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.”

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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:


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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.

I care for someone with a serious mental illness.

Sometimes the illness “gets in the way.”

What are appropriate boundaries, and how do I set them?

1. Discuss how you hope to treat others and how you expect to be treated.
2. Agree on a format for solution when these expectations are not met.
3. Plan and stick to individual, separate activities as well as “together time.”
4. Respect one another’s privacy and clearly establish times or topics that are off limits.
5. Do not tolerate self injury, violence or abuse of any kind.
   If they occur, seek help or tell someone immediately.
6. Safety is a top priority. If you question anyone’s safety, get help. Call a responsible adult or dial 911.
7. Expect that your relationship will be kind, supportive and loving. Always work toward that goal.

What skills or strategies will help me deal with a family member or friend with a mental illness?

1. Show compassion. Being diagnosed with a mental illness can be scary and confusing. Some people are relieved by a diagnosis and actively seek treatment; others may be devastated, ashamed or in denial.
2. Encourage your loved one to learn about treatments and services. Remind them that finding the right treatment or services takes time and involves some trial and error.
3. Practice “active listening.” Listen and then express your understanding back. Acknowledge his/her feelings. Don’t discount them, even if you believe them to be symptoms of the illness.
4. Understand medication challenges. Side effects often make people want to stop taking their medicine. Urge them to take their meds and talk to the doctor about making adjustments.
5. Know that recovery isn’t just about staying on medication. Self-esteem, social support and contributing to society are essential elements of recovery.
6. Learn to cope with unusual behavior. People with mental illnesses are sometimes disruptive or behave in an embarrassing way. If this happens, tell a responsible party, like a parent or doctor. This information can lead to more effective treatment.

I love someone who has a serious mental illness.

How can I prevent our relationship from being all about mental illness?

1. Participate in normal, fun activities together. Watch movies, play games, go for walks, etc.
2. Establish “no health-talk” times.
3. Work together on necessary tasks, such as cooking, grocery shopping and gardening.
4. Create routines and schedules that encourage living healthfully and well.
5. Always be respectful, kindand supportive. And expect the same in return.

How can I have healthy relationships with family members and friends living with a mental illness?

1. Offer practical help. Drive or be present at appointments.
2. Give respect. Honor the need for, and right to, privacy; and always treat others with dignity and respect regardless of circumstance.
3. Establish a support network. Seek your own support from family and friends. Self-help and support groups also provide an opportunity to talk with others in similar situations.
4. Take time out. Pursuing your own interests will help you remain patient and compassionate. You can only help others when you are physically and emotionally healthy.
5. Maintain hope. There is hope for recovery, and with treatment, many people with mental illnesses have happy, productive, fulfilling lives.

I have a family history of mental illness.

What should I watch for, in myself, to remain healthy?

1. If you have a family history of mental illness, avoid drugs and alcohol. They can trigger the illness.
2. If you’re worried about your own mental health, keep a daily log or journal of your concerns.
3. Learn symptoms and signs of onset and monitor yourself for these.
4. Confide in someone you trust and ask them to tell you if you exhibit these symptoms or behaviors.
5. Talk to your parents, school counselor or doctor if you are worried about your own mental health.
6. To maintain good mental health, eat a well-balanced diet, get at least 30 minutes of physical exercise every day, sleep 8 or more hours each night and avoid drugs and alcohol.

What can I do if I’m concerned about the mental health status of a family member or friend?

1. Write down the behaviors or actions that worry you. Be as specific as possible.
2. If your friend is another teen, talk to their parents or school counselor.
3. At a time when you both are calm and comfortable, share your list and the fact that these are symptoms of an illness that can be treated.
4. If he/she already has a mental health diagnosis, encourage a return visit to the doctor.
5. If no diagnosis has been made, stress the fact that these symptoms require medical assessment and treatment.

I care about someone with a mental illness.

What can I do to help?

• Accept the diagnosis without placing blame.
• Educate yourself. Learn the facts about symptoms and treatment to alleviate your fear.
• Remember, despite symptoms, this is the same person you care for.
• Know that there is help and hope for your loved one.
• Continue to offer love and support.

What is mental illness?

• A mental illness is a disease that causes disturbances in thought and/or behavior.
• Mental illness makes it hard to cope with ordinary demands and routines.
• Mental illness can be triggered by a variety of causes, including a stressful situation or series of events, another illness, genetics, biochemical imbalances, or a combination of those factors.