Today, approximately 5.7 million U.S. adults in the U.S. have bipolar disorder, a serious mental illness. Also known as manic-depressive disorder, the illness is characterized by extreme mood swings.
Bipolar disorder typically develops during an individual’s late teen or early adult years, with half of all cases emerging before age 25.
Bipolar disorder is characterized as one of several types, depending upon the cluster of symptoms:
- Bipolar I— requires at least one full manic episode, with or without depressive episodes.
- Bipolar II – features cycles of depression and elevated moods (often referred to as hypomanic episodes) that do not reach the level of a full mania.
- Bipolar Disorder Not Otherwise Specified (BP-NOS) — does not fully meet criteria for Bipolar I or II or follow a fixed pattern.
- Cyclothymia – exhibits much milder symptoms of the disorder.
An estimated 10-20% of affected individuals also experience rapid cycling, characterized by at least four episodes in one year.
Manic symptoms include excessive excitement, restlessness, increased energy, racing thoughts, irritability, sleeplessness, and a tendency to engage in reckless and impulsive actions.
Depressive symptoms include sadness, crying episodes, weight loss or gain, feelings of hopelessness or helplessness, decreased energy, loss of interest in daily activities, and thoughts of death or suicide.
Sometimes psychotic symptoms may also be present, such as hallucinations or delusions; e.g., “I am the wealthiest person in the world.”
While the causes of bipolar disorder are not completely understood, several risk factors may influence its development.
An individual whose parent or sibling has the disorder is up to six times more likely to develop the illness. Researchers are seeking specific genes that play a causative role. MRIs have shown structural changes in the brains of affected individuals. Imbalances in neurotransmitters, important brain chemicals, may be another culprit, as well as hormone imbalances.
Trauma or extreme stress may influence the development of the disorder or trigger episodes.
Without treatment, bipolar disorder often worsens over time. Treatment is usually a combination of medication and psychotherapy.
Common medications used include:
- Mood stabilizers, including Lithium and various anticonvulsants.
- Atypical antipsychotics, such as Zyprexa or Abilify.
- Antidepressants, usually in combination with a mood stabilizer.
- Symbyax, FDA-approved specifically for bipolar disorder.
- Benzodiazepines, such as Klonopin or Ativan for anxiety and sleep disturbance.
Medication may be a lifetime commitment for a person with bipolar disorder.
Psychotherapy can help individuals learn to cope with the effects of the illness and avoid situations which might trigger episodes. Cognitive behavioral therapy (CBT) teaches individuals to change negative patterns of behavior and thought, while interpersonal and social rhythm therapy focuses on improvement of relationships and more stable daily routines. Psychoeducational approaches provide information to increase understanding and assist in recognition of warning signs.
Therapists also work with entire families or with groups of individuals with bipolar disorder. Family-focused therapy helps families with communication, symptom recognition, and more effective coping skills. Group therapy allows individuals to learn from others with the disorder, while practicing better interpersonal skills.
For individuals who have been resistant to other treatment methods, electroconvulsive therapy (ECT) has offered some benefit.
While there is no permanent cure for bipolar disorder, effective treatment can lead to better illness management and allow individuals to live normal lives.
Constant hand washing, repetitive touching of doorways, checking ten times to make sure the stove is turned off: these are all examples of behaviors we frequently associate with obsessive compulsive disorder, or OCD.
The nature of obsessive compulsive disorder
OCD is a type of anxiety disorder, characterized by unwanted, uncontrollable thoughts as well as repetitive or ritualized behaviors. While the thoughts and actions are irrational and unproductive, the affected individual is unable to resist the urge to express them.
An obsession is a frequent and uncontrollable impulse, thought, or mental image that an individual experiences. They are often quite disturbing or unpleasant, as well as distracting.
A compulsion is a behavior or ritual that an individual repeatedly completes as a way of trying to make an obsessive thought go away. Individuals with obsessive thoughts about being unclean may wash their hands until they are raw. However, compulsive behavior not only does not reduce an obsession; these frustrating and time-consuming acts usually increase anxiety.
Treatment of obsessive compulsive disorder
OCD is a mental disorder that responds successfully to treatment. The two most effective types of OCD treatment are cognitive-behavioral therapy and medication, often used in combination.
Cognitive-behavioral therapy, or CBT, is a type of psychotherapy that involves retraining one’s thought patterns so that compulsive behaviors no longer feel necessary.
Two CBT components are most effective in treatment of obsessive compulsive disorder:
- Exposure and response prevention, or ERP, is a treatment that involves repeated exposure to a source or common cue for an obsession, while the individual refrains from the associated compulsive behavior. Using the previous example of compulsive hand washing, an individual might be asked to repeatedly touch a public restroom’s door handle and then be prevented from hand washing. Gradually the individual learns that nothing catastrophic occurs when the behavior is not performed. The more an individual is exposed to an anxiety-provoking trigger without incident, the more the association weakens. ERP is a therapy based upon literally facing one’s fears.
- Cognitive therapy focuses on the obsessive thoughts themselves. Individuals with OCD often think of “worse-case” scenarios or experience an exaggerated sense of personal responsibility for things they cannot really control; e.g., a plane crash. Through “cognitive restructuring,” harmful thought patterns can be challenged and healthier, alternative ways of thinking can be developed. For example, the hand-washing individual may explore the underlying belief prompting this behavior, such as “I am unclean.” Once an unrealistic belief is discovered and challenged, the need to engage in the anxiety-reducing behavior may disappear over time.
Medication has also been found to be effective in obsessive compulsive disorder treatment for many individuals. Some psychiatric or psychotropic medications help control obsessions and compulsions. These include antidepressants that increase serotonin levels in the brain, which may be low in individuals with OCD. Medication, if indicated, is normally used in conjunction with psychotherapy.
Professional treatment for OCD is highly effective, with research findings of long-term recovery rates of up to 75% or more. With proper intervention, individuals struggling with the anxiety and frustration of obsessive compulsive disorder can resume productive lives.
Mason, OH – Steven F. Kendell, MD, has joined Lindner Center of HOPE as a staff psychiatrist.
Dr. Kendell is board certified in general psychiatry. As a staff psychiatrist at Lindner Center of HOPE his principal work is in adult partial hospitalization, adult inpatient care and outpatient services.
Prior to joining the Lindner Center of HOPE, Dr. Kendell served as Director of Research at Blue Horizon International Stem Cell Investigation and Treatment Program in New York, New York. Dr. Kendell’s other clinical positions have included serving as Attending Psychiatrist at Appalachian Behavioral Healthcare, Athens, Ohio; Attending Psychiatrist at Kettering Behavioral Medicine Center in Kettering, Ohio and Attending Psychiatrist at Butte County Department of Behavioral Health in Chico, California.
Dr. Kendell’s academic appointments have included Assistant Professor of Psychiatry at Ohio University College of Osteopathic Medicine in Athens, Ohio; Assistant Professor of Psychiatry at Boonshoft School of Medicine in Dayton, Ohio, and Assistant Professor of Psychiatry at Yale School of Medicine, New Haven, Connecticut.
Dr. Kendell has received a number of awards and honors and has been a member of several professional societies. He also has supervised medical students and has co-authored several original reports, book chapters and scientific abstracts.
Lindner Center of HOPE provides patient-centered, scientifically-advanced care for individuals suffering with mental illness. A state-of-the-science, free-standing mental health center and charter member of the National Network of Depression Centers, the Center provides psychiatric hospitalization for individuals age 12-years-old and older, outpatient services for all ages, research and voluntary, live-in services. The Center’s clinicians are ranked among the best providers locally, nationally and internationally. Lindner Center of HOPE is affiliated with the University of Cincinnati (UC) College of Medicine.
An estimated 8 – 15% of all women experience symptoms of depression during menopause. Unfortunately, problems are often misdiagnosed, because many of the symptoms of depression mimic those of normal menopause. Increased fatigue, appetite and sleep disturbance, difficulty concentrating, and increased irritability are symptoms of both clinical depression and peri-menopause (the 8-10 years prior to full menopause) or menopause.
Extended periods of sadness or melancholy, accompanied by feelings of hopelessness or helplessness, call for medical intervention, as clinical depression may be present. Untreated, depression can lead to a host of emotional and physical problems, and, in extreme cases, even suicide. Several recent studies point to an increased risk of depression in menopausal women, even those without any history of the disorder. One study, published in the Archives of General Psychiatry, found that women were four times more likely to develop depressive symptoms in peri-menopause than prior to its onset.
Causes of menopausal depression
The most frequent culprit in the development of women’s midlife depression is the significant drop in estrogen levels that accompanies the onset of menopause. Emotional changes associated with low estrogen levels include depression, anxiety, and increased irritability. With the loss of estrogen, other hormones and neurochemicals become imbalanced as well. In particular, those affecting stress and mood, such as cortisol and serotonin, may be disrupted. Low serotonin levels are frequently associated with the development of depression.
The stress caused by other menopausal symptoms can also contribute to feelings of depression. Insomnia, night sweats, mood swings – symptoms such as these can make the most emotionally balanced person feel out of kilter. An individual who is biologically more prone to depression may find such menopausal symptoms to be a trigger for a depressive episode.
Finally, age-related stressful life changes and events may coincide with menopause, such as the loss of fertility, “empty nest” syndrome, occupational changes, parental care giving, and marital strife. These stressors may contribute to feelings of depression.
Women more likely to suffer menopausal depression include those with a history of depression and those who experience a surgical menopause, due to the sudden loss of estrogen.
Menopausal depression treatment
Menopausal depression can be treated successfully, with significant symptom management. The most common form of treatment is hormone replacement therapy. Often used to manage menopausal symptoms such as hot flashes, estrogen therapy has also been found to reduce depressive symptoms. A study reported in the American Journal of Obstetrics and Gynecology found that 80% of menopausal women reported positive mood changes as the result of oral estrogen doses.
Antidepressants can also provide benefit to women with menopausal depression. Those which help the body raise its serotonin levels are particularly effective.
Psychotherapy has also been found to be an effective treatment method. Trained professionals can assist individuals in learning how to re-frame negative thoughts and reduce stress levels.
A focus on appropriate self-care is helpful for any woman facing menopause. Many symptoms can be managed through practicing such strategies as vigorous physical activity, stress management exercises, good sleep habits, and healthy eating.
Statistics can be somewhat ambiguous when it comes to eating disorders. Over the years, there have been countless studies conducted surrounding the prevalence of illnesses such as anorexia nervosa, bulimia nervosa and binge eating disorder. Although many of these studies convey slightly different findings, one thing is certain: Millions of Americans struggle with eating disorders.
While the majority of eating disorder sufferers are young women and adolescent girls, research has discovered that more and more males — an estimated 10 to 15 percent — are struggling with eating disorders as well. Additionally, incidents of these disorders in older women have been on a steady incline in recent years.
Why the Upward Trend?
New information is surfacing in regard to women in their 40s, 50s and 60s maintaining a negative body image, and as a result, continuing unhealthy eating patterns or developing eating disorders. Recent studies have found that over 60 percent of women 50 years of age and older are acutely concerned about their weight. Roughly 13 percent of these women suffer from some type of eating disorder.
Some older women keep their eating-related struggles hidden for years. Others, after having addressed an eating disorder earlier in life to at least some degree, relapse as they approach middle age. There are of course a variety of other factors that may contribute to the development of eating disorders in middle-aged women. These include a divorce or the loss of a mate where a woman feels she needs to lose weight to regain a level of attractiveness. It’s also not out of the question for a woman to develop an eating disorder for the first time later in life.
Never Too Late to Begin Treatment
Regardless of age or gender, anorexia treatment, bulimia treatment and treatment methods for other eating-related illnesses have evolved throughout the years. The percentage of successful outcomes continues to increase. Treatment for eating disorders usually consists of a combination of nutritional counseling, individual or group therapy, and in many cases, medications.
With the discovery of eating disorders in so many older women, mental health professionals are realizing that life-long care may be required even after a young woman has shown significant signs of recovery. However, those who get help for eating disorders early do have the best chance at long-term recovery.
This blog is written and published by Lindner Center of HOPE.
When the subject of disabilities surfaces in our thoughts or conversations, it is common to first consider those caused by some type of physical ailment or affliction. Conditions such as arthritis, heart disease and back problems are certainly primary causes of long-term disabilities in our nation. However, mental illness is the leading cause of disability in U.S. citizens ranging in ages from 15 to 44, according to National Institute of Mental Health (NIMH) statistics.
What these numbers show is that many Americans and people around the world are affected by illnesses such as depression, bipolar disorder, schizophrenia and a host of other mood and anxiety disorders in the prime of their working lives. Unfortunately, these numbers show no sign of subsiding anytime soon. In fact, they continue to rise, as do the number of filings with the U.S. Social Security Administration (SSA) for disability benefits due to mental illnesses.
The SSA and Mental Illness Claims
The SSA has established specific criteria that qualify those suffering with mental disorders for disability benefits. Basically, it must be determined that an existing mental condition limits or impairs one’s ability to fulfill their work obligations. In most situations, assessments and evaluations must be performed by mental health professionals. Additionally, evidence must be submitted to the SSA that indicates the individual in question is unable to perform their assigned job duties as a consequence of their condition.
Getting Back on their Feet
It is important for those with mental health issues to make their employers aware of their situation. All too often, workers are hesitant or afraid to address their condition with their employers for fear of negative repercussions. But behavioral or productivity problems could lead to termination, which also often results in the loss of insurance, creating even more problems for these individuals in regard to receiving treatment.
When documented mental health issues are reported to an employer, they are obligated under Americans with Disabilities Act (ADA) regulations to accommodate that employee with whatever they need to successfully perform their job duties, or to make their working situation as comfortable as possible. In lieu of applying for disability benefits, this can allow an employee to continue to work while receiving mental health treatment and take measures that will eventually enable them to effectively manage their condition.
This blog is written and published by Lindner Center of HOPE.
Anxiety affects many people, and sometimes it may seem impossible to stop worrying about things you cannot control. These questions and fears can be paralyzing and sometimes might affect your daily life. However, there is a way to push these fears aside and get on with your normal routine.
Start by letting yourself worry, but only for a certain amount of time. Set a time each day to go over these worries, for example 20 minutes each day at noon. It should be a time of day far from bedtime, but during this period you’re allowed to worry about whatever is on your mind.
Outside of this time however, no worrying allowed. If a worry comes up during the day, write it down and save it for your worry period.
During your worry period, ask yourself if this problem can actually be solved. If so, start thinking of ways you can solve the problem and find a solution. If it’s not a problem that can be solved, you must find a way to accept that, so you don’t continue to worry about it.
Another good way to combat anxiety is to be aware of how others make you feel. The way other people act around us can be contagious, so pay attention to they way other people affect you. Keeping a journal is a good way to take note of this behavior so you can avoid these people in the future.
When you start to notice certain people making you feel anxious, make an effort not to be around those people. Perhaps a certain conversational topic makes you feel anxious, so make note of it, and avoid that topic from now on.
By following these simple tips, you will be able to control and combat your anxious feelings from now on.
This blog is written and published by Lindner Center of HOPE.