Book Review: Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry

The front cover of Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry (affiliate link*), by Lynn Nanos, featuring a police car shining its headlights on a sleeping homeless person wearing a green hoodie. Credit: Lynn Nanos.

*Disclosure: Some of the links below are affiliate links, meaning, at no additional cost to you, I will earn a commission if you click through and make a purchase. Thanks for supporting the work at The Bipolar Parent!

America’s mental health system is broken. It has failed millions of people suffering from mental illness and will continue to do so unless sweeping changes are made. That’s the premise of Lynn Nanos’ Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry (affiliate link*).

I was offered a copy by the author in exchange for an honest review, which after reading the book, I am thrilled to provide. Nanos is a clinician in the field of emergency psychiatry in Massachusetts with over twenty years of experience in the field. She is uniquely qualified to write this book, having spent much of her life caring for the sickest of the sick.

According to Nanos, there are three core problems in the broken psychiatric system: a lack of inpatient beds due to deinstitutionalization; malingerers, who falsify claims of mental illness to request inpatient treatment; and that patients are “dying with their rights on.” The latter means that a prioritization of patients’ rights causes people suffering from psychosis who refuse treatment due to a lack of insight into their mental illness to be discharged from hospitals too early. These patients are often homeless and vulnerable to being attacked on the streets. Nanos’ solution to these problems is to promote a program called Assisted Outpatient Treatment (AOT), a court-ordered program which forces patients suffering from psychosis to comply with treatment when living in the community.

Nanos describes a condition called ansognosia, where patients have a lack of insight into their mental illness. This book has special significance for me because I have bipolar and have endured psychosis, like the patients in the many case studies Nanos covers in Breakdown. When I suffered a psychotic break, I had no insight into my mental illness, like many of the patients suffering psychosis that Nanos describes. I was fortunate in that, as I complied with treatment, I gained such insight and was able to take steps towards recovery before I left the hospital. Like Nanos points out, this is not the case with the majority of others.

What Doesn’t Work Well in Breakdown

Because I don’t want to end on a negative note, I’ll start with one item that didn’t work well for me in Breakdown.

• Disclaimers: The opening chapter is full of disclaimers about what the book does and does not cover. These disclaimers are vital to understanding how the rest of the book works, but they make for dry reading, especially for a first chapter. However, I don’t know how else Nanos would have structured this. These disclaimers are necessary, and they need to be placed upfront.

That’s it. That’s all I didn’t like. If a reader can get past the tedious first chapter, the meat of Breakdown is brilliant.

What Does Work Well in Breakdown

As promised, here’s what does work well in Breakdown:

• Fulfilled Promise: In the opening chapter, Nanos promises a solution to the issues she raises later on, and she delivers on this promise. The writing is accurate and engaging, with case studies of patients offering an emotional look into people who suffer psychosis and their mental illnesses. The book is a blend of clinical information and painfully personal writing, which is another part of what Nanos promises and delivers.
  Research-Backed Opinions: Nanos’ commitment to scientific research is admirable. She cites approximately 300 studies, and the last chapters of Breakdown are especially filled with mental health statistics, which back up her claims.
  Professional Formatting: Despite being self-published, Breakdown is professionally formatted. The cover, featuring a presumably homeless man being confronted by police while lying on a sidewalk, is well-drawn and fabulous. Not that I’m saying to judge a book by its cover, but Breakdown is visually pleasing inside and out.
  Case Studies: The most arresting parts of Breakdown are the case studies. Nanos demonstrates why psychotic patients need treatment through the examination of her encounters with them in a clinical setting. Some examples are: a woman who traveled from Maine to Massachusetts because a spirit called “Crystal” ordered her to, a man who smeared dead insects on his neighbors’ doors to help purify toxins in their apartments, and Lily, a woman who delivered dead dogs to strangers, among other stories. Most of these people refused adequate treatment due to ansognosia. A great number of them bolted before Nanos was able to arrange for transportation to hospitals. Some of them were violent, and a few went on to assault their loved ones, with two specific cases ending in death. The case studies are the most effective parts of Breakdown, and demonstrate why the AOT program is so important.

Final Thoughts

Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry (affiliate link*) is a fascinating book. It’s professionally written and formatted, research based, and effectively delivers its message. The case studies were especially enlightening, and are the heart of Breakdown.

Mental health issues affect all of us, whether we suffer from mental illness, have loved ones who do, or are impacted by the mentally ill people all around us. Read this book and see how you, too, can join the mental health discussion.

*Disclosure: Some of the links above are affiliate links, meaning, at no additional cost to you, I will earn a commission if you click through and make a purchase.

Related:

• Book Review: Dyane Harwood’s Birth of a New Brain
• “How do You Define Mentally Ill?”
• How to Talk to Someone Experiencing A Bipolar Mood Episode
• America Has Highest Rate of Bipolar Disorder Diagnoses in 11-Nation Study

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How Specific Gene Variants May Raise Bipolar Disorder Risk

In this data visualization, each horizontal line is an individual. Those with bipolar disorder were more likely to be on the lower end of the CPG2 protein expression scale, and more likely to have gene variants that reduced expression. Credit: Rathje, Nedivi, et. al.

A new study by researchers at The Picower Institute for Learning and Memory at MIT finds that the protein CPG2 is significantly less abundant in the brains of people with bipolar disorder (BD) and shows how specific mutations in the SYNE1 gene that encodes the protein undermine its expression and its function in neurons.

Led by Elly Nedivi, professor in MIT’s departments of Biology and Brain and Cognitive Sciences, and former postdoc Mette Rathje, the study goes beyond merely reporting associations between genetic variations and psychiatric disease. Instead, the team’s analysis and experiments show how a set of genetic differences in patients with bipolar disorder can lead to specific physiological dysfunction for neural circuit connections, or synapses, in the brain.
The mechanistic detail and specificity of the findings provide new and potentially important information for developing novel treatment strategies and for improving diagnostics, Nedivi said.

“It’s a rare situation where people have been able to link mutations genetically associated with increased risk of a mental health disorder to the underlying cellular dysfunction,” said Nedivi, senior author of the study online in Molecular Psychiatry. “For bipolar disorder this might be the one and only.”

The researchers are not suggesting that the CPG2-related variations in SYNE1 are “the cause” of bipolar disorder, but rather that they likely contribute significantly to susceptibility to the disease. Notably, they found that sometimes combinations of the variants, rather than single genetic differences, were required for significant dysfunction to become apparent in laboratory models.

“Our data fit a genetic architecture of BD, likely involving clusters of both regulatory and protein-coding variants, whose combined contribution to phenotype is an important piece of a puzzle containing other risk and protective factors influencing BD susceptibility,” the authors wrote.

CPG2 in the Bipolar Brain

During years of fundamental studies of synapses, Nedivi discovered CPG2, a protein expressed in response to neural activity, that helps regulate the number of receptors for the neurotransmitter glutamate at excitatory synapses. Regulation of glutamate receptor numbers is a key mechanism for modulating the strength of connections in brain circuits. When genetic studies identified SYNE1 as a risk gene specific to bipolar disorder, Nedivi’s team recognized the opportunity to shed light into the cellular mechanisms of this devastating neuropsychiatric disorder typified by recurring episodes of mania and depression.

For the new study, Rathje led the charge to investigate how CPG2 may be different in people with the disease. To do that, she collected samples of postmortem brain tissue from six brain banks. The samples included tissue from people who had been diagnosed with bipolar disorder, people who had neuropsychiatric disorders with comorbid symptoms such as depression or schizophrenia, and people who did not have any of those illnesses. Only in samples from people with bipolar disorder was CPG2 significantly lower. Other key synaptic proteins were not uniquely lower in bipolar patients.

“Our findings show a specific correlation between low CPG2 levels and incidence of BD that is not shared with schizophrenia or major depression patients,” the authors wrote.

From there they used deep-sequencing techniques on the same brain samples to look for genetic variations in the SYNE1 regions of BD patients with reduced CPG2 levels. They specifically looked at ones located in regions of the gene that could regulate expression of CPG2 and therefore its abundance.
Meanwhile, they also combed through genomic databases to identify genetic variants in regions of the gene that code CPG2. Those mutations could adversely affect how the protein is built and functions.

Examining Effects

The researchers then conducted a series of experiments to test the physiological consequences of both the regulatory and protein coding variants found in BD patients.

To test effects of non-coding variants on CPG2 expression, they cloned the CPG2 promoter regions from the human SYNE1 gene and attached them to a ‘reporter’ that would measure how effective they were in directing protein expression in cultured neurons. They then compared these to the same regions cloned from BD patients that contained specific variants individually or in combination. Some did not affect the neurons’ ability to express CPG2 but some did profoundly. In two cases, pairs of variants (but neither of them individually), also reduced CPG2 expression.

Previously Nedivi’s lab showed that human CPG2 can be used to replace rat CPG2 in culture neurons, and that it works the same way to regulate glutamate receptor levels. Using this assay they tested which of the coding variants might cause problems with CPG2’s cellular function. They found specific culprits that either reduced the ability of CPG2 to locate in the “spines” that house excitatory synapses or that decreased the proper cycling of glutamate receptors within synapses.

The findings show how genetic variations associated with BD disrupt the levels and function of a protein crucial to synaptic activity and therefore the health of neural connections. It remains to be shown how these cellular deficits manifest as biopolar disorder.

Nedivi’s lab plans further studies including assessing behavioral implications of difference-making variants in lab animals. Another is to take a deeper look at how variants affect glutamate receptor cycling and whether there are ways to fix it. Finally, she said, she wants to continue investigating human samples to gain a more comprehensive view of how specific combinations of CPG2-affecting variants relate to disease risk and manifestation.

Materials provided by Picower Institute at MIT.

Related:

• Gene Breakthrough on Lithium Treatment for Bipolar Disorder
• Scientists Conclude After 12-year Study That Bipolar Disorder Has Seven Causes
• Bipolar Genes Linked to Autism

How to Spot Depression in Children, Even Preschoolers

Trigger Warning: Brief discussion of suicidal ideation.

Preschool depression is often overlooked, because the symptoms are difficult to spot or may be explained away by hopeful parents and teachers. Depression in adults is widely known, but can preschoolers suffer clinical depression? Science says they can.

Scientists began studying depression in preschoolers 20 years ago, and the research continues today. According to the conclusion of a new study led by Dr. Joan Luby of the Washington University School of Medicine in St. Louis, preschoolers suffer depression. Luby’s team examined 306 children ranging from 3 to 6 years old. This study demonstrated that 23% of the 3-year-olds endured depressive symptoms every day for two consecutive weeks. As the age of the child increased, the rate of major depressive disorder diagnoses also increased. The 4-year-olds suffered depressive symptoms at a rate of 36%, while the 5-year-olds showed a rate of 41%. The children who had suffered extremely stressful or traumatic events in their lives also had a higher incidence of depression than the controls.

Preschoolers generally can’t describe their emotional states. They’re still learning what emotions are and they lack the ability to vocalize them. This is the difficulty in diagnosing depression in preschoolers, and why you may need help spotting it. In order to allow the study participants to express how they perceive themselves and get a sense of what young children were feeling, Dr. Luby’s team asked a series of questions using puppets. How the children responded gave the researchers a clue about how the kids were feeling.

Further complicating the picture is the prevalence of other conditions along with depression, like Attention Deficit Hyperactivity Disorder (ADHD). In Dr. Luby’s study, about 40% of the study participants also dealt with ADHD, which tends to drown out symptoms of depression, because the symptoms are similar. This can even persist later in life. Children who suffer depression are more than four times as likely to suffer an anxiety disorder later in life than kids who don’t suffer depressive symptoms.

A preschool-aged boy in blue hoodie sprawling on a parent’s lap. Credit to flickr.com user Quinn Dombrowski. Used with permission under a Creative Commons license.

But what does depression look like in a 3-to-6-year-old?How can you, as a parent, spot it? Well, depression in children looks a lot like depression in adults. For example, anhedonia, the inability to experience pleasure from normally enjoyable activities, can show up in adults as a lack of enjoyment in things like golfing or writing. Preschoolers with anhedonia find little to no joy in their toys. Both adults and children with depression are restless and irritable. Depressed kids whine a lot, and don’t want to play.

When they do play, children may decide that their stuffed animals decided to “die” today and decide to bury them. Anytime you see a preschooler demonstrate methods of suicide or death with a stuffed animal without mimicking an episode of your life, such as a death in the family, your antennae need to come up. That could indicate suicidal thoughts.

But the most common symptom of depression in children is deep sadness. Not someone who’s sad for a day, but all the time, no matter who he or see is with or what he or she is doing. Sadness in the face of goals that have been thwarted is normal. But depressed children have difficulties resolving the sadness to the point where the misery affects their ability to function regularly. If your child appears to be sad to the point of inability to enjoy anything or regulate their other emotions, then get a recommendation from your pediatrician for a child psychologist or a behavioral therapist.

Other notable symptoms of childhood depression are an exaggerated sense of guilt, shame, and insecurity. Depressed preschoolers generally feel that if they do a naughty thing or disobey, that means they are inherently bad people.

Here’s a breakdown of the symptoms of depression in children of any age, including preschoolers:

• Deep and persistent sadness
• Irritability or anger
• Difficulty sleeping or focusing
• Refusing to go to school and getting into trouble
• Change in eating habits
• Crying spells
• Withdrawing from friends and toys
• Fatigue
• Anhedonia – inability to derive pleasure from enjoyable activities, like playing with toys
• Whining
• Low self-esteem and insecurity
• Shame and guilt
• Timidity

Preschoolers may be especially vulnerable to depression’s consequences. Young children are sensitive to emotions, but lack the ability to process strong feelings. Early negative experiences–including separation from a caregiver, abuse, and neglect–affect physical health, not just mental. Multiple studies have linked childhood depression to later depression in adulthood.

This is why properly diagnosing and treating these children early is so vital. One established intervention for treating childhood depression is called Parent-Child Interaction Therapy, or PCIT. Originally developed in the 1970s to treat violent or aggressive behaviors in preschoolers, PCIT is a program where, under the supervision of a trained therapist, caregivers are taught to encourage their children to manage their emotions and stress. The program typically lasts from 10 to 16 weeks.

The Bottom Line

Dr. Luby’s research is met with resistance. Laypeople typically think the idea of preschoolers suffering depression ridiculous, and even some doctors and scientists don’t believe children are cognitively advanced enough to suffer from depression. Preschool depression remains a controversial topic, which makes it harder to diagnose in your child.

But depression in children 6 years and older has been well established by decades of data. Is it really so hard to think that preschoolers might suffer depression as well? Dr. Luby and her team have been looking at the data for 20 years, and have concluded that preschoolers can suffer depression, just like older children and adults.

Admitting that your child is depressed may make you feel like you’re a failure. After all, if you can’t protect your children from depression, who can? But clinical depression is chemical. This is not your fault. You may have been told that depression doesn’t exist in preschoolers, or that you’re overreacting. You may be called a helicopter or hovering parent. But trust your instincts. You know your child better than anyone else. Don’t be afraid to go against stigma for your child’s benefit.

Up to 84,000 of America’s 6 million preschoolers may be clinically depressed. If your child is one of them, you are not alone. There is no shame to depression. The condition is not your child’s fault, just as in adults. No parent likes to see her child suffer, and getting help for depressed children is vital to their well-being.

If your child suffers depressive symptoms, especially anhedonia, ask your pediatrician for a recommendation for a behavioral therapist or child psychologist. Typically, the earlier the intervention, the more successful the results.

Good luck.

Related:

• Children at High Risk for Bipolar Disorder Genetically Vulnerable to Stress
• What to Do if Your Child Has Bipolar Disorder
• How to Talk to Your Kids About Mental Illness

 

How Sugar May Harm Your Mental Health

Sugar, especially refined white sugar which has been processed, inflates waistlines and contributes to obesity. But, while some studies have shown that sugar may have a detrimental effect on the mood, not a whole lot of research has been done on sugar’s effects on mental health.

In a past post, Good, Good, Good Nutrition, part II: Foods to Avoid When Managing Bipolar Disorder, we covered how sugar can cause wild mood swings in bipolar patients. And how obesity can make some bipolar medications ineffective, especially if the weight is gained around the middle. But there are other ways sugar harms mental health.

Let’s dig in.

Addictive Properties

The addictive properties of sugar have been studied in recent years, though the research is still controversial. But anyone who’s craving a chocolate fix can understand how additive sugar is. Sugar and actual drugs both flood the brain with dopamine, a feel-good chemical which changes the brain over time. Among people who binge eat, the sight of a milkshake activated the same reward centers of the brain as cocaine, according to a Yale University study. Speaking of cocaine, rats actually prefer sugar water to the hard drug. And according to a 2007 study, rats who were given fats and sugar to eat demonstrated symptoms of withdrawal when the foods were taken away.

A spoonful of sugar on a black background. Credit to flickr.com user Gunilla G. Used with permission under a Creative Commons license.

Cognitive Effects

Sugar may also affect your ability to learn and remember things. Six weeks of drinking a fructose solution similar to soda caused the rats taking it to forget their way out of a maze, according to a University of California Los Angeles (UCLA) study. In the same study, rats who ate a high-fructose diet that also included omega-3 fatty acids found their way out of the maze even faster than the controls, who ate a standard diet for rats. The increased-sugar diet without omega 3s caused insulin resistance in the rats, which leads to diabetes and damaged brain cells crucial for memory.

Depression

Countries with high-sugar diets experience a high incidence of depression. Mood disorders may also be affected by the highs and lows of sugar consumption and subsequent crashes. In schizophrenic patients, a study has shown that eating a lot of sugar links to an increased risk of depression.

The researchers behind the study produced a couple of theories to explain the link. Sugar suppresses the activation of a hormone called BDNF, which is found at low levels in people with schizophrenia and clinical depression. Sugar also contributes to chronic inflammation, which impacts the immune system and brain. Studies show that inflammation can cause depression.

Anxiety

Sugar consumption doesn’t cause anxiety, but it does appear to worsen anxiety symptoms. Sugar also causes the inability to cope with stress. Rats who ate sugar and then fasted showed symptoms of anxiety, according to a 2008 study. In a study in the following year, rats who ate sugar (as opposed to honey) were more likely to suffer anxiety. While you cannot cure anxiety through a change in diet, you can help the body cope with stress and minimize symptoms if you avoid sugar.

The Bottom Line

The good news is, people are consuming less sugar now that the risks to eating it are clearer. A decade ago, Americans ate sugar for 18% of their daily calories, but today that’s dropped to 13%. The more we learn about the human body and how our choices in foods affect us, the more we can tailor our diets to maximize the benefits to our health and minimize the risks.

Related:

• Bipolar Disorder Medication and Weight Gain
• Why Medicinal Weight Gain is Devastating to the Mentally Ill
• Good, Good, Good Nutrition, part I: Foods to Eat to Help Manage Bipolar Disorder
• Bipolar Disorder Manifests Differently in People Who Binge Eat

 

America Has Highest Rate of Bipolar Disorder Diagnoses in 11-Nation Study

Bipolar disorder, a disease characterized by “highs” (called mania) and “lows” (called depression), does not discriminate. It affects men and women equally, has been affecting children more and more, and appears to have a roughly similar incidence across all ethnic, racial, and socioeconomic groups. About 2.4% of people around the world are diagnosed with bipolar disorder in their lifetimes.

According to a new 11-nation study conducted by researchers around the world, the United States has the highest incidence of bipolar disorder, at 4.4%. India has the lowest rate at 0.1%, followed by Japan at 0.7%. Lower-income nations typically demonstrated lower rates. Colombia, a lower-income nation, bucked the trend with a incidence of 2.6%.

But why does the U.S. experience the highest bipolar rate among all 11 nations studied? Let’s dig in.

Wealth

Wealth may play a role. Individuals in higher-income nations were more likely to be diagnosed than those in lower-income nations. The exception is Japan, with an incidence rate of 0.7%.

Unfortunately, the U.S. also has the largest worldwide gap between the rich and the poor. The economic stressors are greater than in other Western societies. This means there are more psychological stressors among the poor of America, which may lead to substance abuse and fragmentation of the family.

Immigrant Melting Pot

Genetics may also contribute in the rate of bipolar disorder in different countries. Studies have confirmed that the condition sometimes runs in families, and that the lifetime chance of an identical twin of a bipolar twin developing the disorder is about 40% to 70%. So the genetic makeup of a country may affect the rate.

But what about immigrants? America is known as the “melting pot” of the world, due to all the immigrants that come here. Among people who have emigrated, the actual expression of bipolar disorder is the same as it is in the population that those people have left. However, what’s interesting to note is that, in those cases, their children tend to have higher rates of mental illnesses, including bipolar disorder, by a factor of as much as tenfold.

Social scientists suspect that the lack of extended family and cultural systems may result in higher incidences of bipolar disorder, as environmental stressors play a factor in the development of the disease. With a lack of familial support, immigrants have less of a buffer in terms of a social network, especially when they first arrive.

And immigrants seeking a new life in America might be more risk-taking than people who stay in their home countries. The immigrant belief that they can find success here takes a certain mindset of grandiosity and other symptoms of hypomania, which may be more common among people who suffer from bipolar disorder.

Stigma

A stylized map of South America. Credit to flickr.com user Stuart Rankin. Used with permission under a Creative Commons license.

Stigma also plays a part in the incidence rate of bipolar disorder among different countries. Fewer than half of those suffering from the disorder sought help for it. And only a quarter of those in low-income countries were treated by a mental health professional for bipolar disorder.

Some cultures are reluctant to talk about psychiatric things. Lower-income nations experience higher rates of stigma. Fewer people are willing to come forward with their struggle with mental illnesses, which leads to a lower perceived rate of bipolar disorder.

Cultural awareness of mental illnesses also contributes to the problem of stigma. Americans are fairly aware of bipolar disorder as a disease, whereas the symptoms of the condition may be missed or ignored in lower-income nations. This leads to lower rates of diagnosis.

The Bottom Line

No matter where people live, bipolar disorder causes serious impairment among those who suffer from it. People need to be less afraid about seeking help for their mental illnesses. Educating individuals about the disease may help combat stigma. Greater awareness among cultures will only help people get much-needed treatment.

Related:

• Bipolar Disorder Diagnosable by a 15-minute Electrocardiogram, Study Finds
• Scientists Conclude After 12-Year Study That Bipolar Disorder has Seven Causes
• Children with Bipolar Disorder May be Diagnosed with Vitamin D Blood Test in the Future

A Quarter of People With Fibromyalgia Show Bipolar Disorder Symptoms

Fibromyalgia and bipolar disorder appear to be connected. New research shows that a quarter of fibromyalgia patients who were screened tested positive for bipolar symptoms. Because these diseases are found in tandem, it’s known as comorbidity. If you have one disorder going on, despite their differences, you might have both.

Credit to flickr.com user CJS*64. Used with permission under a Creative Commons license.

The causes of fibromyalgia are yet to be discovered, and up to 5% of the population may be affected. More common in women, fibromyalgia is a disorder that causes muscle and joint aches. Other symptoms are fatigue, and, occasionally, depression.

Dr. William Wilke from the Cleveland Clinic in Ohio and his colleagues gave 128 patients with fibromyalgia four questionnaires. The first was the Mood Disorder Questionnaire (MDQ) for bipolar disorder, to determine the link between bipolar and fibromyalgia. Next was the Beck Depression Inventory (BDI) for depression. The scientists also used the Epworth Sleepiness Scale (ESS) for daytime sleepiness, and the Fibromyalgia Impact Questionnaire Disability Index (FIQ‐DI) to assess for functional capacity.

According to the MDQ screen, just over 25% of the patients were likely to have bipolar disorder, demonstrating a clear link between fibromyalgia and bipolar disorder. People who showed symptoms of bipolar also suffered from more severe depressions than people who didn’t show symptoms of bipolar disorder, which is really no surprise, given bipolar disorder’s depressions.

The BDI’s results were also of interest: 79% of the fibromyalgia patients were clinically depressed. Of those people, up to a third of the people who suffered from depression also reported symptoms of bipolar disorder.

The ESS showed that 52% of the patients with fibromyalgia–just over half–experienced daytime sleepiness, which doesn’t relate to bipolar disorder, but is interesting nonetheless.

Wilke’s team pointed out that some medications that treat fibromyalgia may also trigger mania in bipolar patients, and therefore doctors are urged to be cautious.

So, if you have fibromyalgia, you might want to talk to your doctor about the potential for bipolar disorder before you take medications to treat the disease, because those medications can trigger manic episodes. Similarly, if you have bipolar disorder, those muscle aches and fatigue might be something more; get screened for fibromyalgia.

How to Follow a Mediterranean Diet to Help Manage Bipolar Depression

Credit to flickr.com user Annette Young. Used with permission under a Creative Commons license.

As several studies have pointed out, eating a healthy diet is crucial for managing bipolar disorder. I recently linked to a study demonstrating that a Mediterranean diet helped alleviate the symptoms of depression. New research shows that following such a diet can even help prevent depression in the first place. If you eat these prescribed foods, then you may be able to alleviate or prevent bipolar depression as well.

In addition, following this diet may lower “bad”  cholesterol, reduce the risk of heart disease, and help reduce the incidence of Parkinson’s, Alzheimer’s, and some cancers–including breast cancer, when supplemented with mixed nuts. So why not give the diet a try?

But what is a Mediterranean diet? It emphasizes:

• Eating fruits, vegetables, beans/legumes, nuts, and whole grains as primary food sources
• Replacing butter with healthier fats such as olive oil
• Avoiding salt, and using herbs and spices instead
• Only eating red meat a few times per month, and eating fish and poultry twice a week instead
• Drinking moderate amounts of red wine (optional)

To follow the diet more fully, aim for seven to ten servings of fruits and veggies per day. Switch to whole-grain bread, cereal, pasta, and rice. Keep cashews, walnuts, and almonds around for snacking, but don’t eat too many, as they’re high in calories. Don’t eat butter; try olive oil and canola oil as a substitute. Eat healthy fats in general. Nosh on water-packed tuna, trout, or salmon once or twice a week, but avoid fried fish.

Don’t eat red meat unless it’s lean; avoid sausage and bacon. Choose low-fat cheese, fat-free yogurt, and skim milk. Avoid sugar. If you drink alcohol, have a glass of wine at dinner, but purple grape juice can be an alternative. For a sample meal plan that breaks down consumption by calories, click here.

There are a couple of downsides to the Mediterranean diet, however. One is the high cost. A personal finance blog, The Simple Dollar, posted a detailed breakdown of the costs of switching from butter to olive oil, and red meat to salmon, as well as other foods. According to the breakdown, salmon is almost twice as expensive as ground beef, so if you have a large family, then you might want to change over to ground turkey instead.

The other downside of the diet is its complexity. Not only is overhauling your regular eating patterns hard, balancing your intake of proteins, fats, and carbohydrates over several different meals is difficult. I know that when I’m depressed, I choose to make one of these twenty-two easy, delicious meals, most of which are carb-heavy. Those are great, but if you’re trying to follow the Mediterranean diet, then that link is not for you.

But don’t let the cost or complexity of the Mediterranean diet throw you. In-season produce, the backbone of the diet, is generally cheaper than meat, be it red or fish or poultry. And switching from butter to olive oil is easy. You don’t have to follow a diet to a T to get some of the benefits.

By following this diet, you may be better able to manage bipolar depression, which can take all the help you can get. The bottom line is, just do what you can. Eat more fruit. Swap ground beef for ground turkey. If eating more vegetables or switching some unhealthy fats for healthier ones is all you can do, that’s still great. You’ve got this.

Tackling the Clutter Demon With Bipolar Disorder

For those of us living with bipolar disorder, the battle to control the mess in our houses is very real.

Anyone who has ever been depressed knows that cleaning is a struggle, to put it mildly, especially when you can’t even shower or feed yourself. And when we’re manic, we either can’t concentrate to clean the clutter, start new tasks without picking up our messes, or purchase frivolous items to soothe anxiety. In persons with bipolar I specifically, the wiring in their frontal lobes is so tangled that they suffer these executive functioning difficulties even during stable periods.

The Life-Changing Magic of Tidying Up: The Japanese Art of Decluttering and Organizing, by Marie Kondo. Also known as the Kon Mari Method.

Studies have even shown that hoarding is linked to bipolar, for the same reasons. We’re just wired to create messes.

But there is hope. I’ve just started decluttering using the KonMari method, based on the book The Life-Changing Magic of Tidying Up: The Japanese Art of Decluttering and Organizing, by Marie Kondo. In short, you tidy by category. In order to start the process, you first search the house for items (clothes, books, papers, miscellany, and then sentimental clutter). Then you lay them out on the floor. Then you hold each item and ask if it “sparks joy” before making a decision to keep it and put it away, donate it, or toss it.

I feel a little silly doing this, but so far the method has really worked to tidy up my clothes closet. I got through my closet and dresser in three hours, and donated two full garbage bags. I now only have five items hanging up, one full-sized drawer full of clothes, and an underwear drawer. I’m exhausted.

One caveat to the method for bipolar I people especially is that I can easily see how it could trigger a hypomanic episode. The elation from throwing things out is very real, and it might be difficult for a person with mental illness to stop once he or she has started. It’s almost ritualistic, which might spell trouble for people suffering from Obsessive Compulsive Disorder.

This is also not a method to use when you’re depressed. Laying out all my clothes on the floor was overwhelming, and I was fortunate to have my sister to walk me through the KonMari process. I confess that first, we had to clean up the floor to make enough room to sort through the clothes, which took half the time we’d allotted to going through them (three hours total).

So, I have a mixed review of the KonMari method. It’s effective, but dangerous. I’ll hold off on giving a full review until I’ve completed the six months the book says the method takes.

Bipolar? Your Brain is Wired to Make Poor Decisions

Credit to flickr.com user TZA. Used with permission under a Creative Commons license.

Struggling to plan and make decisions while depressed or manic are common problems. But have you ever had trouble doing the same while relatively stable? New research may show why.

 

Researchers examined ninety patients’–forty-five with bipolar disorder in stable moods, and forty-five controls without bipolar disorder–brains, and discovered that, in the bipolar sufferers, there are certain areas of the brain that have reduced activation regardless of mood due to structural damage.

This is the first study to look at the relationship between functional magnetic resonance imaging (MRIs) and structural MRIs in bipolar disorder. The scientists found that the patients with bipolar suffered from reduced cortical thickness and thus had less activity in areas of the brain that controlled impulses, or contributed to making decisions.

The study was published in Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, and conducted by scientists at the University of California, Los Angeles.

As this is the first study to find a link between structure and function, the results are exciting. The research proves that bipolar disorder damages your brain. You’re not stupid; your brain is just wired to make impulsive decisions and be poor at planning.

The scientists who conducted the study hope that their research will be used in future intervention studies. Good news!

Depression Changes Our Language

Credit to flickr.com user darkwood 67. Used with permission under a Creative Commons license.

Depression. A pit of despair for many people. Scientists have attempted to pin down the relationship between depression and language for a long time now, and technology has just given researchers the breakthrough they needed.

In the past, field studies were carried out by scientists who took notes on what people said. Now, computers can analyze banks of data in seconds, picking up on patterns that a human analyst might miss. Researchers fed personal essays, diary entries, and blog posts to their computers and found some interesting patterns in the language of people suffering from depression.

It should come as no surprise that people who deal with depression use more negative language, with words such as “lonely,” “sad,” and “miserable.” But what surprised the scientists was the use of first-person pronouns, such as “I,” “myself,” and “me.” People who suffer from depression apparently don’t use very many second- and third-person pronouns, such as “you,” “they,” and “them,” indicating that depression is a self-focused disease. Researchers found that the pronoun usage was more indicative of depression than the negative language.

However, on an examination of 64 different forums, absolutist language, using words such as “always,” “never,” and “completely,” was a better indicator of mental health issues than negative language or pronouns. On suicidal ideation forums, the use of absolutist language was 80% greater than language used by 19 control forums. This shows that people who suffer from depression have a black-and-white outlook.

Scientists hope that computers will soon be able to classify mental disorders from blog posts. Such classification is already outperforming trained therapists.