<![CDATA[Depression - Health.com]]> en daily 1 Subscribe with My Yahoo!Subscribe with NewsGatorSubscribe with My AOLSubscribe with BloglinesSubscribe with NetvibesSubscribe with GoogleSubscribe with PageflakesSubscribe with PlusmoSubscribe with The Free DictionarySubscribe with Bitty BrowserSubscribe with Live.comSubscribe with Excite MIXSubscribe with WebwagSubscribe with Podcast ReadySubscribe with WikioSubscribe with Daily RotationEverybody feels sad once in a while. Depression, on the other hand, is a complex condition characterized by profound sadness, lethargy, feelings of worthlessness, and a loss of interest in social activities. About 15 million people in the U.S. are diagnosed with clinical depression each year.Subscribe with My Yahoo!Subscribe with NewsGatorSubscribe with My AOLSubscribe with BloglinesSubscribe with NetvibesSubscribe with GoogleSubscribe with PageflakesSubscribe with PlusmoSubscribe with The Free DictionarySubscribe with Bitty BrowserSubscribe with Live.comSubscribe with Excite MIXSubscribe with WebwagSubscribe with Podcast ReadySubscribe with WikioSubscribe with Daily RotationEverybody feels sad once in a while. Depression, on the other hand, is a complex condition characterized by profound sadness, lethargy, feelings of worthlessness, and a loss of interest in social activities. About 15 million people in the U.S. are diagnosed with clinical depression each year. <![CDATA[How to Cope With Mental Illness During the Holidays]]> http://feeds.health.com/~r/health/depression/~3/dE_CeV91KcA/0,,20323573,00.html
All About Bipolar. Since her diagnosis, Pilkington has had more than her share of holiday crises. Over the years she has learned how to cope with the stress—and risks—of the holiday season. ]]> depression to mania. One year was particularly difficult, however. My father passed away on New Year's Day in 2008.

He was very ill throughout the holidays and we all knew his death was imminent. As the eldest child, I took on all the funeral planning and felt I had to be the rock for everyone else. I completely ignored my own needs because I thought I had to be strong for the rest of the family.

It all blew up in my face. By mid-January, I was having bouts of psychosis that included hearing my father's voice urging me to commit suicide. I hadn't allowed myself to grieve for him, and I was also overwhelmed by the hustle and bustle of the holidays. While trying to be there for others, I had inadvertently set myself up for disaster.

Since then, the holiday season tends to make me anxious. I'm working on putting myself first, but I have a habit of doing the exact opposite—and it’s a habit that's proving hard to break.

I’ve learned that the crowds, family functions, and last-minute shopping can spell trouble, but I also know there are steps I can take to reduce anxiety and keep my sanity in the midst of all the madness.

I’ve found the most important thing is to plan ahead. Regardless of how hard you try to avoid it, you will inevitably be faced with stressful situations. Try these six strategies to get through the holidays in one piece.

1. Know your limits.
My husband has a very large family. His father had more than 10 siblings, and more than 100 people attend the family Christmas celebration each year. There are so many of them that I still can't keep count.

Being in the middle of that many people is way too much for me to deal with. I can handle a dozen relatives at a time for a short while, but even the thought of being in a crowd of 100 makes me want to scream. I don't like crowds and I can take only so much before I start to crack.

A few years ago I decided that I'd no longer attend the big celebration, and I usually opt for the smaller gatherings instead. Large get-togethers are sometimes unavoidable during the holidays, however, and I've been forced to find ways to deal with the fear and anxiety they provoke. During family functions, it's not unusual to see me heading for the door. Sometimes it helps to find a quiet spot outside and spend a few minutes away from the crowds. Enjoying a little quiet time often allows me to get through the day without a major meltdown.

Leaving a party altogether is a last resort, but there are times when my efforts to cope with the stress just don't help. When you go to a holiday gathering, you should always have an exit strategy. Be prepared with an excuse in case you need to make a hasty exit. Making up excuses isn’t really possible once I'm beyond the point of rational thinking, so having an excuse before I reach that point comes in handy. Sometimes just knowing that you have a way out of a situation before it turns bad can help lessen your anxiety.

Next Page: Don't overschedule
2. Don’t overschedule.
Holiday parties, parades, and banquets can pile up quickly and overload your frazzled nerves. There are always so many events to attend, but I pick and choose a few and forgo the rest. Sometimes it's necessary to avoid certain places or people. If I know I'll be uncomfortable in a situation, I politely decline the invitation. Some people don't understand this, but I think it's better for them to be upset because I didn’t attend than to be upset because I had a major meltdown and ruined the festivities for everyone.

I especially try to avoid attending events several days in a row. I give myself a day or two to relax before tackling the crowds again. I need all of my energy to cope with one event at a time, and if I become overloaded with obligations then I won't be able to function. One event at a time is hard enough. If you know you have to face it again tomorrow, you'll spend the entire time worrying about both events and end up miserable.

3. Skip the holiday toasts.
I have never been more than a social drinker, and now I refrain from drinking altogether. Some time ago I started to notice that even though I'm in a jolly mood if I have a few drinks, I'll have fits of rage for several days afterward. My medication stops working and it takes a few days for it to straighten out.

If the people around you are drinking, it can be very easy to consume a bit too much alcohol. Alcohol may seem like a good way to take the edge off, but it can make matters worse. Clouding your judgment and losing your inhibitions is a recipe for disaster. Also, if you take prescription medication, alcohol may interfere with its ability to work properly. A few hours of pleasure aren't worth a week of pain.

4. Ask for help with holiday errands.
Thousands of frenzied shoppers can make holiday gift buying unbearable. I do as much of my shopping online as I possibly can. If I need items from a local store, I make a list and send my husband to pick them up. Occasionally I'll brave the crowds, but I never enter stores during the last-minute shopping rush.

5. Don't forget your meds.
I never have a problem remembering my medication—unless I change my routine. My schedule goes out the window during the holiday season, and my medications slip my mind from time to time. Missing even a single dose can wreak havoc and make me want to retreat to my room and stay there.

Don’t get so caught up in holiday celebrations that you forget to take your medication. Without it, you may be headed for disaster. Ask a friend or family member to remind you when it's time to take your medication.

6. Don't ignore the warning signs.
It's easy to let things slide during the holidays, but if you allow stress to keep building, it will get the best of you in the end. By the time February arrives, I am usually at such a low point that hospitalization is considered.

Don’t put off asking for help until you feel you're reaching your breaking point. Ask for help at the first sign of distress, and call your doctor if necessary. It may be difficult to contact your doctor over the holidays, so be sure to ask for an emergency contact ahead of time.
]]> Amy Pilkington (shown with her husband) has had more than her share of holiday crises. http://www.health.com/health/condition-article/0,,20323573,00.htmlhttp://feeds.health.com/~r/health/depression/~3/wQ7NFX0Yh9E/0,,20323573,00.html <![CDATA[Drugs Used to Treat Bipolar Kids Cause Rapid Weight Gain]]> http://feeds.health.com/~r/health/depression/~3/EcHfOzCQ_4M/0,,20315794,00.html

Christoph U. Correll, MD, of Albert Einstein College of Medicine, in the Bronx, N.Y., and his colleagues found that children and adolescents who take the drugs, known as atypical antipsychotics, gain an average of 10 to 19 pounds in the first few months, depending on which drug they are prescribed.

“That’s a lot of weight to acquire very rapidly,” notes Christopher K. Varley, MD, of Seattle Children’s Hospital, who wasn’t involved in the study but co-wrote an accompanying editorial.

The findings were published this week in the Journal of the American Medical Association.

Use of atypical antipsychotics in children has increased fivefold since the early 1990s. Prescriptions for one drug, risperidone (Risperdal), were up 10% in 2007. That year, 389,000 children and teens nationwide were prescribed the drug, and 240,000 of those were 12 or younger, according to information presented to a U.S. Food and Drug Administration (FDA) panel in 2008.

At the same time, more children are being diagnosed with bipolar disorder than in the past. Although experts agree that the medications can help some young patients (for example, bipolar children who have severe manic episodes or autistic kids who endanger themselves and others with violent behavior), many question their widespread use for other conditions, such as attention deficit hyperactivity disorder (ADHD).

The new findings suggest that these medications could have lasting consequences for young patients, in the form of weight problems (including obesity), heart disease, and diabetes.

Families already under the stress of coping with a young one’s mental illness may have a particularly hard time helping their child maintain a healthy weight, says Dr. Varley.

According to Dr. Varley and his co-editorialist, Jon McClellan, MD, of the University of Washington, in Seattle, “these results challenge the widespread use of atypical antipsychotic medications in youth.”


Next Page: How antipsychotics affect children's weight gain
Experts have long known that atypical antipsychotics can cause patients to gain weight. But Dr. Correll’s report is the first, and one of the largest, to investigate how these drugs affect children who haven’t used the medications previously.

Researchers looked at 205 children and teens with mood disorders, schizophrenic illness, or disruptive or aggressive behavior disorders. Fifteen children who refused medication or stopped taking it acted as a control group. The children ranged in age from 4 to 19, with an average age of about 14 years.

Children who took olanzapine (Zyprexa) gained the most weight in the first 11 weeks, an average of 18.7 pounds, and also had higher total cholesterol and triglyceride levels. Those taking quetiapine (Seroquel) gained 13.4 pounds and also had a rise in total cholesterol and triglycerides. Risperidone didn’t seem to affect cholesterol levels but was associated with higher triglyceride levels, and patients gained an average of 11.7 pounds. At 9.7 pounds, weight gain was lowest with aripiprazole (Abilify).

Overall, half of the children gained more than 7% of their original body weight. Children in the control group gained less than half a pound.

At present, the FDA has approved only two drugs, risperidone and aripiprazole, for use in children; both are approved to treat schizophrenia and bipolar disorder, and risperidone is also approved for “irritability associated with autistic disorder.”

In their editorial, Dr. Varley and Dr. McClellan point out that a lot of the research used to back up the use of atypical antipsychotics in children has been done in adults, and the makers of the drugs have funded much of it.

The study by Dr. Correll and his colleagues wasn’t funded by the pharmaceutical industry, but he and his coauthors report consulting for many drug companies, including the makers of the drugs they looked at in the current study—AstraZeneca (Seroquel), Bristol-Myers Squibb (Abilify), Eli Lilly (Zyprexa), and Ortho-McNeil-Janssen (Risperdal).

Dr. Varley argues that there’s been a “broadening” of the use of atypical antipsychotics in children. For example, they are sometimes added on to other medications, or used to treat children with impulse control problems or oppositional behavior who could probably benefit from therapy or behavior management strategies.

Doctors who decide to prescribe these medications, he adds, must be “darn sure” their patients need them, especially since patients may be on the medication for months or even years, resulting in major weight gain that could quickly lead to obesity and the health problems that accompany it.

Dr. Correll says that atypical antipsychotics are sometimes the only thing that can help autistic children with severe aggression, and that the medications are also very helpful for bipolar children with severe mania who aren't helped by mood-stabilizing drugs like lithium. Although Dr. Correll agrees that their use is controversial—especially for treating autistic children's aggressive behavior and outbursts, based on the idea that therapy and other approaches should be tried first—he argues that therapy sometimes isn't possible for these children until they are medicated.



Dr. Correll could not say whether these medications might be overprescribed. “Numbers alone cannot tell you whether the use is appropriate or inappropriate,” he says. “These determinations can only be made on a case-by-case basis.”



What the findings make clear, he adds, is that families need to be informed of the risk of weight gain, and that children should be prescribed the lowest-risk atypical antipsychotics first. “These medications are not created equal when it comes to side effects,” Dr. Correll says. He suggests that doctors monitor patients closely for weight gain, and work with their families to help them “really focus on a healthy lifestyle” before the child has gained weight.
]]> http://www.health.com/health/condition-article/0,,20315794,00.htmlhttp://feeds.health.com/~r/health/depression/~3/MYJQE_m1ivs/0,,20315794,00.html <![CDATA[Antidepressant Use in Pregnancy Can Affect Newborn]]> http://feeds.health.com/~r/health/depression/~3/A3q2MeAKIis/0,,20310293,00.html

Depression itself can have ill effects for both mom and baby. Therefore, the benefits of the antidepressants—known as selective serotonin-reuptake inhibitors (SSRIs)—may still outweigh the risks for some women, researchers say.

“There is no easy way out of this,” says Tim Oberlander, MD, a developmental pediatrician at BC Children’s Hospital, in Vancouver, who has studied the effects of SSRIs on children exposed in the womb, but was not involved in the current study. “Depression needs to be managed, and for some women, the use of these medications is appropriate and necessary.”

The new study, led by Najaaraq Lund, MD, of Aarhus University, in Denmark, found that babies whose mothers had taken SSRIs were born earlier and were more likely to require treatment in an NICU.

Women have been using SSRIs during pregnancy since the early 1990s, Dr. Lund and her colleagues point out in the report, which is published in the October issue of Archives of Pediatrics & Adolescent Medicine. These drugs, which include Zoloft, Prozac, and others, are widely considered to be the safest type of antidepressant medication to take during pregnancy. It’s been difficult to confirm their safety, however, especially since investigators have to find a way to distinguish between the effects of depression itself—and habits that depressed women may be more likely to engage in, like drinking and smoking—and the drug on the newborn.

Dr. Lund and her colleagues tackled this issue by including a group of women who reported a history of some type of psychiatric illness but weren’t taking SSRIs. Some, but not all, of these women had suffered from depression. “Using this group as a comparison group takes into account possible genetic or lifestyle factors associated with present or previous psychiatric disorders,” the researcher notes.


Next Page: Babies twice as likely to be born preterm
Babies twice as likely to be born preterm
The analysis included 329 women who took SSRIs in pregnancy, 4,902 with a history of psychiatric illness who weren’t taking the drugs, and 51,770 women who reported no history of psychiatric illness and weren’t taking SSRIs. All had received prenatal care at Aarhus University Hospital between 1989 and 2006.

Babies of women taking SSRIs were born an average of five days earlier than those born to women who had no mental illness, and were twice as likely to be born preterm. The babies whose mothers took SSRIs were 2.4 times as likely to have been admitted to the NICU than infants who hadn’t been exposed to the drugs in utero. They were also more than four times as likely to have Apgar scores below eight, just five minutes after birth. (Apgar scores measure an infant’s health at birth by looking at his or her breathing, heartbeat, reflexes, muscle tone, and skin color; scores of seven and above are considered normal, and a newborn’s Apgar score has no influence on how he or she will fare later in life.)

There was no difference between SSRI-exposed babies and unexposed babies in head circumference or birth weight.

Antidepressant medication is just one part of the equation in addressing women’s mental health during pregnancy, notes Dr. Oberlander, who says depression in pregnancy is a “huge public health issue” with lasting implications for women and their children. Helping ensure that women are getting enough social support and adequate nutrition is essential, he adds, while alternative treatments for depression—such as exercise, light therapy, and omega-3 fatty acids—ought to be explored further. “In general, optimizing non-pharmacological treatment would be a really important step,” he says.

He explains that it is essential to follow SSRI-exposed babies as they grow up, to identify any problems and intervene as necessary. However, he and Dr. Lund agree that it's still unclear whether the differences seen at birth will have lasting effects on a child's development and health.

"As depression itself can influence birth outcome in a negative direction, treatment is warranted in some cases based on the existing body of evidence,” Dr. Lund says. “In cases with mild or moderate symptoms, psychotherapy can be used as an alternative treatment. In severe cases and in patients with a history of recurrent, severe depression, continuation or initiation of treatment might be the best option.

"Every single case should be considered individually, and the decision should be made by the woman and her ob-gyn and psychiatrist," she says.
]]> Istockphoto http://www.health.com/health/condition-article/0,,20310293,00.htmlhttp://feeds.health.com/~r/health/depression/~3/cRoam3-u1JU/0,,20310293,00.html <![CDATA[Depression, ADHD Increase Teens’ Risk for Internet Addiction]]> http://feeds.health.com/~r/health/depression/~3/k05ZCsyO-0I/0,,20310219,00.html

Although an Internet addiction is not an official diagnosis, signs of a potential problem include using the Internet so much for game playing or other purposes that it interferes with everyday life and decision-making ability. (The diagnosis is being considered for the 2012 edition of the Diagnostic and Statistical Manual of Mental Disorders, the “bible” of mental ailments published by the American Psychiatric Association).

Too much of a good thing
Past research suggests that 1.4% to 17.9% of adolescents are addicted to the Internet, with percentages higher in Eastern nations than in Western nations, according to the study published Monday in the Archives of Pediatrics & Adolescent Medicine.

In the survey of 2,293 seventh-grade students in Taiwan, 10.8% developed an Internet addiction, which was determined by a high score on an Internet addiction scale. Definitions vary, but an Internet addiction usually includes symptoms such as spending a lot of time on the Internet (especially more time than intended), an inability to cut back on usage, a preoccupation with online activities, and symptoms of withdrawal such as anxiety, boredom, or irritability after a few days of not going online.

The researchers from Kaohsiung Medical University Hospital, in Taiwan, followed the youngsters for two years and found that ADHD and hostility were linked to Internet addiction in children in general. In girls—but not boys—depression and social phobia also predicted problems.

Boys were at a higher risk of Internet addiction than girls, and those who used the Internet for more than 20 hours a week, every day, or for online gaming, were at higher risk as well.

The Internet as therapy
Michael Gilbert, a senior fellow at the Center for the Digital Future at the University of Southern California’s Annenberg School for Communication, says the findings were no surprise.

“The study’s indication that children who are hyperactive or diagnosed ADHD are finding an outlet on the Web makes such perfect sense,” he says, because those children crave the constant stimulation of fast-paced video games and interactive social networks.

Kids with depression, anger issues, or social problems also turn to the Internet as therapy, adds Gilbert, who was not involved in the study. “They can take on an avatar or a different identity, and can contact other kids with the same problems and social inadequacies; they don’t have to function in conventional social ways.”

And while Gilbert is not surprised by the research—he regularly studies the impact of the Internet and cell phone usage on family relationships—he says it’s important that it is given the attention it deserves.

“I don’t get the feeling when I talk to therapists that they really understand the concept of addiction to the Internet,” he says. “They think more in terms of pornography sites or gambling sites specifically, but Internet addiction itself is not fully understood yet by the therapeutic community.”


Next Page: The potential for epidemic
The potential for epidemic
Internet addiction may be not as widespread in the U.S.—or at least not as well recognized—as in Asian countries. In 2008, for example, a Chinese survey showed that more than four million teenagers spend more than six hours a day online.

But if at-risk children—such as those identified in the Taiwanese study—are given sufficient time and exposure without careful monitoring, Internet addiction could easily become one of the most chronic childhood diseases in America, says Dimitri A. Christakis, MD, of the Center for Child Health, Behavior, and Development, in Seattle.

Our culture practically demands we spend time online, he says, with Wi-Fi connections in coffee shops and BlackBerries and iPhones that allow Internet access almost anywhere. “It would be as if we mandated that everyone drink two beers every day or everyone gamble for an hour every day,” says Dr. Christakis, co-author of The Elephant in the Living Room: Make Television Work for Your Kids.

What parents, doctors, and teachers can do
Internet addiction among younger generations may often go unnoticed, however, because parents and pediatricians themselves are using the Web more than they’d like.

Since adolescents cannot easily avoid computers, treatment for addiction cannot simply involve abstaining from the Internet, says Dr. Christakis. Parents, educators, and medical professionals need to identify high-risk children early on and monitor their Internet usage to prevent problem behavior from forming.

Time on the Internet needs to be monitored as well, especially for children who may be at high risk for addiction because of depression, ADHD, or social problems, says Dr. Christakis.

“You can’t tell a kid never to use the Internet the way you’d tell an alcoholic never to have a drink again,” he adds. “But parents need to be thinking about what types of Internet or online gaming are particularly addictive. Ones that allow for continuous, real-time feedback are particularly risky.”

Gilbert says that families should strive to make the Internet a healthy part of their home life. “Putting the computer in a very public place, like the hallway, can integrate the Internet into normal life, rather than it becoming something you go off and do in secret,” he says.

Teachers and health-care professionals should also take the potential for Internet addiction seriously, according to Dr. Christakis, who cowrote an editorial published with the study. “Our intention in raising this concern is not to be alarmist but rather to alert pediatricians to what might become a major public health problem for the United States in the 21st century,” he writes.

The National Science Council of Taiwan funded the study.
]]> http://www.health.com/health/condition-article/0,,20310219,00.htmlhttp://feeds.health.com/~r/health/depression/~3/OUGHAPEqnn4/0,,20310219,00.html <![CDATA[Back to School With Bipolar? How College Can Unleash Mania]]> http://feeds.health.com/~r/health/depression/~3/29-fYQBOj4k/0,,20304580,00.html
bipolar disorder, or those at risk for the condition, are even more vulnerable in a college environment. Academic pressures, social concerns, and sleep disruptions can lead to bouts of depression as well as mania, the euphoric, revved-up state characteristic of bipolar disorder. Without the right treatment and support, bipolar college students face higher dropout rates, drug and alcohol abuse, and even suicide.

“The new structure and new stresses for [bipolar] students who leave home to go to school sometimes can trigger problems and relapses,” says Richard Kadison, MD, the chief of mental health services at Harvard University and the author of College of the Overwhelmed: The Campus Mental Health Crisis and What to Do About It. These stresses, he adds, can also trigger mania in students who have an underlying vulnerability to bipolar disorder. “Oftentimes, the first manic episode occurs in college,” Dr. Kadison says.

At its most severe, bipolar disorder is a dangerous condition that can lead to psychotic episodes and hospitalization. Milder forms of the disorder can cause problems as well, and can interfere with academic success. A 2006 study in the Journal of Affective Disorders compared a group of bipolar adults with a group of healthy adults who had similar IQs and social backgrounds. More than 60% of both groups entered college, but their achievements differed greatly: Nearly half of the control group received a college degree, compared to just 16% of the bipolar group.

Students with bipolar disorder can survive—and even thrive—in college, but doing so requires a plan. Taking the proper medications, arranging for the appropriate counseling and medical care on campus, avoiding drugs and alcohol, maintaining a steady sleep and study schedule, and finding sources of peer support are all crucial and can make the difference between achieving your goals and dropping out.

A breeding ground for bipolar symptoms
Jennifer Overfield, 23, was diagnosed with bipolar disorder during her senior year of high school in Rochester, N.Y., but it wasn’t until she left the support of her family and went away to college that the disease threatened her life.

During the first weeks of her freshman year, she felt isolated and alone. She quit the soccer team and stopped going to classes. She started to stockpile medications and alcohol. In October, she drove to a nearby apple orchard, downed the pills and alcohol, and passed out. She woke up in the hospital after spending three days in a coma. (A passerby had seen her taillights, found her unconscious, and rushed her to the hospital, where she was medevaced to a larger hospital.) Overfield says she remembers being angry to be alive.

“I kept telling my family and friends that I was OK, but I was planning my suicide,” says Overfield, who is now a healthy senior at the University of North Carolina, Wilmington. “I had so much support back home—and then, in this new place, I didn’t even know where the counseling center was.”

Numerous aspects of college life can trigger a manic or depressive episode. Sleep deprivation and the keeping of irregular hours—both common practices on college campuses—are known to trigger mania, while binge drinking and the use of substances such as marijuana can cause depression. Stress, whether it stems from the pressure to succeed academically or to fit in socially, can trigger mania as well. According to Russell Federman, PhD, the director of Counseling and Psychological Services at the University of Virginia student health center, the desire to fit in and conform to the college lifestyle can cause some bipolar students to abandon healthy behaviors—even their medications.


Next Page: College doesn’t cause bipolar
College life often reveals the symptoms of bipolar disorder for the first time, particularly for those at risk of the condition who have not yet been diagnosed. (The college years, in fact, overlap with the stage in life in which bipolar disorder typically first appears—between 19 and 23 years old, according to some estimates.)

James Whaley experienced his first manic episode at the University of Tennessee, Knoxville. Whaley’s lifestyle was less than healthy: In college he smoked a lot of marijuana and experimented with hallucinogenic mushrooms and a drug similar to LSD. He had a serious depressive episode his freshman year, and then, in the winter of his sophomore year, he entered a full-blown manic episode with psychosis. “I thought I was having an existential breakthrough, but it was really a manic high,” Whaley says.

Federman says that the symptoms of bipolar disorder do not appear spontaneously. “The lifestyle irregularities and the stresses of college life don’t in and of themselves cause bipolar disorder,” he explains. “You need a genetic vulnerability for bipolar disorder to emerge. But if you’ve got that vulnerability, the lifestyle irregularities of the first and second year of college can certainly be a precipitant.”

Strategies for managing bipolar disorder
Students who have been diagnosed with a bipolar spectrum disorder can take steps to minimize the risk of a relapse and stay balanced. Perhaps the most important step is to make sure you have a support system at school, which usually means connecting with the medical and counseling staff on campus. Students who attend school away from home may choose to maintain contact with their existing psychiatrist, but experts urge students to also make contact with campus health services.

“Even if a student with bipolar disorder has what they considering to be their primary health provider at home, they need to have someone at college as well,” says Elizabeth Gong-Guy, PhD, the director of counseling and psychological services at UCLA. “And if a student with bipolar disorder is looking at a college in a rural community, they need to be proactive about what their local access to psychiatric care will be.”

Having a psychiatrist close at hand isn’t important only for emergencies. In fact, bipolar students who have been stabilized on medication while at home may need to fine-tune their prescriptions while at school. “Students sometimes need adjustments to their medication in the new environment,” Dr. Kadison says. “It varies a lot, depending on the resiliency of the student, the supports that are already in place, and how much of an academic challenge the student is facing.”


Next Page: The four S’s of bipolar stability
Campus health services also provide counseling, which can help students cope with the emotional stress of living with bipolar disorder. Just as important, counseling can teach students everyday strategies for managing their symptoms.

In his forthcoming book, Facing Bipolar: The Young Adult’s Guide to Dealing With Bipolar Disorder, Federman outlines what he calls the “four S’s of bipolar stability”: structure, stress management, sleep management, and self-monitoring. This framework entails setting—and sticking to—a regular schedule of studying and sleep, and learning to recognize the signs that you are beginning to drift into mania or hypomania.

Stacy Hollingsworth, 25, who graduated from Rutgers University in May 2008, has what her doctor calls bipolar type III, a diagnosis that typically describes a form of hypomania associated with antidepressants. Dealing with depressive episodes in college, Hollingsworth never knew when she was going to crash, so she made sure to do her assignments well ahead of time. She also talked to her professors on the first day of class about her mental health and documented her case at disability services on campus. Students tend to associate such resources with physical disabilities, but these centers often help students with mental health disorders as well.

“I felt OK about sharing with professors, and they were great about working with me,” Hollingsworth says. “Be prepared to encounter people who don’t understand, but try to get the college behind you.”

Other sources of support on campus
In addition to campus health services, peer counseling can be a valuable source of support. Overfield now runs a National Alliance on Mental Illness (NAMI) support group on her campus because she doesn’t want students to feel as alone as she did her freshman year. She advises students with mental illness to reach out. “We want to make people more aware of the counseling office at orientation,” she says. “One of our major messages is, ‘You are not alone.’”

Whaley took a semester off from school and spent a summer at a community college near his home before returning to the University of Tennessee, Knoxville in the fall of 2008. Now a 21-year-old senior, he communicates often with his doctor and parents, a strategy that has helped him remain stable. He tries to schedule his classes in the middle of the day to facilitate a regular sleep schedule, and he does his best to avoid alcohol and drugs. However, he has struggled to find a group of peers who have dealt with mental health problems. Right now, there is no NAMI affiliate on his campus.

In addition to NAMI, an organization called Active Minds is trying to open the dialogue about mental illness on college campuses. Founded by Alison Malmon in 2001, following the suicide of her older brother, the organization now has more than 200 chapters nationwide. Active Minds organizes events such as National Day Without Stigma and has partnered with the Depression and Bipolar Support Alliance to create peer support groups on college campuses.
]]> (ISTOCKPHOTO) http://www.health.com/health/condition-article/0,,20304580,00.htmlhttp://feeds.health.com/~r/health/depression/~3/lYYeYgFTTgI/0,,20304580,00.html <![CDATA[Depression Treatment Makeover: Hemmis Edition]]> http://feeds.health.com/~r/health/depression/~3/_qlggHg-3OU/0,,20276152,00.html
Paige Hemmis is a self-taught carpenter and a member of the design team on ABC's Emmy Award-winning Extreme Makeover: Home Edition. Although you'd never know it from the sunny personality she exhibits on the show, she has been diagnosed with (and treated for) major depression. In April 2009, Hemmis teamed up with Wyeth Pharmaceuticals on the Blueprint for Hope campaign, in the hopes that her story will help others learn more about depression, seek help, and create a "blueprint" for treating the condition.

When you watch the show, it's hard to believe that at one point in my life I had trouble getting out of bed in the morning. I'm smiley—I have to put on a happy face because my job is improving lives and making other people feel good.

Depression is often seen as a mental issue. For me, the physical effects of the disease were what brought me to the doctor in the first place. I never had any symptoms until 2004, when I began to feel exhausted. I'd put on a happy face, but behind the scenes, my life was in turmoil. After gaining 25 pounds and spending six weeks sleeping no more than two to four hours a night, I finally went to a doctor. But I didn't think it was depression. I thought something was physically wrong with my body.

It felt like I had mono; everything hurt and I had no energy. I went to the doctor and he asked me questions like "Is it hard to get up in the morning?" and "Are you withdrawing from friends?" The answer was "yes," of course. When he diagnosed me with depression, I was surprised. He explained to me that you don't have to be sad or suicidal to suffer from depression. I always assumed that it was a mental thing—if you're sad, just pull yourself up by your bootstraps and you'll be fine.

The diagnosis gave me a name for what was going on in my body, but I had to learn to treat it. Just like every blueprint for a house is different, every person diagnosed with depression will have a different "blueprint" for treatment. Both my mother and grandmother were diagnosed with depression. I saw more behavioral symptoms in them, but I knew they were taking medication and they seemed to have it under control.


Next Page: My blueprint for treatment
I began taking antidepressants and talking to someone. The antidepressants were wonderful, even though I had to try a few of them before I found one that worked, and I started to get a sleep schedule in place. Talking to a professional was a little harder. It was like nothing I've ever done before, and I had all these preconceived notions of the type of people who went to therapy. What would I say when I get in there?

I went to a life coach, and we just talked about my schedule and work. I was keeping things bottled up, because I thought I couldn't, or shouldn't, complain when I'm working with families who have so much less than I do. I went the back way and built up to talking about deeper issues. Now I can call him for unbiased advice.

I also made small lifestyle changes, such as starting to fit in time to exercise. (See Hemmis's simple and cost-effective DIY tips for managing depression) I'm not a gym-goer, but I tried to fit in 20-minute walks whenever I could. I'd bring my cat with me on the road, which made traveling easier. And, of course, my close friends and family were supportive.

I've been lucky that I haven't suffered any relapses, and I now know what my triggers are. If I don't get enough sleep, I feel that exhaustion and freak out a little. I've been there and don't want to go back. Although I started small, I got to the point where I was managing my depression and sticking to a treatment plan. My doctor noticed my improvement, and he and I decided to try easing off antidepressants. We tried it for a month at first, and it was a surprisingly easy transition. I haven't taken antidepressants for a year now.

Although my close family and friends knew about my depression, I didn't share my struggle with the rest of the world. It wasn't until one of my close friends admitted that she had been depressed and had gotten help. She told me she never would have called anyone had it not been for me. I didn't want anyone to suffer in silence, so I'm now a spokesperson for Blueprint for Hope, hoping that others find the courage to treat their depression.
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“You'll certainly find higher risk in families where someone has bipolar disorder,” says Greg Simon, MD, a psychiatrist and researcher at Group Health Cooperative in Seattle and the chair of the scientific advisory board of the Depression and Bipolar Support Alliance. “But the risk is still not that high in absolute terms.”

In other words, the genetic link doesn’t mean that one bipolar parent or even two will necessarily produce a bipolar child. Other factors, including stressful life events, abrupt changes in sleep patterns, and chronic medical illnesses, can contribute to a person’s risk.

Studies report rates of bipolar disorder between 4% and 15% in children with one bipolar parent, compared to 0% to 2% in the offspring of parents who don't have the disorder. And if both parents are bipolar, rather than just one, a child is about 3.5 times more likely to develop the condition.

Some bipolar parents have regrets
Even so, when a parent who is bipolar sees the disease manifest itself in a child, statistics don’t seem to matter anymore. It just feels as if the disease is simply hereditary.

Stacey Galka, 38, of Denver, is a single mom who was diagnosed with bipolar disorder when she was 26. At that point, her daughter was already 5 years old. Stacey says her own diagnosis was a relief because it helped her to make sense of why her life had always been so chaotic, but when her daughter was diagnosed with bipolar disorder at age 13, Stacey had trouble accepting it. “In all honesty, if I had known then what I know now, I would have never had a kid,” she says. “It was difficult enough for me to go through what I did."

While the chances of some children having bipolar disorder are heightened by genetic factors, there are ways of treating the illness. Ronald R. Fieve, MD, a psychopharmacologist in private practice in New York City, notes that medications have revolutionized the lives of people living with bipolar disorder and provided successful treatments.

In order to mitigate the onset of bipolar disorder in any at-risk child, however, Dr. Fieve says that general health is very important: normal sleep patterns, a healthy diet, regular exercise, and the avoidance of drugs and alcohol. Sleep deprivation or major life stresses can precipitate the onset of a manic or depressive episode.

Brandi, 34, lives in Colorado Springs. She was diagnosed after her first pregnancy kicked her into a manic episode, and medications have stabilized her moods. Now, she has two daughters. Although she worries that they’ll inherit the disorder, she says she is more concerned about how her own bipolar disorder may affect her. As a bipolar parent, she tends to yell, make bad decisions with food or shopping, and gets easily agitated when her symptoms flare. “I do worry that they're going to end up with something. I keep a close eye on my 3-year-old,” she says. “I have to keep telling myself, ‘This is normal 3-year-old behavior. She's just fine.’ So I guess it's not a matter of being afraid of her being bipolar so much as I'm afraid of how she's going to turn out because of my bipolar.”


Next Page: A genetic test for bipolar on the horizon
A genetic test for bipolar on the horizon
Experts have discovered that there may be many more genes involved in bipolar disorder than scientists initially thought.

Alexander B. Niculescu III, MD, PhD, an assistant professor of psychiatry and medical neuroscience at the Indiana University School of Medicine, is working to develop a genetic test that, along with other information such as family history, would evaluate a child’s risk for developing the illness.

“These tests will be just another piece of information that says you may be at higher (or lower) risk,” he says. "Your genes are not necessarily your destiny. For the illness to manifest itself, you have to have environmental effects—stress, exposure to infections, neurotoxins, drugs. In the end, prevention and early intervention in at-risk individuals can make a big difference.”

Dr. Niculescu and his team are also developing blood biomarker tests to assess illness severity and measure response to treatment. “Once the illness has manifested itself, we need to have objective tools to do a better job of treating people and to help personalize treatment,” he says. “Blood biomarker tests are such tools.” Both the genetic tests and the biomarker tests will likely be available within the next five years.

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“If your child is bipolar, he or she will need to take a mood stabilizer, such as lithium, and maybe other drugs,” says Mani Pavuluri, MD, PhD, director of the Pediatric Mood Disorders Program at the University of Illinois at Chicago. “It’s best for parents to be collaborators rather than passive responders to their child’s psychiatrist. There may be mismanagement and overdiagnosis, and children react to medication in different ways.”

Depending on the age of the child and his or her symptoms, talk therapy and other forms of counseling (including family therapy) may also be useful. Talk therapy usually cannot serve as a substitute for medication, however.

Most children and teens with bipolar disorder will require treatment for years, and in some cases for life. A 2008 study in the Archives of General Psychiatry found that nearly 45% of children diagnosed with bipolar disorder experienced manic episodes after the age of 18; more than 35% were reported to have a substance use disorder.

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Bipolar disorder in children and teens is sometimes misdiagnosed as major depression, attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder. Even so, more children and adolescents are being diagnosed with bipolar disorder than ever before. A 2007 study in the Archives of General Psychiatry reported that between 1994 and 2003 the rate of bipolar diagnosis in people age 18 and younger increased forty-fold. Overdiagnosis is “a huge problem,” says Mani Pavuluri, MD, PhD, director of the Pediatric Mood Disorders Program at the University of Illinois at Chicago. “So is underdiagnosis.”

It’s important to know the symptoms of bipolar disorder in children and teens so that you can adequately inform your child’s doctor. Some of the medications prescribed for the conditions listed above can actually exacerbate the symptoms of bipolar disorder.