Addiction Treatment Blog

Mania is for practical purposes the mirror image of depression. Approximately 50% of people affected present with an elated, euphoric mood. They may be grandiose in their attitudes and beliefs uninhibited in their behaviour. However, the remainder may be irritable and tetchy rather than elated and euphoric and paranoid rather than grandiose. Common to both groups is an increased level of activity, so that hyperactivity is perhaps the most consistent diagnostic feature of mania. In addition, there is typically an increase in appetite and a decrease in time spent asleep.

In 1853, Falret and Baillarger independently described a bipolar disorder, in which affected individuals cycled between periods of elation, or mania, and depression. This was variously called folie circulaire or folie à deux periodes. It forms the basis for what is now recognised as manic-depressive disorder. In 1896, Emil Kraepelin divided the major psychiatric illnesses into manic-depressive illness and schizophrenia. The former was primarily a disorder of mood, the latter a disturbance of cognitive functions. The former usually followed an episodic course with individuals recovering to normal between episodes. The latter was more likely to become a chronic illness with a majority of affected individuals not every fully recovering. These distinctions have broadly speaking held to this day. Read more…

As with almost any other pills, antidepressants has their own side effects.

For the first 2 weeks of taking an antidepressant, there may be little other than side effects. Generally, these will be mild. In some cases, however, they may be irritating or even intolerable. The first point to be made is that an antidepressant should only cause tolerable side effects. If treatment makes someone clearly worse, it should be stopped until advice has been sought and until that advice addresses the problem in hand.

Where side effects are more tolerable, there can be a great problem in distinguishing the effects of treatment from some of the symptoms of the illness. Both drugs and illness may cause a dry mouth, headache, indigestion, increased anxiety, sleeplessness or sedation for example.

There is a further unusual aspect to antidepressant side effects. When individuals are depressed, they are often much less sensitive to the effects of anything. They can’t smell, taste or hear as acutely before, for example. It is also common to find that sleeping pills don’t help the insomnia that goes with depression – even three to four times the recommended dose may not bring about sleep. After recovery, some people may be knocked by a low dose of the same sleeping pill that appeared inactive several weeks previously.

However, while some people are less sensitive to side effects when they are depressed, others seem more sensitive. It is very difficult, therefore, to predict the side effects that an antidepressant will have.

The side effects listed are typical. Some occur in everyone to some extent, depending on the particular compound, but they are usually mild and wear off after a few days. Even if they are severe, it should be noted that these side effects are reversible and will halt almost immediately on stopping the drugs.

As with the neuroleptics, there are two sorts of side effects to note. There are those which may feel like a worsening of the illness, like feeling more nervous, feeling strange or unreal, or even hearing voices. These latter side effects are the ones that need careful judgement. Read more…

There are seven major physical treatments for depression at present.

• Tricyclic Antidepressants (Table 1). These have until recently been by far the most widely used.
• The Monoamine Oxidase Inhibitors (MAOIs) (Table 2).
• Reversible Inhibitors of Monoamine Oxidase (RIMAs) (Table 3).
• 5-HT Reuptake Inhibitors (Table 4).
• Other Antidepressants (Table 5).
• Treatments for Bipolar Disorders or Prophylaxis of Recurrent Disorders (Table 6).
• Others (Table 7)

In the last category, a number of other treatments are marketed for or used for depression and they often work, but whether they are antidepressants in the same sense as electroconvulsive therapy (ECT), imipramine or phenelzine is a matter of dispute. The 5-HT-1a agonist, buspirone, has in addition been marketed as an antidepressant, and a further compound from this group, flesinoxan, looks as though it may also emerge as an antidepressant.

Finally, there is also ECT, the mechanism of action of which, and its use clinically will not be discussed at any length in this article. Its role when antidepressants fail to work and in cases of mania will be considered at a later stage. Read more…

Coping with stress can be hard at times.

The term ‘affective disorder‘ is sometimes taken to encompass both the mood and anxiety disorders. In this blog, it will be restricted to the former. Two disorders will be considered, depression and mania. Depression will be covered first followed by a consideration of mania and then the question of prophylaxis of recurrent episodes of a bipolar disorder, be they depressive or manic.

It is perhaps more difficult to specify exactly what antidepressants do than it is for any other drug that acts on the brain. In the following articles, I will employ an ulcer model of depression in an attempt to clarify the issues. This model, however, simplifies both ulcers and depression and this should be borne in mind. In clear cut cases of depression, an ulcer model performs passably. But in less clear-cut cases, the difficulty in pinpointing what it is that antidepressants do re-emerges.

Another way to consider the issues is by considering what the terms ‘mood’ and ‘emotion’ mean. These are notoriously difficult to define, but one way the problem has been approached is to define them in relation to each other – to compare, for instance, the relation of mood to emotions with the relation between climate and weather, or the relation between the pedal and the keys of the piano. Read more…

Learning from Burnout: Developing Sustainable Leaders and Avoiding Career Derailment

We were inspired to write our book, ‘Learning from burnout: developing sustainable leaders and avoiding career derailment’ for reasons of personal biography as well as professional practice. The former concern one of us burning out in their early thirties while working as a human resources executive for an IT company; the latter relates to our consultancy work with organisations helping them manage and develop their leadership talent. We noticed an increasing trend among this population towards action addicted, adrenalized working lives and what appeared to be – based on the number who were burning out – unsustainable approaches to the pursuit of career. At the same time we recognised that organisations were becoming increasingly more demanding and absorptive, and as a consequence, work and workplaces increasingly more all consuming. Like the high speed internet connections that serve our offices and our homes, work seemed to be always on. It had become a seven day a week preoccupation which was always there, brought into every facet of human life through the wonders of the Blackberry and the mobile phone. Work, it seemed, never slept, and those enslaved to it were sleeping a great deal less than they used to.

Burnout was the inevitable consequence of this heady combination of addictive behaviour and organisational greediness, or so it seemed to us. But when we referred to the literature on burnout we discovered that the leading authorities in the field believed burnout was largely caused by organisations, rather than both the organisation and those who work for them. We thought this rather odd. It did not resonate with our own experience of burnout, or with what we were seeing among the high achievers with whom we were working.

In addition, the self help industry’s claims that burnout can occur to anyone has devalued its meaning as a serious psychological condition. Apparently you are equally vulnerable to burnout whether you’re an over-stressed baby boomer, in a bad marriage, having a mid life crisis or a female indoor sex worker. As a result, the term has – to all intents and purposes – become meaningless. Read more…

The inner calm induced by this is an ideal counter to the stress of life.

The inner calm induced by this is an ideal counter to the stresses of life. Recent studies by neuroimaging on monks, trained in the art for many years, have shown areas of the brain responsible for creative thinking are more active during meditation.

Meditation is brain training for relaxation.

The ability to relax is an essential part of good mental health. It lowers the pulse rate, lowers blood pressure, lowers the level of stress hormones and leads to a more relaxed mental state and greater mental flexibility.

Just as with any other kind of exercise, there are many ways to do it and it needs to be done regularly. One trip to the gym will not get you fit. There are different types of meditation, some based in the mind, others in the body. For example, Transcendental Meditation is mind based. It involves repeating a completely meaningless mantra over and over again, whilst not falling asleep, and learning to let go of thoughts that inevitably bubble up during the meditation. It helps to show that a thought is nothing more than a thought. It shows that the mind produces thoughts just as a biscuit factory produces biscuits. Overall, one biscuit is very much like any other biscuit and only rarely does a biscuit or thought have any significant consequences. Read more…

Loneliness is not just about being alone.

Loneliness is not just about being alone. It is just as possible to feel lonely, even amongst a group of friends. Rather, loneliness reflects separation from other humans. We are a social species and constantly need to make contact with members of our own species; of our own tribe. Some people are more social than others, but we all have a need to connect and communicate with others like ourselves. Unfortunately, all too often, someone can be left feeling they are from a different planet.

Relationships and a feeling of being in control are the keys to managing loneliness. The worst triggers for loneliness are loss of an important relationship or relationships. One of the worst times can be the first term at university, or the first week at your first job when social skills may still lonely despite the presence of lots of people frequently reflects a poor relationship with self (low self-esteem), and less efficient social skills. Read more…

ECT sounds far worse than it actually is.

ECT is a physical procedure used to treat severe, treatment-resistant depression and, more rarely, extremely suicidal patients and patients with treatment-resistant mania. It is not known how or why it works, but it does. Approximately 100,000 people are treated each year. ECT consists of giving electrical shocks to the brain under an anaesthetic. It sounds far worse than it is. It is usually given in courses of six to twelve treatments. The risks of treatment are related to the anaesthetic, memory loss and confusion following treatment. Anti-depressant treatment is usually started before and continued after a course of ECT.

It seems to have an effect similar to rebooting a computer: at some point the depressive pathways are bypassed and a normal mood takes over. The worst long-term side effect is memory loss. This has three parts: a number of existing memories seem to be lost beyond recall; memories of the course of ECT and surrounding events are often not stored; and, subsequently, it is harder to remember things than before. This does improve with time. It also improves as the depression lifts. Read more…

A good diet brings healthier lifestyle and better mental health.

When we are depressed we either eat too much or too little. We eat for comfort, or we have no appetite as we are so miserable.

If you can face up to it, even feeling so wretched, try eating at least some ‘healthy‘ things – go and buy some fresh vegetables, fruit, fish. In general, if you can train yourself to eat well when you feel well it will help carry you through the bad times. Don’t just go for the tinned food, the take-away, the snacks. Go to the market, where you will get better value. Try and get local produce, the stuff the supermarket won’t buy because it isn’t round enough, or flat enough. Go to the market at the end of the day to get reduced prices. ‘Organic’ carries the stamp of health but is expensive, and may not be relevant; after all, it is a stamp of diminished value now – with the ‘organic’ take-away the ‘organic’ bar of chocolate. Tinned foods and pre-packaged foods are a damned sight better than no food, but they usually contain too much salt and sugar, not enough of the vitamins fresh foods would provide and artificial taste enhancers to make you want more.

It is easy to get overweight if you’re depressed and the two then interweave – low self-image leads to eating and eating leads to low self-image.

Try and break the cycle. Sometimes it’s easier to DO something rather than STOP doing something. Go to the gym and start getting fitter and then eat better when you’ve started feeling the benefit. It doesn’t take genius to eat better, prepare wholesome food or cook something halfway healthy, and, once taste buds have readjusted, it tastes much better anyway… what you call a win-win situation. Read more…

The Depression Alliance

The Depression Alliance provides relief from and prevention of depression by providing information, support and understanding to those who are affected by it.

Contact

Helpline 0845 123 2320
Email: information@depressionalliance.org.uk
Website: www.depressionalliance.org.uk

The Depression Alliance May Help By:

• Local support: They have a national network of self-help groups, which help people affected by depression to share experiences and coping strategies with others in similar situations. Group meetings are not the same as therapy but many people find they gain from the support and understanding of fellow members. New people are always welcome. To find your local group there is a list of addresses and contact email and telephone numbers on the website. Groups vary in size and frequency of meeting. Some may meet weekly or monthly and in various locations. Most groups operate an introduction system where each member gets about five minutes to introduce themselves. However, you don’t have to speak if you don’t want to. Each group has an organizer. It is important to know that the Group Organizer is not a trained therapist and may be suffering from depression themselves. Read more…