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Simple yet effective strategies to cope with your loved one.

Bipolar News

December 15, 2004

Note: One or more of the following articles may require a subscription to view the entire article.  We cannot post articles that require a subscription.  We are sorry for the inconvenience.

Equetro OK'd for Bipolar Disorder
Forbes - New York,NY,USA
... has approved the Shire Pharmaceuticals drug Equetro (extended release carbamazepine) for acute manic episodes associated with bipolar disorder, the company ...

Bipolar Disorder - New Evidence of Brain Chemistry Abnormali
About Mental Health - USA
ANN ARBOR, MI (October, 2000) People with bipolar disorder have an average of thirty percent more of an important class of signal-sending brain cells ...

MR spectroscopy may be best bipolar-disorder gauge
Charlotte Observer (subscription) - Charlotte,NC,USA
WEST PALM BEACH, Fla. - Magnetic resonance (MR) spectroscopy may prove to be the definitive diagnostic test for bipolar disorder, a serious brain illness ...

SHIRE'S BIPOLAR DRUG GETS FDA APPROVAL
PharmExec.com - Iselin,NJ,USA
Shire Pharmaceuticals Group Plc announced it has been granted Food and Drug Administration approval for its bipolar drug Equetro (extended-release ...

Study Demonstrated Long-Term Treatment with Zyprexa(R) Reduced ...
mysan.de - Germany
... is indicated in the United States for the short-term and long-term treatment of schizophrenia, for maintenance in the treatment of bipolar disorder, and either ...

Feeling blue?

St. Louis Post-Dispatch; 12/13/2004; HARRY JACKSON JR.; Of the Post-Dispatch

You're not alone. Lots of people feel down during the holidays. The good news: You can do something about it.

When the holidays aren't as happy as they're supposed to be, counselors call the mental state -- unofficially -- the holiday blues. The generic moniker doesn't describe a clinical condition, but one that's all too common.
Holiday blues occur when people stress out as times get too chaotic or don't live up to their expectations. Counselors say having the blues is about control: The holidays control the person and the person has lost control of the holidays.

"We're separated from our families, we overindulge -- eat a lot of rich foods, drink to excess -- and the overindulging can contribute to our feelings of not being ourselves and not feeling quite right," says Dr. Karen Broquet, associate professor of clinical psychiatry and internal medicine at Southern Illinois University School of Medicine in Springfield. "It compounds things if you're feeling blah and unsettled, anyway, and you've got invitations to four parties in a week, and you're eating a lot of fatty foods or drinking more than you're accustomed to. It just contributes to a cycle."

Randy Larsen, head of the Department of Psychology at Washington University, prefers to frame the malady as holiday stress rather than blues.

"The people who get in trouble around the holidays are people who do too much, expecting too much of themselves and others," he said.

The birth of the blues

The blah feeling that's opposite of what folks are supposed to feel during the holidays has many sources:

Biology: Larsen says stress combines with a biochemical component to bring on the holiday blues. "People drink more alcohol. People change their eating patterns. They eat more unusual kinds of foods that throw them off."

Disruption: "There's just a lot of disruption around the holidays, socially, biochemically," Larsen said. "People are thrown off-track, and they're more emotional and reactive."

Too much time: Add that to the extra time on some people's hands, and the mix can be sorrowful. "Some people have trouble when they have a lot of time on their hands," Larsen said. He compared it to the Sunday effect: Psychotherapists generally get most of their emergency calls on Sunday. Their patients are alone, not at work, not socializing.

Loneliness: Loneliness is a feeling of being out of control, a feeling of being separated from family and friends because of forces that you can't control.

Unrealistic expectations: "If your expectations are too unrealistic, then you're setting yourself up for disappointment, and disappointment is a big part of the blues," said Dr. Joan Lang, head of the Department of Psychiatry at St. Louis University School of Medicine. "Take a realistic look at your expectations and how likely it is that this holiday will meet them at all."

Flooded with false images: Television constantly presents the public with images of family and holidays that relatively few people are living.

"Resist the constant bombardment of things that don't exist but are presented throughout the atmosphere as the norm, such as the perfect family, the perfect body, the perfect incomes that few, if any, people ever achieve," Lang said. "It's the 'Santa only brings toys to good little kids -- not naughty kids or kids living in poverty.'

"If you're aware that you're being manipulated, the chances of (TV images) working are reduced a little bit. You know the shows on TV are made up, and the beautiful people who surround you at every turn, that's their full-time job, being beautiful."

Counselors suggest doing something about it.

Larsen has co-written a textbook that includes a chapter on being happy. He says those elements can apply to holiday blues. The bottom line is take control, he says, and decide not to feel bad and not to do the things that generate bad feelings.

"Manage the stress or the expectations or activities," he said. That sometimes means to learn to say no. "Keep a lid on things and don't let them get out of control."

Don't let demands on yourself and the demands of others wreck your disposition. For example, if you're supposed to bring pumpkin pies to a gathering, buy them at a store, he said. The hours it takes to prepare them sometimes can take more of a toll than just the time.

Broquet, of Southern Illinois University School of Medicine, says another way to take control is to embrace the original meaning of the holidays.

"People who have a strong faith or spiritual background tend to be less prone to the expectation mismatch of holiday blues than people who have a purely secular approach," she said. "And it doesn't matter what your faith background is, whether it's Christian or some other faith.

"One of the theories is that a strong faith goes hand in hand with a sense of meaning or a sense of purpose. When things are going well, having a core sense of meaning is nice, but when things are not going well, having a core sense of meaning or purpose for the suffering has a very strong protection against depression and other emotional fallout from the suffering."

Lang suggested setting priorities and limits. "Don't expect more than your world might deliver," she said, "and don't take on more than is realistic.

"Concentrate on the part of the holiday that has to do with being with loved ones, faith traditions. Look at the reality you have and see what you can do about it so it won't sandbag you."

As for loneliness, "Realize you don't have to be alone," Lang said. "There are people in the same boat, people in the neighborhood, or at work or more distant family.

"A lot of it has to do with how you frame it. If you're thinking, 'Poor me, I'm alone,' that's not likely to turn into a nice day."

Larsen suggested continuing your routine and taking time for yourself. "Don't quit exercising because you're busy," he said. "To keep down the disruption, continue doing the things you like to do."

= = = =

How to feel better

Mental health experts emphasize that you shouldn't get holiday blues mixed up with depression. Depression brings your life to a standstill and should be treated with counseling and possibly medication. Holiday blues can be relieved with some affirmative action. If you can laugh, and an invitation or getting out of the house cheers you up, you've got the blues, not depression.

Counselors suggest avoiding excessive alcohol as a way to buffer sadness. Alcohol is a depressive drug and will make matters worse.

Here are some other suggestions:

Don't automatically attribute sadness to the holidays. You may have a reason to feel sad that has nothing to do with the holidays.

Don't try to do and be everything. "Negotiate with yourself," said Dr. Joan Lang, head of the Department of Psychiatry at St. Louis University School of Medicine. Decide what you can and can't do and what you will and won't do, and then enforce your decisions.

Don't dwell on past bad holidays. Look to the future and dwell on the good things that are happening to you now. Both the good ol' days and the bad ol' days are gone.

Focus on what you have, not what you don't have. This attitude protects people around the holidays: "In another generation we would have called that counting your blessings," said Lang. "We tend to focus on what we don't have. But when we focus on what we do have, regardless of how meager it might be, it really has an impact on the emotional component."

Surround yourself with people who care. Make new friends. Renew old friendships.

Don't sit around the house feeling sorry for yourself. Hit the road, take in a movie. A lot of people are out after the day's festivities are done.

Do something new. If you haven't tried it, try it. If you have and you liked it, do it again.

Do free things. Drive around looking at holiday decorations. Go window-shopping. Check local calendars for free or inexpensive outings.

Accept people's invitations. Just because you're too cool for a tree-decorating party doesn't mean there won't be nice people there.

Have your own party. Invite friends over and enjoy the company.

Volunteer to help others. This can range from building houses to reading books to children. For ideas, check out the United Way Web site (www.stl.unitedway.org/ volunteer). Or call Rick Skinner at 314- 539-4284, or e-mail him at skinnerr@ stl.unitedway.org. "It's fine to support charities that support your goals and values," said Lang. "The more personal and meaningful the gift, the better."

= = = =

The suicide myth

The belief that suicides increase during the holidays has become so entrenched that some news stories tend to repeat it without checking out the facts, according to several studies on the issue.

The truth is that suicides actually drop between Thanksgiving and Christmas, said Dr. Karen Broquet, a professor of psychiatry at Southern Illinois University School of Medicine in Springfield. The American Association of Suicidology confirms that December has the lowest suicide rate of any month of the year. The National Center for Health Statistics has found that suicides drop by about 20 percent during the holidays.

Studies show that suicides average about 36 for every 1 million people nationwide during the year, but drop to under 30 during the holidays. April, June and July are actually the highest months for suicides in America.

Researchers found that very few publications attributed statements that the risk of suicide increased during the holidays. The studies didn't address television news.

The National Institutes of Health reports that the primary causes for suicide in America are bipolar disorder, also known as manic depression, and conditions that mimic mental illness during episodes of drug or alcohol abuse. The federal agency added, however, that depression can intensify during the holidays.

(Copyright (c) 2004 The Post-Dispatch)

NATION Ronald Williamson, exonerated death row inmate

Newsday; 12/13/2004; THE ASSOCIATED PRESS

OKLAHOMA CITY - Ronald Williamson, a former death row
inmate exonerated by DNA evidence five days before his scheduled execution,
died Dec. 4, his sister said.

Williamson died at 51, five years after he was freed from prison and nearly
seven weeks after being told he had cirrhosis of the liver, Annette Hudson
said.

Williamson, a second-round draft choice for the Oakland Athletics in 1971
and a star high school athlete from Asher, spent six years playing baseball for
farm teams of the Oakland A's and New York Yankees, Hudson said.

When arm injuries ended his career, Williamson returned to nearby Ada,
where he had a brief marriage and held various sales jobs. He then moved back
in with his parents and stopped working, Hudson said.

"From the disappointment of not making it in baseball, he turned to
alcohol," Hudson said. "He just started declining."

In late 1982, the body of Deborah Sue Carter, 21, was found in a garage
apartment. Williamson was arrested for the murder four years later. Williamson,
diagnosed as suffering from bipolar disorder, told authorities he recalled
having a dream in which he pulled a cord around the woman's neck, but he also
dreamed he stabbed her. Carter had not been stabbed.

He and another man allegedly linked to the slaying by hairs from the crime
scene were convicted in the case. After 12 years, they were freed in April 1999
after DNA evidence proved their innocence; Williamson was just five days away
from execution. Their civil lawsuit was settled in 2002 for an undisclosed sum.

Another man whom prosecutors used to link Williamson to the crime was
ultimately sentenced to death for Carter's murder.

After his release from prison, Williamson lived with his sister, unable to
live on his own because of his mental problems and alcoholism.

"The only time he had happiness in his life, he told me, was his years
playing baseball," Hudson said.

Copyright 2004, Newsday Inc.

BIPOLAR DISORDER Drugs that help also are harmful

Newsday; 12/12/2004; OFELIA CASILLAS. CHICAGO TRIBUNE

CHICAGO - The same drug that helped Rachel Mason
graduate from eighth grade by controlling her bipolar disorder caused her to
weigh more than most girls at the ceremony.

The drug that eased her rages also sparked insatiable hunger. When she
slipped into a white-flowered red skirt for the event, the teen who stands only
a few inches taller than 5 feet weighed 243 pounds.

"It's in my head," said Rachel, now a high school freshman in Mount
Pulaski, Ill. "In my stomach, I usually don't want to eat anything."

Apprehensive about severe side effects associated with the first generation
of drugs approved to treat psychosis - including tremors, muscle contractions
and involuntary movements that can cause disfigurement - doctors have embraced
a new group of drugs during the last decade, among them Risperdal and Zyprexa.

As time passes, however, adverse effects have emerged for these new drugs -
including a ravenous hunger that makes children badly overweight and
susceptible to future diabetes.

The dramatic weight gain can be emotionally difficult for teens at a time
when social pressures are especially intense. Some refuse to take a drug that
causes weight gain.

Although the Food and Drug Administration has approved these
second-generation anti-psychotic drugs to treat mentally ill adults, the agency
has not agreed to their use in youths. Doctors prescribe the drugs based on
clinical trials, experience and limited data.

Some of these newer drugs have other side effects as well - one drug causes
a decrease in white blood cells, for example; others cause tremors, sedation
and low blood pressure.

An FDA red flag

This year, the FDA added a warning label about increased diabetes risk to
the anti-psychotic drugs, which doctors find are tied to increased cholesterol
and triglyceride levels.

"It's a huge problem. All of these medications right now are double-edged
swords," said Dr. Michael Naylor, University of Illinois at Chicago director of
child psychiatry. "You're kind of left with a dilemma: Do I choose a
medication that can harm me or an illness that can harm me? It's a terrible
choice."

Rachel's parents, Stephen and Michelle Mason, knew early that something was
wrong. In second grade, Rachel would crawl under her desk. She'd scream, chew
on erasers, eat paper. Other children were afraid. After her rages, Rachel
never remembered what happened.

Rachel saw four psychiatrists in six months and was diagnosed with bipolar
disorder at age 8. No medication worked as well as the Zyprexa she started in
sixth grade.

Her body soon ballooned. She never felt full. In June, she weighed 253
pounds.

Dr. Christoph Correll, a research psychiatrist at The Zucker Hillside
Hospital in Glenn Oaks, N.Y., has followed 360 children ages 4 to 19 on
second-generation anti-psychotic drugs. Interim results found children gained
mostly fat, some of it deposited on their abdomens. With many putting on more
than 7 percent of their baseline body weight, they were at risk for future
heart attack, stroke and diabetes.

Results of a study

"The gateway to these serious complications in the future is the weight
gain," Correll said. "The numbers we found were very surprising and sobering."
A 12-week study of 50 youths published in the 2002 Journal of the American
Academy of Child and Adolescent Psychiatry found Zyprexa and Risperdal were
associated with "extreme weight gain in adolescents, much higher than that
reported in adults." Experts say the increased weight can not only affect
health but also perpetuate depression. "Oh gosh, it puts their self-esteem to
the floor," said Dr. Louis Kraus, Rush University Medical Center chief of child
and adolescent psychiatry.

Pharmaceutical companies say they are working to eliminate the weight-gain
problem.

Eli Lilly and Co., which makes Zyprexa, is looking into which patients gain
the most weight, said spokeswoman Marni Lemons. "It's possible that a receptor
that improves your functioning [also] improves your appetite," Lemons said.
"Is it possible to create a drug that doesn't have weight gain as a side
effect? We don't know. We have researchers looking into that."

Doctors also say they worry over how the drugs work in growing bodies since
long-term effects have not been extensively studied in children.

"We are learning about the safety issues as we are using the drugs in
children," said Dr. Julie Zito, a University of Maryland pharmacy and
psychiatry associate professor. "In my mind, there is not sufficient data that
establishes them as effective and safe in children for long-term use."

The FDA has requested that five of these drugs be evaluated in children, a
spokesman said.

A delicate balance

In the meantime, parents like Michelle Mason struggle to balance the drugs'
risk with their control over paranoia, delusions, aggression, and, in Rachel's
case, violent rages.

"If a child is psychotic, they can't be in school, OK?" said Suzanne
Andriukaitis, executive director of the National Alliance for the Mentally Ill
in Chicago. "Overweight kids can be in school and will have plenty of company."

In June, Rachel stopped taking Zyprexa and began Risperdal. She had gained
50 pounds since the previous August.

On the new drug, Rachel has been in a good mood, but sometimes, she still
can't stop eating. Her weight peaked in August at 266 pounds. That same month,
she started high school - the "new world" she had been hoping for. She became
an officer in her first club - the Family, Career and Community Leaders of
America. She gets good grades and has served as greeter for visiting volleyball
teams.

On Risperdal, Rachel's mood is better than her mother had anticipated. And
since August, she has lost 2 pounds.

Best of all, Rachel has found new friends who accept her.

Copyright 2004, Newsday Inc.

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