How Do Mass Shootings Impact People’s Attitudes Toward The Mentally Ill?

Taken from the Pacific Standard  which is found  HERE.

Christopher Harper-Mercer, the Umpqua Community College gunman, was, by all accounts, a loner. A recluse.

Of course, this is no surprise. From Adam Lanza to Elliot Rodger, practically every mass shooter over the past several years has been described using a special set ofIsolated Gunman Adjectives, all of which revolve around his troubled status as a social outcast. Someone who was unsociable, disturbed.

When news outlets provide this information about mass shooters, does it really help our quest to understand, predict, and ideally prevent these tragedies by identifying risk factors for violence?

Blaming mass violence on mental illness is misleading at best. Mentally ill people are far more likely to be the victims of violence than they are the perpetrators. Only about four percent of violence can be attributed to those suffering from mental illness. Drug and alcohol abuse is a far greater predictor; people who abuse alcohol or drugs but have no other mental illness diagnoses are almost seven times more likely to be violent. Even if we’re only looking at the “awkward recluse” angle, socially isolated children are also significantly less likely than their more social counterparts to engage in delinquent behavior during middle and high school—mostly because many adolescent crimes are egged on by delinquent friends, or committed while under the influence of drugs or alcohol at parties. Loners don’t really have friends. Or go to parties.

Media coverage that mentions “mental illness” can end up reinforcing stigma directed toward the mentally ill, and, in turn, toward those who may be a little socially awkward or reclusive.

At any rate, being socially awkward or reclusive is not actually a risk factor for violence—and neither is mental illness. In fact, sadly, it’s suicide for which mental illness is the strongest risk factor—not homicide. That certainly isn’t the picture we usually get from the news media, which loves to paint a picture of either “mental illness” or the “reclusive outcast” (or a combination of the two) as catch-all bogeymen for mass violence. Unfortunately, those portrayals don’t occur without consequences.

When the media mentions certain groups (or types) of people in the context of trying to find a logical source to blame for mass violence, it has serious consequences for the general public’s perceptions of those groups. Media coverage of Islam after 9/11 dramatically shifted public opinion toward seeing Muslims as “violent,” and the ongoing disproportionate focus on crimes committed by African Americans results in people thinking (even subconsciously) that they’re more “dangerous” than whites. News coverage doesn’t even need to outright link an identity with violence to create negative associations. A 2013 study conducted by Emma McGinty, Daniel Webster, and Colleen Barry found simply mentioning “mental illness” in a newspaper article about a mass shooting immediately made readers significantly more likely to say they would refuse to work closely with or live next door to someone mentally ill, and also made them more likely to say they see all mentally ill people as “dangerous.” This negative generalization occurs even though, of course, “mental illness” is an incredibly broad umbrella, covering everything from anxiety and depression to schizophrenia and bipolar disorder to autism and ADHD—all drastically different diagnoses with different prevalence rates and different symptoms.

Media coverage that mentions “mental illness” (either broadly or focused on more specific diagnoses) can end up reinforcing stigma (a.k.a. the process of de-valuing members of a group because that group seems to deviate from typical social norms) directed toward the mentally ill, and, in turn, toward those who may be a little socially awkward or reclusive.

Stigma matters. People with stigmatized identities have lower levels of self-esteem, higher levels of stress, poorer health, a lower quality-of-life, fewer close relationships, and experience higher rates of discrimination in the workplace. When it comes to mental illness, stigma is one of the biggest barriers to seeking treatment, can quickly lead to relapse, and can hinder recovery. Experts have even expressed concern that mental health-centered gun control laws might backfire in a very dangerous way because of stigma-related concerns: If potential clients are worried their psychiatrists might turn them in to the government and take away their guns because of something they say, they may be less likely to seek help or disclose important information in therapy. Of course, it doesn’t just end there: Members of stigmatized groups often face ostracism, bullying, and name-calling.

We can’t figure out some magic formula for identifying a Dangerous Shooter, and in the process of trying to do just that, we’re hurting real, innocent people. Apparently, presidential candidate Ben Carson suddenly wants to know why there isn’t a “national push to study [mass shooters],” to figure out what they all have in common with one another. But there have, in fact, been massive studies on those shooters, and the data reveals nothing helpful. As Dr. Jeffrey Swanson, one of the leading experts on the link between violence and mental illness, notes in a 2014 interview with ProPublica, “the risk factors for a mass shooting are shared by a lot of people who aren’t going to do it … if you paint the picture of a young, isolated, delusional young man … that probably describes thousands of other young men.” Most of these massive studies can get slightly more specific; the majority of the research also suggests that mass shooters tend to share issues with substance abuse, easy access to guns, and a history of being victimized or bullied. But these don’t exactly narrow down the suspect list much either—especially in a country where there is roughly one gun for every person, making firearm access exceptionally common.

To be very clear—most stigmatized, bullied, and/or ostracized people do not become mass shooters. But what we can say, for sure, is that there’s nothing about stigmatization that could actually be seen as helpful. As we spend all this time in the wake of mass shootings talking about the Second Amendment, we’d do well to remember that there is also a Fourth—we can’t exactly round up and detain every angry, ostracized young man who knows where to quickly find a gun without probable cause, so pointing fingers at entire swaths of people who we deem “suspicious” is an ultimately futile exercise.

It Can’t Be Depression…I’m A Christian

I originally posted this article in 2010 but it is just as relevant today as it was then.  Allan

This article is reproduced with permission from Christian Odyssey and their website can be found   HERE. The article details the experience of Pastor Mark Mounts as he came to the realization he was suffering from severe depression. If there is anyone reading this who feels like a failure as a Christian due to your personal struggles please realize that is not true. Here is one of scores of examples of Christian “leaders” who suffer just as you do. There is help and hope for you!  Allan

It was 11:00 a.m. on a weekday morning and the pastor was having difficulty finding the energy to get out of bed. He wasn’t feeling very “pastoral,” and the guilt was overwhelming. He had phone calls to make, people to visit, sermons to work on, and family obligations were mounting. But all he really wanted to do was get in his car, drive to anywhere but here and forget about everything.

Thirty minutes later he finally mustered the energy to get up and go into the bathroom. On the way, his wife met him. She had a look in her eyes he had never seen before. With a soft voice, but filled with tension, she looked him and said, “For the last few months, you have looked like a walking dead man. I’m worried about you and I don’t know what to do.” That was the straw that broke the camel’s back. He knew something was very wrong, and he had to get help.

That was many years ago. The pastor did get help, and today his depression is under control. I know, because I was that pastor.

I’m still a pastor, but now I’m also a professional counselor and therapist, and my years of professional experience have shown me that depression is far from unique among Christians. Many pastors and parishioners feel that no matter how much they get involved and how much time they sacrifice, they just can’t shed the gloominess that seems to follow them everywhere. So they work harder and give more with the hope that this will make the gloom go away. They try Bible study, but they can’t seem to focus. They try prayer, but they don’t know what to say.

Even worse, they don’t feel like being around people anymore, whether at church or at home. They’re not as patient as they used to be. They get frustrated and angry more easily. Little things that never used to bother them now do. And guilt sets in; they get angry at themselves, try to set new schedules and goals to make themselves do what they know they should, only to be disappointed at their seemingly endless lack of “character” to follow through. Their tempers get shorter and shorter, or they escape to the isolation of their beds, not having the energy to even start the day.

This scenario is a textbook case of clinical depression. Oh no — surely not. Christians, of all people, born again with a new life in Christ, shouldn’t get depressed, should they?

Should Christians get depressed?

As a pastor and professional counselor, this is one of the questions I am asked most often. Christians feel guilty about being depressed. They feel they should “know better.” This leads to denial, which only makes matters worse. Well-meaning friends, and even pastors, who don’t understand what is going on, encourage them to “snap out of it,” and offer advice on “getting their Christian act back together.”

But depression isn’t something a person can “snap out of.”

In the late 1990s and early 2000s several groundbreaking studies brought significant insight into the biology behind depression. In laymen’s terms, these studies showed that some people’s brains simply do not have the capacity to recover from the biological effects of stress and crisis (Kramer, p. 131). This in turn literally shrinks a part of the brain that controls feelings.

When you finally see a
counselor, be honest. The more you tell them, the more they can help. Sometimes, when you talk with someone who has an objective perspective, it can make the gloom begin to lift.

The cause of depression is rooted in brain chemistry. The chemicals necessary to maintain this particular area of the brain are not sufficient. As a result, one’s mood is affected, and depression eventually can set in. Genetics has a strong impact on a person’s tendency to become depressed. It isn’t a matter of being Christian or not Christian, converted or not converted or saved or not saved. As Dr. Peter Kramer states in his book, Against Depression, when talking about a study focused on twins:

“Even bleak environments elicit depression only in the vulnerable. That a shared environment rarely shows up in the chain of what causes depression pushes a good deal of what we call environment into the background” (ibid., 135).

We all accept the fact that our bodies wear out and run down and are susceptible to disease. We can even accept the fact that our brains can be ravaged by diseases such as Alzheimer’s. But some Christians will not accept the fact that clinical depression also has specific biological causes. They’d rather categorize depression as a “bad attitude” or “lack of faith.”

What should you do?

If you suffer from depression, there are some things you can do.

First, find a good professional who can help you, someone who is licensed by the state where you live. They will have credentials like LPC (Licensed Professional Counselor), LCSW (Licensed Clinical Social Worker), a Ph.D. in clinical psychology, or a Psy.D. (Psychological Doctorate). When you contact them, ask if they have a specialty. If they don’t, ask if they will work with someone who is challenged with depression. If they answer yes, ask whether they refer their clients for medication evaluations, or use counseling only. If you happen to have a history of trauma or abuse (many do, so don’t feel alone), make sure you ask whether the therapist is trained in such areas. It’s important for you that they are.

Finding a counselor may feel like an overwhelming task, but it’s extremely important. Admitting that you can’t carry this load on your own is a huge step toward feeling better.

If you want a Christian counselor, you can check websites such as “The American Association of Christian Counselors” AACC). They have a search option that will help you find a counselor in your area. Again, make sure they are state licensed, and don’t be afraid to ask questions. You do have the right to find a counselor you’re comfortable with, but realize you will have to eventually make a decision; it may never feel “perfect.”

When you finally see the counselor, be honest. They are there to help, not condemn. The more you tell them, the more they can help. Sometimes, when you talk with someone who has an objective perspective, it can make the gloom begin to lift.

Some come to me and say, “I’ve tried talking with my family, and it doesn’t seem to be getting any better.” Their attempts at trying to talk with their family, especially a husband or wife, have actually added to their gloominess or depression. This makes them feel even worse. What they don’t realize is that depression affects not just the victim, but also everyone close to them. People who try to help can end up taking the inevitable rejection personally and become upset. It’s not their fault; they simply don’t understand the dynamics of what’s going on. But their reactions can actually make your depression worse. That’s why it’s so important you get a professional, objective perspective.

But what if you see a counselor for several sessions and the cloud doesn’t seem to be lifting?

Clinical depression defined

The definition of clinical depression or a major depressive episode as recognized by most clinicians is as follows:

“The essential feature of a Major Depressive Episode is a period of at least 2 weeks during which there is either depressed mood or the loss of interest or pleasure in nearly all activities” APA, DSM-IV-TR, pg. 349, 2005).

To further clarify this condition, one must experience at least five or more of the following symptoms for at least two weeks to meet the criteria for a Major Depressive Episode. They are:

  1. Depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty), or observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.
  2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by either subjective account or observation made by others).
  3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5 percent of body weight in a month), or decrease or increase in appetite nearly every day. Note:In children, consider failure to make expected weight gains.
  4. Insomnia or hypersomnia (can’t get out of bed) nearly every day.
  5. Psychomotor agitation or retardation nearly every day (observable by others, not subjective feelings of restlessness or being slowed down).
  6. Fatigue or loss of energy nearly every day.
  7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick).
  8. Diminished ability to think or concentrate, or indecisiveness nearly every day (either by subjective account or as observed by others).
  9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or suicide attempt or a specific plan for committing suicide (ibid., 356).

Note: Many clinicians feel that if one has only two or three of these characteristics for an extended period of time, they are still at risk for becoming seriously depressed and should seek help.

To medicate or not medicate…
that is the question


When I went through my serious depression, I believed that working harder, praying more, and serving more would make me feel better. But that simply isn’t true. After weeks of therapy, my therapist told me I was a good candidate for anti-depressant medication. At first I felt like a total failure. Me…a Christian pastor…needed…happy pills!

So my therapist wisely explained to me in understandable terms what was going on biologically in my brain, and how the medications would help. It had nothing to do with demons, not being good enough, or not being converted. I was able to understand that I was one of those people who had a vulnerability to depression. In my case, my therapist had realized that anti-depressant medication was not the first resort. But as he began to understand my situation, he realized medication could help.

When I started thinking about it, I realized I had probably been depressed several times in my life; I just didn’t know what it was. But this time was worse than anything I had ever experienced. I couldn’t get out of bed and I had constant shortness of breath. I was yawning and sighing all the time. I felt a tremendous pressure in my chest and experienced chest pains. My eyes felt like they were going to fall out of the back of my head. I didn’t want to be around anybody, and I had developed a temper, especially with my children. It felt like something had wrenched my soul from my body. It was horrible! So, I decided to take the medication, and what a difference it has made.

You have to be aware of something regarding these medications. People are different, and our body chemistries differ greatly. So, be patient! These medications take several weeks to show results, and they may have side effects. Those can eventually go away; they did for me. But if they don’t, there are other medications you can try. The key is to find one that works for you and realize it may not be the first one you try; so hang in there!

Antidepressant medications are not happy pills. They certainly were not for me. But they did lift the cloud so I could begin to talk about how I was thinking and feeling. Before taking the medication, talking about my thoughts or feelings would only add to my depression. The medications changed that. I still had to talk, and I stayed in counseling for more than a year. I learned that I had been taught some pretty unhealthy ways to think about people and situations. But, thanks to a great counselor, a loving and supportive family, anti-depressant medication, and most importantly, a loving and forgiving God, the cloud finally lifted.

What about personal spirituality?

In Matthew 11:28-30 Jesus said, “Come to me, all you who are weary and burdened, and I will give you rest. Take my yoke upon you and learn from me, for I am gentle and humble in heart, and you will find rest for your souls. For my yoke is easy and my burden is light.”

Jesus understands our dark feelings, our doubt, our discouragement, and yes, even our depression; and his desire is to help us. Sometimes, the help we need might include professional counseling and antidepressant medication. After all, God created the minds that created these medications, and it is not a sin to take them if you truly need them.

If you are depressed, there is help for you. It is okay to admit it, and it is okay to get help. Life will still have its ups and downs, but there are options for you if the “downs” last for a long, long time.

If those around us are telling us that something is wrong with us and they don’t know what to do for us, we need to listen with a humble heart.

Mark Mounts has a Masters in Professional Counseling from Liberty University and is a Licensed Professional Counselor in the Houston area. Mark did his pre-graduate internship at Texas Children’s Hospital in Houston and focused in the area of Early Childhood Intervention. Mark now has a part-time counseling practice at the Houston Center for Christian Counseling where he counsels children, teens, families, and individual adults. He is also a full-time pastor for Community Christian Fellowship (a congregation of Grace Communion International). Mark has been married to his wife Debra for 25 years and they have two teenagers, ages 14 and 15.


• Peter D. Kramer, Against Depression. London: Viking Penguin, 2005.

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). American Psychiatric Association, 2005.

Lithium and a Prayer: A Few Thoughts on Mental Illness, Medication, and Spirituality

Taken from Patheos  which is found   HERE.

Two weeks ago spiritually-minded people from across the country flocked to Hot Springs, NC for the 2015 Wild Goose Festival. The Wild Goose Festival is a progressive Christian festival celebrating art, justice, and spirituality.

One of the talks was given by Sarah Lund, author of “Blessed Are the Crazy,” and David Hosey, Associate Chaplain for the United Methodist Protestant Community at American University in Washington, DC. Their presentation,  entitled “Christ on the Psych Ward,” explored the intersection of mental illness with Christian spirituality.  This was one of the first times the topic of mental illness had been addressed at Wild Goose. In order to continue the extremely important conversation around mental health and perpetual journey towards mental, spiritual, and physical healing, I have ceded this month’s post to David — my friend and man I plan to marry in 42 days. In 2011, David was diagnosed with a form of bipolar disorder. To read more of David’s writing or find more resources on mental health, visit his blog:Foolish Hosey


After Sarah Lund and I gave our talk on mental illness at the Wild Goose Festival a few weeks back, there have been a few things that I’ve been pondering, mainly based on stories or questions that people shared with me after the talk.

One recurring question had to do with medication. Different people asked it in different ways, but it boiled down to something like this:

“I know that since I [or a loved one] have been diagnosed with a mental illness that taking prescribed medication is the healthy thing to do. I know it’s harmful to think that if I [or my loved one] just prayed harder or had more faith, that this would go away. So why does it still feel like prayer should make this better?”

I get where they’re coming from.

At a certain, important level, this is just a case of stigma doing it’s thing. Even if I don’t hold the personal, intellectual belief that positive thinking or prayer or ‘just having more faith’ would make mental illness go away, there’s enough of that kind of thinking floating around for me to internalize it on an emotional level. Folks who have decided that even if we pray for a sickness to be healed, we should probably see a doctor, too, find the idea that mental illness is somehow in a different category a bit stickier to overcome.


But on another level, I think this feeling that prayer or faith ought to be able to get us out of mental health crises is worth paying some attention to. Because mental illness — and, I think, illness in general — really does go after us at a spiritual level, even if there is a biological or chemical or psychological explanation for it.

Here’s what I mean. When I talk about spirituality, a term that can be rather nebulous, what I’m talking about is meaning-making. I’m talking about questions like, “Who am I? What am I doing here? What’s my purpose? What are my passions? What are my deepest held beliefs?”

It’s exactly all of that — purpose, meaning, identity, worth — that mental illness attacks.

While medication can defend against those attacks by restoring some equilibrium, helping us build our resilience, moderating our out-of-control moods — it can’t actually, by itself, do the hard work of healing the damage done to the “Who am I and what am I here for?” part of our lives.

What medication can do — and this is super-important — is give us a bit of the stability that we need to do some of that hard work. ‘Cuz it’s awfully hard to spend time in, say, vocational discernment mode when your brain is trying to kill you.

I’m reminded of a passage from Barbara Brown Taylor’s hauntingly beautiful Learning to Walk in the Dark. She speaks of her guides on a cave expedition in which she and her guides spend some time sitting in the sort of absolute darkness that can only exist deep below the earth’s surface:

When it is time to go, I follow Rockwell and Marrion back out of the cave again, thinking about what good guides they are. They kept me safe while letting me practice courage. They pointed me in the right direction without telling me what to see. Though they have been here many times before, they let me explore my own cave. Maybe that is the difference between pastoral counselors and spiritual directors. We go to counselors when we want help getting out of caves. We go to directors when we are ready to be led farther in.

To ‘pastoral counselors,’ we who grapple with mental illness or mental health crises could add therapists, psychiatrists, social workers — all the people who help us out of the cave when we feel like we’re running out of oxygen.

Ultimately, we’ll need to do the work of going into our darkness, of poking around in it. Whether that’s a matter of spiritual direction or some other practice of faith, it’s only by going in and through that we can discover our true selves and begin to work out what it is that we are called to be.

But in the meantime, the medication, the counseling, the treatment — that keeps us from drowning.

I hope this is helpful for folks who are wrestling with this question. We need all the help we can get, honestly.

Back in 2011, during my series of psychiatric hospitalizations, I wrote a song called ‘sufficient.’ One line that I scribbled down in a journal kept coming back to me until it found it’s way into music: “ain’t no pill that’ll fill this hole in your heart.”

That line is true. It takes a whole lot more than a lithium pill to start to feel human again.

Take the pill, anyway.

The quote is from Barbara Brown Taylor, Learning to Walk in the Dark (HarperOne, 2014), pg. 129. 

Antipsychotic Use Rising Among Teens And Young Adults

Taken from  Yahoo News  Which is found   HERE.

A growing number of teens and young adults are being prescribed antipsychotics, a new study suggests.

In particular, it appears they’re being used to treat attention deficit and hyperactivity disorder (ADHD) – a condition for which the powerful drugs are not approved.

The percentage of teens using antipsychotics rose from 1.10 percent in 2006 to 1.19 percent in 2010. Use among young adults ages 19 to 24 rose from 0.69 percent to 0.84 percent, the study found.

With roughly 74 million children under 18 in the U.S., these small percentages add up to large numbers of medicated kids.

“Great caution should be exercised in the use of antipsychotics, especially for young children,” said lead study author Dr. Mark Olfson, a research psychiatrist at Columbia University in New York.

Olfson and colleagues analyzed prescription data from 2006, 2008, and 2010 as well as records from 2009 combining pharmacy and medical claims information.

The records covered prescriptions filled at approximately 60 percent of all retail pharmacies in the U.S.

Overall in 2010, approximately 270,000 antipsychotic prescriptions were dispensed to younger children, 2.14 million to older children, 2.80 million to adolescents, and 1.83 million to young adults, the authors write.

Antipsychotic drugs include Abilify (aripiprazole), Risperdal (risperidone), Seroquel (quetiapine), Zyprexa (olanzapine) and others.

For younger children, antipsychotic use declined from 2006 to 2010, the researchers report in JAMA Psychiatry. Prescriptions fell from 0.14 percent to 0.11 percent for kids aged one to six, and from 0.85 percent to 0.80 percent for children aged seven to 12.

This is most likely due to increased efforts to curb antipsychotic use among younger kids over concerns about side effects such as weight gain, high cholesterol and uncertainty about the long-term effects of the drugs on the developing nervous system, Olfson said by email.

Among children 18 and under, the most common reason for antipsychotics was ADHD, the study found. This diagnosis accounted for about 53 percent of prescriptions for younger children, 60 percent for older kids, and 35 percent for teens.

“This is concerning because evidence of antipsychotics’ efficacy for treating a number of behavioral health disorders is lacking,” said Meredith Matone, a research scientist with PolicyLab at the Children’s Hospital of Philadelphia.

Antipsychotics are approved in the U.S. for treatment of psychotic conditions including bipolar disorder and schizophrenia, as well as for easing aggression among cognitively impaired youth, Matone, who wasn’t involved in the study, said by email.

“Increasingly, many youth are receiving these medications to treat behavior problems in the absence of a more severe psychiatric illness,” she said.

Part of this may be due to who is prescribing the drugs, according to an editorial by Dr. Christoph Correll, a psychiatry researcher at the Zucker Hillside Hospital in Glen Oaks, New York and the North Shore-Long Island Jewish Health System.

Out of roughly seven million antipsychotic prescriptions written for children, adolescents and teens in 2010, only 29 to 39 percent came from a child and adolescent psychiatrist, he noted in the editorial.

“I was most surprised by the fact that the majority of youth receiving antipsychotics did not have a mental disorder diagnosis,” Correll told Reuters Health by email.

The study also exposed a gender gap, with prescriptions for boys outpacing girls during elementary, high school and college years.

“The peak use among adolescent boys, who are frequently diagnosed with ADHD and are also treated with stimulants, strongly suggests that antipsychotics are commonly used to treat impulsive aggression and other behavioral symptoms,” Olfson said.

Before parents agree to start their child on antipsychotics to manage aggressive behavior, they should ask about alternative treatments such as anger management, counseling for parents on how to respond to aggression, and other psychosocial options, he said.

“The main takeaway for clinicians and families is that for youth without psychiatric symptoms, alternatives to antipsychotic treatment should be tried whenever possible,” Correll said. “When antipsychotics are used, the lowest risk agents should be used for the shortest time possible.”

Seeking Better Ways To Treat The Lows Of Bipolar Disorder

Taken from the Wall Street Journal  which is found  HERE.

Distinguishing between regular depression and bipolar disorder is one of the toughest calls psychiatrists face. The symptoms are often similar, but medications that ease depression can make bipolar patients worse by triggering manic episodes.

The dilemma is fueling new research efforts to understand how the two conditions differ and how to predict which patients will respond to which drugs. Scientists at the Mayo Clinic, which treats some 3,000 patients a year with bipolar disorder, are collecting DNA samples, blood tests, brain scans and clinical information in hopes of identifying genetic risk factors, or biomarkers, that can lead to earlier diagnoses and individualized treatments. Researchers at the University of Pittsburgh Medical Center and elsewhere are usingneuro-imaging studies to understand how depression differs in the brains of patients with and without bipolar disorder.

Depression in bipolar disorder can look very much like regular depression, known as unipolar depression. Patients might feel hopeless, sluggish, irritable and have thoughts of suicide. The manic side of bipolar disorder includes periods of frenzied energy; racing, irrational thoughts and sometimes dangerous behavior. These might not appear for years, or patients might not recognize the symptoms, leading to delayed diagnoses.

Even when patients are diagnosed with bipolar disorder, as many as 50% of them are treated with antidepressants, studies of medical practice patterns show.

“We don’t have a lot of treatment options for the depression phase of bipolar disorder, which is very troubling from a public-health standpoint,” says Mark Frye, chairman of psychiatry at the Mayo Clinic in Rochester, Minn. “That’s why clinicians still reach for those antidepressants.”

Fran O’Loughlin, 48, of Green Bay, Wis., says she has had bouts of depression since high school and was finally diagnosed with bipolar disorder about five years ago. She has been on more than a dozen medications that provided relief only temporarily, often making her feel manic and then crash even lower. One such episode last year left her hospitalized for seven days.

“My doctor and I have both been very aware and very cautious about introducing an antidepressant into the mix. I just can’t find happiness and we keep hoping the antidepressants will bring that to me,” Ms. O’Loughlin says.

The incidence of bipolar disorder—formerly known as manic depression—has risen steeply in the past 20 years to an estimated 4% of the U.S. population. That is due in part to rising awareness and a broadening definition. (Bipolar I involves at least one episode of mania lasting seven days or more; bipolar II is less severe, with significant depression but milder “hypomanic” episodes that don’t necessarily interfere with daily functioning.) Some experts say the sharply expanding use of antidepressants—up 400% since 1988, according to government surveys—may also have triggered some cases of bipolar disorder.

Scientists aren’t sure how antidepressants can bring on a manic episode, called mood-switching, in some bipolar patients. Thedisorder is believed to involve dysfunction in neurotransmitters, the chemical messengers in the brain. Many antidepressants target those same neurotransmitters, and may overcompensate, some experts suggest. Studies show mood-switching occurs in 10% to 25% of patients, more often in young people than adults.

Some studies suggest that antidepressants can increase the instability of those mood-regulating chemicals, creating more up-and-down cycles. “Essentially, they are the worst thing you can take for the illness,” says Nassir Ghaemi, head of the mood disorders clinic at Tufts University and co-director of a long running study of treatments for bipolar disorder funded by the National Institute of Mental Health.

Concerns that antidepressants might spark manic episodes were first raised in the 1960s with the use of tricyclic antidepressants. Newer depression medications such as bupropion (Wellbutrin) and selective serotonin re-uptake inhibitors, such as fluoxetine (Prozac) and sertraline (Zoloft), seem to pose less of a risk of mood shifting.

Mood stabilizers such as lithium are usually the first medications clinicians prescribe when bipolar disorder is diagnosed. Anticonvulsant drugs such as lamotrigine (Lamictal) or antipsychotic drugs such as olanzapine (Zyprexa), quetiapine (Seroquel) and lurasidone (Latuda) can also help slow racing thoughts. But most of those drugs have significant side effects and are only marginally effective at controlling depressive symptoms. So some psychiatrists say they cautiously add antidepressants as well.

“I’ve had patients with bipolar disorder who get well and stay well on a single mood stabilizer. But if the depression is not lifting, sometimes you try an antidepressant as well,” says Milena Smith, a psychiatrist in Annapolis, Md., who teaches at Johns Hopkins University School of Medicine. “Clearly some people with bipolar disorder do better with a combination of a mood stabilizer and an antidepressant, and we don’t know in advance who those will be,” she says.

Recommendations issued in 2013 by the nonprofit International Society for Bipolar Disorders say that for patients with a history of mania or hypomania, antidepressants should be prescribed only in conjunction with mood-stabilizing medications, and discontinued if patients show signs of mania or increased agitation.

But patients may not remember manic episodes. “Memories seem to be laid down differently during manic or hypomanic episodes,” says Dr. Smith. She says she often asks friends or family members if a patient she is evaluating has had periods of rapid energy or decreased need for sleep.

Mayo Clinic scientists earlier this year identified a gene variationthat may protect bipolar patients from developing manic symptoms while taking antidepressants such as Prozac. “Our hope is that further studies like that can help clinicians understand for which bipolar patients antidepressants might be helpful, not helpful or even harmful,” Dr. Frye says.

At the University of Pittsburgh Medical Center, psychiatrist Mary Phillips and colleagues have observed that the brain’s prefrontal cortex, which regulates thoughts and behavior, communicates differently with the amygdala, the center of emotions, in bipolar depression, unipolar depression or a healthy state. The patients’ brains “may look the same, but they are not functioning in the same way,” says Dr. Phillips, who is director of the Mood and Brain Lab at the UPMC Western Psychiatric Institute and Clinic.

In another study, they found patients with bipolar disorder had less blood flow to a region of the prefrontal cortex called the anterior cingulate gyrus—involved in decision-making, empathy, impulse control and emotion—than people with unipolar depression. Dr. Phillips and colleagues were able to identify, with about 80% accuracy, which patients had which form of depression by looking at their brain images. That raises the prospect brain scans could someday help with diagnosing.

Therese Borchard says her bipolar disorder involves far more depression than mania. “I love being manic, to a certain extent. You feel alive-but then you crash afterward,” says Ms. Borchard, who founded an online community called Project Beyond Blue for people with intractable depression. She has been on a shifting combination of mood stabilizers and antidepressants. “What’s difficult is finding the right amount so you are lifted from the depression but don’t have cycles of mania,” says Ms. Borchard, who also writes the “Sanity Break” column for

Ms. Borchard, 44, of Annapolis, Md., recommends some lifestyle steps to help keep people with bipolar disorder on an even keel. Among them: A vigorous aerobic workout for 45 minutes, at least three times a week, can keep runaway thoughts and emotions in check. And getting at least eight hours of sleep at regular time is critical, she finds. “Mania feeds on insomnia,” she says.

Dr. Smith also suggests patients track their moods regularly in a journal or software program to help discover what triggers emotional shifts. An app called Mood 24/7, developed at Johns Hopkins University, sends users a text every day asking them to rate their mood from 1 to 10 and then tracks it on a graph that patients and their therapists can evaluate.

Antidepressants & Self Harm

Taken from  the  Los Angeles Times   which can be found    HERE.

About a decade after the Food and Drug Administration first warned that antidepressant medications increase the risk of suicidal thoughts and behaviors in children, new research has found that kids and young adults starting on high doses of antidepressants are at especially high risk, especially in the first three months of treatment.

Among patients 24 and younger, those who started treatment for depression or anxiety with a higher-than-usual dose of selective serotonin reuptake inhibitor (SSRI) were more than twice as likely to harm themselves intentionally than those whose treatment began at the customary dose and increased slowly, the study found.

For every 150 such patients treated with high initial doses of SSRIs — antidepressants marketed under such commercial names as Zoloft, Paxil, Prozac, Celexa and Lexapro — the study suggests one additional suicide would be attempted. By contrast, young patients starting SSRI therapy at doses considered customary were at only slightly elevated risk of self-harm, about 12% above the level of their depressed peers not taking medication.

The latest research on depression treatment, conducted by epidemiologists at Harvard University and the University of North Carolina, was published Tuesday in JAMA Internal Medicine.

The researchers found no increased risk of suicidal behavior among adults older than 24 who started medical treatment for depression or anxiety at larger initial doses.

About 18% of young people diagnosed with depression were prescribed an initial antidepressant dose that was higher than that recommended by clinical guidelines: For the antidepressant fluoxetine (better known by its commercial name, Prozac), for instance, a standard dose would be 10 milligrams daily for the first week, increasing to 20 milligrams for the next three weeks, and only then considering any increased dose.

Given that antidepressants appear to be less effective in young people than in older patients, and that higher doses do not appear to bring more or faster relief, the author of an invited commentary in JAMA Internal Medicine suggested that prescribing physicians should abide by the well-worn maxim “start low, go slow,” and monitor patients closely during their first several months of treatment.

The study used medical records to track 162,625 U.S. residents, ages 10 to 64, who were diagnosed with depression and prescribed SSRI between 1998 and 2010. It found that more than half of antidepressants in that period were prescribed by primary care doctors, and about an additional quarter by practitioners not specialized in mental health. Even in children, fewer than 30% of antidepressant prescriptions were issued by psychiatrists.

The authors acknowledged that they could not discern why younger patients on high initial doses of antidepressant were more likely to try to harm themselves. Although it could have been the dose at which these young patients began their therapy, it is equally plausible that younger patients who are correctly perceived to be in a mental health crisis are more likely to be treated more aggressively, but not more likely to get better with SSRIs.

It might also be that those started on high-dose SSRIs are more likely to discontinue their therapy and to suffer from “discontinuation syndrome,” which can bring physical symptoms of anxiety and is sometimes linked to unpredictable behavior.

The Reinvention Of Rene Syler

Taken from  Hope to Cope  which can be found  HERE.

As co-anchor of The Early Show (as the CBS morning program was known for years), René Syler was at the top of the TV game. The first African-American woman to host a network news program, she spent her high-pressure workdays interviewing high-profile guests such as former President Bill Clinton and actor Will Smith.

Evenings found her contentedly heading out of New York City to the Westchester County home she shares with her husband, media executive Buff Parham, and their two children.

Then, in December 2006, Syler was let go from her job on The Early Show—just as she was about to undergo a preventive mastectomy. She was 43.

Syler had already weathered a couple of difficult years agonizing about her mammogram results, family health history, and the seemingly inevitable onset of breast cancer. Finding herself adrift professionally sent her into a tailspin.

“In retrospect, I had lived a pretty charmed life from my birth to age 42,” Syler says. “I had always been very driven, and had accomplished a lot.”

Having her first book published was a bright break in the dark clouds Good-Enough Mother: The Perfectly Imperfect Book of Parenting came out in 2007, a few months after her surgery—but as time went on good news seemed scarcer and scarcer.

After climbing to the pinnacle of success, she discovered that finding a new job in the ultra-competitive world of broadcast journalism was even harder in mid-life. Opportunity after opportunity fizzled out, until Syler felt her purgatory would never end. At one point, as an added indignity, all her hair fell out after a visit to the hairdresser to have it chemically relaxed.

In the face of repeated disappointments and rejection, depression took root in her mind and body.

“There were days when I’d drive the kids to school and then return home and go back to bed,” Syler says. “I kept waiting for someone to save me, but what I didn’t realize then, was that I had to save myself.”

In November 2008, a bout of asthmatic bronchitis landed Syler in the hospital. When her doctor asked how she was feeling, Syler answered in tears.

“I told my doctor how I couldn’t seem to see my way out of the depression, and how I had a hard time getting out of bed in the morning,” Syler says.

The doctor prescribed an antidepressant, which took the edge off her symptoms and gave her the respite she needed to reassess her views of herself and her future.

Perhaps most importantly for her mental health, Syler learned to embrace her own advice and cut herself some slack. The premise of Good-Enough Mother is that women need to let go of their unattainable ideals, figure out what works for their individual families, and practice self-care in order to care for others.

“I think there is value in the struggle that I went through,” Syler says. “I’m no longer interested in painting a rosy picture all of the time. I realize I’m allowed to have feelings.”

She had to redefine the meaning of success, both in terms of her career and her self-image.

“I try to do as much as I can in my life, but not to try to do everything perfectly,” she says. “I see so many women striving to be perfect, and then feeling depressed when they fall short. I think the most important thing we can do is to take a deep breath and focus on the things in life that really matter.”

For Syler, that includes her husband, her teenage children, and her beloved yellow Labrador retriever, Olivia. All of them served to motivate her when she was feeling down. Her dog needed walks, her children needed their mother. Wanting to be there for them forced Syler to get up each morning, and ultimately face her own challenges.

“I learned that even the strongest people get beat up and I made it my mantra to get through each day one step at a time,” Syler says. “Rather than trying to take on too much, I broke things down into manageable chunks.”

As it became more and more obvious that her path forward didn’t lie in traditional television, Syler looked to online options. In 2010, she rebuilt her book’s website, got serious about blogging, and converted a closet in her home to record videos to post.

She began to take a stand on current events and issues that affect parents. Before long, the site was attracting more than 50,000 visitors a month.

Syler says taking back control of her career was empowering. As part of re-establishing herself, she envisioned her life as a pond and realized that the more fishing poles she put into the pond, the better her chances of landing a fish.

“My first pole was carving out content for my website,” she says. “This was something that no one else could take away from me.”

And with each fish she landed, other nibbles followed. Because of a blog she wrote about theme parks, Syler was invited to be the keynote speaker at Walt Disney World’s annual Social Media Moms Conference in 2011. That led to a profile in an online magazine about her self-reinvention. That came to the notice of executives at the Live Well Network, a digital channel of the Disney-ABC Television Group, who approached Syler about hosting a new show. For Sweet Retreats, Syler travels the country to feature vacation destinations.

“I found you gain the most when you have nothing to lose, when there is nowhere to go but up,” Syler says. “It’s possible to rebuild after rocky times, but you must let your passion guide you, and surround yourself with others who support you. Most of all, understand no one will believe in you as much as you believe in yourself.”

What a difference seven years makes. In addition to Sweet Retreats, Syler is back in front of the cameras as a co-host of Exhale, a talk show on Magic Johnson’s new network. She is a popular motivational speaker, a tireless breast cancer advocate, and continues to grow her Good Enough Mother brand.

“I never thought I’d ever be in this place I am today since I never saw myself doing anything other than anchoring the news,” says Syler, who turns 51 on February 17. “I lost my job, I lost my breasts, I lost my hair, and I fought depression, but in losing all of those things, I also found myself.”

René Syler’s tips

Kick fear to the curb. Syler has learned to challenge the phantoms that hold her back. “I’m able to recognize irrational thoughts for what they are, to realize where they are coming from, and to change my internal dialogue and challenge my fears,” she says. “When I look back at old pictures of me, the overwhelming thing I see is fear—fear of losing my job, or making people angry. Today, I’m fearless.”

Don’t fall for “Pinterest parenting.”
That’s Syler’s term for online images that project a false ideal. “For a mom who is sitting at home in sweats, covered in her baby’s vomit, looking at photos of these supposedly perfect families, it can create feelings of inadequacy,” she contends. She suggests staying away from social media when you’re feeling blue and likely to compare yourself unfavorably to others.

Take the long view. Syler has grown more accepting of the fact that life sometimes gives you a pie in the face. “The difference is I now try and look at a bad day as a bad moment and move on,” she says, “rather than letting it weigh me down.”



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