Marks Psychiatry

A study out of the University of Manitoba conducted by Ann Guevremont MEd. and Marni Bromwell PhD. concluded that depression in a woman occurring at anytime between one year before and nine years after birth is a risk factor for the child later developing ADHD. They also found the chances of the child developing ADHD is greater the more chronic the depression. In fact, maternal depression increased the chances 1.5 – 2 fold.

I’m not sure what to make of this information. There have been previous studies linking maternal depression and ADHD, but this is the first that has established a time frame for which the maternal depression impacts the child.

This data suggests that ADHD is not solely biological since the mother’s mental condition even after birth can influence the development of ADHD. It makes me wonder how much of a role maternal nurturance and attention to the child play in the child’s ability to focus and attend to things. If a depressed mother doesn’t pay enough attention to her child because she is depressed, does the child compensate for this in a way that causes them to have trouble with attention or impulsivity?

Many more questions need to be answered about this. But for now, it emphasizes the importance of mental health before and after pregnancy. Many women go undiagnosed and suffer silently. But knowing a mother’s mental state can have a far reaching impact on her family, perhaps more women will talk with their doctors about how they feel and more clinicians will be more vigilant in screening for maternal depression even years after childbirth.

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At the International Conference on Bipolar Disorder, Dr. Rasmus Licht of Denmark reported on a study of 155 adult patients with bipolar disorder. The patients were treated with lithium and lamotragine (lamictal). They found lamictal tended to be more effective in patients whose index episode was depression and lithium was better for patients whose index episode was mania.

Unfortunately, they found that by five years on the single medication, only two out of the original 155 patients were able to remain on one medication. The remaining patients failed treatment (had a relapse of symptoms) and this usually happened within the first 1 1/2 years.

Following bipolar patient’s progress for five years makes this study unique, and it supports the idea that the majority of patients require more than one medication to control their symptoms in the long run.

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I sometimes hear people ask “one minute I feel down, the next minute I’m really happy, am I manic depressive?”

Bipolar disorder or manic depression is a mood disorder whereby a person has discreet episodes of depression or mania. The index episode is a term used to define the first episode. If a person’s index episode is depression, they may not be diagnosed with bipolar disorder until they have a manic episode. That is, this person may be diagnosed as having depression for years until they have a manic episode at which time their diagnosis will change to bipolar disorder. The person who has mania as their index episode will start with a diagnosis of bipolar disorder.

Everyone is different, but a typical course of the illness is such that a person may have 1-2 episodes of mania and/or depression in a year or every few years. Rapid cycling bipolar disorder is defined by having four or more episodes in a year.

So back to the question - people with bipolar disorder don’t switch between depression and mania within the course of a day. In fact, depression requires symptoms lasting two weeks to be considered a depressive episode. The situation of extreme moods that flip back and forth over the course of a day would be considered emotional lability or emotional volatility that may be present in a person with anxiety or a mood disorder (such as depression or bipolar disorder). But it can also be a part of someone’s personality. For example, people with histrionic personality traits can have dramatic or “over the top” responses that are intense reactions to life issues that are not necessarily a mental disorder that requires medication treatment.

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Hoodia is a cactus-type plant from Africa that has many uses, however the native populations of South Africa have used it for indigestion or infection.  The plant Hoodia gordonii has been recognized as an appetite suppressant since the late 1970’s in Africa, but in the US there have been no definitive studies establishing it as a safe and effective appetite suppressant.

Despite this, media hype about the drug began around 2004 when 60 minutes aired a special on it’s effectiveness and since then others have followed suit such as the Today Show and Oprah catapulting it’s popularity.  To protect consumers, Hoodia exporters must be issued a CITES (the Convention on International Trade in Endangered Species of Wild Fauna and Flora) certificate by the office of Western Cape Nature in order for Hoodia to be legally exported abroad from Africa.   It is illegal to export Hoodia without this certification.

Why is a psychiatrist talking about Hoodia?  Having treated patients who took Hoodia (at their own initiative), I’ve seen how it has benefited most and also had some negative effects.  Most established appetite suppressants available in the US are stimulants and stimulants as a side effect can lessen one’s desire to eat.  It’s not clear what the active ingredient (P57) does, but I wouldn’t be surprised if it’s not a naturally occuring stimulant.  As such, it can also have the unwanted affects of agitation and anxiety.  If you already have anxiety, this could really worsen your condition.

Some people have dealt with this by taking less than the recommended dose.  The pills are usually capsules and can’t be split, but rather than taking it three times a day, some people have taken it once a day at the time of their worst cravings.  I have heard some people say Hoodia “takes the edge off” their cravings giving them enough contol to choose not to eat junk or munch unneccessarily.

We know there is no magic pill to control weight, as controlling your eating requires behavioral change.  So for some who recongize that long term control of eating is a lifetime, lifetstyle adjustment, Hoodia can be something that gets them started in the right direction long enough to get used to a new way of eating and using food.

Of course, as with any drug (and herbal remedies are drugs too, just naturally occuring ones), a person considering starting it should check with their health care provider prior to taking it.

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Medication discontinuation syndrome can happen when a person stops their medication abruptly. In general, medication should be tapered off slowly with medical supervision. But since we don’t know precisely how slow is slow enough for each individual, sometimes tapering off the medication can still result in some withdrawal symptoms.

Usual withdrawal symptoms are things like fatigue, irritability, diarrhea, headache, anxiety, or feeling like you have the flu. These symptoms typically last a few to several days.

There have been some who have experienced electric shock sensations when stopping Effexor and some other serotonin agents such as Cymbalta, Paxil, etc. This is very unusual, but I’ve heard patients describe it as a “brain shock” that was worsened with movement. In the literature, reports of these symptoms last up to 5 days.

The origin of these sensations is not entirely clear, but thought to be a form of paresthesia (which is the sensation of feeling tingling or creeping on the skin). Paresthesias result from our nerves being activated in a particular area when there is no apparent trigger for the activation – for example, feeling a pinprick on your skin when you haven’t been pricked by a pin.

The electric shocks have been helped by adding back the medication that was discontinued and tapering it more slowly or adding another long acting serotonin agent such as Prozac.

Therefore, stopping medication abruptly is usually not a good idea, especially if you have been taking a particular agent for a long time. It’s best to discuss a tapering schedule with your doctor so that you can have the smoothest transition possible.

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Sleep latency is the amount of time it takes to fall asleep. Normal is considered to be 15-25 minutes (some say 30minutes). I’ve had many people tell me with disappointment that it takes them 30 minutes to fall asleep and how they know people who can fall asleep instantaneously. They are surprised to hear that 30 minutes falls into the normal range.

In fact, a sleep latency of less than 5 minutes is considered to be a sign of sleep deprivation. So, if you can go into a dark room and fall asleep within 5 minutes – this isn’t necessarily a good thing and could mean you need more sleep.

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