Friday, September 29, 2006

TO WRITE: Sounds and sights that heal
The poet Jane Kenyon had bipolar disorder and wrote about it beautifully and evocatively. (She died in 1995 of leukemia.) Her book Otherwise: New and Selected Poems is a favorite of mine.
In part six of her poem Having It Out with Melancholy, she wrote:

In and Out

The dog searches until he finds me
upstairs, lies down with a clatter
of elbows, puts his head on my foot.

Sometimes the sound of his breathing
saves my life -- in and out, in
and out; a pause, a long sigh....

Good poets create vivid, memorable images in the reader's mind. But these "images" need not be visual. I love the auditory details of this poem -- can't you just hear the clatter and the breaths?

Play with this...
Think of a sound you love or that soothes you, and write about it in either a poem or in regular prose form. Describe it so that a reader can "hear" it, and detail how it makes you feel.

Monday, September 25, 2006

TO READ: An Antidepressant That Works in Hours
Research at the National Institute of Mental Health recently revealed that a single intravenous dose of a medication known as ketamine relieved depressive symptoms in as little as two hours in some people with treatment-resistant depression. Most antidepressants require four to eight weeks or more to be fully effective.

Ketamine, used in higher doses as an anesthetic in humans and animals, is only being used experimentally, in hopes that it will help scientists develop other new, faster-acting medications. The drug probably won't become widely used clinically because of potential side effects, including hallucinations and euphoria, at higher doses. Ketamine is thought to act quickly because it exerts its effect late in the series of biochemical actions that regulate mood, whereas current antidepressants target earlier steps in the series.

In the study, 71% of the treatment-resistant patients (who had tried an average of six medications without relief) felt improvement within one day of the treatment, and 29% of these people became nearly symptom-free during that first day. Thirty-five percent of those receiving ketamine still felt improvement a week later. None of the patients in the study had serious side effects.

TO WRITE: What are you willing to risk?
In her book on depression You Are Not Alone, Julia Thorne writes:

"Getting better means taking risks. The first risks I took were physical, like starting ballet classes at age 37. Then, I took emotional ones. I began expressing my thoughts. I joined a support group. I made new friends. If there is something good for you that feels emotionally risky, try writing it down. Sometimes seeing it in print gives you courage."

Play with this...
Take five minutes to make a list of things you could do for yourself that feel "risky." Then choose one and write continuously for 15 minutes. Imagine clearly how you could do that thing and describe in detail how it would feel. The next day, reread what you've written and see if you've gained any courage.

Monday, September 18, 2006

TO READ: Publishing your writing
There are many ways in which writing can enrich the life of a person living with a mood disorder. Releasing one's work "into the universe" to be read by family, friends, peers and everyone else is one. But where to get started?

Today I'd like to plug a wonderful organization, The Awakenings Project, which operates out of Chicago. A link to its site is at the right. The Awakenings Project encourages, promotes and disseminates many forms of art created by people with mental illness -- visual art, theatre, music and literature among them. Its journal, Awakenings Review, is a great place for writers coping with depression or bipolar disorder to consider submitting poetry, fiction or essays -- about mental health issues or other topics. Published (usually) twice a year, the Review is attractive and well-produced, and includes black-and-white photography and drawings (you can submit these too).

The submission deadline for the next issue is December 31, so you have some time to put together your best work. To read the submission guidelines, link to their site and click on "literature." You can also order back issues there. I've published poetry in this journal, and I recommend it if you're interested in taking that next step with your writing.

Friday, September 15, 2006

TO WRITE: Recovering from emotional trauma
Published authors and my own students report a variety of helpful effects from writing about their mental health and other life situations. But did you know that there is also scientific evidence that writing can help your health?

For example, after writing for 20 minutes a day, four days in a row, about a life trauma, people tend to go to the doctor much less often than usual -- they feel healthier and, after a brief period of sadness, they usually feel happier and report having more insight. When patients with asthma or rheumatoid arthritis do this four-day exercise, they experience decreased symptoms, and the effects can be seen even four months later. This kind of "expressive writing" can lower blood pressure and heart rate, and can even lead to cellular changes that boost the immune system. And, while it hasn't been studied on depressed people per se, it has led to "decreased depressive symptoms" among a more general population. These results are amazing!

Now investigated around the world, expressive writing has been studied in cancer patients, Holocaust survivors, AIDS patients and more. Professor James Pennebaker of the University of Texas at Austin has led this field of research, and you can find a link to his website at the right of this column. It includes loads of information -- and several fun self-tests.

Play with this...
Try the four-day experiment yourself. Write continuously about a traumatic event, particularly one you've kept secret. You can write about the same one each day, or vary the topics. Make a note of how you feel before and after each 20 minute writing session, and see what results you find. Then let me know!

Wednesday, September 13, 2006

TO READ: Comparing bipolar disease to arteriosclerosis and diabetes
I recently attended the California conference of NAMI -- the National Alliance on Mental Illness -- the nation's largest mental health advocacy program. Between scientific sessions, legislative ones and peer support discussions, there were plenty of tables filled with brochures, information, advertising... and, of course, give-aways, including pens and post-it pads advertising your favorite psych drug.

One of the most interesting things I picked up was an information sheet put out by the California Psychiatric Association: Comparison of Three Chronic Diseases with a Clear Combination of Biology and Behavior. In three columns it contrasted bipolar disorder (a brain/central nervous system disease), arteriosclerosis (heart/circulatory system) and diabetes (pancreas/digestive system). I won't summarize all the results here, but several were especially interesting to me. "Yes," there is a clear genetic predisposition to all three. There are typical medications for all three, and all three also require behavioral changes, such as accepting the disorder and developing insight into it, exercise, compliance with medications, and appropriate therapy, such as psychotherapy or diet.

One of the most exciting part of the comparison for me was the medical treatment effectiveness: 85-90% for bipolar, 43% for arteriosclerosis, variable for diabetes. I hadn't realized that bipolar disorder was considered this treatable. Now, the details of just how stable or symptom-free one had to be for any of these illnesses was not spelled out. However, I found it encouraging.

Still, the most important point, I think, is that it is gradually becoming more obvious to more people that mental illnesses are real illnesses -- biologically based brain disorders -- and should be treated as such. This allows no room for stigma. Few physicians, lay people, insurance companies or patients themselves would discriminate against a person with heart disease or diabetes. Mental illnesses must be treated with equal levels of concern and compassion.

Friday, September 08, 2006

TO WRITE: A story from your illness
Today I'm going to ask you to write a story. It's a story you already know well. It's the story of an episode of your depression (or mania or psychosis, if those apply to you). I'm not suggesting you write your life history here, just a single period during which you had symptoms.

Research has found that writing about difficult times in story form -- that is, with a beginning, a middle and an ending -- is one technique that can be especially helpful emotionally. First, recall how this particular episode began. Then, describe in detail how it felt. Finally, explain how it resolved, whether that was in an hour or a year. Did your symptoms lessen on their own? Did you get medical help? Social or spiritual help?

Write continuously for 20 minutes to create this short story. Research has also found that sometimes people feel sad for a short while after writing about a trauma, but that this tends to pass quickly and greater happiness and satisfaction results. However, if you feel extremely upset during or after writing, make sure you get appropriate help. (And remember the "flip out" rule described earlier -- if you think a topic is just too disturbing, write on some other topic instead.) Let me know what you discover!

Tuesday, September 05, 2006

TO READ: Transcranial magnetic stimulation -- a new option
I've been feeling pretty down lately. You know... lousy mood, feelings of dread, hard to start anything, weird thoughts flitting around. We all know our own brand of misery when our symptoms really kick in. It's discouraging when all those pills I swallow every day aren't doing their job, but I'm fortunate I've got a secret ally these days too.

For the last year and a half or so, transcranial magnetic stimulation (TMS or rTMS for "repetitive" TMS) has worked wonders for me when depression descends. Every three or four months, my neurochemistry changes and, no matter how well my life is going, I get depressed. But these days, a five-minute-a-day treatment for four weeks, which applies a strong, pulsing magnet to the right side of my skull, breaks up the dysfunctional feelings and thoughts. For me, it's as effective as ECT, but easier -- no anesthesia, no grogginess, no driving restrictions or memory loss.

TMS is still in its investigational stage, not yet FDA approved, so it's only available to certain patients at certain research sites. I'm lucky enough to have gotten in on the ground floor at Stanford (since I'm such a good customer). The treatment is done in an office. After carefully measuring the way my thumb twitches when my head is magnetically stimulated at different sites, the proper treatment location can be mapped on my skull. The doctor holds against the side of my head a plastic "wand" device which is connected to a computer and a machine that generates a precise magnetic field. The wand clicks as it sends 60 one-second magnetic pulses to a specific area of my brain, stimulating activity in that region. After three minutes' rest, we do another 60 seconds, and I can go home. Sometimes I have a moderate, but short-lived headache.

I get plenty of driving in going to Stanford five days a week for four weeks, but it's definitely worth it to me. After two weeks, I'm usually improving; after four I'm nearly back to baseline. I'm told TMS seems to help about half of those who try it for either unipolar depression or bipolar depression. Like so much in psychiatric treatments, the detailed mechanism of action isn't known. But I'm very grateful it works for me. Hopefully it will be more widely available soon and everyone will have one more treatment option to consider.

Friday, September 01, 2006

TO WRITE: What little things help?
If someone recently diagnosed with depression were to ask you what helps you cope, what would you say? Chances are you'd mention medicines, therapy, maybe ECT. But what other "little" things help you on those tough days too?

For me, talking with friends (especially those who personally know depression) over coffee often helps. Also on my list are browsing bookstores, looking at magazines, petting my cat Onyx, chocolate (in moderation!), exercise -- even a little bit such as a walk -- and, of course, sitting down and writing.

Play with this...
Make a list of things that ease your depression. Then choose one or two and describe them in detail. What do you do? How does it really feel? Why do you think it helps? Write continuously for 15 minutes. Perhaps you'll develop new appreciation of these activities or find new ideas.