Bipolar 2 From Inside and Out

Posts tagged ‘news stories’

The Journey to Proper Meds

By areeya_ann / adobestock.com

This week when I went to my four-times-a-year med check, I told my psychiatrist that I thought I needed a change in medication. The previous time I saw him I had expressed concerns over assorted Life Stuff that was making me extremely anxious. Given what was going on in my life at the time, the anxiety was understandable.

Since then my anxiety has lessened somewhat, now coming out mostly as irritability and difficulty sleeping. And my depression now makes me feel like I have a low-grade fever – logy, listless, exhausted (which is not helped by the sleep problems) – plus the usual depressive numbness, lack of holiday cheer, and all the rest.

My psychiatrist listened to my symptoms, then discussed my meds with me. There were only two, both mood levelers, that he would recommend increasing. I chose the one that had had the most dramatic effect on me when I started taking it. So he increased the dosage from 200 mg. to 300 mg. We’ll see how that works out. I’m to call him before my next med check if I need to.

I’m used to changes in medications. It took a long, trying – even painful – time for my previous psychiatrist and me to work out the cocktail of drugs that would alleviate my seemingly treatment-resistant bipolar disorder. We tried various antidepressants, anti-anxiety agents, anti-seizure meds, antipsychotics, mood levelers, and I-don’t-remember-what-else. At last, when we were about to give up and try ECT, one of the drugs worked. It took some more tinkering before we got the dosages right, but for years now, I’ve been on basically the same “cocktail” of drugs.

Psychiatric Times, in an article on switching antidepressant medications (most of the literature seems to focus on antidepressants), reports that “approximately half of all patients fail to achieve an adequate response from their first antidepressant medication trial. High treatment failure rates make it critical for prescribers to know how to safely and effectively switch antidepressants to ensure patient-treatment targets are met.” Other publications put the figure at nine percent, one-third or two-thirds. Whichever is correct, it’s a substantial number.

One method of switching medication is simply called “the switch.” The patient goes off one drug and onto the other. But there are problems with that, including drug interactions between the old medication and the new one.

The technique most recommended is the one that my previous psychiatrist used with me, which is known as “cross-tapering” – tapering down on the first drug and then ramping up on the second. A “wash-out period” when no drug is given allows time for the first med to clear the body before the second is given. This is promoted as the safest method.

I can testify that it is also the slowest and most miserable. Going off one drug, being basically unmedicated while you wait for the second drug to ramp up, and then possibly going through the whole process again when the second drug doesn’t work either (or has side effects you can’t tolerate) is brutal. I went through the process more than once, and it was hell. Basically, it took me back to full-strength depression during the wash-out period and minimal to no effect as the new drug being tried ramped up.

However, eventually, we found a drug that made a huge difference and that, in conjunction with my other medications, allowed me to function almost normally. Close enough for jazz, as they say. The recent adjustment in dosage does not appear to be having much of an effect yet, but I didn’t expect it to. Pretty soon, relatively, I’ll know. And if it doesn’t help – or if it induces side effects – I still have my psychiatrist’s phone number.

References

https://www.psychiatrictimes.com/view/strategies-and-solutions-switching-antidepressant-medications 

https://www.uptodate.com/contents/switching-antidepressant-medications-in-adults

https://www.healthline.com/health/mdd/switching-antidepressants

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Take a Hike: Nature and Mental Health

photo from the author’s collection

 As a child and as a teenager, I was a Girl Scout. We hiked. We camped. We did all sorts of nature-related crafts. We ate wild plants. Well into my 20s, I was an outdoorsy-type person, hiking on the Appalachian Trail, walking to all my classes through the leafy green environs of my college campus, even trudging contentedly through the copious snowfall. One year I lived in a log cabin on a hilltop so far from civilization that you had to go to town to pick up your mail.

All the while, I had bipolar disorder, and it was relentless, I experienced the inevitable mood swings, the crashing lows, the tempestuous highs, the confusing mixed states. 

Now, everywhere you turn, there are articles and memes touting how time spent in nature is good for various psychiatric conditions. When you look more closely, though, the studies often refer to simply alleviating bad moods or improving cardiovascular health. Very few of them seem to apply to actual mental illnesses. Perhaps this is to be expected, since improvements in emotions or mental health are largely self-reported or tracked by means of a survey. It’s hard to quantify mental health. But let’s take a look at some of the studies anyway.

Harvard Men’s Health Watch published an article called “Sour Mood Getting You Down? Get Back to Nature.” The subtitle on the piece read, “Research suggests that mood disorders can be lifted by spending more time outdoors.” Then the article went on to suggest that “ecotherapy” shows “a strong connection between time spent in nature and reduced stress, anxiety, and depression.” 

The subtitle suggests that the outdoors has an effect on alleviating mood disorders. The body of the article, though, stresses alleviating unpleasant moods in general, not primarily what psychiatrists would class as mood disorders. The article cited a 2014 study saying that “people who had recently experienced stressful life events like a serious illness, death of a loved one, or unemployment had the greatest mental boost from a group nature outing.” Stressful and sad events, certainly, but not mood disorders such as PTSD, clinical depression, or bipolar disorder.

The article also cites a report published online March 27, 2017, by Scientific Reports, which suggests that “listening to natural sounds caused the listeners’ brain connectivity to reflect an outward-directed focus of attention, a process that occurs during wakeful rest periods like daydreaming. Listening to artificial sounds created an inward-directed focus, which occurs during states of anxiety, post-traumatic stress disorder, and depression.” It does mention psychiatric disorders, but it says only that inward-directed focus occurs during these states, not that inward-directed focus causes them.

Greater Good published an article that claims, among other things, that “scientists are beginning to find evidence that being in nature has a profound impact on our brains and our behavior, helping us to reduce anxiety, brooding, and stress, and increase our attention capacity, creativity, and our ability to connect with other people.” Again, this says nothing about actual psychiatric disorders.

The article also cited a Japanese study: “Results showed that those who walked in forests had significantly lower heart rates and higher heart rate variability (indicating more relaxation and less stress), and reported better moods and less anxiety, than those who walked in urban settings.” The researchers concluded that there’s something about being in nature that had a beneficial effect on stress reduction, above and beyond what exercise alone might have produced.

This, of course, does not apply to those in urban settings who do not have much access to forests or sometimes even parks. And the abstract of the Japanese study says, “Despite increasing attention toward forest therapy as an alternative medicine, very little evidence continues to be available on its therapeutic effects. Therefore, this study was focused on elucidating the health benefits of forest walking on cardiovascular reactivity.” It doesn’t really deliver what the headline offers: “How nature makes you kinder, happier, more creative.” Good heart health is, of course, a good thing, but to extrapolate that to mental health benefits is quite a stretch.

The UK’s Mind.org does offer a link between ecotherapy and mental health in one instance, at least: “Being outside in natural light can … be helpful if you experience seasonal affective disorder (SAD), a type of depression that affects people during particular seasons or times of year.” This article also acknowledges that there are “other options for treatment and support – different things work for different people….You might do an ecotherapy programme on its own, or alongside other treatments such as talking therapies, arts and creative therapies and/or medication. Some ecotherapy sessions follow a set structure, and incorporate types of talking therapy, such as cognitive behavioural therapy (CBT). People in the group may or may not have experience of mental health problems, but the main focus is usually working together on the shared activity.” This at least sounds both more scientific and more likely to produce results.

If a walk in a natural setting does you good and alleviates your symptoms of mental illness, then by all means, make it part of your routine (or do it as often as you can manage). My bipolar depressions, however, are so debilitating that I am unable to plan, much less embark on, a walk in nature, even as far as the mailbox. Bringing nature indoors is, of course, an alternative. But the little plant pictured here, which needs two ounces of water once a month, is all I can really handle.

Resources

https://www.health.harvard.edu/mind-and-mood/sour-mood-getting-you-down-get-back-to-nature

https://greatergood.berkeley.edu/article/item/how_nature_makes_you_kinder_happier_more_creative

https://www.hindawi.com/journals/ecam/2014/834360/

https://www.mind.org.uk/information-support/tips-for-everyday-living/nature-and-mental-health/how-nature-benefits-mental-health/

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My Mental Illness Is Real

By gustavofrazao via adobestock.com

Five years ago this month, Greg Abbott, the governor of Texas, vetoed a bipartisan mental health bill because he didn’t believe mental illness existed. He was influenced by Scientologists, a group founded by writer/guru L. Ron Hubbard, that opposes psychiatry, among other things. Abbott is still the governor of Texas.

Aside from Scientologists, what leads people to deny the reality of mental illness, when the signs are all around them? After all, one out of every four people will experience a mental disorder at some time in their lives.

I can think of several reasons. Not good reasons, but reasons.

The first is the “boy who cried wolf” syndrome. People who suffer mental illnesses just keep on suffering them, darn it. It’s not like they have one episode and then it’s gone, like a broken arm. After the second uncompleted suicide attempt or the fourth episode of cutting, the observer concludes that the person with mental problems really has none and the symptoms are just “cries for attention.” In other words, the only thing wrong with the person is that they want to be seen as mentally ill, but really isn’t. They are dismissed as “crazy,” but not mentally ill.

Then there is caring burnout. A person may be sympathetic to a friend or family member with depression or PTSD or whatever, may help them through a number of episodes. But at some point, they get tired. They simply can’t continue expending the considerable effort it can take to deal with a mentally ill person. “If she cancels or doesn’t show up to one more coffee date, that’s it!” they think. I have lost friends for this reason.

Another, more complicated reason is the denial of a person’s reality. I may be suffering internally, but it may not show on the surface. Many of us with mental disorders try to hide the symptoms and sometimes, especially among the high-functioning, it even sort of works for a while. The reality is that the illness continues “behind the scenes,” as it were, and is not apparent to others. This is a double whammy. The disorder exists, but is denied by observers – and maybe even the person who has it.

The truth is that my mental illness is real. It is mine to live with and mine to deal with and mine to experience. What you think about it or whether you believe in it does not affect the reality of it at all.

Well, that’s not quite true. Denial of mental illness does cause pain to the person who has one. Not being believed, being discounted, being blamed for various behaviors can be at the least wearying and at the most, soul-crushing. It feels like gaslighting to have someone say, “You’re not really ill. You’re just making it up/a drama queen/overreacting/going through what everyone goes through. Snap out of it!”

Just imagine what those people in Texas felt when they couldn’t get the help they needed because the governor “didn’t believe” in mental illness. The bill would have given “more resources to medical professionals that help residents dealing with mental health problems. The bill in question was widely popular, supported by many large medical associations in the state and both political parties,” reported the Greenville (TX) Gazette.

Far be it from me to wish a mental disorder on anyone, including Abbott or his family, but sometimes the only way a person can truly understand the reality of mental illness is when it strikes close to home – especially to a family member. One of my own relatives didn’t really believe until she saw up close what I was going through. She now at least believes, though she doesn’t really understand.

Real understanding may be too big a leap for some people to take who have not experienced mental illness for themselves. Belief in its existence ought to be much easier. Apparently, it isn’t.

Resource

http://www.greenvillegazette.com/r/texas-governor-vetoes-mental-health-bill-because-he-doesnt-believe-mental-illness-is-real-103158/

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Young Children and Involuntary Commitment

Involuntary commitment. In California, it’s a 5150. In Massachusetts, it’s a Section 12. In Florida, it’s the Baker Act. But right now, we’re talking about Florida. Whatever the Baker Act was meant to do, it wasn’t meant to do it to six-year-olds. Yet in Florida, a six-year-old girl was involuntarily committed for two days of psychiatric evaluation after a temper tantrum at school. The child has attention deficit hyperactivity disorder and a mood disorder.

According to CBS News, a sheriff filed a report, and a social worker stated the girl was a “threat to herself and others,” “destroying school property” and “attacking staff.” Duval County Public Schools told CBS that “‘the decision to admit a student under the Baker Act is made by a third-party licensed mental health care professional'” and that the response was “‘compliant both with law and the best interest of this student and all other students at the school.’”

Florida’s Baker Act was established around 50 years ago and allows authorities to “force such an evaluation on anyone considered to be a danger to themselves or others.” Danger to self or others has long been the standard for involuntary commitment, but until recently, it has seldom been used on young children, especially without immediately notifying their parents.

“The number of children involuntarily transported to a mental health center in Florida has more than doubled in the last 15 years, to about 36,000,” according to a 2019 report by the Baker Act Reporting Center. In another such incident, a “12-year-old boy with autism was taken to a facility in a police cruiser. It was the boy’s first day in middle school and during a meltdown, he scratched himself and then made a suicidal reference,” according to CBS. The boy’s mother says that the school had a plan to follow if the boy made threats, but the plan was ignored.

It’s certainly true that six-year-olds have threatened suicide and some, unfortunately, have completed the act. And 12-year-old boys definitely have the potential to harm themselves and others. But for schools – with the help of law enforcement personnel and mental health professionals – to “Baker Act” children is an extreme interpretation of the law. “The law specifies that minors can only be held for 12 hours before [a mental health] examination is initiated. For minors, notification must be provided as soon as the child arrives at the facility,” according to the Family Center for Recovery. The law does not say that parents must be notified when the child is taken away from the school.

The Family Center adds, “The statute specifically calls for ‘substantial’ evidence, which is [a] much higher bar than simple suspicion. As a result, people cannot be involuntarily institutionalized simply because they’re acting strangely, refuse to seek psychiatric examinations, or have occasional mood swings or outbursts.”

Need I point out that all children, not just special needs children, experience occasional mood swings or outbursts? School personnel are supposed to be trained to handle these situations.

But “zero tolerance” policies for “acting out” and threatening school property have led to such excesses and others, such as the use of in-school restraints and seclusion. Restraints and seclusion are now being called into question, especially since they have been used capriciously and brutally, especially on children with special needs. IEP plans that specify procedures to follow if a child has a meltdown, as with the 12-year-old, and in schools that supposedly have staff trained to handle special needs children, like the six-year-old, are too often not communicated to staff or simply ignored.

Of course, such treatment is the exception rather than the rule. Some states are beginning to enact laws regarding restraint and seclusion. And many well-trained special needs educators would never countenance such treatment of mentally ill or neurodivergent students. But 36,000 children is a lot. Two-day commitment away from parents is excessive for a six-year-old. Police officers taking children away in cruisers before notifying parents is unconscionable. The law specifies that minors can be held for only 12 hours before [a mental health] examination is initiated. For minors, notification must be provided as soon as the child arrives at the facility.

Florida state lawmaker Jennifer Webb has introduced a bill to reform the Baker Act. It includes training for school officials and resource officers and establishes rules on when a parent should be notified that their child might be committed.

“[The Baker Act] should only be used as a last resort,” she told CBS.

 

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What Should Medical Students Learn About Mental Illness?

I recently saw a news story reporting that a single medical school, Des Moines (IA) University, has made it mandatory for medical students to learn how to care for patients with mental illness.

Funny. I would have thought that was already happening in medical schools across the country. Apparently not. Although medical schools teach prospective doctors to diagnose mental illness, the article notes, they do not require students to learn how to care for the mentally ill. When the class started in 2018, it was an elective, but it later became a requirement.

The curriculum includes having people in recovery from mental illness, loved ones of patients, and healthcare providers speak to the class. It is hoped that this will combat the stigma that arises from student doctors only seeing mental patients on locked wards when they are in severe crisis.

Of course, confinement on a locked ward is not typical for people with SMI. Many people with bipolar disorder and even schizophrenia, for example, require inpatient treatment only occasionally, spending the majority of their lives receiving treatment, medication, and therapy as outpatients. One wonders if the stigma surrounding mental patients extends to them as well. Do some GPs tend to ignore physical disorders while focusing on the mental ones? It’s fairly well known that doctors sometimes focus on a person’s weight as being the cause of all their symptoms instead of looking for (or testing for) other conditions. Might there be a similar narrowing of focus regarding mental patients?

Looking at the course, the answer may be yes. Interestingly, the main concern in developing the course seems to be that because doctors were so uncomfortable treating psychiatric patients that they focused on the SMI and never diagnosed and treated conditions such as heart disease, hypertension, and other medical problems. Professor Dr. Lisa Streyfeller cites what she calls “really horrifying statistics that folks with severe mental illnesses die on average 15 to 30 years earlier than people who don’t have those illnesses.”

As important as it is that people with SMI receive treatment for their psychiatric conditions, physicians need to be aware that such people have physical needs and illnesses as well. And as encouraging as it is that mental patients themselves, and their loved ones and caregivers, are included in the curriculum, the article made no mention of teaching prospective doctors how to interact with mental patients they encounter in their practices. If such courses do not exist in medical schools other than DMU, where are doctors going to learn how to talk with and understand the many, many patients they will have who suffer with anxiety, depression, mania, anorexia, and the dozens of other diagnoses?

In some communities, first responders such as police and EMS workers are beginning to have mental health practitioners go on “ride-alongs” to help educate emergency personnel on how to handle situations involving the mentally distressed. Classes like the one at DMU (if others existed) could benefit from having students “ride along,” doing internships or rotations with established doctors who treat the physical as well as the mental symptoms of their patients. Perhaps psychiatric rotations in medical schools could include student practice in community or campus mental health centers instead of just locked wards. Perhaps medical schools could involve students in role-plays involving speaking with and treating the mentally ill, the way they sometimes do for prospective doctors’ encounters with terminal patients.

With NAMI reporting that 1 in 5 U.S. adults – 20% – experience mental illness each year and that
1 in 25 U.S. adults – 4% – experience serious mental illness each year, the odds are overwhelming that future doctors will need to learn how to treat patients both physically and mentally, as well as simply on a human level.

Here’s hoping that the DMU model class idea spreads – and that medical school education on mental health someday will be covered more thoroughly than a single class and a visit to the locked ward.

 

Reference:

https://whotv.com/2020/01/08/dmu-becomes-first-medical-school-to-require-mental-health-course-for-students/

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Should You Lie About Your Disorder?

We all know that when writing a resume, you should write either “good” or “excellent” when you refer to your health. Any other response will make it certain that your resume will be headed straight for the circular file.
But what about your mental health? Most resumes and most job applications don’t include a space for that, but what if they did? What would you answer? What should you answer? And should you tell the truth if you do answer?
 
In one corner of England, job seekers were encouraged to hedge their bets or to flat-out lie. The British newspaper The Guardian reported that welfare personnel “have urged jobseekers who have depression to hide their diagnosis and only admit on work applications that they are experiencing ‘low mood.'” 
 
Fortunately, there has been a backlash from mental health organizations, who describe the advice as an “outrage” likely to increase stigma. They point out that “the law provided protection to disabled people, including those with mental health problems, if their disability has a substantial, adverse, and long-term effect on normal daily activities.”
 
The welfare department in question brushed off the controversy by saying the suggestion was only “well-intentioned local advice” and encouraging people seeking jobs to “speak freely about a health condition or disability.” But that’s not a choice that everyone is willing to make.
 
Whether or not to disclose one’s mental health condition when applying for a job is not an easy decision. American law (at the moment) protects employees and potential employees under the Americans with Disabilities Act (ADA). But many people are rightly suspicious that disclosing a mental illness at the application is a one-way ticket to unemployment. Even when applications invite you to disclose and pointedly proclaim that they abide by EEOC regulations, many people choose not to disclose.
 
Disclosing after you’ve been hired or have been working at a place for a while is another matter. Many people (including me) have lost jobs because their bosses and coworkers don’t understand mental illness. There is plenty of motivation never to mention it.
 
That may not always be possible, however. Sometimes, the symptoms of bipolar disorder or another serious mental illness are obvious and negatively affect work. (I’m included here, too.) If a person isn’t able to do the work – for whatever reason – it’s understandable that they will be let go.
 
That brings us to the subject of accommodations that permit a person to do the work. Under ADA law, persons with disabilities, including mental disorders, are to be given “reasonable accommodations” to help them perform their job duties. For blind, deaf, or mobility-impaired workers, these accommodations are obviously necessary and most employers can and will provide them. (There is also no question as to whether to disclose these disabilities or not. Visible disabilities are more widely understood than invisible ones.)
 
Accommodations for mental disorders need not be difficult, either. Solutions such as flextime, work-at-home situations, or time off for appointments are more and more being offered to all employees, regardless of ability level, and these can certainly help people with mental illness, too. Other reasonable accommodations might include flexible break times, an office with a door or full-spectrum lighting, or the understanding that phone calls and emails need not be returned instantly. Of course, to receive these accommodations, one must disclose the disorder and negotiate the possible solutions, which can certainly be daunting, if not impossible, for those with anxiety disorders, for example.
 
But what we’re talking about here is not whether to disclose a disability on an application or to an employer. What we are talking about is misrepresenting a potentially disabling condition – or to use the less polite term, lying about it. I don’t have “occasional mood swings,” I have bipolar disorder. My depression is not simply a “low mood,” it can be debilitating. And I suspect that even admitting to a “low mood” might be greeted with something less than understanding by a potential or actual employer.
 
Ayaz Manji, a senior policy officer at a mental health charity in England, said of the semi-disclosure policy, “Anyone who discloses a mental health problem at work deserves to be treated with respect, and jobcentres should not be reinforcing stigma by advising people not to disclose.”
 
He’s right, of course. Disclosing or not disclosing is a hard enough choice for the mentally ill. Lying about one’s condition should not even be a consideration. And isn’t lying on resumes and applications an automatic cause for dismissal? 
 
For more information:

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Children’s Bodies, Children’s Minds

I read recently that the Duchess of Cambridge was visiting a series of schools to mark Children’s Mental Health Week. The duchess is the royal patron of Place2Be, a children’s mental health charity. The article said that this year’s theme for Mental Health Week would be “Healthy: Inside and Out, focusing on the connection between physical and mental health.”

The article explained, “The charity works with more than 280 primary and secondary schools across England, Scotland and Wales, providing support and expert training to improve the emotional wellbeing of pupils, families, teachers and school staff.” 

The duchess, it says, would be meeting with members of the school community to discuss students’ school readiness, teacher welfare, the wellbeing of the school community, and the importance of being active; and also talk with parents about good routines and habits around sleep, screen time, healthy eating, and exercise.

All of which sounds fine and worthy. But does anyone else see something missing from this public relations tour? Maybe it’s just me, but there doesn’t seem to be much actual emphasis on children’s mental health.

Yes, we know that the body and the mind are intimately connected. Yes, we know that children need a sense of wellbeing. Yes, we know that being active and eating healthy are important for kids. And we know that parents, teachers, and school communities have important roles to play in students’ healthy development. We also know that sleep, healthy eating, and exercise are good for people with mental illnesses. Hell, they’re good for everyone.

But there’s a lot more to mental health than physical fitness and a sense of wellbeing. If that was all it took, we could just eat kale and kiwis, meditate, and send the therapists home.

Of course, the article was short and seemed to focus on the duchess’s meetings with the youngest kids, who after all the most photogenic. Maybe the charity and the duchess also educate about the thornier aspects of mental health. Maybe they promote dialogue about self-harm, suicide prevention, childhood depression, and other conditions. I would like to think that they do.

But the article and many others like it focus on the physical and feel-good aspects of mental health and not the mental and emotional. Bubble baths for self-care! Pets as the best therapists! Super foods for regulating moods!

Memes are not the answer. And the physical aspects of mental health are certainly important. But we’re talking about mental illness and mood disorders here. Can’t we at least spend time talking about the mind and the emotions?  Maybe even have a dialogue about what happens when something goes wrong with them? Stress the importance of seeking help when one is confused, overwhelmed, and despairing?

I think society at large is still uncomfortable talking about mental illness and twice as uncomfortable talking about mental illness in children. Many of us are still laboring under the illusion that childhood is a uniformly happy time. In fact, many kids suffer from serious mental illnesses. If the statistics give any indication, 20% to 25% of them will experience a mental health problem at some time in their lives.

We should talk about this and ultimately do something about it. Something more than emphasizing good physical health and getting celebrities to do 30-second spots about how they too experience depression, though these are indeed good things.

I’ve written before about what I think a mental health curriculum in schools should look like (https://wp.me/p4e9Hv-Jw, https://wp.me/p4e9Hv-Hl). I suppose that first we need to be aware that children can and do have mental health problems – that it may not be “just a phase they’re going through” or something they’ll “just get over.” It’s a serious problem and requires serious attention, not to mention serious actions.

Whatever else we do, let’s put the mental back into mental health.

 

 

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Self-Medicating: Bipolar and Booze

Self-medicating – using alcohol or drugs to dull the emotional pain of a mood disorder – is pretty common among people with bipolar and other mental disorders, particularly the undiagnosed.

It’s a dangerous thing to do. People with major depression are said to be twice as likely to develop a drinking problem if they self-medicate with alcohol a lot. Then there’s the possible interaction between alcohol or drugs with a person’s prescribed meds.

To be perfectly honest, there were times in my life when I self-medicated with wine, beer, or liquor. During one particularly dark time, when I had been prescribed benzos for a physical ailment, that was thrown into the mix. And, again with the honesty, I still sometimes have wine or beer with dinner, though I know I shouldn’t. I could say that I know how much I can drink without it affecting my reaction to my meds, but the fact is that I just shouldn’t.

Recently, however, a study was published in the journal Nature Communications which said that “getting drunk causes the same molecular changes in the brain as taking rapid antidepressants.” Here are the basics.

It was a study done on mice, which means it’s a long way yet from applying to human beings. The set-up was this: Mice were given alcohol, then placed in a container of water. Being passive and willing to drown was taken as an indication that the hapless creature was depressed. Sure enough, the mice that were given alcohol proved to be more active and energetic in trying to swim, which was taken as a sign of not being depressed.

The study did not end happily for any of the mice, however. Their brains were examined to determine how the alcohol achieved its antidepressant effects.  The scientists say that changes in the boozy mouse brains showed that alcohol has effects on neurotransmitters that were similar to the way antidepressants affect the brain. That’s a long way from saying that alcohol is good for the depressed, though.

The premise of the experiment sounds a little shaky to me. I mean, assuming the swimming mice to be less depressed than the drowning mice strikes me as just a wee bit anthropomorphic. Plus, the mice seem to have been situationally depressed (by being left to drown), rather than chronically, as in clinical depression. However, the brain study seems more interesting to me. After all, it compared the effects of alcohol directly with the effects that antidepressants have on neurotransmitters and said that the former “mimicked” the latter.

What’s the takeaway from all this? Well, first of all, it’s hardly blanket permission for the depressed to go out and indulge indiscriminately. Further experiments are needed, presumably ones that will work their way up the animal kingdom until they come to depressed humans, though one hopes that they are not thrown into water to sink or swim.

If those further studies go the same way as the mouse study, I rather imagine the result will be something like the medical advice that you can take a glass of red wine to stave off heart disease – not a blanket approval, but the use of a potentially hazardous thing to ward off a potentially worse thing. Of course, that will not apply to alcoholics or others who must avoid the substance altogether for any of a variety of reasons.

I also note that the study focused on the effects of alcohol in relation to depression only. The manic phase of bipolar disorder was not part of the study and drinking while manic is well known to be a really bad, though often occurring, thing. Of course the same can be said of drinking and depression.

For now, the best advice is simply not to drink if you are depressed or bipolar. Don’t use me as an example. I’m not sharing this to encourage anyone to indulge in potentially destructive, even lethal, behavior. As always, Your Mileage May Vary, especially when compared with that of drunken, depressed, or dead mice. But drinking is still far from a good idea for the bipolar.  And don’t mix it with benzos either.  Trust me on this. It’s a slippery slope.

 

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Big Box Mental Health

photo by rawpixel.com from Pexels

According to an article published on the blogsite She Knows, “a Boston-based company that manages mental health care for 40 million people, has opened a small clinic in a Walmart location in Carrollton, Texas, and has plans to expand the program in other retail locations throughout the country.”

And I don’t know whether to vomit or applaud.

Walmart’s ubiquity is one point in its favor. They’re everywhere. And for some people, whether they love or despise Walmart, it’s the only choice they have for groceries, household goods, or much of anything else. Those areas are also likely to be underserved by the mental health system, such as it is.

And sparse as the options offered by the Walmart walk-in clinics is – treatment for anxiety, depression, grief, relationship issues, and stress management – it’s more than a lot of people have access to now. The trial site is said to be staffed with one licensed clinical social worker, has a sliding fee scale for those with no insurance, and will soon be approved for Medicaid reimbursement (it is hoped). There will even be remote Skype therapy services if necessary.

All that is good, as far as it goes. But does it go far enough? Will people be able to get more than a pat on the head and a pep talk as they do their weekly or monthly shopping? How will the walk-in clinic handle referrals for people with serious mental illness or a need for psychotropic medication, something that clinical social workers can’t provide? How many people can get help from a single professional? How good is internet therapy? And what percentage of Walmart shoppers have access to the internet?

The walk-in clinics are touted as reducing stigma around mental health issues. After all, the thought is, getting your mental health services at Walmart will become as natural as getting a haircut or an eye exam there. Well, maybe. On the other hand, how many people are willing to have their friends and neighbors see them publically, sitting in the waiting room or ducking surreptitiously through the door? It seems to me it might perpetuate stigma, rather than lessening it.

Besides, Walmart is hardly a bastion of high-quality goods and services. Will the mental health services be second-rate as well? It could be that even second-rate care is better than no care at all. But it’s surely not enough to deal with issues that require long-term therapy with actual treatment plans; scheduled repeat visits; building a relationship with a particular therapist; access to medications; and all the other aspects of more effective treatment, especially considering complicated disorders like bipolar, OCD, or anorexia.

I fully admit that I hate Walmart – the way they have driven out local Mom and Pop stores, for example, and the way they treat their employees. But I have many choices of where to shop near where I live, and access to both therapists and psychiatrists, and insurance that covers my appointments and medications. If I weren’t looking through the lens of privilege, I might see things a lot differently.

So for now, I guess my attitude is to wait and see. One test location does not a Walmart Psych Empire make. Perhaps it will succeed; perhaps not. Perhaps it will become the Great Clips of the psychotherapy world.

But while I’m waiting, I’m hot holding my breath.

 

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Mental Health

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Mental Illness and Voting

people standing with signage on street

Photo by Rosemary Ketchum on Pexels.com

No, I’m not going to tell you how to vote. And I’m not going to say the country is bipolar just because we’re so divided. What I am going to do is talk about the issues you should be concerned with during these mid-term elections and what you need to do in order to make your vote count.

Despite the fact that mid-term elections are usually boring, plagued by low turn-outs and minor local issues, this time they are likely to have national significance. This time we are voting on people – representatives, senators, and governors – who will make the policy for our states and our nation, including policies that affect the mentally ill.

Health policy. We’re not voting directly on national health policy, but we are voting for or against the people who make those policies. Those policies include support for the ACA (Obamacare), especially its protections for those with pre-existing conditions.

This has become a hot-button issue this year and you will likely hear and see ads that tout the various candidates’ support for insurance that covers pre-existing conditions. The key here is to do a tiny bit of research. Whatever a candidate says now, has he or she always supported coverage for pre-existing conditions? Or does the candidate have a history of trying to do away with such insurance coverage? Promises are not the point here. Past actions are. Given the choice between an incumbent and a newcomer, I personally will go for the newcomer if the incumbent has a track record of trying to dismantle coverage for pre-existing conditions.

Another important issue for the mentally ill is safety net programs, particularly Social Security, Medicare, and Medicaid. Many people with mental illness depend on these programs to cover their basic living and medical expenses. Believe a candidate who wants to gut these programs. Many of them see the people who benefit from these programs, particularly SSDI, as “moochers,” “freeloaders,” and drags on society. If you or a loved one needs this kind of assistance, vote accordingly.

There may also be local issues regarding police training, housing, and the homeless that are relevant to persons with mental illness. Spend a few minutes researching before you vote. Some Internet sites such as BallotReady.org and Vote411.org can help.

Your vote. Your vote only counts if you actually cast it and that can be a problem for those with mental or emotional disorders. Going to the polls can seem an impossible feat. But given the significance of the coming elections, spending some spoons to do so can have long-term repercussions.

If you have trouble getting to the polls, first make sure you know where your polling place is this year. It may have changed since the last time you voted. Then ask around. Some cities, like mine, are offering free bus rides to polling places and some services like Uber are offering discounted fees. Neighbors who go to the same polling place or members of support groups you belong to can potentially provide transport. Don’t forget to ask friends and family, if you can. They may not realize how important voting is to you or the difficulty you have getting to the polls.

If your difficulty is not getting to the polling places, but being at them, plan ahead. There are likely to be crowds this year and you may want to have a support person with you, especially one who also plans to vote. You may even be able to call the polling place ahead of time and find out when their peak voting times are so you can avoid them. If possible, avoid the noon rush, when many people take a voting break from work, and just after local businesses close for the day.

You may have heard rumors of intimidation at the polls this year. These are likely exaggerated, as are predictions of civil unrest after the results are known.  If anyone tries to interfere with or influence your voting, find an official poll worker or ask for a provisional ballot, which is your legal right. Call the police if you have to. Rely on a support person to help you get through the process.

Remember that this year’s elections are important. If at all possible, VOTE.

 

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