The connection between physical ailments and mood is not a new one. It is well-established that medical illness, ranging from infections to cardiovascular disease, can result in increased symptoms of depression, while depression can predispose people to become physically sick more often. Now, a growing body of evidence shows that depression and physical illness have something important in common: inflammation.
Continue reading » “Can Anti-inflammatory Drugs Treat Depression? Some Promising New Evidence But Not Yet Enough”Category: Bipolar Disorders and Depression
Understanding Premenstrual Dysphoric Disorder (PMDD)
Imagine a mood disorder in which intense mood swings come predictably every month, wreaking havoc on any idea of calm normalcy. Depressed mood, lethargy, decreased interest and hopelessness occur along with marked irritability, anger, agitation and insomnia. One has the sense of being overwhelmed and “out of control.” Arguments and heightened tearfulness ensue. Then everything returns to normal for the next week or two, only to be turned upside down by the dreaded monthly roller-coaster.
Continue reading » “Understanding Premenstrual Dysphoric Disorder (PMDD)”Bipolar Disorders and the Case of the Missing Self
Every few years, a new author comes along who is uniquely capable of giving voice to the ineffable aspects of their experience with serious mood problems: Kay Jamison with her (An) Unquiet Mind, William Styron who perceived Darkness Visible, and Sylvia Plath’s The Bell Jar are the more modern prototypes. Recently, a freelance journalist, Linda Logan, published a brief piece in the New York Times: The Problem With How We Treat Bipolar Disorder 1. This mini-memoir is second-to-none in capturing the roller-coaster ride that is far-too-often the case with this illness.
Continue reading » “Bipolar Disorders and the Case of the Missing Self”Brain Problems in Bipolar Disorder: What We Know and How We Know it, circa 2013.
“Is there something wrong with my brain?” “Does part of my brain not work correctly?” Each time we make a diagnosis of bipolar disorder in our practice, these questions inevitably and understandably come up. People want to know about their illness. This conversation is often an essential part of the treatment.
Continue reading » “Brain Problems in Bipolar Disorder: What We Know and How We Know it, circa 2013.”Postpartum Troubles Point to Increased Risk of Future Bipolarity
In our clinical work, we are always striving to determine who is at high risk of developing bipolar disorder. Our patients come to us with a variety of mood and anxiety problems. Often, those who are ultimately diagnosed with bipolar disorder have experienced a long period of misdiagnosis and incorrect treatment.
Continue reading » “Postpartum Troubles Point to Increased Risk of Future Bipolarity”IPSRT as monotherapy in bipolar II disorder: can psychotherapy be more than an ‘adjunct’ in the treatment of bipolar disorder?
Clinicians who work with patients suffering from bipolar disorder have known this for quite some time: medication alone, while helpful in controlling many of the acute symptoms of bipolar disorder, is not enough to help patients manage this complex illness. Patients often feel overwhelmed by the diagnosis and need support to adjust to the realities of fluctuating mood states, which frequently result in interpersonal and occupational dysfunction. For these and other reasons, psychotherapy is an important component of bipolar disorder treatment.
Continue reading » “IPSRT as monotherapy in bipolar II disorder: can psychotherapy be more than an ‘adjunct’ in the treatment of bipolar disorder?”New Wonder Drug Remarkably Effective in Bipolar Disorder: Lithium (Yes, Lithium).
The single most important research study in the past year in the area of clinical therapeutics of bipolar disorder was conducted by Geddes and colleagues at Oxford University in England[1]. Using a randomized open-label design (no placebo control group and subjects knew which medications they were receiving), the BALANCE study sorted 330 subjects with bipolar disorder type I into three treatment groups: lithium alone, valproate (Depakote) alone, or combination treatment with both lithium and valproate. The outcome measures were time to recurrence of a major mood episode, either mania or depression. The study design allowed for an extended, two year follow-up on these subjects. This time frame allows for meaningful assessment of genuine prophylactic effects. The results found that combination therapy was most effective, marginally more so that lithium alone, but significantly greater than valproate monotherapy. The interpretation of the data supports the unique efficacy of lithium as the single-most effective mood stabilizer available.
Continue reading » “New Wonder Drug Remarkably Effective in Bipolar Disorder: Lithium (Yes, Lithium).”Acute Antidepressant Effects of Lamotrigine: More and More Disappointing.
In the past several years, two new studies have been published examining the efficacy (in pristine, experimental conditions; rigorous selection criteria, minimal comorbid conditions) and effectiveness (real world variability) of lamotrigine (Lamictal) in the treatment of acute bipolar depression [1, 2]. These and other studies were recently summarized in a review paper by Amann and colleagues in the Journal of Psychopharmacology[3]. Attempting to synthesize disparate findings, Amann concludes that “…the antidepressant effect of LTG in acute bipolar depression, if it exists, is small.”
Continue reading » “Acute Antidepressant Effects of Lamotrigine: More and More Disappointing.”Not the SAMe Old Story: New Antidepressant Data on Popular Nutritional Supplement.
Evidence is building for the use of SAMe (S-adenosyl methionine) as adjunctive therapy in major depressive disorder. Just this past August, a landmark study by Papakostas, et al, demonstrated the superior efficacy of SAMe when combined with other antidepressant agents (e.g., fluoxetine, venlafaxine, duloxetine) over antidepressant monotherapy.1 Although SAMe has been reported to induce mania in some case reports, there may be a potential role in treatment for bipolar depression as well.2
Continue reading » “Not the SAMe Old Story: New Antidepressant Data on Popular Nutritional Supplement.”Riluzole: Promising Therapy for Treatment-Resistant Mood Disorders.
One 8-week study showed possible response based on significant improvement in Montgomery-Asberg Depression Rating Scale scores in patients treated for acute bipolar depression when riluzole was added to other antidepressants.1 However, the small, non-randomized, non-blinded nature of the trial limits the conclusions that can be drawn. Of note, there were no instances of mania or hypomania in this trial, indicating that riluzole may not have the mood destabilizing effects of many other antidepressants. Trials with larger sample sizes would be necessary to confirm this result.
Continue reading » “Riluzole: Promising Therapy for Treatment-Resistant Mood Disorders.”