Personality/Anxiety/Mood Disorders

Posted by Barbara Melville

I’ve had a lot of feedback on this subject, from both professionals and people with PTSD. This morning, I received an email from someone describing how they had experienced relief of their PTSD symptoms but had been unsure as to why. Many years later, they heard about propranolol in the news, a drug they had been prescribed for a medical condition around the time their symptoms improved.

This is something I’ve wondered about – people who have a) experienced trauma and/or post traumatic stress and b) been prescribed propranolol for other reasons. I telephoned a friend who has PTSD and is taking propranolol for heart disease. She too described an improvement in symptoms since taking this drug, even though her regimen would be quite different to those used in research studies.

I do not wish to trivialise these accounts in any way, but it’s important not to jump to conclusions – there could be a number of factors attributing to why these people experienced improvements. I’ve also only had a very quick web search but it’s incredibly likely that this area has already been brought into question. I’m going to take some time over the next month to explore this in more depth.

Posted by Barbara Melville

Monoamine oxidase inhibitors (MAOIs) are powerful and effective antidepressant drugs. I agree that MAOIs are likely overlooked as an effective treatment. They’re also a victim of misinformation, with conflicting factsheets in different corners of the web. I cannot overstate how important it is to read the documentation that comes with these medications. For doctors who provide separate factsheets regarding restrictions, it is essential that these are up to date.

Anyway – misinformation. Many online mental health resources (including well-known, reputable organisations) provide different details about what can and cannot be eaten when taking MAOIs. I find this unacceptable. If I were a patient considering these drugs, I would understandably want to completely avoid the risk of interactions. I imagine such contradictions could cause unnecessary distress to those prescribed them, not to mention the fact that following the wrong diet can be very dangerous.

It’s unfair on readers if information is inaccurate. I try very hard to research thoroughly. This becomes more challenging when supposedly good sources aren’t consistent with each other. Anyway, I did find some excellent research papers in the end. I’ve also emailed some of the drug companies that make MAOIs to ask for the information leaflets and dietary restrictions that they provide for patients. Let's hope they don't contradict each other.

Posted by Barbara Melville

The boundary between sadness and depression is a topic that has inspired much debate. When a physical illness is present, depression may be seen as a realistic outcome. This can be unhelpful and stigmatising. For example, it may promote the idea that people should expect and tolerate symptoms of depression.

The main difference between sadness and depression is that depression persists and notably affects our functioning. However, this is quite a general definition. Researchers sometimes use different definitions and measurement scales, which calls their results into question. Which scale is the right one? Which definition is correct? Where do we draw the line? Are there other factors to consider?

I think communication can be a huge factor when considering health complaints. I make no secret of the fact I have chronic pain, and I definitely make no secret about how abysmal the communication has been. Different professionals lobbied contradictory pain management models, insisting that I’d be harming myself if I took advice elsewhere. This lack of consistency was much more stressful than any symptoms.

That is, however, my personal experience, which may or may not be similar to the experiences of others. Fortunately, I have not had depression alongside my pain condition, and I think this is partly because I have supportive friends and family that I can talk to. I’d never underestimate the importance of such support.

Posted by Barbara Melville

When I was researching lithium and pregnancy, it quickly became apparent that alternatives really need to be investigated. Bipolar disorder is one of the mood disorders that responds well to lithium treatment, and most women with bipolar disorder are in their childbearing years. Since both continuing lithium and stopping lithium present risks, potential mothers may have some difficult choices to make.

What about alternative drugs? Other mood stabilizers pose similar risks and so are unlikely to be prescribed to someone who functions well on lithium. There are some other medications, such as certain types of antidepressants and antipsychotics, which may be safer in pregnancy than lithium. However, many may have already tried such drugs, without success.

Lithium and breastfeeding is also an area of controversy, with most sources advising against it. However, although we do know it’s passed into the breast milk, there has been no research into the full implications of lithium and nursing. We do know that serious illness relapse is a likely implication of not recommencing lithium shortly after the birth. Possibly another tough choice for mothers-to-be.

I wonder if Dark Therapy may be a suitable intervention for pregnant women. I’m stabbing in the dark here (no pun intended) as I really have no idea if such a treatment would pose risks to pregnancy. I imagine that amber glasses (that is, glasses that block out blue spectrum light) are likely to be a safe self-help option, possibly as part of a holistic, bigger picture. I’ll see if I can find out some more…

Posted by Barbara Melville

I wouldn't be surprised if rates of depression in children and adolescents are far greater than statistics would suggest. It may be hard for children to express themselves and some may be unaware that what they're going through is actually a recognized, treatable illness. They may have picked up on powerful, negative messages surrounding mental health, thereby putting them off coming forward.

Where do these messages come from? We know that children are impressionable but we also know that human perceptions are complex and difficult to measure. Children may pick up messages anywhere, including at home and/or school. The modern media is a likely culprit for perpetuating myths, with many TV shows and films portraying negative images of people with mental health problems.

I think this area needs a much stronger body of evidence in terms of treatment, especially regarding antidepressants, which are currently subject to controversy. I also think that raising awareness on this topic is very important. Depression can be such a miserable, isolating experience. Young people and their carers need to know that they’re not alone – there is support out there.

I’ve certainly seen improvement in child/adolescent psychiatry in the last decade or so, so here’s hoping that a) it’s not my imagination and b) it will continue to improve. There also seem to be heightened awareness, with many online mental health resources being developed for young people. The school counselor was a non-existent job when I frequented the Scottish school halls, but now they seem to be considered essential. I think that’s exactly how it should be.

Posted by Barbara Melville

Our bodies rely on the substances we put in it. Although specifically measuring effects on mood can be difficult, there are strong links between what we eat and how we feel. The term “food and mood” has become very popular in recent years, though some practitioners remain unsure about the concept. This is understandable to a point, given the complexity when considering individuals, mood disorders and nutrition. However, I think it’s always worth including nutrition in the big picture, as part of a holistic approach to good mental health.

I once supported a woman diagnosed with premenstrual dysphoric disorder. She struggled with diet, describing strong and unpleasant carbohydrate cravings that lasted for two weeks out of every month. She tackled the cravings by overindulging in sweet foods, leaving her feeling miserable and tired. She managed these symptoms by keeping a food diary for a few cycles and then looking at foods, specifically complex carbohydrates, that would take the edge off her cravings without resulting in sluggishness, feelings of low mood and weight gain. She said she felt the effects were small but still worth having, especially in combination with the other interventions she was trying.

This isn’t an example of how to manage PMDD in general because other women with this diagnosis may have vastly different experiences. But it does show someone taking control and raising their awareness about their diet, and then making a couple of worthwhile changes. I’ve decided I’m up to the challenge. I’ve always thought my diet was pretty good, but is it? We’ll soon see. I’m already feeling rather doubtful. I think “ice cream” is likely to appear a little more often than I’d like.

Posted by Barbara Melville

Pregnancy is often recognized as a time of vivacity – a time to bloom, glow and be joyous. Unfortunately, it can be a time of great vulnerability, as many mothers-to-be have discovered. The culprit, antenatal depression, appears to have gained some recognition in recent years. However, I’d say the journey has really just begun. I think I’m going to get a t-shirt that says, “More Research, Please” because it would definitely be well-worn.

I had so many questions when I set out to research this topic. Is depression linked to poor neonatal outcome? If so, is this link causal or correlative? Can antidepressants be used in pregnancy? If not, why not? And that was just for starters. Unfortunately the picture is far from clear, and I found myself confused and frustrated at the vast number of conflicting studies. This then led me to ask: what on earth are sufferers supposed to do? This must be awful for them and their carers.

Another issue that came up during my research was the question of how we define depression, when mood swings in pregnancy are considered “normal”. I think this is an individual issue – if you experience symptoms that are negatively impacting on your life, then it’s worth taking a closer look. With this is mind, I feel “antenatal distress” is a better term as it encompasses all of those suffering distress during pregnancy, not just those with a diagnosis. But anyway, the terms (or labels?) we use are a blog post for another day.

Posted by Barbara Melville

Currently, there is research being undertaken in the UK that will specifically look at how CBT (cognitive behavioral therapy) can help sufferers of emetophobia, the extreme fear of vomiting (hereafter referred to as v* for the benefit of sufferers). Although I think CBT may be a promising treatment, I’d like to see more research into this phobia, in particular, the mechanisms associated with v*.

My concern is that many sufferers report being able to prevent themselves from v* , and in some cases report not being able to v* even when they want to. These themes have recurred so often in research (what little there is), and the topic is often discussed on phobia forums. Some sufferers report being dismissed and even being laughed at when they describe being able to stop themselves from v*. However, should this be dismissed? What if, as odd as it may sound, there is some validity to these concerns?

Some researchers did look into this idea, suggesting that sufferers may actually be able to train themselves not to v*. The neural hypothesis suggests that the v* center in the brain may respond to inhibitory stimulation from the limbic system, learning that v* is completely unacceptable. There is also physical hypothesis that suggests breathing and stomach muscles may also be controlled to prevent v*. These ideas are understandably difficult to put to the test, both scientifically and ethically.

CBT aims to modify thoughts, feelings and behaviors. A possible thought challenge might be, “If I’m going to v*, there’s nothing I can do about it”. But what of those who believe they can keep it down – will this challenge work? Surely we should explore these possible ideas further, in case some chronic sufferers are really unable to v*?

Posted by Barbara Melville

The National Association for Mental Health and the Better Sleep Council recognize May as Better Mental Health month and Better Sleep Month. This got me thinking (and reading) a lot about the relationship between sleep problems and mental health. The link appears to be strong, if not fully understood. It’s my hope that future research will bring some clarity to this area.

Sleeping difficulties may be a symptom of depression, or perhaps even a cause or trigger. I recently read a study on bipolar disorder that showed how sleep disturbances may indicate imminent mood changes. When recognized, such signs may be used to manage or even prevent these episodes. Unfortunately, it’s quite easy to take sleep for granted. It is likely that many of us don’t really think about our sleep until it becomes problematic.

Fortunately, the occasional bad night isn’t out of the ordinary, and unlikely to do any harm. Lasting sleep problems, however, can be pervasive and may pose health risks. It is therefore wise to get sleep problems checked out by a qualified physician.

Making sleep a health priority is a good step in managing or preventing sleep problems. We can look at our lifestyle, our sleep environment and the issues affecting us. These areas may be key in dealing with (and preventing) sleep problems. The Better Sleep Council offer a wealth of information on how to sleep better, including advice on sleep hygiene, tips on what to avoid and how to choose a mattress.