Manic-Depressive Illness: Bipolar Disorders and Recurrent Depression, 2nd Edition

Author: Frederick K. Goodwin, Kay Redfield Jamison
4.6
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Comments

by tokenadult   2017-08-19
I had better jump in here right away, because the last thread about depression on Hacker News basically got swallowed up by an n=1 anecdote, and while anecdotes are wonderful (we all prefer to make decisions based on anecdotes we feel we can relate to rather than based on statistics), it takes a lot more than one anecdote to represent a complicated subject.

As my last keystrokes about depression here on Hacker News pointed out, there isn't just one disease known as depression. Depression is a symptom pattern (prolonged low mood contrary to the patient's current life experience) found often in the broad category of illnesses known as mood disorders. Behavior genetic studies of whole family lineages, genome-wide association studies, and drug intervention studies have all shown that there are a variety of biological or psychological causes for mood disorders, and not all mood disorders are the same as all other mood disorders. I know a LOT of people of various ages who have these problems, so I have been prompted for more than two decades to dig into the serious medical literature[1] on this topic. (I am not a doctor, but I've discussed mood disorders with plenty of doctors and patients.) I've seen people who tried to self-medicate with street drugs end up with psychotic symptoms and prolonged unemployment, and I've seen people with standard medical treatment supervised by physicians thrive and enjoy well off family life. The best current treatment for depression is medically supervised medication combined with professionally administered talk therapy.[2]

The human mood system can go awry both by mood being too elevated (hypomania or mania) and by it being too low (depression), with depression being the more common symptom pattern. But plenty of people have bipolar mood disorders, with various mood patterns over time, and bipolar mood disorders are tricky to treat, because some treatments that lift mood simply move patients from depression into mania. And depression doesn't always look like being inactive, down, and blue, but sometimes looks like being very irritable (this is the classic sign of depression in teenage boys--extreme irritability--and often in adults too). Physicians use patient mood-self-rating scales (which have been carefully validated over the years for monitoring treatment)[3] as a reality check on their clinical impression of how patients are doing.

As the blog post kindly submitted here points out, a patient's mood disorder influences the patient's whole family. The more other family members know about depression, the better. Encouraging words (NO, not just "cheer up") are important to help the patient reframe thought patterns and aid professional cognitive talk therapy. Care in sleep schedules and eating and exercise patterns is also important. People can become much more healthy than they ever imagined possible even after years of untreated mood disorders, but it is often a whole-family effort that brings about the best results.

[1] http://www.amazon.com/Manic-Depressive-Illness-Disorders-Rec...

[2] Combination psychotherapy and antidepressant medication treatment for depression: for whom, when, and how. Craighead WE1, Dunlop BW.

Annu Rev Psychol. 2014;65:267-300. doi: 10.1146/annurev.psych.121208.131653. Epub 2013 Sep 13.

[3] http://emedicine.medscape.com/article/1859039-overview

by tokenadult   2017-08-19
I thought that the Neti pot was a private enterprise project, not one investigated through alternative medicine research funding by the federal government. I see from the journal article link you kindly shared (thank you very much for that) that "Support for this study was provided by the Small Grant Program from the Department of Family Medicine, University of Wisconsin, Madison." So one conclusion from this is that there will continue to be funding sources for investigation of new therapies whether or not there is a federal government agency specifically tasked with funding investigation of "alternative" therapies.

It is useful to remind people that it takes nearly a billion dollars to bring a drug to market, so if the public discovers a new use of equivalent efficacy for a natural treatment or a drug already in the public domain for less than a billion dollars it is a benefit.

That's a very good point. Economic issues matter. What I would like to know more about is whether there has ever been, or ever will be, an "alternative" therapy of comparable safety and effectiveness that will come to market at less research expenditure than a "big pharma/mainstream medicine" therapy for the same condition. Human subject safety and effectiveness studies are inherently expensive, and until they are done, it is not clear that two therapies from two different paradigms of treatment are comparable at all.

Thanks for the other link about antidepressant drugs. The best considered view of the authors of the standard textbook on recurrent and bipolar depression

http://www.amazon.com/Manic-Depressive-Illness-Disorders-Rec...

is that mood stabilizers (lithium, depakote, carbamazepine) are better first-line drugs for depression with cyclic course than the SSRI drugs mentioned in the link you shared, and that talk therapy, especially if based on cognitive principles, is surely as effective as SSRIs and often needed in conjunction with any drug treatment for depression. The new SSRI drugs for depression indeed do not make mood disorder symptoms go away all by themselves, in the majority of cases.

by tokenadult   2017-08-19
This issue is much discussed here on HN. The links RiderofGiraffes kindly shared didn't include either HN thread that submitted the Scientific American article mentioned in the blog post submitted here.

http://news.ycombinator.com/item?id=788259

http://news.ycombinator.com/item?id=795292

As I noted in each of those threads, the issue of connections between creativity and mood disorders has been studied at book length. The most authoritative of the several books on that issue is by psychologist (and mood disorder patient) Kay Redfield Jamison, author of Touched with Fire: Manic-Depressive Illness and the Artistic Temperament,

http://www.amazon.com/Touched-Fire-Manic-Depressive-Artistic...

and co-author of the definitive text on manic-depressive illness

http://www.amazon.com/Manic-Depressive-Illness-Disorders-Rec...

who has thought out loud in her writings over the years about whether treatments for depression that help suffering people may also deprive society of creative output. Her current thinking on the issue--and she takes lithium herself every day--is that the best-evidenced mood-stabilizing treatments for mood disorders are helpful to patients and increase rather than decrease their ability to contribute useful work product to society. Her co-author, Frederick K. Goodwin, M.D., is still deeply skeptical of some antidepressant medications (e.g., the selective serotonin reuptake inhibitors) because of their capacity for inducing mania in many bipolar patients.

P.S. The illness of game theorist John Nash, the subject of the wonderful book A Beautiful Mind, was almost surely manic-depressive illness rather than schizophrenia. At the time he was diagnosed, American physicians misdiagnosed about 50 percent of cases of manic-depressive illness as schizophrenia, because of the mistaken diagnostic criteria used in Freudian psychiatry. Patients started getting better sooner in America as their diagnosis and treatment improved based on ideas from Europe (Kraepelin's diagnostic categories), Australia (lithium treatment for mood disorders), and America itself (cognitive talk therapy as pioneered by Aaron Beck, a former Freudian who found out that Freudian views of depression were incorrect).

There seems to be a seasonal surge of interest in this subject on HN right now. Hm.