Marijuana Success Stories: #2 – Depression

By Anonymous

I am writing this because I believe it is important to get as much information as possible regarding medical marijuana use out into society, so that we can begin (it’s really sad we’re not there yet) to change public perception.  I am a 32-year-old music teacher, athletic coach and professional musician.  I am married and I have two children.  I have a bachelor’s and master’s degree.

My primary reason for using marijuana is to deal with symptoms related to periodic bouts of severe depression.  My mother is diagnosed bipolar, and her father was also.  Incidentally, his mother, my great-grandmother died by committing suicide.  It is likely she also suffered severe depression and it would appear that it is at least partly a genetic characteristic.

I was first diagnosed with clinical depression while I was in high school at approximately age 14.  But I am certain that my feelings and symptoms began at puberty around age 11.  At the time of my diagnoses I was adamantly opposed to the use of marijuana or drugs of any kind.  I was then and am now a competitive endurance athlete and saw it as being in opposition to that endeavor. Read more

Preventing and Reversing Weight Gain Associated with Psychiatric Medications

By Candida Fink MD

Many people who carry the bipolar diagnosis also carry something else – extra pounds – primarily due to the medications used to treat mania or depression. Atypical antipsychotics, including Zyprexa and Seroquel; anti-manics, including lithium and Depakote; and even some antidepressants have been known to pack on the pounds, despite a person’s best efforts to stay fit and trim.

Doctors and therapists don’t always treat medication-induced weight gain with the sensitivity or importance it deserves. As long as you’re not manic or depressed, they seem to think you should be thankful and accept the weight gain as a necessary trade-off for the privilege of mood stability. Others casually shift the responsibility to their patients, suggesting that normal exercise and dieting can shed the unwanted pounds, rarely acknowledging the fact that when you’re depressed, you may not feel much like jogging or swimming laps.

When you’re not the one carrying the extra 10 to 50 pounds, it’s easy to shrug it off as though it’s of little concern, but weight gain can and often does lead to other problems:

• Poor self-esteem: from tight-fitting clothes and looking or feeling not as fit as they would like.
• Medication noncompliance: stopping the medications they suspect of causing the weight gain.
• Physical health risks: including high-cholesterol, diabetes, and heart disease.

Weight gain is one of the most common and difficult side effects of many of the medications used to treat bipolar disorder and other psychiatric illness. It is something I address daily with patients and families – when picking an initial medication or adjusting or changing prescriptions. This topic comes up constantly.

In this post, I highlight the most common culprits (the medications most likely to cause the most weight gain) and offer a pro-active approach that has helped many of my patients keep the pounds off or shed them later.

Atypical Anti-psychotics

Almost all of the atypical antipsychotics are notorious for causing fairly significant weight gain in most (but not all) people who take them. Here’s the list of culprits ranked from most to least risk for causing weight gain:

• High risk: Olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), aripiprazole (Abilify), and clozapin (Clozaril)
• Little to no risk: Ziprasidone (Geodon) and older first-generation antipsychotics such as perphenazine (Trilafon)

The weight gain from antipsychotics appears to come from increased appetite (”hyperphagia”) and some changes in metabolism. This family of medicines also has varying degrees of risk of certain health risks such as diabetes and elevated cholesterol, which may be related to the medication’s effect on metabolism.

Anti-depressants and Anti-anxiety Medications

Anti-depressants and anti-anxiety medications all have some risk of weight gain, although not typically in the same severe range as the antipsychotics. The risk seems to be more individualized – some people notice a lot of change in appetite and weight and some notice little. Occasionally, some people actually lose weight on these meds. In addition, these medications do not carry specifically the risks of diabetes and high cholesterol.

The most common antidepressants and anti-anxiety medications are the SSRI’s and SNRI’s (the weight gain risk really depends on the individual):

• SSRI’s: Fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa) are some examples.
• SNRI’s: Venlafaxine (Effexor) and Duloxetine (Cymbalta) are the most common.

Bupropion (Wellbutrin), which is in a class of its own, is the only antidepressant without any risk of weight gain – but it is not particularly effective for anxiety.

Anti-Manics or “Mood Stabilizers” and Anti-Seizure Medications

Mood stabilizers and the anti-seizure medications often used to treat or prevent mania may also carry the risk of causing weight gain, but the risk varies depending on the medication and its effect on the person taking it:

• High risk: Valproic acid (Depakote)
• Moderate risk: Lithium
• Low risk: Lamotrigine (Lamictal) and carbemazapine (Tegretol)

Curbing Weight Gain via Medication

When medication triggers weight gain, one of the more obvious solutions is through medications – either selecting a different medication that’s less likely to cause weight gain or adding a medication that has a track record for negating the weight-gain side effect. Here are some common options:

• Choose a different medication. If Zyprexa causes significant weight gain, for example, switching to Geodon may deliver similar benefits with little or no risk of causing weight gain.
• Try a different form of the same medication. Olanzapine (Zyprexa), for example, is also offered as a dissolvable tablet (Zydis) that melts in your mouth. The theory is that your mouth membranes absorb most of the medication before it gets into your stomach where it’s more likely to stimulate the appetite. (This does not have any scientific support at the moment, but it doesn’t hurt to try.)
• Add topiramate (Topamax) to the mix. Topiramate has been shown, in some studies, to reduce appetite and limit weight gain (particularly weight gain associated with atypical antipsychotics).
• Add metformin (Glucophage) to the mix. Metformin, a medication used to treat diabetes, -is being studied to see if it may reduce weight gain and/or the risk of developing diabetes associated with some psychiatric medications.
• Replace your atypical antipsychotic with an older, first-generation antipsychotic. The atypical antipsychotics (second-generation antipsychotics) generally have been thought to have fewer serious side effects than the older versions. However, several recent studies have indicated that the atypical antipsychotics may not have any better outcomes than the older ones, such as perphenizine (Trilafon) and molindone (Moban). And while the older antipsychotics have their own particular risk profile – movement disorders in particular – they do not have the same weight gain and metabolic risks seen in the newer drugs. So it seems that the choices for medications may be broader than we have gotten used to recently. In other words, for some people, the older, less expensive antipsychotics may be a better choice.

In some cases, changing medications can be “just what the doctor ordered.”

Taking a Proactive Approach to Curbing Weight Gain

In my practice, we remain well aware of the potential weight gain risks associated with the various medications and prescribe medications in such a way as to reduce the risks as much as possible. In addition, we take a very proactive approach in monitoring weight and take action as soon as we notice any changes:

1. We monitor weight and appetite from the start, so that we can take action before the weight gain becomes a big problem. You needn’t jump on the scales every day. We just check weights at regular visits and sometimes recommend briefly keeping a food and/or appetite journal.
2. We order regular lab tests to keep an eye on glucose and cholesterol levels. The testing should be done at least once a year – probably more like every six months. It should include just a routine glucose and a lipid panel. The “range” on the lab slip shows the cut offs, but more importantly, we’re looking for significant shifts from baseline.
3. When starting a new medication or changing medications, work with your doctor to increase the calories you burn while maintaining your caloric intake. Any movement will do, so don’t think you have to join a gym – walking a little more each day can do wonders. Likewise, you don’t have to go on a strict diet – try to keep the calories going in about the same as before or with as little increase as possible. Some studies have shown that the weight gain can be more limited with a proactive approach to nutrition and exercise. We may include a consult with a nutritionist or exercise trainer (assuming that’s an option) to help plan and monitor calorie intake and develop reasonable and doable exercise or movement plans. Small, manageable changes are the goals.
4. We often work together with the primary care doctor in all of the steps. Because of the medical risks with the atypicals, it’s a good idea to keep the primary care physician in the loop; they can keep a closer eye on health issues related to these meds, and may have other ideas or input regarding keeping weight gain down to a dull roar.

The most important factor here is good communication with your prescriber and regular monitoring of the medications and their effects – both good and bad. Some weight gain may be unavoidable, but try to be honest with your doctor about what you will and will not live with in this department.

Remember: Call your doctor to discuss any problems with the medicines, rather than stopping the medication on your own. This is a team project, and the outcomes are better when the team works together.

If you have any additional tips or suggestions on preventing or reversing the weight gain associated with psychiatric medications, please share your insights and experiences with others by posting a comment.

Schizophrenia 101: Treatment for Schizophrenia

Schizophrenia usually first appears in a person during their late teens or throughout their twenties. It affects more men than women, and is considered a life-long condition which rarely is “cured,” but rather treated. Most patients do not experience a complete remission of symptoms. However, this disorder can be managed by a combination of psychosocial therapies and medications.

The primary treatment for schizophrenia and similar thought disorders is medication. Unfortunately, compliance with a medication regimen is often one of the largest problems associated with the ongoing treatment of schizophrenia. Because people who live with this disorder often go off of their medication during periods throughout their lives, the repercussions of this loss of treatment are acutely felt not only by the individual, but by their family and friends as well.

Successful treatment of schizophrenia, therefore, depends upon a life-long regimen of both drug and psychosocial, support therapies. While the medication helps control the psychosis associated with schizophrenia (e.g., the delusions and hallucinations), it cannot help the person find a job, learn to be effective in social relationships, increase the individual’s coping skills, and help them learn to communicate and work well with others. Poverty, homelessness, and unemployment are often associated with this disorder, but they don’t have to be. If the individual finds appropriate treatment and sticks with it, a person with schizophrenia can lead a happy and successful life. But the initial recovery from the first symptoms of schizophrenia can be an extremely lonely experience. Individuals coping with the onset of schizophrenia for the first time in their lives require all the support that their families, friends, and communities can provide.

With such support, determination, and understanding, someone who has schizophrenia can learn to cope and live with it for their entire life. But stability with this disorder means complying with the treatment plan set up between the person and their therapist or doctor, and maintaining the balance provided for by the medication and therapy. A sudden stopping of treatment will most often lead to a relapse of the symptoms associated with schizophrenia and then a gradual recovery as treatment is reinstated.

Therapy

Psychotherapy is not the treatment of choice for someone with schizophrenia. Used as an adjunct to a good medication plan, however, psychotherapy can help maintain the individual on their medication, learn needed social skills, and support the person’s weekly goals and activities in their community. This may include advice, reassurance, education, modeling, limit setting, and reality testing with the therapist. Encouragement in setting small goals and reaching them can often be helpful.

People with schizophrenia often have a difficult time performing ordinary life skills such as cooking and personal grooming as well as communicating with others in the family and at work. Therapy or rehabilitation therapy can help a person regain the confidence to take care of themselves and live a fuller life.

Group therapy, combined with drugs, produces somewhat better results than drug treatment alone, particularly with schizophrenic outpatients. Positive results are more likely to be obtained when group therapy focuses on real-life plans, problems, and relationships; on social and work roles and interaction; on cooperation with drug therapy and discussion of its side effects; or on some practical recreational or work activity. This supportive group therapy can be especially helpful in decreasing social isolation and increasing reality testing.

Family therapy can significantly decrease relapse rates for the schizophrenic family member. In high-stress families, schizophrenic patients given standard aftercare relapse 50-60% of the time in the first year out of hospital. Supportive family therapy can reduce this relapse rate to below 10 percent. This therapy encourages the family to convene a family meeting whenever an issue arises, in order to discuss and specify the exact nature of the problem, to list and consider alternative solutions, and to select and implement the consensual best solution.

Medications

Schizophrenia appears to be a combination of a thought disorder, mood disorder, and anxiety disorder. The medical management of schizophrenia often requires a combination of anti-psychotic, anti-depressant, and anti-anxiety medication. One of the biggest challenges of treatment is that many people don’t keep taking the medications prescribed for the disorder. After the first year of treatment, most people will discontinue their use of medications, especially ones where the side effects are difficult to tolerate.

As a recent National Institute of Mental Health Study indicated, regardless of the drug, three-quarters of all patients stop taking their medications. They stopped the schizophrenia medications either because they did not make them better or they had intolerable side effects. The discontinuation rates remained high when they were switched to a new drug, but patients stayed on Clozapine about 11 months, compared with only three months for Seroquel, Risperdal or Zyprexa, which are far more heavily marketed — and dominate sales. Because of findings such as this, it’s generally recommended that someone with schizophrenia begin their treatment with a drug such as Clozapine (Clozapine is often significantly cheaper than other antipsychotic medications). Clozapine (also known as Clozaril) has been shown to be more effective than many newer antipsychotics as well.

Anti-psychotic medications help to normalize the biochemical imbalances that cause schizophrenia. They are also important in reducing the likelihood of relapse. There are two major types of antipsychotics, traditional and new antipsychotics.

Traditional antipsychotics effectively control the hallucinations, delusions, and confusion of schizophrenia. This type of antipsychotic drug, such as haloperidol, chlorpromazine, and fluphenazine, has been available since the mid-1950s. These drugs primarily block dopamine receptors and are effective in treating the “positive” symptoms of schizophrenia.

Side effects for antipsychotics may cause a patient to stop taking them. However, it is important to talk with your doctor before making any changes in medication since many side effects can be controlled. Be sure to weigh the risks against the potential benefits that antipsychotic drugs can provide.

Mild side effects: dry mouth, blurred vision, constipation, drowsiness and dizziness. These side affects usually disappear a few weeks after the person starts treatment.

More serious side effects: trouble with muscle control, muscle spasms or cramps in the head and neck, fidgeting or pacing, tremors and shuffling of the feet (much like those affecting people with Parkinson’s disease).

Side effects due to prolonged use of traditional antipsychotic medications: facial ticks, thrusting and rolling of the tongue, lip licking, panting and grimacing.

There are many newer antipsychotic medications available since the 1990’s, including Seroquel, Risperdal, Zyprexa and Clozaril. Some of these medications may work on both the serotonin and dopamine receptors, thereby treating both the “positive” and “negative” symptoms of schizophrenia. Other newer antipsychotics are referred to as atypical antipsychotics, because of how they affect the dopamine receptors in the brain. These newer medications may be more effective in treating a broader range of symptoms of schizophrenia, and some have fewer side effects than traditional antipsychotics. Learn more about the atypical antipsychotics used to help treat schizophrenia.

Self-Help

Self-help methods for the treatment of this disorder are often overlooked by the medical profession because very few professionals are involved in them. An adjunctive community support group in concurrence with psychotherapy is usually beneficial to most people who suffer from schizophrenia. Caution should be utilized, however, if the person’s symptoms aren’t under control of a medication. People with this disorder often have a difficult time in social situations, therefore a support group should not be considered as an initial treatment option. As the person progresses in treatment, a support group may be a useful option to help the person make the transition back into daily social life.

Another use of self-help is for the family members of someone who lives with schizophrenia. The stress and hardships causes of having a loved one with this disorder are often overwhelming and difficult to cope with for a family. Family members should use a support group within their community to share common experiences and learn about ways to best deal with their frustrations, feelings of helplessness, and anger.

Mental Health Professionals

A psychiatrist, who attends to the biological or medical needs of the patient, directs the treatment of schizophrenia. Social workers and other mental health professionals devise and supervise a plan to address the socialization and educational components of the treatment. Difficulties in social skills are addressed by involvement in group treatment and planned group activities that include appropriate behavioral interaction and conversational topics. To be better able to cope with day-to-day living, the patient learns or re-learns more productive, acceptable behavior.

Other aspects of treatment deal with personal care, living skills, managing money and other practical matters. In many areas, people who have schizophrenia are able to receive assistance from local community mental health facilities and possibly qualify for a case manager. A case manager is someone who helps to ensure that the patient can get to appointments and group activities, monitors the progress of the patient and helps him apply for other available assistance.

The case manager may become a very important resource for the schizophrenic patient, especially for cases in which there is no family member available to become involved. The case manager may come to serve as the patient’s major advocate in dealing with landlords, social service agencies and utility companies. The case manager is trained to know local, state and federal programs that may be accessed to meet the particular needs of each client.

The specific programs available at community mental health facilities differ from one facility to another, but most offer some helpful programs. The importance of involvement in regular activities cannot be overemphasized. This part of the treatment addresses the social and interactional skills that are necessary for everyday life. When these services are provided in an environment that the patient views as safe and nonthreatening, the opportunity exists for the patient to develop greater trust in others. Such treatment can help the patient to re-integrate into society more comfortably. While not all schizophrenic patients will require the services of a case manager, the vast majority are encouraged to follow a psychosocial treatment plan as well as the medical and drug plan supervised by their physician.

Sources:

National Institute of Mental Health (NIMH)

Michael Bengston, M.D.

John M. Grohol, Psy.D

How to Manage Your Medications

People who have bipolar disorder usually take many pills every day. Here are ways to make sure you take the right pill at the right time, and learn what you should know about your medications.

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Bipolar Medication Non-Adherence Issues

Many people with bipolar stop taking their medications at some point in their treatment. This is a reality that patients, doctors, and family members often wrestle with. But it’s important to understand some of the possible reasons why. Understanding that there are often compelling factors in someone’s decision to stop their meds can help loved ones approach the problem without judgment. And for people with bipolar disorder it is critical to honestly evaluate why they want to stop taking their medication, because then they can tackle these issues directly and without judging themselves.

Non-compliance or non-adherence? Anyone who’s ever taken bipolar medication has heard the term non-compliance. It means not doing what your doctor and therapist tell you to do. In most cases, it means not taking your meds as prescribed. Unfortunately, the term carries a subtle connotation that the patient is not being a good little girl or boy. As such, many people with bipolar understandably find it offensive, preferring instead to use the term non-adherence.

Outside observers often seem to think that the main reason people with bipolar stop taking their meds is because these people are just irrational, irritable, and obstinate… especially when they start becoming manic. Although mania could be a contributing factor in some cases, people often have other reasons for stopping their medications, including the following:
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Marijuana Success Stories: #1 – Rapid Cycling Bipolar Disorder

By John Frederick Wilson

In bipolar or manic-depressive disorder, the inconsolable misery of major depression alternates with mania or uncontrolled elation. In the manic phase people with bipolar disorder are cheerful, gregarious, talkative, energetic, and hyperactive. Their spending is often extravagant and their behavior reckless. They may imagine that they have extraordinary talents and are or soon will be rich and powerful. This reckless, restless cheerfulness and expansiveness can suddenly turn into incoherent agitation, irritability, rage, paranoia, or grandiose delusions.

Antidepressants alone are not a good treatment for bipolar disorder and may even make it worse. Lithium carbonate, introduced into medicine at about the same time as tricyclics, has revolutionized the treatment of bipolar disorder. It prevents mania and to a lesser extent bipolar depression. Although lithium takes several weeks to start working, its success rate is about 70 percent and 20 percent of patients are completely freed of their symptoms. Patients generally require long-term maintenance treatment, and because lithium can be toxic it must be used carefully. Chronic use may endanger the heart, kidneys, and thyroid gland. Usually the dose is gradually increased until the drug begins to work and then periodically readjusted according to the patient’s age, medical condition, and psychiatric symptoms.

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Recovering Your Mental Health – Using Medications

Your physician may suggest one or more medications to help you feel better. Using these medications should be your decision, but first, you need answers to some important questions. To get those answers, you might ask your doctor or pharmacist, check a book about medications at the library, or search a reliable information source on the Internet. Double check with your health care provider before making a final decision.

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How Bipolar Disorder Affects Women

Women with Bipolar Disorder
Research shows that women tend to experience more periods of depression than men. Women are more likely to develop bipolar II disorder — meaning they never develop severe mania, but instead have milder episodes of hypomania that alternate with depression.
Women are also at higher risk for rapid cycling, which means having four or more episodes in one year. Varying levels of sex hormones and activity of the thyroid gland in the neck — together with the tendency to be prescribed antidepressants — may contribute to rapid cycling, researchers believe.

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Tips on Managing Mania

By Jeanie Lerche Davis

There’s no denying the exhilaration that mania brings. For many with bipolar disorder, there’s a period of denial—a disbelief that the wonderful surge of energy and euphoria marks a disease that truly needs treatment.

“Mania is a fascinating thing … it’s the brain creating its own hormonal high,” says Carrie Bearden, PhD, a clinical neuropsychologist and assistant professor of psychiatry at UCLA. “Most people first become manic in their early 20s, at a time in life when they’re not thinking about death, when they feel immortal.”

Indeed, some degree of risky business is the hallmark of mania. Erratic driving and out-of-control spending sprees are common. It’s a time when flashy business ideas are borne, torrents of phone calls made.

And yet, that’s not true for everyone. There are several types of bipolar disorder, and all involve episodes of mania and depression—but to varying degrees.
• With bipolar I, there are severe mood swings.
• With bipolar II and cyclothymic disorder, there are milder versions of the illness.
• Mixed bipolar is both mania and depression at the same time—a dangerous mix of grandiosity, racing thoughts, yet irritable, moody, angry.

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Understanding Treatment for Bipolar Disorder

At present, treatment for bipolar disorder is most often with a combination of a mood-stabilizing drug and psychotherapy. The main mood-stabilizing drugs used for the treatment of bipolar disorder include lithium carbonate, valproic acid (also known as Depakote) and carbamazepine (Tegretol), Lamictal, Topamax, Gabitril, and many other antiepileptic agents. They also include some newer antipsycohitic agents.

While drug treatment is primary, ongoing psychotherapy is important to help patients understand and accept the personal and social disruptions of past episodes and better cope with future ones. In addition, since denial is often a problem, routine psychotherapy helps patients stay on their medications. (Patient compliance is particularly tricky in adolescence.) Almost all forms of psychotherapy can be used — cognitive, behavioral, or psychodynamic; individual, family, or group therapy.

The family or spouse of a patient should be involved with any treatment. Having full information about the disease and its manifestations is important for both the patient and loved ones.
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