Marks Psychiatry

A symptom of depression can be anxiety, but a person can also have a co-morbid (meaning simultaneously occurring) anxiety disorder that is a separate entity from their depression. Some anxiety disorders that can occur with depression are Panic Disorder, Generalized Anxiety Disorder, Obsessive Compulsive Disorder, Social Phobia and Post-Traumatic Stress Disorder. It is not uncommon for the anxiety to present prior to the depression. In fact, according to an article in the Journal of Psychiatric Research (2003;37:187-92), the prevalence of generalized anxiety occurring with major depression is close to 70%. This is a high percentage.

Other studies show that 28% - 38% of those with bipolar disorder have a separate anxiety disorder. One study in the American Journal of Psychiatry (2004;161:2222-9) showed that an anxiety disorder occurring with bipolar disorder was associated with an earlier age of onset. The authors noted that teenagers developing bipolar disorder at an earlier age likely began with anxiety problems as a prelude to developing the mood symptoms.

Why is this important? Unfortunately we have seen that anxiety disorders can worsen the course of depression or bipolar disorder, making it harder to achieve remission of symptoms. The untreated symptoms can lead to substance abuse as a way to self-medicate. If a person is in the throws of serious mood episode (depression or mania), it can be easy for all those involved to overlook the anxiety disorder or not aggressively manage the anxiety because of the attention to the mood symptoms. So these findings emphasize the importance of diagnosing and managing comorbid anxiety disorders in individuals with major depression or bipolar disorder.

Popularity: 50%

Theresa H. M. Moore of the University of Bristol in England and her colleagues have conducted research which concluded that having used marijuana at any point in your life increases the risk of having a psychotic episode by 40%. This was more than twice the risk of those who have never smoked marijuana. The heavier the use, greater the chance of developing psychosis. Heavy use was defined as smoking more than 100 times in a lifetime or currently smoking marijuana weekly.There study does not definitively establish a causal relationship between marijuana and psychosis, but it’s about the best that it gets because the only way to establish causality would be to do a randomized, controlled study having some people smoke marijuana to see what happens later in life. This type of study would be unethical.

I found this study interesting because I often hear people say “there’s nothing wrong with marijuana” or “marijuana should be legal.” These findings illustrate the fact that marijuana is a drug that can have very negative effects on your life, for the rest of your life.

Popularity: 31%

I saw a flyer advertising Life Coaching at a local medical center. The flyer said that Life Coaching promoted change and you could expect the your life to be changed by adding “zest” to your life, look at things from a different perspective, create action plans and be more creative.

I read that and thought, those are pretty big promises how could anyone pass that up?

I often feel as though I am doing life coaching with patients who do not have serious mental disorders but are simply seeing me for life issues. It has taken me a while to depart from my more rigid, psychoanalytic stance that I learned in my residency training to a stance that allows me to give more direct, practical feedback (as opposed to deep, psychoanalytic interpretations).

But I’m still doing therapy. I’m listening to patients discuss their issues and helping them recognize blind spots, form a different perspective, suggest other alternatives they may not have thought of, etc. As a therapist, I have to remain neutral, that is, I’m not giving advice based on what I would do if I were in the situation. That’s one of the differences between professional feedback and advice from a friend or colleague.

I can’t imagine having anything useful to say to people (that was not my own personal opinion) if I were not a trained therapist. So I’m still a little baffled at how the trained life coaches achieve the results listed earlier without some experience/knowledge of psychology.

Some people may not need psychological interpretations but may benefit from having a person who gives you their undivided attention and is supportive. But be cautious in whom you choose to work with especially if you plan to share your innermost thoughts with them as the life coaching industry is not regulated in the same way as therapists. In this type of work, maintaining professional boundaries becomes of utmost importance.

Popularity: 24%

Researchers at Rochester Medical Center have seen good results in Provigil (brand name for modafinil) improving the negative side effects of chemotherapy that impact cognitive function. Chemo-brain is a term used to describe the foggy, fuzzy thinking and poor memory experienced by some patients after they have undergone chemotherapy.

The research group based their findings on a study of 68 women undergoing chemotherapy for breast cancer. They were treated with Provigil for 8 weeks to combat fatigue. However, the women found they had significant improvement in their ability to concentrate as well as memory and learning.

Provigil is a drug prescribed for excessive daytime sleepiness due to Narcolepsy (which is a problematic sleep condition) and shift-work sleep disorder. Provigil activates the brain in the same way as stimulants like amphetamines and caffeine. Why not just use Adderall or caffeine? Provigil does not have the negative effects on the heart as does Adderall so it is potentially safer.

The study uses a small group of patients and is funded by the drug company who makes Provigil.  Despite this, the results are promising. If future studies confirm that Provigil improves cognitive deficits due to chemotherapy, this could significantly improve the quality of life for patients undergoing chemotherapy.

Popularity: 28%

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.

Popularity: 40%

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Popularity: 33%

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.

Popularity: 37%

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.

Popularity: 32%