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July 2003 Member Newsletter
click here to play ENYA-I Want Tomorrow Each month the newsletter will include latest news, interesting facts, upcoming events, medical information and ideas for "coping".
We are always looking for new ideas and topics for the monthly newsletter. If you have an idea or would be interested in writing an article, please let us know.
Novel Antipsychotics in Bipolar Disorder
Naveed Iqbal, MD, of Albert Einstein College of Medicine, Bronx, NY, contributed to the discussion by focusing on the use of novel antipsychotics in the treatment of bipolar disorder. Approximately 40% of patients who present with a major depressive episode may actually be experiencing a depressive episode in the context of bipolar disorder, and failure to properly diagnose bipolar patients has important clinical implications.[20] Research has shown that certain antidepressants may induce or exacerbate mania or rapid cycling in bipolar patients if an antidepressant is given without concurrent administration of a mood stabilizer.[21-23]
One feature that may help clinicians differentiate between individuals experiencing a major depressive episode in the context of bipolar disorder from those experiencing a major depressive episode in the context of major depressive disorder is that bipolar patients will display a decreased need for sleep but are not tired the next day. Once patients have been diagnosed with and treated for bipolar disorder, it is recommended that clinicians use a mood stabilizer to treat acute mania or depression and to prevent subsequent manic episodes.
Disadvantages of Conventional Antipsychotics in Bipolar Disorder
A number of patients present with psychotic symptoms in the context of a manic episode. Conventional antipsychotics have long been used to in the acute treatment of mania, but there is limited evidence that they are effective during the maintenance phase of treatment for bipolar disorder. Moreover, the long-term use of typical antipsychotics is complicated by the increased risk of, TD, EPS, cardiac problems, and neuroleptic malignant syndrome.[25]
Using Novel Antipsychotics in Bipolar Disorder
The efficacy and more benign side effect profile of the novel antipsychotics in schizophrenia have also been observed in patients with bipolar disorder, and they have been reviewed extensively by Ghaemi.[26] Thus far, currently available data suggest that many of the currently available novel antipsychotics are effective in the acute management of mania.
Clozapine appears to be useful in the treatment of bipolar disorder and other severe mood disorders.[27] However, as with its use in the treatment of schizophrenia, clozapine is not recommended as a first-line treatment for bipolar disorder because of the associated risks of agranulocytosis and seizures.
As monotherapy, risperidone 6 mg/day was as efficacious in the acute treatment of mania as haloperidol 10 mg/day and lithium 800-1200 mg/day for 1 month in a non-placebo-controlled study.[28] Two double-blind trials have also demonstrated that risperidone as an add-on to mood stabilizers was superior to a mood stabilizer plus placebo.[29] Adjunctive risperidone also appears helpful, particularly during maintenance therapy for bipolar disorder. A small study of patients treated with adjunctive risperidone following breakthrough symptoms while on maintenance mood stabilizing medication found improvement in several patients and no manic relapse in any patients.[30]
Data from several studies suggest that olanzapine is effective in the acute and longer-term treatment of mania. In recent double-blind, controlled trials, patients acutely treated with olanzapine as monotherapy demonstrated significantly greater reductions in mania than did patients treated with placebo.[31,32] A small, open study of olanzapine as an adjunct to mood-stabilizing medications also found significant improvements among patients following the addition of olanzapine in the acute stages of treatment.[33] Data from a recent double-blind study suggests that intramuscular olanzapine is similarly safe and effective in reducing acute agitation in patients with bipolar mania.[34] In this study, patients treated with olanzapine were significantly calmer 2 hours after the injection than were patients treated with lorazepam or placebo. With respect to long-term use, olanzapine appears to be effective and safe for bipolar disorder as an adjunct to mood stabilizers.[35,36]
Emerging data suggest that quetiapine is helpful as an add-on therapy for patients who do not respond fully to mood stabilizing medication. A small study of patients with bipolar disorder or schizoaffective disorder who demonstrated a suboptimal response to mood stabilizers found that quetiapine added in an open fashion was associated with significant reductions in mania and depression.[37]
The novel antipsychotics are not without their side effects, however. Weight gain is particularly salient among patients treated with olanzapine and may be compounded by mood-stabilizing agents, which are themselves associated with substantial weight gain (eg, divalproex). In a recent study published by Guille and colleagues,[38] bipolar patients treated with olanzapine demonstrated significantly greater weight gain (mean weight of 16.1 lbs) compared with those treated with risperidone (mean weight gain of 7.8 lbs).
Algorithm for Acute Treatment of Bipolar Disorder. Ghaemi has recommended that the treatment of acute mania should follow these steps[26]:
Begin with lithium or valproate as monotherapy.
If patients do not respond fully within 1 week, then novel antipsychotics such as risperidone, quetiapine, or olanzapine may be added. These agents have the advantage of stabilizing mania without worsening depressive symptoms. Clinicians may also consider adding clonazepam.
If patients still do not respond adequately within 4-6 weeks, clinicians may consider adding anticonvulsants such as valproate or carbamazapine to lithium, or lithium to valproate.
As a next step, clinicians may consider adding novel anticonvulsants such as lamotrigine, topiramate, or gabapentin.
If patients present with persistent depression, bupropion or paroxetine may be added but should be tapered after 1 month of euthymia.
Recently published recommendations for the treatment of bipolar disorder advocate for the use of lifelong pharmacologic maintenance treatment for the majority of patients suffering from this illness.[39] Although emerging findings support the efficacy of the novel antipsychotics in the acute treatment of mania and in the management of breakthrough symptoms while patients are sustained on mood stabilizing medication, more data are needed before the novel antipsychotics are recommended specifically for the prophylaxis of mania. Thus, current recommendations suggest that first-line acute and maintenance treatment for bipolar disorder should be accomplished with a mood stabilizer and that novel antipsychotics should be used adjunctively among patients who fail to achieve or maintain response with mood stabilizing medication.
Self Love Meditation
We begin by practicing this love meditation on ourselves ("I"). Until we are able to love and take care of ourselves we cannot be of much help to others. After that we can practice on others ("he/she," "they")-first on someone we like, then on a neutral person, then someone we love, and finally someone the mere thought of whom makes us suffer.
May I be peaceful, happy, and light in body and spirit.
May I be safe and free from injury.
May I be free from anger, afflictions, fear and anxiety.
When you have meditated on yourself and feel comfortable move to those people listed above, in that order.
Taken from Teachings on Love byThich Nhat Hanh
POSTED BY BUTTERFLYME:
Basic Human Rights
1. YOU HAVE A RIGHT ... to all the good times that you have longed for all these years and didn't get.
2. YOU HAVE A RIGHT ... to joy in this life, right here, right now - not just a momentary rush of euphoria but something more substantive.
3. YOU HAVE A RIGHT ... to relax and have fun in a non-alcoholic and in a non-destructive way.
4. YOU HAVE A RIGHT ... to actively pursue people, places, and situations that will help you in achieving a good life.
5. YOU HAVE A RIGHT ... to say no whenever you feel something is not safe or you are not ready.
6. YOU HAVE A RIGHT ... to not participate in either the active or passive "crazy-making" behaviors of parents, of siblings, and of others.
7. YOU HAVE A RIGHT ... to take calculated risks and to experiment with new strategies.
8. YOU HAVE A RIGHT ...to change your tune, your strategy, and your funny equations.
9. YOU HAVE A RIGHT ... to "mess up", to make mistakes, to "blow it", to disappoint yourself and to fall short of the mark.
10. YOU HAVE A RIGHT ... to leave the company of people who deliberately or inadvertently put you down, lay a guilt trip on you, manipulate or humiliate you, including an alcoholic parent, a non-alcoholic parent, or any other member of your family.
11. YOU HAVE A RIGHT... to put an end to conversations with people who make you feel put down and humiliated.
12. YOU HAVE A RIGHT ... to all of your feelings.
13. YOU HAVE A RIGHT ...to trust your feelings, your judgement, your hunches, your intuition.
14. YOU HAVE A RIGHT ...to develop yourself as a whole person emotionally, spiritually, mentally, physically and psychologically.
15. YOU HAVE A RIGHT ...to express all of your feelings in a nondestructive way and at a safe time and place.
16. YOU HAVE A RIGHT ... to as much time as you need to experiment with this new information and these new ideas and to initiate changes in your life.
17. YOU HAVE A RIGHT ...to a mentally healthy, sane way of existence, though it will deviate in part, or all, from your parents' prescribed philosophy of life.
18. YOU HAVE A RIGHT ...to carve out your place in this world.
19. YOU HAVE A RIGHT ... to follow any of the above rights, to live your life the way you want to, and not wait until your alcoholic parent gets well, gets happy, seeks help, or admits there is/was a problem.
The above is an excerpt of the wonderful book entitled Your Perfect Right of which I would recommend to all for a healthier way of living.credits:http://members.aol.com/leghausa FREEMIKEMy groupsCircle of FriendsCircle of The HeartFreemike web page
10 TIPS to ASKING for the HELP YOU NEED - written by Jim M. Allen **
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Everyone needs help from time to time, but not everyone knows how -- or feels comfortable -- asking for it. Here are ten tips to help you learn how to get the help you need:
1. Remember, if you don't make the request, it will NEVER happen.
Wayne Gretzky once said, "One hundred percent of the shots I don't make don't go in." Likewise, the unasked question is never answered.
2. Don't beat around the bush.
Just ask!
3. If it's an extraordinary request, say so.
BIG requests are often the best requests. Be 100% upfront and honest about what you want and what's involved.
4. If the request is work that YOU normally (or should) do, explain why you can't.
You don't need to provide tons of detail, but again, be honest with the person you're making the request of (and with yourself).
5. Don't assume you know what the answer will be.
Maybe they'll say "No." Of course, they might say "Yes."
6. Recognize that the person *can* say "No."
You may not like it, but it will happen from time to time.
Accept it and move on.
7. Make one request at a time.
Asking for help, assistance, changes, etc., is fine, but don't overwhelm a person with multiple requests all at once.
8. Make the request clear and distinct.
If there's an exact way it needs to be done, let the person
know. Give them all the information to make a good decision, but also so they can really do what you need them to do.
9. Trust the person to do the right thing.
If you've made your request clear and the person has said that they'll do it, expect they'll do it correctly. Don't follow them around and hound them about it.
10. Say "Thank you."
(Even if they turn you down.)
Good idea from KOKOROGRL
thread number 647.1
Today was hard...
I got in the bath and shaved for the first time in awhile(I'm usually an everyday shaver). I washed my hair and deep conditioned it. I soaked in the tub with lavendar for awhile and when I got out I meditated on the bathroom floor, just because....
I came down to my room and put lotion all over, I painted my toes and fingernails, while my hair was up in hot rollers. I also put on a full face of make up, can't remember when I did that last.
As I pulled out the rollers and saw all the beautiful curls bounce down onto my shoulders I realized how long my hair had gotten since I had been wearing it up in a ponytail or pigtails for the last six months or so.
I looked in the mirror really long............I mean really long. Tori Amos was blasting in the background as I pulled out some really nice clothes, not just my flannel pj's and my "wifebeater"
I looked again in the mirror, at this stranger, this totally beautiful stranger looking back at me. The stranger others see, the one with no problems at all.
I smiled, she smiled back at me, I said "Hi, Louise" she said the same.
I picked up my purse and went to the bookstore and walked around, then I went to the mall and made eyecontact with people and smiled, they smiled back. Then I went to my usual subway where they are sooooooooooooooooo used to the "regular me" They all stopped for just a moment when they saw me(remember I'm in here about 3x a week) I know they were thinking"is it really her?"
Then I came home. I caught a glimpse of myself in the mirror again as I was walking by getting ready to sit down at the table to eat. I stopped and said...
"I love you"
It wasn't about the way I looked, that had nothing to do with it. I can't explain what it was but it was something. Maybe the time and energy I finally gave myself.
Posted by MIMIKAY: (post number 675.1)
Another article I wrote for my group but wanted to share it here...
Letting go:
When I first started working with online support groups it almost overwhelmed me with the depression I had.. I just didn't know how to safely let it go so that I was not "taking on" everyones struggles yet was still able to reach out and help them through their times. ( and I am still learning how to let go to let others help me through my rough times, in many ways thats the hardest for me.. )
Anyways, I digress.. *S* ( Who me?)
For me to be able to keep on working with the group and being your Hostess here, I had to find a way to let go at the end of each day. A way I can let someone else carry the burdens so I can rest. So tonight, I want to share with you what has helped me. I know it will sound a bit crazy, or even silly.. Maybe others out there can add their thoughts and ideas as to what works for them in letting go. ( or maybe you are all scratching your heads wondering what in the world the rambling rose is talking about. LOL )
Here is what helps me...
As I get ready for bed each night I lie there and close my eyes. With my eyes closed I envision me walking along a sandy beach. On the beach are many boxes, each one labeled. The labels represent my burdens.. For instance today they may be labeled such as: Childs Health, Fear, Sadness, Bewilderment, Etc.. Moored on the beach is a boat. Theres a long ramp leading up to it and I start loading up the boxes. A man is there helping me, Jesus is his name. Others may chose to have a female, or someone they can associate their creator with.. Together we load the boxes onto the boat. Then turning around I notice others are there.. Theres Iris, who I am worried about, theres Fmily members there, family members there, world leaders there, etc.. Jesus is standing at the top of the ramp, and me at the bottom. I help each one up the ramp and release them into Jesus trust. Once everyone and all the boxes are loaded I untie the boat and it sails off into the sunset. Jesus in charge of all its merchandise. And I know that I can rest now, for they are no longer my burdens as I have given them away.
I am not sure if I have explained this in a way that it makes sense.. *S* I hope so. I am sure other imagery can be used as well.. This is just one that was taught to me about a year ago and has really helped me in letting things go.. ( when I remember to do it.. LOL )
ON FORGIVENESS:
Forgiveness
by dreamweaver, 5th November 2001.
When we think of forgivenes, we think of it in terms of forgiving others. I challenge you to consider, what does forgiving others do for you?
Is forgiveness as simple as some would have us think. I used to think not but now looking back I wonder.
It certainly is simpler than carrying the grudges, and allowing them to weigh us down.
It is certainly easier than that feeling of bitterness that encompasses us, and affects everything we do in our lives.
I dont think forgiveness is a one time thing, nor do I believe that it is strictly for the benefit of the transgressor.
To forgive is to free yourself even more so. Often the transgressor has no desire to be forgiven. In fact they often do not know that they have offended. And if you tried to explain the offense chances are they would not understand. We are all so different, each unique in our own way. We come from so many backgrounds etc. that what we may consider a major wrong, others will see as normal every day life.
So when we talk about forgiveness, lets talk about it in terms of us. Thats what truly matters after all. Even if we forgive today, and let it go. The chances are, at some other point in our life, something will come up to remind us. At those times it is important to stop and once again forgive. And in doing so I think you will find that it comes easier and easier, until one day you will realize it truly is forgiven for good.
If we dont, however, try to forgive in the first place, we are allowing those anger, bitter, resentful feelings to control our lives. We lose so much of who we are when we allow that to happen. I know, I speak from personal knowledge. When we do this, hold our grudges, keep our hurts bottled up within, we are proclaiming the transgressor as winner.
What a waste of a perfectly good day to spend it in the past. The saying, yesterday is history, tomorrow is a mystery today is a gift thats why its called the present really isnt as profound a saying as one would think..
It really is that easy. We cant change yesterday, so take the lessons we were meant to learn and get on with living today.
Should we stumble, should we fall, and once more become embraced by that past hurt, then it only means we are human, thats OK. Just remember at one point to pick yourself up, brush yourself off, and set your sites forward once more. Lord knows I have fallen more than my share of times. Its those falls that ultimately teach us how to live.
We all have a choice in how we will live, you know. We can chose to be bitter, to be angry to be consumed in despair.. Or we can chose to look for the blessings in our lives, to live in joy, to focus on the positive in our lives. Its there you know, all around you are positives. You just have to open your heart to see.
So many times in my life I lost site of these treasures. I have let anger control my life, bitterness, jealousy, and deep hurts that I thought would never heal.
I was wrong, so very wrong. That was no way to live at all. For the past week I have been deep in learning this lesson, in more ways than I can even begin to tell you. But today I am once more picking myself up, brushing myself off, and setting my sites forward. And ya know what, life does look so much better from this angle.. POSTED BY BUTTERFLYME:
12 Suggestions For Taking Care Of Yourself Thomas Wright, LMFT
1. Learn to air your feelings. Don't keep them bottled up inside you. Share your sorrows and disappointments with someone you trust. Remember, expressed feelings are changed feelings.
2. Avoid comparing yourself with others by admiring their gifts and ignoring your gifts. This kind of envy causes self-disgust. Put no one's head higher than your own.
3. Form a small group of people you can call on for emotional support. Agree to "be there" for each other. Offer advice only when it is asked for. Listen without interrupting. Take turns talking and listening.
4. Take time to play. Remember that play is any activity that you do just because it feels good. Remind yourself that you deserve to take time to play.
5. Don't forget to laugh, especially at yourself. Look for the humor in things around you. Let your hair down more often. Do something silly and totally unexpected from time to time.
6. Learn to relax. You can find books, tapes, programs, classes, instructors and other materials to teach you how to relax. Relaxation improves the mind, helps the body heal, and feels so much better than stress and tension.
7. Protect your right to be human. Don't let others put you on a pedestal. When people put you on a pedestal, they expect you to be perfect and feel angry when you let them down.
8. Learn to say no. As you become comfortable saying no to the unreasonable expectations, requests or demands of others you will discover that you have more compassion. When you do say yes to others, you will feel better about yourself and the people you're responding to.
9. Change jobs if you are miserable at work. First, try to figure out if the job is wrong for you or if certain people are causing you to feel miserable at work. Try paying more attention to the things you enjoy about your job and less attention to the things that annoy you. Remember that all jobs have some unpleasant aspects. (click)
10. Stretch your muscles. Break a sweat. Go for a walk. Ride a bike. Park farther from the door. Take the stairs. You don't need fancy clothes, club memberships or expensive equipment to add exercise to your daily life. 11. Practice being a positive, encouraging person. Each time you give others a word of encouragement you not only feel better, but you build up your best self.
12. Pay attention to your spiritual life. Slow down. Practice sitting quietly. Listen to your inner voice. Spend time thinking about the things which bring peace, beauty and serenity to your life. Find the courage to follow your own spiritual path if a traditional religion has not been helpful for you
Quick Relationship Profile: Verbal Abuse
Masking the Anger
by Dr. Irene
The following characteristics are common in verbally abusive relationships: In the beginning these relationships are wonderful - you think you finally met your dream person! But, the relationship deteriorates over time. The deterioration can occur over a few months or may take years.
This pattern is opposite from the progression in a "normal" relationship, where people start off slowly and grow to trust and love each other more over time.
Insecure or shy people are most vulnerable to abusive partners. Controlling people are often expert pursuers. They are very big on charm, compliments, gifts, etc. They make you feel as though you are the most special person in the world. During this stage, they really think you are the most special person in the world. They can't be with you enough, can't go out of their way for you enough...until you're hooked. Then the party starts.
There is a breach of boundaries on both sides. Neither the abusive controller nor the codependent victim has a clear sense of where one person begins and the other ends. Neither realizes they have this problem.
The relationship is an emotional roller roaster. There is little peace. Just when things seem to be going well, the angry person somehow manages to pick a fight.
The angry person usually doesn't take responsibility for creating the problem. Somehow, the partner is blamed, or is provoked to lose their temper
When the angry person is bad, they are very, very bad. When they are good, they are very, very good. (They have to be - to make up for all their mis-behavior!)
The angry person pursues when you have pulled back emotionally or are fed up with them.
The angry person does not allow their partner to be angry with them. If you are angry at them, they get even angrier with you.
Many angry people and codependent people are addiction prone. Many evidence problems with drugs or alcohol, sex addiction, gambling, shopping, food, workaholism, etc.
The angry person is emotionally needy and may feel neglected or jealous when their partner spends time with close friends or family members, their stepchildren, even their own children.
Many angry people get angrier if their partner gets sick. Who will take care of them now?
Emotional trust and comeradie are lacking. The angry person does not know how to trust and the victim has no basis to trust.
EFFECTS
OF LONG-TERM EMOTIONAL & VERBAL ABUSE
ON THE VICTIM
Isolation from others -
Low self-esteem -
Depression -
Emotional problems -
Illness -
Increased alcohol or drug use -
Withdrawal from real life or detach - escape...
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