

Aren’t meds dangerous in the long term?
Appropriate medication therapy may be lethal in one patient out of two hundred thousand (the same odds of getting hit by lightning). In contrast, people with untreated or partially-treated bipolar dis- order have up to a 25 percent lifetime risk of suicide. Far more have lost years of their lives, jobs, friends and family connections due to ongoing symptoms. It’s a bit of an unreasonable comparison to claim that one doesn’t want to take medication due to the risks, when not taking medication itself increases the risk of suicide, let alone the risk of other losses. Weigh risks and benefits fairly.

Is it OK to miss my meds occasionally?
Compliance is key. Assuming your illness is in remission and you are having no adverse effects, there is little reason to consider altering your treatment, except in certain circumstances of weight change, aging, pregnancy, or specific medical treatments. Just as in
controlled diabetes, where any change in insulin dose (or missed doses) is likely to result in instability, the same is true in bipolar disorder. However, unlike in the case of diabetes, where blood sugar will stabilize quickly when meds are resumed, in bipolar disorders a medication that was previously effective may no longer work.

Do I need to do more than take meds to achieve and stay in remission?
You can do a lot more! Along with lifestyle changes like Interpersonal and Social Rhythm Therapy (IPSRT), yoga, exercise, and healthy eating, various supportive individual, family, and group psychotherapies are associated with better short- and long-term outcomes.

Do I really have to tell all my clinicians about all the medicines I’m taking?
Absolutely! The reason for this is that there are many effects of non-psychiatric medicines on bipolar disorder (e.g. steroids, antihypertensives, etc.) as well as interactions between other medicines and psychiatric medications that are not necessarily available for review in texts or on the Web, but will hopefully be familiar to your clinician. It is critical to avoid nutritional supplements, over-the-counter meds, even prescribed medications until the prescriber has reviewed the new medicine with your psychiatric clinician.

Can I still have a drink from time to time?

That’s a really bad idea. While this may not be the best-received advice, it is important to abstain completely from alcohol, illegal substances, herbal medicines and even caffeine. These substances can actually make you more ill, in addition to confounding the question of whether or not you can be treated to remission with less medicine. You will be relieved to know that chocolate is still OK!

As always, active treatment requires collaboration between an engaged and informed patient and a psychiatric clinician skilled in the treatment of bipolar disorders. You can increase the odds of being treated properly by being well- informed and actively participating with your clinician at regular appointments.”

—–

For more information on the diagnosis and treatment of bipolar disorder, visit the Depression and Bipolar Support Alliance website.

The National Institute of Health’s National Center for Complementary and Alternative Medicine has proven that chamomile, long used as a folk remedy for anxiety, stress and tension, is a statistically effective treatment.

*The text below is from their website:


________________________________________________________________________

Study Shows Chamomile Capsules Ease Anxiety Symptoms Chamomile

Generalized anxiety disorder (GAD) has a wide array of psychological and physical symptoms. Although prescription drugs can help, they often have undesirable side effects. Many people experiencing symptoms of anxiety do not seek medical attention, turning instead to alternatives. One traditional remedy in widespread use is the herb chamomile. However, scientific evidence to support the use of chamomile for anxiety has been lacking.

NCCAM-funded researchers at the University of Pennsylvania recently conducted a randomized, double-blind, placebo-controlled trial to test the effects of chamomile extract in patients diagnosed with mild to moderate GAD. For 8 weeks, the 57 participants received either chamomile capsules containing 220 mg of pharmaceutical-grade extract from Matricaria recutita (German chamomile), standardized to 1.2 percent of the constituent apigenin; or chamomile-scented placebo capsules containing lactose. The initial dose of one capsule daily was increased to two capsules daily at week 2; dosages were then adjusted incrementally (up to five capsules) in some participants. Researchers used the Hamilton Anxiety Rating (HAM-A) and other tests to measure changes in anxiety symptoms over the course of the study; dosage adjustments were based on HAM-A scores.

Compared with placebo, chamomile was associated with a greater reduction in mean HAM-A scores-the study’s primary outcome measure. The difference was clinically meaningful and statistically significant. Chamomile also compared favorably with placebo on other outcome measures (although the differences were not statistically significant), and was well tolerated by participants.

These results suggest that chamomile may have modest benefits for some people with mild to moderate GAD. As this was the first controlled trial of chamomile extract for anxiety, the researchers note that additional studies using larger samples and studying effects for longer periods of time would be helpful. They also point out that other chamomile species, preparations (e.g., extracts standardized to constituents other than apigenin), and formulations (e.g., oil or tea) might produce different results.
Reference

* Amsterdam JD, Yimei L, Soeller I, et al. A randomized, double-blind, placebo-controlled trial of oral Matricaria recutita (chamomile) extract therapy for generalized anxiety disorder. Journal of Clinical Psychopharmacology. 2009 Aug;29(4):378-382.

Are you the parent of a teen?

Get that kid to bed by 10!

According to a new study published in the journal, Sleep, parents who enforce earlier bedtimes are doing their teens a big favor.

Why?

Kids who stay up until midnight or later are 24 percent more likely to be depressed and 20 percent more likely to have suicidal thoughts, than teens with bed times of 10 p.m. or earlier.

Dr. James E. Gangwisch and his colleagues of Columbia University Medical Center in New York City made the discovery. According to Dr. Gangwisch, “It’s… a common idea that older adolescents don’t need as much sleep as younger adolescents, but that’s really not true–they still need about 9 hours of sleep at night.” Depression has long been linked to inadequate sleep in both teens and adults. The team’s report verifies this fact and notes the connection could be “bidirectional”-meaning getting too little sleep boosts depression risk, while being depressed makes it harder to sleep.

Gangwisch’s team looked at over 15,000 seventh- through twelfth-graders who, along with their parents, were surveyed in 1994-1996. Fifty-four percent of parents said their teens had to go to bed at 10 p.m. or earlier on school nights. Twenty-one percent set bedtime at 11 p.m., and twenty-five percent allowed their children to stay up until midnight or later. More than two-thirds of the teens said they went to bed when they were supposed to.

Considering the possibility that parents who were stricter about bedtime might have other traits or behaviors that protect their child from depression, the researchers analyzed the relationships between the teens and their parents and then accounted for this in their study.

They found no link between a set bedtime and how much teens felt their parents cared for them, but there was a strong relationship between bedtimes and whether or not the teens felt they got enough sleep. Adding to the importance of getting enough sleep, the team learned that kids who got five hours of sleep nightly or less were seventy-one percent more likely to be depressed, and forty percent more likely to have suicidal thoughts than their peers who got eight or more hours of sleep a night.

“Getting adequate sleep is really important for our mental health as well as being able to focus and have the necessary energy and motivation to do the things we need to do during the day,” Gangwisch noted.

So, parents of teens, take note: Eight or more hours of sleep are vital to your teen’s mental health. Staying up late is not to be considered a privilege, but rather a health risk.

Acceptance

~A Poem~

She denied when first informed.

When she heard the girl was sick and always would be.

“Not my daughter.”

“She’s brilliant. We prize that.”

~

She raged as illness unfolded.

Living the day-in, the day-out, fearing dreams would never come about.

“This is not our life!”

She had such plans. She cherished them. She clung.

~

She trembled when the crazy bubbled up.

When her fear, fueled by helplessness, boiled on over with it.

She’d always had control.

That’s how she lived.  She controlled.

~

She prayed when hope refused to settle in.

When getting through a day sans crisis was success.

“God can do miracles.”

“We need one. I’ll do whatever it takes.” She begged.

~

She mourned as miracles failed to manifest.

When she knew the girl was sick and always would be.

When she knew that her mind was truly ill.

She, they, so prized it.

…time…

She loved when they spent time together.

When the girl chose to live and she chose to live beside her.

When she knew their plans had changed, but that the change was right and good.

They would move on. They would be well.

~

And now.

They rejoice.

She is ill, but lives, stays, well.

Lives, loves, learns. Well.

And ~ blessed be ~ brilliance, bravery, beauty ~ accompany.

They, too, are here to stay.

MovE! MOve! MoVe!

As biological organisms we were created to move, not to exist in a sedentary state. Respect the connections between body, mind, emotions and spirit; and understand the fact that a body kept from motion is a body storing negative emotion.

If you move less, you will feel more stress.

Ya gotta move to get it out.

If your job requires that you sit for extended periods of time, get up and stretch periodically. For two or three minutes of every hour, work out the kinks and stiff spots, breathe deeply, walk around your building, release tension and ponder the blessings you enjoy. You’ll feel much better and perform your work more optimally.

Follow this link to About.com for a more detailed description of an easy 2-Minute Stretch Routine.

This is the most recent installment in an ongoing series elaborating on 52 proven stress relievers identified by researchers at Texas Woman’s University.

How to Live a Long, Happy Life

* Be very outgoing.

* Learn how to manage stress.

These two common traits were found in the children of people who lived to 100, and longevity runs in families.

“We have observed that these appear to be really important traits that set the children of centenarians apart from other people the same age who may not age as well,” said Dr. Thomas Perls, director of the New England Centenarian Study at the Boston University School of Medicine. The study focuses on older people and their family members, and has tracked the health of children of centenarians as they age, trying to uncover the common denominators of longevity.

Perls and his colleagues looked at 246 children of those who lived to 100 to see if they, now about age 75, had common personality traits. Five personality traits were identified, evaluated and compared to published norms. They were: Neuroticism, extroversion, openness, agreeableness and conscientiousness.

The researchers found that the offspring of centenarians were more extroverted than the published norms. That means “they are quite social, establish important friendships and view these friendships as ’safety nets,’ ” important sources of help when needed, Perls said.

Those studied scored lower than the norms on neuroticism, which enables them to manage stress very well.

Women in the study also scored high in agreeableness, a trait that leads to more friendships. The men in the study scored no higher in agreeableness than normal, and men and women scored average levels for openness and conscientiousness.

As for the exact relationship between personality and longevity, “we are relying on scientific literature to understand exactly what it means,” Perls said. For instance, he said, it makes sense that scoring lower in neuroticism — and handling stress well — would contribute to a longer life, because stress has been shown in scientific studies to be a risk factor for cardiovascular disease. Other research has found social ties to be important to an older person’s health.

“We really found that the offspring of centenarians, in their 70s and early 80s, are very much following in the footsteps of their parents,” Perls said. “They have 60 percent reduced rates of heart disease, stroke and diabetes.”

But what to do if you aren’t naturally outgoing and aren’t good at handling stress?

You can get better at each.

Not naturally outgoing?

Make a point of trying to be more outgoing. Travel more, engage others in conversations, join groups with common interests, volunteer.

You don’t handle stress well?

Read all of the stress management posts on this and other sites, and figure out what will work for you—then DO IT!

And take the Life Expectancy Calculator at Living to 100.

You may learn some new tricks to improve your quality of life.

*More on this topic can be found online in the Journal of the American Geriatrics Society.

Make friends with non-worriers.

Nothing will cause you to worry more frequently or with greater intensity than spending too much time with chronic worrywarts, nay-sayers and fuss-budgets.

Nothing saps your energy more than associating with people who dwell in that faithless, negative state of mind. They’ll suck the joy right out of your life.

Surround yourself with hopeful, optimistic friends. Your life will be much less stressful.

This is the most recent installment in an ongoing series elaborating on 52 proven stress relievers identified by researchers at Texas Woman’s University.

As rates of depression and anxiety increase in older adults, health-care providers are searching for more effective methods of treatment. Since most elderly people already take prescription drugs, many PCPs want a non-pharmaceutical alternative.

New research may have discovered the solution in an old therapy model.

Melinda Stanley, a professor in the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine in Houston, found that people over age 60 who were treated with cognitive behavior therapy (CBT) had less worry, fewer depressive symptoms and improved general mental health at the end of the study compared to people who received biweekly telephone calls from their health-care provider.

“This kind of treatment (CBT) can be useful for people who have anxiety, and it can help them learn how to manage it better,” said, Stanley.

“Many older adults are not…thrilled with the use of medications for anxiety. Many times, they’re already on medications for chronic health conditions, and they may be afraid of side effects. This is a non-medication treatment option,” she noted.

The study included 134 people with an average age of 67. All were being treated in primary care for anxiety. Half of those involved in the study participated in cognitive behavior therapy with experienced therapists. They had up to 10 sessions of CBT over three months that included relaxation training, problem-solving exercises, behavioral sleep management, cognitive therapy and education and awareness training.

The other half received standard primary care, and they were called biweekly to ensure their safety and provide support if needed. Both groups were told to call the therapists if their symptoms worsened.

Response rates in the CBT group were much higher– 40 percent compared to 22 percent — versus the usual care. Worry severity and depression reduced more in the CBT group, and overall mental health improved more in the CBT group, based on the Penn State Worry Questionnaire.

This is good news, and much less expensive than long-term medication management. As managed health care evolves, we must look to both innovative and tried-and-true treatment approaches.

Simplify, simplify, simplify. . .

If it doesn’t serve you and the highest good of all… let it go.

Release the unnecessary…

the unhealthy…

the unproductive.

Examine what you have and what you need; and then let go of unnecessary, unhealthy or unproductive material goods, thoughts, beliefs, relationships. Free yourself.

Let it all go.

Become the essential you, identify your essential needs and move toward them. This is, in essence, your destiny.

This is KISMET.

This is the most recent installment in an ongoing series elaborating on 52 proven stress relievers identified by researchers at Texas Woman’s University.

Distinguish between basic needs, higher needs and wants or preferences.

Our basic physical needs are air, water, food, protection from the elements and sleep.

Everything else is a higher need or preference.

It’s important for all of us to work toward higher needs. We want good health, satisfying employment, rewarding relationships, a sense of belonging and so on up the pyramid.

But take note: Designer shoes are not on Maslow’s pyramid of human needs. Neither are BMWs, bigger houses, dinners out three times a week, or international vacations. These all are wants or preferences.

Don’t get attached to preferences. Don’t undervalue your life if you cannot afford these luxuries. Enjoy them if you can, release the desire for them if you can’t. Your life is not worse, less significant or less valuable if you don’t accumulate possessions or unusual experiences. In fact, a growing number of philosophers and spiritual leaders say that a focus on the material blinds us to the truly valuable.

Ultimately, the choice is yours.

Choose to be happy. Choose contentedness.

Find the value and joy in the experiences available to you every single day, and embrace them.

This is the most recent installment in an ongoing series elaborating on 52 proven stress relievers identified by researchers at Texas Woman’s University.