Those of us who have had to suffer through many years of depression, like me, may not find this information to be so surprising.  I think it would be rare occasion where doctors actually write prescriptions for the perfect antidepressant the 1st time someone makes them aware of being depressed, but that’s just my opinion.

Prozac, Cymbalta, Zoloft, Paxil, WellButrin, Effexor XR… the list goes on. These are just a handful of Brands I was given to ‘help’ with my depression. Effexor XR seemed to work, but after the first 2 weeks it was all back to the same old feelings of worthlessness, insecurity, sporadic crying, not to forget a Huge drop in my sex drive, which is not usual for  me

I spent over 10 years of my life making great attempts to find the proper medication that fits me the best, break free of the horribly rapid mood swings which often resulted in a deeper depression at the spur of a moment. Little did we all know, we were being ripped off by Big Pharma ~ BIG TIME !!! Even worse, they put our personal health at risk just to make a buck! How pitiful.

Posted by: Mark Hyman MD;  April 24, 2010 07:00 AM ~ The Huffington Post

Here’s some depressing recent medical news:  Antidepressants don’t work. What’s even more depressing is that the pharmaceutical industry and Food and Drug Administration (FDA) have deliberately deceived us into believing that they DO work. As a physician, this is frightening to me. Depression is among the most common problems seen in primary-care medicine and soon will be the second leading cause of disability in America.

The study I’m talking about was published in *The New England Journal of Medicine. It found that drug companies selectively publish studies on antidepressants. They have published nearly all the studies that show benefit — but almost none of the studies that show these drugs are ineffective.

That warps our view of antidepressants, leading us to think that they do work. And it has fueled the tremendous growth in the use of psychiatric medications, which are now the second leading class of drugs sold, after cholesterol-lowering drugs.

The problem is even worse than it sounds, because the positive studies hardly showed benefit in the first place. For example, 40 percent of people taking a placebo (sugar pill) got better, while only 60 percent taking the actual drug had improvement in their symptoms. Looking at it another way, 80 percent of people get better with just a placebo.

[Read More...]

Here are a few things you can do to start treating your depression today.

7 Steps to Treat Depression without Drugs

1. Try an anti-inflammatory elimination diet that gets rid of common food allergens. As I mentioned above, food allergies and the resultant inflammation have been connected with depression and other mood disorders.

2. Check for hypothyroidism. This unrecognized epidemic is a leading cause of depression. Make sure to have thorough thyroid exam if you are depressed.

3. Take vitamin D. Deficiency in this essential vitamin can lead to depression. Supplement with at least 2,000 to 5,000 IU of vitamin D3 a day.

4. Take omega-3 fats. Your brain is made of up this fat, and deficiency can lead to a host of problems. Supplement with 1,000 to 2,000 mg of purified fish oil a day.

5. Take adequate B12 (1,000 micrograms, or mcg, a day), B6 (25 mg) and folic acid (800 mcg). These vitamins are critical for metabolizing homocysteine, which can play a factor in depression.

6. Get checked for mercury. Heavy metal toxicity has been correlated with depression and other mood and neurological problems.

7. Exercise vigorously five times a week for 30 minutes. This increases levels of BDNF, a natural antidepressant in your brain.

Overcoming depression is an important step toward lifelong vibrant health. These are just of few of the easiest and most effective things you can do to treat depression. But there are even more, which you can address by simply working through the 7 Keys to UltraWellness.

Mark Hyman, M.D. practicing physician and founder of  The UltraWellness Center is a pioneer in functional medicine. Dr. Hyman is now sharing the 7 ways to tap into your body’s natural ability to heal itself. You can follow him on Twitter, connect with him on LinkedIn, watch his videos on Youtube and become a fan on Facebook.

*Study: The New England Journal of Medicine ~ “Results Among 74 FDA-registered studies, 31%, accounting for3449 study participants, were not published. Whether and how the studies were published were associated with the study outcome. A total of 37 studies viewed by the FDA as having positive results were published; 1 study viewed as positive was not published. Studies viewed by the FDA as having negative or questionable results were, with 3 exceptions, either not published (22 studies) or published in a way that, in our opinion, conveyed a positive outcome (11 studies). According to the published literature, it appeared that 94% of the trials conducted were positive. By contrast, the FDA analysis showed that 51% were positive. Separate meta-analyses of the FDA and journal data sets showed that the increase in effect size ranged from 11 to 69% for individual drugs and was 32% overall.”

It has been a little over a year since I’ve been on ANY chemical medications for depression and I still have my moments but it really has gotten loads easier to overcome, compared to when I last took them. I couldn’t understand why, Not One of these medications worked for me! I knew I was depressed, so I swallowed “Anti” depressants (doctors orders), and expected at least one of them to actually work!!

Well, now I understand why not.

~Tiffi

Major Depression

What is major depression?

Major depression is a serious medical illness affecting 15 million American adults, or approximately 5 to 8 percent of the adult population in a given year. Unlike normal emotional experiences of sadness, loss, or passing mood states, major depression is persistent and can significantly interfere with an individual’s thoughts, behavior, mood, activity, and physical health. Among all medical illnesses, major depression is the leading cause of disability in the U.S. and many other developed countries. Depression occurs twice as frequently in women as in men, for reasons that are not fully understood. More than half of those who experience a single episode of depression will continue to have episodes that occur as frequently as once or even twice a year. Without treatment, the frequency of depressive illness as well as the severity of symptoms tends to increase over time. Left untreated, depression can lead to suicide. Major depression, also known as clinical depression or unipolar depression, is only one type of depressive disorder. Other depressive disorders include dysthymia (chronic, less severe depression) and bipolar depression (the depressed phase of bipolar disorder or manic depression). People who have bipolar disorder experience both depression and mania. Mania involves unusually and persistently elevated mood or irritability, elevated self-esteem, and excessive energy, thoughts, and talking.  

What are the symptoms of major depression?

The onset of the first episode of major depression may not be obvious if it is gradual or mild. The symptoms of major depression characteristically represent a significant change from how a person functioned before the illness. The symptoms of depression include:

• persistently sad or irritable mood
• pronounced changes in sleep, appetite, and energy
• difficulty thinking, concentrating, and remembering
• physical slowing or agitation
• lack of interest in or pleasure from activities that were once enjoyed
• feelings of guilt, worthlessness, hopelessness, and emptiness
• recurrent thoughts of death or suicide
• persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

When several of these symptoms of depressive illness occur at the same time, last longer than two weeks, and interfere with ordinary functioning, professional treatment is needed.  

What are the causes of major depression?

There is no single cause of major depression. Psychological, biological, and environmental factors may all contribute to its development. Whatever the specific causes of depression, scientific research has firmly established that major depression is a biological, medical illness. Norepinephrine, serotonin, and dopamine are three neurotransmitters (chemical messengers that transmit electrical signals between brain cells) thought to be involved with major depression. Scientists believe that if there is a chemical imbalance in these neurotransmitters, then clinical states of depression result. Antidepressant medications work by increasing the availability of neurotransmitters or by changing the sensitivity of the receptors for these chemical messengers. Scientists have also found evidence of a genetic predisposition to major depression. There is an increased risk for developing depression when there is a family history of the illness. Not everyone with a genetic predisposition develops depression, but some people probably have a biological make-up that leaves them particularly vulnerable to developing depression. Life events, such as the death of a loved one, a major loss or change, chronic stress, and alcohol and drug abuse, may trigger episodes of depression. Some illnesses such as heart disease and cancer and some medications may also trigger depressive episodes. It is also important to note that many depressive episodes occur spontaneously and are not triggered by a life crisis, physical illness, or other risks.  

How is major depression treated?

Although major depression can be a devastating illness, it is highly treatable. Between 80 and 90 percent of those diagnosed with major depression can be effectively treated and return to their usual daily activities and feelings. Many types of treatment are available, and the type chosen depends on the individual and the severity and patterns of his or her illness. There are three well-established types of treatment for depression: medications, psychotherapy, and electroconvulsive therapy (ECT). For some people who have a seasonal component to their depression, light therapy may be useful. These treatments may be used alone or in combination. Additionally, peer education and support can promote recovery. Attention to lifestyle, including diet, exercise, and smoking cessation, can result in better health, including mental health. Medication. . It often takes two to four weeks for antidepressants to start having an effect, and 6-12 weeks for antidepressants to have their full effect. The first antidepressant medications were introduced in the 1950s. Research has shown that imbalances in neurotransmitters like serotonin, dopamine, and norepinephrine can be corrected with antidepressants. Four groups of antidepressant medications are most often prescribed for depression:

• Selective serotonin reuptake inhibitors (SSRIs) act specifically on the neurotransmitter serotonin. They are the most common agents prescribed for depression worldwide. These agents block the reuptake of serotonin from the synapse to the nerve, thus artificially increasing the serotonin that is available in the synapse (this is functional serotonin, since it can become involved in signal transmission, the cardinal function of neurotransmitters). SSRIs include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro), and fluvoxamine (Luvox).
• Serotonin and norepinephrine reuptake inhibitors (SNRIs) are the second-most popular antidepressants worldwide. These agents block the reuptake of both serotonin and norepinephrine from the synapse into the nerve (thus increasing the amounts of these chemicals that can participate in signal transmission). SNRIs include venlafaxine (Effexor) and duloxetine (Cymbalta).
• Bupropion (Wellbutrin) is a very popular antidepressant medication classified as a norepinephrine-dopamine reuptake inhibitor (NDRI). It acts by blocking the reuptake of dopamine and norepinephrine.
• Mirtazapine (Remeron) works differently from the compounds discussed above. Mirtazapine targets specific serotonin and norepinephrine receptors in the brain, thus indirectly increasing the activity of several brain circuits.
• Tricyclic antidepressants (TCAs) are older agents seldom used now as first-line treatment. They work similarly to the SNRIs, but have other neurochemical properties which result in very high side effect rates, as compared to almost all other antidepressants. They are sometimes used in cases where other antidepressants have not worked. TCAs include amitriptyline (Elavil, Limbitrol), desipramine (Norpramin), doxepin (Sinequan), imipramine (Norpramin, Tofranil), nortriptyline (Pamelor, Aventyl), and protriptyline (Vivactil).
• Monoamine oxidase inhibitors (MAOIs) are also seldom used now. They work by inactivating enzymes in the brain which catabolize (chew up) serotonin, norepinephrine, and dopamine from the synapse, thus increasing the levels of these chemicals in the brain. They can sometimes be effective for people who do not respond to other medications or who have “atypical” depression with marked anxiety, excessive sleeping, irritability, hypochondria, or phobic characteristics. However, they are the least safe antidepressants to use, as they have important medication interactions and require adherence to a particular diet. MAOIs include phenelzine (Nardil), isocarboxazid (Marplan), and tranylcypromine sulfate (Parnate).
• Non-antidepressant adjunctive agents. Often psychiatrists will combine the antidepressants mentioned above with each other (we call this a “combination”) or with agents which are not antidepressants themselves (we call this “augmentation”). These latter agents can include the atypical antipsychotic agents [aripiprazole (Abilify), olanzapine (Zyprexa), quetiapine (Seroquel), ziprasidone (Geodon), risperidone (Risperdal)], buspirone (Buspar), thyroid hormone (triiodothyonine, or “T3”), the stimulants [methylphenidate (Ritalin), dextroaphetamine (Aderall)], dopamine receptor agonists [pramipexole (Mirapex), ropinirole (Requipp)], lithium, lamotrigine (Lamictal), s-adenosyl methionine (SAMe), pindolol, and steroid hormones (testosterone, estrogen, DHEA).

Consumers and their families must be cautious during the early stages of medication treatment because normal energy levels and the ability to take action often return before mood improves. At this time – when decisions are easier to make, but depression is still severe – the risk of suicide may temporarily increase.

• Psychotherapy. There are several types of psychotherapy that have been shown to be effective for depression including cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT). Research has shown that mild to moderate depression can often be treated successfully with either of these therapies used alone. However, severe depression appears more likely to respond to a combination of psychotherapy and medication.
• Cognitive-behavioral therapy (CBT) – helps to change the negative thinking and unsatisfying behavior associated with depression, while teaching people how to unlearn the behavioral patterns that contribute to their illness.
• Interpersonal therapy (IPT) – focuses on improving troubled personal relationships and on adapting to new life roles that may have been associated with a person’s depression.
• Electroconvulsive therapy (ECT). ECT is a highly effective treatment for severe depressive episodes. In situations where medication, psychotherapy, and a combination of the two prove ineffective, or work too slowly to relieve severe symptoms such as psychosis or thoughts of suicide, ECT may be considered. ECT may also be considered for those who for one reason or another cannot take antidepressant medications.

What are the side effects of the medications used to treat depression?

Different medications produce different side effects, and people differ in the type and severity of side effect they experience. About 50 percent of people who take antidepressant medications experience some side effects, particularly during the first weeks of treatment. Side effects that are particularly bothersome can often be treated by changing the dose of the medication, switching to a different medication, or treating the side effect directly with additional medications. Rarely, serious side effects such as fainting, heart problems, or seizure may occur, but they are almost always treatable.

• Tricyclic antidepressants (TCAs) cause side effects that include dry mouth, constipation, bladder problems, sexual problems, blurred vision, dizziness, drowsiness, skin rash, and weight gain or loss.
• Monoamine oxidase inhibitors (MAOIs). Individuals taking MAOIs may have to be careful about eating certain smoked, fermented, or pickled foods, drinking certain beverages, or taking some medications because they can cause severe high blood pressure in combination with the medication. A range of other, less serious side effects occur including weight gain, constipation, dry mouth, dizziness, headache, drowsiness, insomnia, and sexual side effects (problems with arousal or satisfaction).
• SSRIs, and SNRIs tend to have fewer and different side effects, such as nausea, nervousness, insomnia, diarrhea, rash, agitation, or sexual side effects (problems with arousal or orgasm).
• Bupropion generally causes fewer common side effects than TCAs and MAOIs. Its side effects include restlessness, insomnia, headache or a worsening of preexisting migraine conditions, tremor, dry mouth, agitation, confusion, rapid heartbeat, dizziness, nausea, constipation, menstrual complaints, and rash.

Reviewed by Dr. Ken Duckworth, NAMI Medical Director, September 2006

Read about Treatments and Supports for Mental Illness

More Fact Sheets

Understanding Major Depression and Recovery(PDF)  

NAMI’s booklet on Understanding Major Depression and Recovery.

Women and Depression Brochure(PDF)  

Learn more about women and depression in this self-help brochure from The National Alliance on Mental Illness (NAMI) that addresses the causes, symptoms, life stages and treatment of depression.  

Ask the Doctor: Treatment Resistant Depression

NAMI’s Medical Director, Dr. Ken Duckworth, talks about treatment resistant depression and several treatment options.

Depression in Children and Adolescents

NAMI’s Fact Sheet on Depression in Children and Adolescents

More Fact Sheets…

Related Resources 

DepressionIsReal.com

Frustrated and concerned by popular misconceptions that trivialize depression as “just the blues” or dismiss it entirely as an “imaginary disease,” seven prominent physician, patient and civic nonprofit organizations have joined together to launch a public education campaign to tell Americans the truth about depression.

Depression Survey Results(PDF)

Depression is one of the most prevalent mental health conditions in the United States, affecting approximately 19 million American adults each year. The symptoms of depression vary widely and may greatly impact the social and economic well-being of sufferers. The goal of this survey is to document the costs of depression in terms of relationships, professional life, and economic well-being.

The Down and Up Show

The Down & Up Show is dedicated to the reality of depression. Each week the hosts talk with some of the world’s top experts on depression, as well as people who have been impacted by this illness. The reality of depression is that it is a debilitating and potentially deadly medical condition that affects some 19 million Americans every year. The other reality of depression is that there is hope.

Living with Major Depression

Welcome to NAMI’s Living with Major Depression community. Here you will find support, get targeted information and connect with people who understand.

Find Support

Learn more about the full spectrum of programs and services that NAMI provides across the country for people living with mental illnesses, and their families and loved ones.

Related Links

Sequenced Treatment Alternatives to Relieve Depression (STAR*D)

NIMH sponsored multi-center clinical trial and information resource.  

CBS Cares: Depression Web Site

As part of their new public service announcement campaign, CBS-TV has created a Web site on depression that contains information and stories.

Treatment for Adolescents with Depression Study (TADS)

NIMH sponsored multi-center clinical trial and information resource.

National Institute of Mental Health

Information from the NIH institute on depression.

Clinicaltrials.gov

Bipolar disorder research studies identified through the U.S. National Library of Medicine’s link to federally and privately funded studies worldwide.

Depression and Bipolar Support Alliance

Organization to improve lives of people living with mood disorders through support, education, and advocacy.

Mood and Anxiety Disorders Program (MAP)

NIMH intramural research and information program on mood disorders.

Source: NAMI

What is bipolar disorder?

Bipolar disorder, or manic depression, is a medical illness that causes extreme shifts in mood, energy, and functioning. These changes may be subtle or dramatic and typically vary greatly over the course of a person’s life as well as among individuals. Over 10 million people in America have bipolar disorder, and the illness affects men and women equally. Bipolar disorder is a chronic and generally life-long condition with recurring episodes of mania and depression that can last from days to months that often begin in adolescence or early adulthood, and occasionally even in children. Most people generally require some sort of lifelong treatment. While medication is one key element in successful treatment of bipolar disorder, psychotherapy, support, and education about the illness are also essential components of the treatment process.

What are the symptoms of mania?

Mania is the word that describes the activated phase of bipolar disorder. The symptoms of mania may include:

• either an elated, happy mood or an irritable, angry, unpleasant mood
• increased physical and mental activity and energy
• racing thoughts and flight of ideas
• increased talking, more rapid speech than normal
• ambitious, often grandiose plans
• risk taking
• impulsive activity such as spending sprees, sexual indiscretion, and alcohol abuse
• decreased sleep without experiencing fatigue

What are the symptoms of depression?

Depression is the other phase of bipolar disorder. The symptoms of depression may include:

• loss of energy
• prolonged sadness
• decreased activity and energy
• restlessness and irritability
• inability to concentrate or make decisions
• increased feelings of worry and anxiety
• less interest or participation in, and less enjoyment of activities normally enjoyed
• feelings of guilt and hopelessness
• thoughts of suicide
• change in appetite (either eating more or eating less)
• change in sleep patterns (either sleeping more or sleeping less)

What is a “mixed” state?

A mixed state is when symptoms of mania and depression occur at the same time. During a mixed state depressed mood accompanies manic activation.

What is rapid cycling?

Sometimes individuals may experience an increased frequency of episodes. When four or more episodes of illness occur within a 12-month period, the individual is said to have bipolar disorder with rapid cycling. Rapid cycling is more common in women.

What are the causes of bipolar disorder?

While the exact cause of bipolar disorder is not known, most scientists believe that bipolar disorder is likely caused by multiple factors that interact with each other to produce a chemical imbalance affecting certain parts of the brain. Bipolar disorder often runs in families, and studies suggest a genetic component to the illness. A stressful environment or negative life events may interact with an underlying genetic or biological vulnerability to produce the disorder. There are other possible “triggers” of bipolar episodes: the treatment of depression with an antidepressant medication may trigger a switch into mania, sleep deprivation may trigger mania, or hypothyroidism may produce depression or mood instability. It is important to note that bipolar episodes can and often do occur without any obvious trigger.

How is bipolar disorder treated?

While there is no cure for bipolar disorder, it is a treatable and manageable illness. After an accurate diagnosis, most people can achieve an optimal level of wellness. Medication is an essential element of successful treatment for people with bipolar disorder. In addition, psychosocial therapies including cognitive-behavioral therapy, interpersonal therapy, family therapy, and psychoeducation are important to help people understand the illness and to internalize skills to cope with the stresses that can trigger episodes. Changes in medications or doses may be necessary, as well as changes in treatment plans during different stages of the illness.

It is useful to know whether the “mood stabilizing medication” prescribed has been approved by the FDA for use in bipolar disorder:

Medications for Mania:

Currently FDA approved: lithium (Eskalith or Lithobid), divalproex sodium (Depakote), carbamazepine (Tegretol), olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), ziprasidone (Geodon), aripiprazole (Abilify)

At least one adequate well controlled study with positive data: haloperidol (Haldol)

Medications for bipolar depression:

Currently FDA approved: combination of olanzapine and fluoxetine (Symbyax)

Also at least one adequate well controlled study with positive data: quetiapine (Seroquel) and lamotrigine (Lamictal)

Medications for preventing (or delaying) recurrence:

Currently FDA approved: lithium (Eskalith or Lithobid), lamotrigine (Lamictal), olanzapine (Zyprexa), and aripiprazole (Abilify) 

Frequently a combination of two or more medications is used, especially during severe episodes of acute mania or depression.

Medication specifics and possible side effects:

Lithium has long been used as a first line treatment for acute mania in people with bipolar disorder for more than 50 years. It generally has more positive impact when used earlier, rather than later, in the course of bipolar disorder. Research shows it is most effective in those individuals with a family history of the illness, and in those experiencing the bipolar I sequence of swings between mania and depression with return to normal function between episodes.

Like all medications, lithium treatment produces side effects. The most common ones are dose-related and can be effectively managed, but for about 30 percent of people who try it, lithium is not tolerable. Lithium side effects may include frequent urination, excessive thirst, weight gain, memory problems, hand tremors, gastrointestinal problems, hair loss, acne, and water retention. There are two important lithium side effects, that can be effectively monitored by a simple blood test: 1)hypothyroidism, which mimics depression and can be easily treated, and 2) less commonly, damage to kidney functions.

Anti-convulsants: The Food and Drug Administration (FDA) approved divalproex sodium (Depakote) in 1995 for treating bipolar episodes. Originally approved in 1983 as a drug to treat epilepsy, Depakote was found to be as effective as lithium for treating acute mania, and appears to be better than lithium in treating the more complex bipolar subtypes of rapid cycling and dysphoric mania, as well as co-morbid substance abuse. In addition, Depakote may be safely given in larger doses to treat acute episodes, and works faster in this situation than lithium. The generic version of this drug is valproic acid. Some people find that the generic version produces more gastrointestinal distress than Depakote.

Depakote may also produce sedation and gastrointestinal distress, but these side effects often resolve during the first six months of treatment, or with dose adjustment. Another dose-related side effect is weight gain, and rare liver and pancreatic function problems may develop while taking Depakote. However, Depakote is generally well-tolerated, and is now prescribed far more often then lithium. Recent controlled trials indicate that the combination of Depakote and lithium is more effective in preventing relapse and recurrence than treatment with lithium alone.

Lamictal (lamotrigine), another anti-convulsant, is effective in the treatment of acute depression in bipolar I and II and in promoting remissions between episodes. For most people, Lamictal has a very tolerable side effect profile. Rarely, this medication can cause a rash serious enough to cause a medical emergency. The risk of this one potentially serious side effect can be reduced by starting with a low dose and going slowly in increasing the dose.

Use of Antidepressants

Standard antidepressant medications (those approved for the treatment of unipolar depression) have not yet been proven effective for bipolar depression. Although the evidence supporting their use for bipolar depression is limited to small or less rigorous studies, these medications remain the most commonly used treatment for bipolar depression. The data from larger studies finds neither evidence of benefit nor evidence that these agents cause large numbers of depressed patients to switch into mania.

Use of Antipsychotic Medications as Mood Stabilizers

To control acute episodes, antipsychotic medications may be used alone (monotherapy), or added to anti-convulsant medications (combination therapy). Medication guidelines now recommend the combination of these two medications as most effective for acute manic episodes. Because the older typical antipsychotic medications run the risk of causing permanent movement disorder, and have been associated with depression when used over the long term, the new atypical antipsychotics are now preferred for this purpose. All the new atypicals are effective in the treatment of acute and mixed mania. Olanzapine (Zyprexa) and risperidone (Risperdal) are FDA-approved for this purpose.

Finding the right preventive/maintenance medicine is an art informed by science and your own observations. Not all medicines that work in the acute phase of mania are as strong in preventing the next episode, so this is an area to explore.

Side effects of the atypicals are different than with first-generation antipsychotics (such as Haldol), although sedation, weight gain, and risk of diabetes are problems associated with many of the new antipsychotics. Clozapine and olanzapine, both effective antipsychotics and mood stabilizers, offer the most risk in this area. Weight gain is a serious clinical concern related to all atypical antipsychotics, and to anti-convulsants as well. Not only can weight gain lead to adult onset also known as type 2 diabetes and cardiovascular diseases, but being overweight is also now the leading cause of medication non-adherence. Doctors advise weekly monitoring of weight in the early stages of taking these medications, along with regular exercise and healthy diets, and people must be willing to make lifestyle changes to maintain optimal health. The FDA has noted an association between all atypical antipsychotics and the risk of diabetes. As the science develops in this area, it will continue to inform medicine choices for the person that best reflect their risks and benefits.             

Reviewed by Ken Duckworth, MD, October 2006

Read about Treatments and Support for Mental Illness

More Fact Sheets:

Understanding Bipolar Disorder and Recovery (PDF)
Guide to Understanding Bipolar Disorder and Recovery.

Child and Adolescent Bipolar Disorder
NAMI’s Fact Sheet on Child and Adolescent Bipolar Disorder

Related Resources:

Find Support
Learn more about the full spectrum of programs and services that NAMI provides across the country for people living with mental illnesses, and their families and loved ones.

Living with Bipolar Disorder
Welcome to the NAMI’s Living with Bipolar Disorder community. Here you will find support, get targeted information and connect with people who understand.

Related Links

Child and Adolescent Bipolar Foundation
An on-line support and advocacy organization focused on childhood bipolar disorder.

Clinicaltrials.gov
Bipolar disorder research studies identified through the U.S. National Library of Medicine’s link to federally and privately funded studies worldwide.

Depression and Bipolar Support Alliance
Organization to improve lives of people living with mood disorders through support, education, and advocacy.

Mood and Anxiety Disorders Program (MAP)
NIMH intramural research and information program on mood disorders.

National Institute of Mental Health
Information from the NIH institute on bipolar disorder.

Systematic Treatment Enhancement Program for Bipolar Disorder
NIMH sponsored multi-center clinical trial and information resource.

Source: NAMI

How To Seek A Divorce And Win In One Easy Step

By Susan N. Wolpin

          Recently there has been a good deal of attention focused on spousal assault and/or child abuse. While there is a need for attention into the matter of domestic abuse, there are too many instances where this attention acts to promote abuse of the abuse law itself. In an alarming number of cases false allegations of abuse have become an omnipotent weapon in an impending divorce/separation/custody action.

          How has this come to pass, one might ask? The answer requires a brief historical analysis. In Pennsylvania, the first domestic abuse act was passed on December 6, 1976. The act provided for reporting requirements and police intervention in domestic relations incidents. However, much discretion for enforcement and intervention was left with the police and other agencies. Due to the lobbying efforts of such groups as ‘A Woman’s Place’ the first substantive act was enacted on April 18, 1988. This is the first of the Acts that began to significantly deprive the wrongly accused of personal freedoms and property rights. Most importantly, these deprivations can and do occur without due process of law. The law was further modified in 1989, 1990, 1994, and most recently in March 1995. The current law as we know it was enacted as 23 PA C.S.A. § 6100 et seq. and is known as the PROTECTION FROM ABUSE ACT (PFA). The Act provides for the following remedies: 

• 1. The accused loses possession and/or is evicted from his home.
• 2. The accused temporarily loses custody of his children for up to twelve months. Under certain circumstances, custody may be permanently lost for two or more years.
• 3. The accused is ordered to pay temporary child/spousal support.
• 4. The accused is prohibited from entering or coming anywhere near the plaintiff’s residence, place of business, school, or family.
• 5. The accused is to have no further contact with the plaintiff or the plaintiff’s family.
• 6. The accused is ordered to pay all of the expenses of the plaintiff, including medical bills, moving expenses, loss of earnings, and attorney’s fees.
• 7. Additionally, the accused is restrained from any further abuse.

While these remedies appear reasonable at first glance, here is the reality in actual practice:

• 1. The accused is immediately thrown out of the family home without his personal property, clothes, or other necessities. He is often given only twenty minutes (under police supervision) to gather what he can. If served at a location other than that home, the accused can be virtually left with no clothing, toiletries, or money.
• 2. The accused loses all or most of his valuables and treasured personal property.
• 3. The accused is denied access to his financial records and documents. These papers are often taken by the plaintiff to her attorney for use in the support/divorce action.
• 4. If there is a joint bank account, the accused often loses access to any assets in this account.
• 5. The accused loses possession of the family home, probably permanently. The accused is usually thrown out of the house for up to ten days while awaiting a hearing before the Judge. This is more than enough time for the plaintiff to move, transfer, and/or distribute the accused’s personal property. In addition, the plaintiff is in a position to destroy the home, if so inclined. The displaced accused remains responsible for all the liabilities connected with the property.
• 6. The accused loses all custody of his children in all but the most exceptional cases. Most often, the accused is denied visitation with the children, either legally, or in practice through the conduct of the plaintiff.
• 7. If and when a formal custody proceeding is commenced, the accused is often reduced to supervised visitation with his children.
• 8. Despite being denied access to his children, the accused will be ordered to pay spousal/child support. The amount of this support may be assessed with no regard to the support guidelines, or the party’s ability to pay. Failure to pay child support will lead to incarceration.
• 9. The accused will be expected to avoid the plaintiff at all costs. If the accused as much as passes the plaintiff on the street, a possible charge and conviction of stalking may follow.
• 10. There will be no provision for the possibility of reconciliation between the parties, even though the Pennsylvania Divorce Code clearly claims that the policy of the Commonwealth is to “Encourage and effect reconciliation and settlement of differences between spouses, especially where children are involved.” A PFA order, prohibiting any further contact or communication ensures that a reconciliation may not even be discussed.
• 11. For all of these benefits and privileges, the accused can then be ordered to pay all of the plaintiff’s fees and expenses. Attorney fees alone can potentially exceed $3000.

        A typical PFA order is often sought when the Common Pleas courts are closed. A temporary Order may be granted by a District Justice at an ex-parte hearing, after an initial interview with and coaching of the plaintiff by volunteers from ‘A Woman’s Place’.

        The District Justice is only permitted to grant a temporary order if he/she feels that the plaintiff is in “immediate and present danger to (herself) or minor children.” This is a factual conclusion which must be based on the representations of the plaintiff, with preparation from a member of the staff of ‘A Woman’s Place’. Despite this statutory requirement, emergency orders are awarded as easily as widgets rolling off an assembly line.

By law, within 10 days a hearing must be held in Common Pleas Court. The accused has been out of the house for that period. His expectancy is that this nightmare is coming to an end. By now he is probably desperate for a hug from his children. But the converse is too often true.

Typically, the accused will be appointed an overburdened pro bono attorney, who will, in most cases, try to pressure the accused into signing an agreement for Final Order by Consent without a hearing. Far too often, men will comply with this after being told “This in not an admission of guilt.” “You don’t want to see her anyway.” “It’s just easier this way. It won’t change anything for you.” The accused is promised almost anything, including the chance at reconciliation, if desired. Just to compel the signing of this document. This agreement will haunt you! It will be used by the plaintiff in any impending action. The agreement is often taken as an admission of guilt, despite the language it contains.  

YOU ARE NOW BRANDED AN ABUSER.

If you refuse to sign the agreement, the case will be heard by the Judge. At this point, you have a chance to try and present your defense.

Good Luck!!

 
 The PFA statute is located at 23 PA C.S.A. § 6100 et seq. Here are a few of the provisions of that statute:

1. The plaintiff may be accompanied by her counsel, and a counselor from ‘A Woman’s Place’. Her attorney is obtained from Bucks County Legal Aid, through ‘A Woman’s Place’. The counselor is permitted to coach the plaintiff’s answers. Oftentimes, the plaintiff is coached to misstate the facts, or to create facts in order to prevail. In the meantime, in Bucks County, the accuseds are represented by a single overburdened attorney acting on behalf of the Bucks County Bar Association, with rules and restraints established by Bucks County Legal Aid. This poor soul often has as many as 50-100 accuseds per day, with seconds for each.

2. The plaintiff may introduce and utilize documents and materials the accused has never before seen. Additionally, the authors and creators of these documents need not be present for cross-examination. The documents need not be authenticated nor shown to be reliable.

3. The standard of proof at these hearings is the “preponderance of evidence.” This means that the discretion remains with the Judge to grant or refuse the Order, based on hearsay or other improper evidence.

4. The plaintiff may then be permitted to relocate with the children to an unknown location. This location MAY NOT be revealed under any circumstances.

5. A Final Order may last as long as one year. However, this period may be extended with no limitations. An extension may be prompted by the plaintiff if she chooses to file further false allegations.

6. Contempt of the Order looms ever in the background. And she doesn’t even need to call the police to charge you. If an Officer sees you near her, her home or even your children, the law gives him the right to arrest you for violating the order. Of course, she may still call the police if she comes up with other ‘evidence’ of a violation.

So, how does this affect divorce? The answer should be obvious. In a divorce, the key issues are often custody, support, and equitable distribution. Under a PFA action, these issues are resolved upon the granting of the final order. While the remedies granted under a PFA are expected to be temporary, the reality is a very different matter. Once a PFA has been granted, the accused, rightly or wrongly, is branded an abuser. The accused will find it difficult to seek relief from the Family Courts at any further point in the system. All other issues will be colored by the plaintiff pointing to the PFA and yelling that this is an abusive man!

With the access of the plaintiff to all of the personal property for the duration of the PFA, the accused has already lost at equitable distribution. Much of the time, the marital estate has been decimated. If an injunction preventing transfer, distribution, or disposition of the marital property remaining in the house is sought, a Family Court Judge will often refuse to grant this. The Judge, to the contrary, can order the accused to turn over any and all liquid assets to the plaintiff or her attorney. This leaves the accused in a position whereby he cannot afford legal counsel to further defend himself.

Among the standards in custody is the nature and extent of alleged abuse in the household. If the plaintiff uses the final order, and she will, during a custody action, the accused may lose all custody, as well. Custody may be further impaired if the plaintiff can scheme to find the accused in contempt of the order.

Additionally, it is not uncommon for the accused to be denied access to his children for months at a time. A final hearing on custody can be repeatedly continued by the plaintiff which can have the effect of continuing the PFA. Also, we have heard, that some volunteers from ‘A Woman’s Place’ advise their clients not to comply with any order that grants custody or visitation to the accused.

Permanent child support will be determined according to the State Guidelines. However, if the abuse issue is presented to the accused’s workplace, he may lose his job, as well. Support will then be determined by what is termed an “earning capacity.” This is the standard which is used when it is alleged that the defendant has wilfully terminated his employment to avoid payment of support. Of course, the accused has been separated from his financial records, and is unable to report his income and expenses.

PFA has become the most employed tool in divorce and custody actions. One simply alleges a false claim of abuse and the accused loses the entire matter. The plaintiff/accuser walks away completely victorious. The number of false abuse claims is ever rising. There are no statistics showing the number of truly founded abuse claims, but it has been reported that nationally the number of false claims is about 56% and growing.

Source:

S.P.A.R.C.

DEPRESSION: Out of the Shadows

A lot of Americans are keeping an important, possibly deadly secret.

The National Institute of Mental Health reports that approximately 18.8 million American adults have a depressive disorder. The disease is not discriminating, seeping into all age, race, gender, and socioeconomic groups. Depression stalls careers, strains relationships, and sometimes ends lives.

So if this many people are living with the disease, why the silence? DEPRESSION: Out of the Shadows is a multi-dimensional PBS project that explores the disease’s complex terrain, offering a comprehensive and timely examination of this devastating disorder.

By weaving together the science and treatment of depression with intimate portrayals of families and individuals coping with its wide-ranging effects, the film raises awareness and eliminates the stigma surrounding this prevalent disease, underscoring the fact that whether we are battling it in our families, our workplaces, or in our own minds, depression touches everyone. 

Through the voices and stories of people living with depression, the film provides a portrait of the disease never before seen on American television. Along with consumers, DEPRESSION: Out of the Shadows also follows acclaimed scientists as they describe the latest neurological research and groundbreaking new treatments for depression. 

Following the film, broadcast journalist Jane Pauley will host a 30-minute roundtable discussion titled TAKE ONE STEP: Caring for Depression, with Jane Pauley in which nationally acclaimed experts will offer advice on recognizing and treating depression.In addition to the broadcast and online presence, the National Alliance on Mental Illness (NAMI) and the YMCA of the USA will implement an outreach campaign, educating about depression in communities across the United States.

All of the DEPRESSION: Out of the Shadows resources combine to powerfully raise awareness, eliminate stigma, and get help. 

Understanding & Managing Depression

 Did you know kids can experience depression?

Childhood is a carefree time, right? Unfortunately, this isn’t true for all kids. About 2% of school-age children appear to have major depression at any one time. Depression in preschoolers is rare, but does occur.

Childhood depression is caused by a variety of factors, including genetics, environment and adverse life stresses. But the good news is that children are surprisingly resilient, and the disorder is treatable in many kids. Medication and/or talk therapy is usually effective; consulting with a pediatrician, school counselor or social worker, or educator are good first steps to finding child-centered mental health care in your community. Take one step. It’s never too late. 

Did you know that depression isn’t just “all in your head?”

Recent scientific research has irrefutably established that depression is a medical illness. It is not a sign of personal weakness, and it cannot be willed or “wished away” any more effectively than, say, non-treated cancer or diabetes. Depression is also known to weaken the immune system, making the body more susceptible to other medical illnesses. But despite depression’s clear biological roots, people living with the disease have often been the victims of blame and societal prejudice. Ongoing research and solid scientific findings are beginning to shed light on depression, clearing up misinformation and slowly reducing stigma.

Did you know there are many potential causes of depression?

Although there is no single, definitive answer to the question of cause, many factors – psychological, biological, environmental and genetic – likely contribute to the development of depression. Causes can occur in any combination, and can include genetic influences (such as family history of the disease); biochemical factors (such as hormonal fluctuations or chemical imbalance); psychological challenges (such as social anxiety and stress), and trauma (such as suffering the loss of a loved one or enduring a violent crime).

Did you know depression is a treatable disease?

Depression is one of the most treatable illnesses, with 80-90% of people who seek treatment finding relief. Many experts suggest using both psychotherapy and medications to treat depression. Other options include psychosocial treatments (such as family education and support groups); electroconvulsive therapy (for severe depression which does not respond to other treatments); and self-care (involving elements such as healthy diet, regular exercise, spirituality and social connection). The challenging news about treating depression is that most people experiencing the disorder never seek help. Approximately 80% of people with depressive disorders go untreated.

Did you know women experience depression more frequently than men?

Depression can develop in anyone, regardless of race, culture, social class, age, or gender. However, across virtually all cultures and socioeconomic classes, women are more likely than men are to experience depression. Clinical depression affects two to three times as many women as men, both in the U.S. and worldwide; an estimated one out of every eight women will experience clinical depression in her lifetime. So why do so many women battle depression? Hormonal changes may play a role, with female depression often emerging at puberty and remaining high throughout the childbearing years. Psychosocial factors that may contribute to women’s increased vulnerability to depression include the stress of multiple work and family responsibilities, sexual discrimination, lack of social supports, traumatic life experiences, and poverty. Studies also indicate that sexual and physical abuses are major risk factors for depression.

Take one step: Health Knowledge is Power!

In the dark when it comes to health information? You’re not alone. According to a recent Institute of Medicine report, nearly half of all American adults have trouble figuring out medical forms, and even have difficulty understanding their doctor’s instructions!

But you can arm yourself with knowledge. Communicate with your health provider, seek out trustworthy resources on the Web and from credible toll-free information hotlines. Ask questions and listen. These small steps can help you become a more savvy health consumer.

So take one step, starting with these fast facts about taking charge of your health.

Print and Online Resources

Depression Fact Sheet Depression affects approximately 15 million American adults every year. Learn about the symptoms and basic treatments for this very treatable condition. English version (PDF, 748k) Spanish version (PDF, 796k)

Depression Statistics Because of depression’s stigma, many people are unaware of how common it is; read the statistics on the disease’s wide reach. English version (PDF, 644k) Spanish version (PDF, 776k)

Depression in Children While rare, childhood depression does exist. Explore its specific symptoms and methods for finding pediatric treatment. English version (PDF, 636k) Spanish version (PDF, 772k)

Depression in Teens and College-Age Students Incidences of depression increase during the teen years. Find out more about its contributing factors and strategies for seeking relief. English version (PDF, 636k) Spanish version (PDF, 772k)

Depression in Older Adults Depression often goes undiagnosed in older people. Learn about potential causes, symptoms and treatments for people suffering depressive disorders later in life. English version (PDF, 736k) Spanish version (PDF, 748k)

Depression in Women Women are twice as likely as men to experience depression. Learn more about possible causes and treatments for female depression. English version (PDF, 636k) Spanish version (PDF, 772k)

Depression in Communities of Color The Surgeon General reports people of color, both adults and children, are less likely than their white counterparts to receive needed mental health care. Find out why, and explore ways to connect all people with the help they need. English version (PDF, 636k) Spanish version (PDF, 772k)

Depression Web Links These revered organizations offer effective starting points when seeking information about depression or related disorders. For advice about specific treatment or medication, always consult a physician and/or mental health professional. 

Individuality

Psychological Abuse,

“Messing with your Mind,”

Is one of the Most Lethal

Forms of abuse.

If you think that you may be in an abusive relationship, or if you know someone who may be,

This information could be helpful in explaining exactly

HOW women can continue to revolve in a cycle of abuse.