Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry
Breakdown: A Clinician’s Experience in a Broken System of Emergency Psychiatry; Book Review by Paul…
I attended an event hosted by the head nurse of the three dialysis units that I used for my patients during my practice. It was a “meet and greet” and there to my surprise were eight health care professionals still working and with whom I had worked closely. There were RNs, LVNS, Techs, Social Workers, Receptionists and Dieticians. They are the “best and the brightest”. In the course of the conversation I was asked what I was doing during doing my retirement. I told them of my retirement, the books, my advocacy, etc. I asked if any of them knew I was bipolar. No hands. One RN asked, “So you had some nervous breakdowns”. I almost cringed. This wastebasket term is still in the lexicon of popular culture even in that of an extremely well trained RN.
Regarding folks with MDD I used to think that lay persons knew of the association of depression with worsening around holidays or around change of seasons, particularly when weather turns cold and nights are shorter. Wrong.
The example above shows how little the general public knows about mental illness!
According to the Mayo Clinic, people with SAD (Seasonal Affective Disorders) usually experience at least two years in a row. Some people with the disorders have the opposite pattern, namely worsening symptoms in the spring or summer. I have already discussed light therapy in my first book. In far northern climes a head lamp with an ultraviolet light is used to minimize symptoms. There are also lamps, floor and table, that one can purchase on Amazon or at stores that specialize in lighting fixtures that folks can use for reading or watching TV. I seem to have more of an early summer issue so I bought a floor lamp for reading.
Elsewhere in the literature, HEPCHOPE.COM, seasonal affective disorder is confined to episodes of major depression not mania but one does not have to have MDD to have depression in winter. This group is more likely to occur in women, people who live far from the equator where days are very short during long parts of the year and younger people.
Again, studies from the Mayo Clinic suggest the etiology is the same as episodes of depression. Changes in the body’s sleep-wake cycle (so-called circadian rhythm) seem to be the driving force. The same thing occurs using rats by changing light/dark cycles. However unlike MDD and BPD MORE serotonin levels in nerve synapses and INCREASED melatonin levels in the pineal gland are observed.
The symptoms are the same of those of MDD. To be sure one has to have the same symptoms and improvement two years in a row. You must not be pregnant or post-partum (seems obvious). You may have a family member with an affective disorder. For sure, weight gain without change in appetite at least requires a thyroid blood level. I must say that when I have tested women (not sexist here) who ask for a thyroid lever for 34 years I have found NONE! There are plenty of other symptoms that suggest that diagnosis. 20% with SAD have BPD but the seasonal component is invariably depression.
The syndrome was first described by in 1984 by Norman E. Rosenthal in the National Institute of Mental Health in the Archives of General Psychiatry. Its prevalence is 10% in Alaska and less than 2% in Florida. It also has been called the winter blues.
Treatment modalities other than ultraviolet light therapy include SSRI drugs, Wellbutrin, melatonin, vitamin D augmentation and physical exercise.
An interesting theory about hibernation in mammals suggests that it is an adaptation to winter months. However, even species that do not hibernate show symptoms of sluggishness and inactivity during winter months.
One retrospective study showed an incidence varying from 6 to 35% of sufferers requiring hospitalization with a higher risk of suicide.
One would think that it is common knowledge that the incidence of suicide is higher in Nordic countries. Certain comments such as the one related at the beginning of this piece lead me to believe that all bets are off regarding what the lay public knows about mental illness. Another example; I was at a reception after the funeral of a dear doctor friend of my vintage. In line, a gastroenterologist asked me: “Paul, so is your bipolar gone?”
For some reason the incidence of SAD in Iceland is LOW. No satisfactory answer has been put forward.
Studies are currently underway at the National Institute of Mental Health (NIMH) using volunteers and volunteers are still being sought.