Bipolar4LifeSupport

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Get Professional Help If You Need It

If the problems in your life are stopping you from functioning well or feeling good, professional help can make a big difference. And if you’re having trouble, know that you are not alone: One in four adults in this country have a mental health problem in any given year.
If you or someone you know is feeling especially bad or suicidal, get help right away. You can call 1-800-273-TALK (8255) to reach a 24-hour crisis center or dial 911 for immediate assistance.

Of course, you don’t have to be in crisis to seek help. Why wait until you’re really suffering? Even if you’re not sure that you’d benefit from help, it can’t hurt to explore the possibility.
A mental health professional can help you:
come up with plans for solving problems
feel stronger in the face of challenges
change behaviors that hold you back
look at ways of thinking that affect how you feel
heal pains from your past
figure out your goals
build self-confidence

Most people who seek help feel better. For example, more than 80 percent of people treated for depression improve. Treatment for panic disorders has up to a 90 percent success rate.
Treatment for a mental health issue can include medication and psychotherapy. In some cases, the two work well together.
What, exactly, is psychotherapy? It’s a general term that means talking about your problems with a mental health professional. It can take lots of forms, including individual, group, couples and family sessions. Often, people see their therapists once a week for 50 minutes. Depending on your situation, treatment can be fairly short or longer-term.
Some people worry that getting help is a sign of weakness. If you do, consider that it can be a sign of great strength to take steps toward getting your life back on track.

FINDING HELP
Get names of mental health professionals from your doctor, friends, clergy. If your workplace has an employee assistance program, it also can provide help.

Interview more than one professional before choosing, if possible. You’ll want to feel comfortable with the person.
You can see a psychologist, psychiatrist, social worker, pastoral counselor or other type of mental health professional. Of these, only a psychiatrist can prescribe medication.
Sometimes, your health insurance company will cover only certain types of providers, so check how your plan works.

GETTING STARTED
If you’ve never been to a mental health care provider, it can feel a little daunting. Knowing what to expect and following a few suggestions can make it easier.
Before you call, prepare a list of questions, like:
What experience do you have treating my issues?
Do you have a particular approach, expertise or training?
What does treatment cost?
Do you work with my insurance plan?
When you call, you may get an answering machine or service. Leave times the provider can reach you and whether or not it’s OK to leave a message on your answering machine or with the person who answers your phone.
Think about what traits you’d like in your provider. If you’re going to be talking to someone about your most personal problems, you want to feel comfortable. Consider if you’d prefer to see a man or woman, if you care whether the person is older or younger, or if there are any other traits that matter to you.
During the first visit, you should expect that the therapist will ask questions about your background and why you’re seeking help. You can ask questions, too, like what treatment would involve and how long it might last. If you’re concerned, you can also ask about confidentiality. Usually, though, it’s understood that the provider respects your privacy—and that group members do too, if you’re meeting in a group.

GETTING THE MOST FROM TREATMENT
Your relationship with your provider is like a partnership. You’ll get more out of if you:
Tell your provider your goals for treatment. Think about whether there are certain behaviors or issues you care about most.
Keep an open mind. Be willing to consider new ways of behaving and thinking that might improve the quality of your life.
Recognize that talking about personal issues can be tough, but it can help you overcome them. In time, treatment should help you develop more coping skills, stronger relationships and a better sense of yourself.
If you think you’re not making progress, you should tell your provider. A good provider will want to work with you so you can get the most out of your sessions. If, after discussing your concerns, you’re still not comfortable, you might consider looking for another provider.
Be honest. Your provider can’t really help you if you don’t share the whole picture. Don’t say you’re fine if you’re not.
Share any concerns about your overall health. It makes sense that you should work with your provider on overall health issues because your mental health and overall health are so closely related.

WHAT ABOUT MEDICATIONS?
Some people with mental health issues find medications very helpful. Still, medications may cause side effects that can be annoying or sometimes even dangerous. You may want to weigh the pros and cons of a particular drug with your provider. You might also decide that you’ll try medication for a while and then re-evaluate.
If you decide to take medication, you may have to wait a few weeks before you start feeling better. Your provider will want to know how you’re doing and may suggest a different medication if the first one doesn’t work well. It can be dangerous to stop taking a medication suddenly, so always talk to your doctor first.
If your provider prescribes a medication, ask:
What is this medication supposed to do?
How soon should I expect to feel better?
When do I take it?
Do I need to avoid certain foods, drinks or other medications?
Do I take it with food or on an empty stomach?
What are the possible side effects?
What can I do if I get side effects?

PAYING FOR TREATMENT
People often have concerns about paying for treatment. Some information may help you figure out what you can afford:
If you have insurance, find out if it covers mental health services and the extent of the coverage, including limits on the number of visits allowed. To qualify for coverage, you might also be required to take certain steps, such as getting a referral from your primary care doctor.
If you have Medicaid or Medicare, the Medicare Participating Physician Directory can help you find a provider who accepts Medicare. Your state Medicaid office, which you can find using the map on the National Association of State Medicaid Directors website, may be able to help you locate a provider who accepts Medicaid.
If you have no coverage, you can ask your community mental health center about lower-cost services. In many states you can dial 2-1-1 to find a community mental health center. You can also contact your local Mental Health America affiliate or Mental Health America’s national resource center.
If you want more information, see MHA FAQs on affordable treatments and paying for prescriptions

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Adjustment disorder is a short-term condition that occurs when a person is unable to cope with, or adjust to, a particular source of stress, such as a major life change, loss, or event.

Because people with adjustment disorders often have symptoms of depression, such as tearfulness, feelings of hopelessness, and loss of interest in work or activities, adjustment disorder is sometimes called “situational depression.” Unlikemajor depression, however, an adjustment disorder is triggered by an outside stress and generally goes away once the person has adapted to the situation.

The type of stress that can trigger adjustment disorder varies depending on the person, but can include:
Ending of a relationship or marriage
Losing or changing job
Death of a loved one
Developing a serious illness (yourself or a loved one)
Being a victim of a crime
Having an accident
Undergoing a major life change (such as getting married, having a baby, or retiring from a job)
Living through a disaster, such as a fire, flood, or hurricane

A person with adjustment disorder develops emotional and/or behavioral symptoms as a reaction to a stressful event. These symptoms generally begin within three months of the event and rarely last for longer than six months after the event or situation. In an adjustment disorder, the reaction to the stressor is greater than what is typical or expected for the situation or event. In addition, the symptoms may cause problems with a person’s ability to function; for example, the person may be unable to sleep, work, or study.

Adjustment disorder is not the same as post-traumatic stress disorder (PTSD). PTSD generally occurs as a reaction to a life-threatening event and tends to last longer. Adjustment disorder, on the other hand, is short-term, rarely lasting longer than six months.

What Are the Symptoms of Adjustment Disorder?

An adjustment disorder can have a wide variety of symptoms, which may include:
Feeling of hopelessness
Sadness
Frequent crying
Anxiety (nervousness)
Worry
Headaches or stomachaches
Palpitations (an unpleasant sensation of irregular or forceful beating of the heart)
Withdrawal or isolation from people and social activities
Absence from work or school
Dangerous or destructive behavior, such as fighting, reckless driving, and vandalism
Changes in appetite, either loss of appetite, or overeating
Problems sleeping
Feeling tired or without energy
Increase in the use of alcohol or other drugs

Symptoms in children and teens tend to be more behavioral in nature, such as skipping school, fighting, or acting out. Adults, on the other hand, tend to experience more emotional symptoms, such as sadness and anxiety.

How Common Is Adjustment Disorder?

Adjustment disorder is very common and can affect anyone, regardless of gender, age, race, or lifestyle. Although an adjustment disorder can occur at any age, it is more common at times in life when major transitions occur, such as adolescence, mid-life, and late-life.

A recent systematic review and meta-analysis that compared benzodiazepines with antidepressants for anxiety disorders has triggered a debate among clinicians about first-line treatments, efficacy for specific disorders, and adverse effects.

Offidani and colleagues1 gathered data through 2012 on published, controlled, and direct comparisons between benzodiazepines and antidepressants for anxiety disorders but were hindered, they said, by a “paucity of studies.”

Their review encompassed 22 studies, 18 of which compared TCAs, such as amitriptyline, clomipramine, or imipramine, with benzodiazepines. Of the remaining studies, 3 compared SSRIs or SNRIs with benzodiazepines and 1 compared the MAOI phenelzine with benzodiazepines. Eleven studies in the meta-analysis compared a ben-zodiazepine with a TCA for the treatment of panic disorder with or without agoraphobia.

While there has been a shift in recent years toward using such newer antidepressants as SSRIs and SNRIs as first-line treatments for anxiety disorders instead of benzodiazepines, Giovanni Andrea Fava, MD, Clinical Professor of Psychiatry at the State University of New York at Buffalo and one of the review’s coauthors, questioned whether the shift is warranted. “There is no evidence to suggest that antidepressant drugs are more effective than benzodiazepines in anxiety disorders,” he said. “Certainly, benzodiazepines have fewer side effects.”

In their review, the authors cited results for various anxiety disorders. “In mixed anxiety, GAD [generalized anxiety disorder], and social phobia, a superior efficacy of TCAs did not clearly emerge,” they said. They acknowledged that studies “with mixed anxiety were difficult to evaluate because of the heterogeneous features of the samples and the confounding effects of depressive symptoms.” The meta-analysis of treatments for panic disorder showed “less efficacy” and tolerability of TCAs than benzodiazepines, according to the review authors.

In trials that compared benzodiazepines with the newer antidepressants, the benzodiazepines “resulted in comparable or greater improvements and fewer adverse events in patients suffering from GAD or panic disorder,” Offidani and colleagues added. Hackett and colleagues2 compared diazepam and venlafaxine extended-release in 540 patients with GAD.

Results showed no significant differences in response rates between groups, but discontinuations and adverse effects were more frequent in patients treated with venlafaxine.

Feltner and colleagues3 compared lorazepam, paroxetine, and placebo for treatment of patients with GAD. “Both active treatments were effective in reducing anxiety-related psychiatric symptoms, while somatic features improved significantly only in patients taking lorazepam.”

Nardi and colleagues4 conducted a randomized, open-label, naturalistic 8-week study to compare the efficacy and safety of treatment with clonazepam and paroxetine in patients with panic disorder with or without agoraphobia. Clonazepam resulted in fewer weekly panic attacks at week 4 and greater clinical improvements at week 8. Anxiety severity was significantly reduced with clonazepam at weeks 1 and 2, with no difference in panic disorder severity. Patients treated with clonazepam had fewer adverse events than patients treated with paroxetine. The most common adverse effects were drowsiness/fatigue (57%), memory/concentration difficulties (24%), and sexual dysfunction (11%) in the clonazepam group and drowsiness/fatigue (81%), sexual dysfunction (70%), and nausea/vomiting (61%) in the paroxetine group.

Offidani and colleagues also cited a long-term follow-up study by Nardi and colleagues5 that compared the efficacy and safety of clonazepam and paroxetine over 3 years of treatment. Long-term treatment with clonazepam led to a small but significantly better Clinical Global Impression of Improvement rating than treatment with paroxetine. Both treatments similarly reduced the number of panic attacks and severity of anxiety. Patients treated with clonazepam had significantly fewer adverse events than those treated with paroxetine (28.9% vs 70.6%;.

On the basis of their systematic review and meta-analysis, Offidani and colleagues concluded that the change in the prescribing pattern that favors newer antidepressants over benzodiazepines in the treatment of anxiety disorders “has occurred without supporting evidence.”

Fava, who is also Professor of Clinical Psychology at the University of Bologna in Italy, believes the shift to the newer antidepressants was for “purely commercial reasons.” He told Psychiatric Times, “The shift from benzodiazepines to antidepressants is one of the most spectacular achievements of propaganda in psychiatry. . . . The use of antipsychotics for anxiety disorders follows the same lines.”

In an editorial citing the systematic review, Karl Rickels, MD,6 founder of the Mood and Anxiety Disorders Section at the

University of Pennsylvania and Stuart and Emily B. H. Mudd Professor of Behavior and Reproduction in Psychiatry, called for more comparison studies and contended that “no evidence for the superiority of the newer antidepressants over benzodiazepines, in terms of both efficacy and safety, exists for either short-term or long-term treatment.”

Peter Roy-Byrne, MD, Professor of Psychiatry at the University of Washington and one of the contributors to the

American Psychiatric Association’s Practice Guideline for the Treatment of Panic Disorder (2009), criticized the study by Offi-dani and colleagues as being of limited value for informing clinical practice today. “I think it is a flawed study, for the simple reason that it compares benzodiazepines with older antidepressants.”

The older antidepressants, he explained, have a greater adverse effect burden than the newer ones, so it is much easier to show some advantage for benzodiazepines in comparison studies. In addition, TCAs are now rarely used for anxiety disorders.

First-line treatment?

Fava and Roy-Byrne disagreed about using benzodiazepines as first-line treatment for anxiety disorders. “Benzodiazepines should be considered first-line pharmacological treatment for all anxiety disorders with the possible exception of obsessive-compulsive disorder,” said Fava, adding that drugs generally should not be the first-line treatment for anxiety disorders, because psychotherapy is very effective.

“I don’t think anybody anymore realistically thinks benzodiazepines should be used as first-line [pharmacological] treatments,” Roy-Byrne countered. He also questioned the practice of using benzodiazepines to help reduce anxiety during the initial weeks of treatment with antidepressants when anxiolytic effects have yet to occur.7 “In my experience, except in rare cases, using low doses of antidepressants and being in contact with patients frequently enough to answer their questions and provide them reassurance is usually sufficient to help them get used to the antidepressant over time. It introduces more logistic complications to put them on a benzodiazepine and then to take them off of it six or eight weeks later.”

The most common use of benzodiazepines, Roy-Byrne said, is in combination with antidepressants for individuals who have had suboptimal responses to antidepressants. He uses benzodiazepines as “second-line” treatments for patients with anxiety disorders, but continues them for the long term only if he sees substantial clinical improvement. “Most of the time it is not worthwhile to use them to just take the edge off symptomatic distress,” he said, noting that behavioral treatment might be a better alternative.

While he prescribes benzodiazepines for anxiety disorders in some of his patients, Roy-Byrne said GAD is “the absolute worst anxiety disorder” for which to use benzodiazepines, because GAD is a difficult diagnosis to make and is often comorbid with other disorders. “Using benzodiazepines for PTSD over the long term is also likely to produce more harm than good, though very short-term use in recently traumatized patients is a sound practice.” He said that it is better to use benzodiazepines for panic disorder and social anxiety disorder, “because they are easier to diagnose and less likely to be confused with other disorders, such as personality disorder or a subacute alcohol problem.

Both Fava and Roy-Byrne were asked about the advantages and drawbacks of benzodiazepines for anxiety disorders. “Benzodiazepines are fast-acting and very well-tolerated drugs with few side effects and interactions with other medications. Their drawbacks are cognitive effects and dependence,” said Fava.

According to Roy-Byrne, the advantages of benzodiazepines “are that they are extremely potent and work very well. A disadvantage is that you can become physically dependent on them, although to be fair, there is also a withdrawal syndrome with antidepressants.” Other disadvantages include cognitive and psychomotor impairments, abuse potential, and most importantly, the possibility, not yet conclusively demonstrated, of a reduced response to CBT. Benzodiazepines tend to be anti-CBT treatments.

“Whereas CBT is very good for anxiety because it toughens you up, improves your coping ability, and lets you become more resilient to stress, benzodiazepines do the exact opposite,” he said. “It has not been extensively investigated, but it is probably true that benzodiazepines may sometimes interfere with CBT programs. CBT requires some anxiety that individuals need to experience upon exposure to desensitize themselves over time. But if they take a potent anti-anxiety drug, they just won’t be anxious.”

“I agree that in some investigations, notably the London-Toronto study [by Nardi and colleagues5], use of benzodiazepines decreased the efficacy of CBT,” said Fava. The same effect is seen with antidepressants in panic disorder and social phobia.8-10 Furthermore, “long-term outcome studies of panic disorder treated by behavioral methods disclosed a detrimental effect of antidepressants and not benzodiazepines.”11 Antidepressants also entail the risk of a switch into an undiagnosed bipolar course, particularly in younger patients.

With regard to the newer antidepressants for anxiety disorders, Roy-Byrne said “they are well-tolerated and they work more slowly than benzodiazepines, so they don’t provide patients with a clear-cut signaling link between taking a pill and feeling an anti-anxiety affect.” There aren’t many drawbacks with the antidepressants, other than the sexual dysfunction associated with most of the agents.

Studies

The most common reason for using benzodiazepines is to add them to antidepressants when treating anxiety disorders that have not optimally responded to an initial antidepressant. According to Roy-Byrne, there is currently no published study comparing this strategy with switching the antidepressant, although a report of the study is in press, which may provide needed information in this debate.

Fava and Rickels call for further comparison studies, conducted, when possible, by non-industry sources. “A well-conducted comparison trial of a benzodiazepine and a newer antidepressant simply does not exist, neither for acute nor chronic treatment,” Rickels said.

In an editorial on whether benzodiazepines still have a role in treating patients with anxiety disorders, Baldwin and Talat12 said, “There is a persisting need for placebo-controlled combination studies in acute treatment; for placebo-controlled augmentation studies after non-response, for example, after unsuccessful treatment with a selective serotonin reuptake inhibitor or cognitive behavior therapy; and for well-designed relapse prevention.

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The topic of Borderline Personality Disorder (BPD) was a main focus at the American Psychiatric Association’s annual meeting this past May. Mental health professionals have long been perplexed by this diagnosis and at a loss for good treatment options. The diagnosis itself has taken on a profoundly negative connotation over the years and just the name conjures up images of unpleasant fictional characters portrayed in the media. In many cases people with this disorder have gotten a bad rap. It was recently revealed, based on a study done by the federal government of over 24,000 adults, that the prevalence of this disorder is about 6%. The disorder is equally present in men and women. This number is far greater than previously thought.

A patient presenting with symptoms of BPD is typically seen as extremely challenging for most clinicians. Many patients go undiagnosed for years and instead are given many other diagnoses that seem to fit only part of their unique disorder. The misdiagnosis then leads to improper or inferior treatment. Borderline Personality Disorder has previously been classified as the result of childhood abuse. In this way it has been somewhat misunderstood. Recent research has shown that there is in fact a biological predisposition to the basic symptoms of the disorder. Abuse will increase a person’s chances for developing the disorder but not everyone with BPD has a history of abuse. One of the things that this distinction hopes to clear up is the belief that the person with BPD is being deliberately manipulative and combative. These beliefs have made it more difficult for sufferers of BPD to get unbiased treatment from clinicians and understanding from loved ones.

In addition to redefining the nature of the disorder, the attention it has received lately has helped educate family and friends of people afflicted with BPD. This is a critical step in the healing process for these individuals because a consistency in relationships is crucial to these individuals. There has been a movement towards more family and patient advocacy and providing better treatment and referral services. According to a Los Angeles Times report, the National Alliance for the Mentally Ill, a well-known patient advocacy group, has placed BPD on its list of “priority populations” for public policy efforts. This increased awareness and focus on the disorder is very good news for those who have lived with this diagnosis and for the people who love them.

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By Susan Perry | Published Thu, May 13 2010 10:22 am

At Mind Hacks this week, British neuropsychologist Vaughn Bell reports on a large Swedish study whose findings seem to support the theory that genius and “madness” are somehow intertwined.

The study, published earlier this year in The British Journal of Psychiatry, found that high-school students — particularly male students — with the very highest (top 2 percent) academic achievement records were four times more likely to be hospitalized for bipolar disorder later in life than their peers with average grades.

The study (which included more than a quarter of a million students) also found that students with the lowest grades were twice as likely as their average-grade peers to develop the disorder.

The finding that both very high and very low grades were associated with an increased risk of bipolar disorder suggests, say the study’s authors, that there may be two different forms of the illness — each with different causes.

The study’s findings held up even after the researchers controlled for factors known to be associated with the development of bipolar disorder, such as the parents’ level of education and socioeconomic status.

Absolute risk still very low
But before any of you parents start panicking, you should know that these findings reflect a relative, not an absolute, risk. In fact, the absolute risk — the chance that any particular high- or low-performing student will develop bipolar disorder — is quite low. “For example,” writes Bell, “of the 9,427 top performing students only 12 were diagnosed and hospitalized with bipolar — a high rate compared to the average performers but still rare.”

Nor should any students use these findings as an excuse to slough off at school. Working hard at school doesn’t cause bipolar disorder. As the study’s authors point out, the illness is strongly genetic, and, therefore, the association between academic achievement and bipolar disorder is most likely a genetic effect. For example, whatever genetically predisposes students to focus and study hard in high school may also predispose them to developing bipolar disorder later in life.

A link to creativity?
Bell disagrees with the study’s lead author, British psychiatrist James MacCabe, that more “creative” students seem to be at greatest risk of developing bipolar disorder.

“I have to say that’s probably pushing it a bit,” Bell writes. “They seem to be fairly evenly spread, although, interestingly, performing well in handicraft and sport indicated the students were less likely to be diagnosed with the condition in later life.”