THROUGH DIFFICULTIES TO THE STARS AUTUMN 2015 EVEN KEEL Our aim at Even Keel is to offer friendship, understanding, information and a sense of hope to people living with Bipolar or other disorders

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76 Wittenoom St, East Perth, WA, 6004 e: offi[email protected] w: evenkeel.org.au p: (08) 9425 2005 Open Fri & Mon 9:30a-2:30p Articles in this issue

Mentally ill people being misdiagnosed and wrongly sent to jail, WA regional lawyer says pp. 5-6 Mental health patients Current List of Support Groups p. 4 choke EDs WA parliamentary report finds Perth emergency departments are being swamped mental health issues higher by unusually high numbers of seriously mentally ill among FIFO workforce pp. 7-8 patients waiting up to three days for a psychiatric hospital bed. What One Star Learned From Raising a Bipolar Son pp. Doctors are being forced to sedate, restrain or bring in 12-15 security guards to monitor the most disturbed patients 10 Tips for Living with a being held in emergency departments because of an Bipolar Person pp. 15-16 acute shortage of involuntary mental health beds.

How to talk to your teen about The West Australian understands the situation has been depression, suicide pp. 17-19 triggered by the decision to give a young patient a six- bed ward to herself at Graylands psychiatric hospital, Feeling Bipolar Disorder In removing five beds usually available for others. Your Gut pp. 21-22 The State’s mental health system was plunged into a rare The difference between “code yellow” emergency, sending authorities into a bipolar disorder and regular scramble to sort out the crisis. depression pp. 25-26 Australian Medical Association WA president Michael Gannon said disinvestment in mental health meant

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capacity was drum-tight and one patient could “shut down the system”. “My understanding is it’s a young woman who may require medium to long-term care so this may not be a short-term solution,” Dr Gannon said. “There needs to be capacity in the system to deal with patients like this because they are not as unusual as you might think. There will always be acute mental health patients who are disruptive to others or are a danger to others and the system needs the ability to cater for them.” It is understood up to 20 patients, who have been detained under the Mental Health Act, have been waiting Editorial in the emergency departments of Royal Perth Hospital and Sir Charles Gairdner Hospital each day for the past Welcome to our latest newsletter week or so. which is packed with what we hope are helpful articles/stories of those Staff in those emergency departments usually struggle to whose lives have been touched by manage half that number of involuntary mental health Bipolar. patients waiting for a psychiatric bed. In this edition you can read about The emergency departments at SCGH and RPH, which Tasmanian man Chris Linton who are believed to be the worst affected, had between 30 recently walked around Tasmania to and 50 patients each at times yesterday. raise awareness of bipolar disorder on p 11. Dr Gannon said a significant amount of emergency department staff’s work related to failings in the mental Mädchen Amick shares her story of health system. “To have someone there hour on hour, day raising a son with Bipolar on pp. on day is a problem for the system,” he said. 12-15. Also we have great article on how to talk to your teen about “Emergency departments are designed to triage patients, depression, suicide on pp. 17-19. sort out who can go home, who needs emergency surgery, who needs admission to the ward. Sadly we see more reported stories of cracks in our mental health “Your journey through ED should hopefully be a short system (see p. 1, pp. 5-6 & pp. 7-8). one. That’s not always the case.

Finally this year Mental Health Week “We’ve got people sitting for days at a time waiting for will run from the 2 - 10 October. involuntary beds. You can find out more details about “That’s horrible for them and it’s horrible for their families events happening here in WA (a few and it’s a massive impost on the system.” a r e s p r i n k l e d t h r o u g h t h i s newsletter) at the following website: A WA Health spokesman said wards were sometimes “temporarily reconfigured to provide appropriate http://mhw.waamh.org.au/2015- individualised care” for the benefit of patients. events/ He said 30 mental health beds would open at SCGH on If you have any stories or articles August 20 you would like to see in future newsletters please email them to:- Source: au.news.yahoo.com [email protected]

Even Keel Bipolar Support Disorder Association Inc. Page 2 e: offi[email protected] w: evenkeel.org.au East Perth Cannington p: (08) 9425 2005 76 Wittenoom St, East Perth The Leisure Plex, Cnr Wharf and Open Fri & Mon 9:30a-2:30p 10:30-11:30am, Mondays Sevenoaks St Contact: The office on 9425 2005 12-1pm, Last Sat of each month Our organisation provides Contact: The office on 9425 2005 information services and support Perth City for individuals with bipolar and related disorders (e.g. anxiety, — In recess — Mandurah d e p re s s i o n , e t c ) . We a re Contact: The office on 9425 2005 1-3p, 3rd Wed each month committed to assisting people Contact: Glenys 0418 828 387 on how to cope with the sort of Riverton for location diagnoses they receive. We MacDonald’s High Rd, Riverton provide a service to family, 6-8pm, 2nd Tues of each month Busselton friends, carers, colleagues and Lyn on 0404 022 902 Caring Friends Support Group other people that are interested in receiving information in Salvation Army Hall, 94 Kent St regard to mental illness issues. Yokine PO Box 260, Busselton 6280 We also present wellbeing C287 Macdonald St, Yokine Every Wed 10am-4pm information sessions to a variety Community Centre Individual Support 10am-12pm o f o rg a n i s at i o n s t o ra i s e 1-2pm, 3rd Sat of each month Call 9751 5866 (Wed only) awareness. Contact: Corrine on 0408 202 747 (Wednesday only) We also offer mutual support Workshop & Group Meeting 1-3pm and self-help to the community Rockingham E: [email protected] through group based services. 12-2pm, 2nd Fri of each month Groups consist of individuals Contact: Ingrid (between 8am-8pm) Inpatient Information Sessions with common experiences and on 0412 522 387 for location interests, led by people with a Sir Charles Gairdner lived experience. Some peers Joondalup Ward D20 within the organisation volunteer one to one assistance either in JOC Wellness and Recovery Fremantle person or over the phone. 1/20 Mercer Lane Alma St Centre, Ward 51 1pm, 1st & 3rd Thurs of each month Royal Perth For many people, joining a Contact: Freddie on 0439 804 061 Ward 2K support group is a major turning Graylands point in coming to terms with mental illness. It can provide Midland Frankland Centre yourself and your family with Midland Women’s Health Care Place Mimdi Park help, information and support in 4 The Avenue PaRK Mental Health Services all aspects of mental health and 10-11am, Last Sat of each month Elanora Dr emotional wellbeing. Talking to Contact: Jessica on 0439 522 140 Marian Centre others who have learned to cope Cambridge St, Wembly can give you new hope… Fremantle

The Meeting Place, 245 South Tce — In recess — Come along and try one of the support groups near you! 1-2pm, 1st Sat of each month Bentley Contact: Corrine on 0408 202 747 Mills St .

Even Keel Bipolar Support Disorder Association Inc. Page 3

How to Keep on an Even Keel

Starting at 12 pm on Tuesday 20 October 2015 The Meeting Place, 245 South Terrace, South Fremantle

This a two-hour, two-week block course about rebuilding your life after having a setback due to mental illness. Discover what YOU really want. Learn how to grow within and beyond what has happened to you.

Date Time Start Time Finish Block Course 20/10/2015 12 pm 2 pm Week One 27/10/2015 12 pm 2 pm Week Two 03/11/2015 12 pm 2 pm Week One 10/11/2015 12 pm 2 pm Week Two 17/11/2015 12 pm 2 pm Week One 24/11/2015 12 pm 2 pm Week Two 1/12/2015 12 pm 2 pm Week One 08/12/2015 12 pm 2 pm Week Two 15/12/2015 12 pm 2 pm Catch Up Day

To enrol or find out more contact Even Keel on (08) 9425 2005 Monday or Friday between 9.30 am to 2.00 pm

Otherwise Contact: Corrine Lorton – 0408 202 747 or Lee Dhepnorrarat – 0449 629 228 (Business Hours)

Cost is $20.00 for concession or $30.00 for non-concession. (This fee includes a membership to Even Keel.)

THROUGH DIFFICULTIES TO THE STARS AUTUMN 2015

Mentally ill people being not just what's said on phone or by video, misdiagnosed and wrongly sent but a face-to-face scenario. to jail, WA regional lawyer says Earlier this year, one of Mr Hunter's clients, a teenage boy accused of a violent crime, needed to be assessed before bail would be considered. But the Bunbury Children's Court heard there was no option for a mental health assessment to be carried out for a child in Bunbury. "It would be preferred for you to be assessed by a medical doctor but this court, in fact no country court, can offer that in the way we would like to," Magistrate Dianne Scaddan told the court. PHOTO: Derek Hunter says it is unfair to jail people due to a lack of mental health resources. Magistrate Scaddan said there was an option (ABC News: Roxanne Taylor) to send the boy with a hospital order to a secure ward at the Franklands Centre facility A lawyer has criticised the way mentally ill in Graylands or the Bentley Hospital. people are treated in the court system in regional Western Australia, saying some are But she said she did not want to commit him being misdiagnosed and even needlessly to a secure mental institutional with no prior sent to jail. understanding of his condition. Legal Aid lawyer Derek Hunter said errors The boy was instead remanded at Banksia were being made during mental health Hill Detention Centre, a jail for children in assessments of accused people, because Perth, where a psychiatrist could assess him they were being carried out remotely via on site. video or audio link. In a separate case at the Bunbury "The time constraints are such that in my Magistrates Court, a mentally ill accused man experience there has been inaccuracies in was forced to spend a night in jail to await information presented, which is critical that availability of a psychiatrist in Perth to carry information is as accurate and thorough as out an assessment via video link. possible," Mr Hunter said. Regional hospitals not being used, Mr Hunter said the assessments were crucial lawyer says in making bail and sentencing decisions. Mr Hunter said it was unfair to jail people "Having someone talk to them by video-link due to a lack of resources. may not produce accurate or reliable "If anyone, particularly if it's a child, is information," he said. obviously suffering or believed to be "A report from that brief interview is the one suffering a mental illness in need of that the judicial officer acts on." treatment, they should be treated in the right "It would be a more thorough and place ... and prison is clearly not the right comprehensive report taking into account place," he said.

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Under WA legislation, specific hospitals are 10 year mental health, alcohol authorised to carry out mental health and other drug services plan assessments and to admit people deemed mentally ill under hospital orders. The Western Australian Mental Health, That includes regional hospitals at Bunbury, Alcohol and Other Drug Services Plan Albany, Kalgoorlie and Broome. 2015-2025 has now been launched for consultation. But Mr Hunter said in his 10 years in Bunbury, he had not once had a client A first of its kind for Western Australia, the assessed or admitted locally. Plan sets a bold and ambitious agenda to achieve system-wide changes over the next He said while legislation allowed those ten years to help the sectors better meet the regional hospitals to be used by the judicial needs of Western Australians with mental system, it was not common practice. health, alcohol and other drug problems and Mr Hunter accused the courts of being support their families and carers. forced to gate-keep the resources at the Using evidence-based modelling and in line Frankland Centre, which has 30 secure beds with international best practice, it provides a to service the needs of WA. blueprint for the optimal quantity, location "Clearly if those beds are full and an and types of services required and sets goals assessment is ordered, that may impact on to achieve changes by 2017, 2020 and 2025. the assessment," he said. To read the Plan, factsheets and view a video Mental Health Minister Helen Morton of the launch visit mentalhealth.wa.gov.au acknowledged that court ordered mental and follow the links from the homepage. health assessments were not available across the state. "Specialist forensic mental health services "Changing Our Tune" - Music are highly specialised in court ordered Festival in Fremantle assessments and the more complex of these can take place over a number of days," she said in a statement. A free festival featuring live music, a skate "For these reasons, utilising specialist clinic and activities for young people! facilities may result in a person needing to Presented by Headspace Fremantle's Youth be transferred to Perth. Reference Group, in association with Music Feedback and the City of Fremantle. "In more straightforward cases, an assessment can be undertaken successfully Date & Time: 11am - 3pm October the 4th. utilising audio-visual equipment, or face-to- Contact Person: Tim Lorian (0407 039 129) face in a non-metropolitan location." [email protected] The Attorney-General has also been Location: Esplanade Park, Fremantle contacted for comment. Cost: Free Source: abc.net.au

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WA parliamentary report finds “If someone dies, gets really sick, I try to mental health issues higher cope by just getting by until he gets home,” she said. “Then I fall apart. I got sick for years among FIFO workforce almost every time he was home as it was the only time I could let my guard down.” IT’S 4am. It’s cold, dark, and it’s time to get up. For Jamie it’s missing out on important family events, birthdays, anniversaries, Jamie Gray crawls out of bed, gets dressed Christmases, New Years and also when and steps out of his tiny tin sleeping shed to something bad happens. begin his 12-hour day in the bleak, red dirt of Koolyanobbing, a small iron ore mining But when he is home, he loves it. site 425km east-northeast of Perth. “(When I’m home) I’m home 100 per cent of Then, when he gets home, he will shower, the time,” he told news.com.au. “I can take eat, maybe have a beer with a colleague, call and pick the kids up from school. his wife Rebecca, or on “special occasions” “I can get up to a sick kid in the middle of the Skype her and the kids if the Wi-Fi is night or I can take the wife out for a cheeky working. lunch date while the kids are at school.” It’s a routine the father-of-three repeats every The couple accept that this is the life, and day for two weeks before flying back to his feel the benefits far outweigh the negatives. home in Warnbro in Perth’s southern suburbs. There, he spends a glorious week at It is no secret the salaries for FIFO workers home where he is just a dad and a husband are considerably higher than the national who occasionally gets to take his wife out on average. a “cheeky lunch date” when the kids are at It’s the reason why about 9.3 per cent of the school. WA population endures the lifestyle. It’s not an easy life, but it is one the Grays are For the Grays, it also means Rebecca can stay content with. at home with the kids. “We made a conscious decision to get into But the long hours, basic accommodation this lifestyle as we have young kids as well as and social isolation is beginning to take its a teenager and we wanted this so that I toll, causing some workers to take their own would be able to stay home with them,” lives. Rebecca told news.com.au. WA has one of the largest FIFO workforces “But there are some drawbacks. in Australia. While the resources sector is in “We enjoy the quality time we get as a family the midst of a downturn, it has been (when he is home). But the hardest thing I estimated there are still about 60,000 people find with the FIFO lifestyle is missing my who continue to fly in and fly out for work. husband. Missing his company, his support, While the Grays consider themselves among not only with the kids but every day. When the lucky few who have the more amenable things happen like a tragedy, I find it very swing of two weeks on and one week off, hard to cope until he is able to get home.” most are stuck with a four and one.

This, Rebecca explained, meant she would It is this rostering system, coupled with other sometimes hold her emotions in until her social factors associated with the FIFO life, husband came home. that the authors of a report into a spate of

Even Keel Bipolar Support Disorder Association Inc. Page 7 THROUGH DIFFICULTIES TO THE STARS AUTUMN 2015 nine suicides among FIFO workers during a and data, rather than on anecdotal and 12-month period believe needs to change. emotive evidence”. This week, a WA parliamentary committee But the committee's chairman, Dr Graham that examined the deaths found that while it Jacobs, said this week that Mr Campbell- couldn’t confirm the nine suicides were Fraser’s response was a cop-out. directly linked to FIFO work, they did “No doubt more research needs to be done conclude the FIFO life increased a person’s but for the industry to say, ‘Well, we need to risk of mental health issues. do more research’, that’s an excuse for doing According to the report, about 30 per cent nothing,” Dr Jacobs told 6PR radio. of the FIFO workforce has mental health The committee has recommended that a issues, while the national average sits at 20 new code of practice be developed for the per cent. resources sector with strong emphasis on “Several research reports were highlighted introducing family-friendly rosters. to the committee that provide robust factual One of the biggest complaints among and reliable data on the prevalence of workers and their families are the rosters. mental illness among WA FIFO workers,” the report stated. Many big mining companies use the four weeks on, one week off roster system for “The studies also emphasise the possibility employees. of under-reporting of mental health problems among this sector of the Committee member Rob Johnson described workforce. the four on one roster as a “disaster”. “The committee is inclined to give weight to The report also recommended improving this emerging evidence.” t e l e c o m m u n i c a t i o n s s y s t e m s a t accommodation sites as well as changes to The report also recommended that improve the reporting of suicides, attempted companies and industry peak bodies suicides and deaths on mine sites, whether acknowledge that, “regardless of contested on or off shift. demographic risk factors for heightened rates of mental illness and suicide, their As for the Grays, while they haven’t studied workforce is vulnerable to suicide”. the report they too would like to see rosters made more family-friendly. “Suicide is therefore a workplace hazard,” it said. But they are also aware of the choice they made. However, not everyone agrees with this assessment. “We would love half and half. We would love it,” Rebecca said. “But there will always be a Bruce Campbell-Fraser from the mining- market for the bigger rosters. funded Chamber of Minerals and Energy insists there was “still no evidence that FIFO “Loads of people choose those rosters as employees have greater suicide rates than they want the money so it’s personal choice. other people in the population”. Don’t go to that job if you don’t like the roster.’ The chamber said FIFO remained a matter of choice for workers and urged the state Source: news.com.au government to “focus on quality research

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Shifting perceptions of strength to do so, and to speak out to try depression reach others facing the same illness. Via social media he has given a message of Depression is not conscious of class, age, reassurance to others facing similar battles: gender, job or geography. Indeed, it cuts "Even though I see myself as a private through all layers of society. person, sharing my story and experiences And yet, because of ignorance among the has been an opportunity to let others out wider public of its debilitating force on a there who are struggling know that you're person, it has acquired a destructive stigma not alone. I hope it encourages people to that separates and isolates the affected from talk about how they're feeling and break the non-affected. down the stigma of depression and anxiety.” Thankfully, with each voice that speaks out, The image of a distressed Clark, an arm with each action an organisation or around him from coach Chris Scott, after the community takes to bring this illness into the Geelong game against Collingwood, was a open, the shadows of shame associated with picture of how darkness can intrude into it are fading. even what should be the light of triumph. According to beyondblue, "On average, one Scott said last week that Clark was "proud of in six people – one in five women and one in the fact that, maybe in some small way, he's eight men – will experience depression at been able to help with the understanding of some stage of their lives. Symptoms can these sort of conditions. I think everyone in range from minor (but still disabling) through society is aware of people who are to very severe." struggling with mental health, it touches us all irrespective of who you are. And slowly It states on its website that it is estimated that the stigma that's been associated with 45 per cent of people will experience a mental health for way too long is being mental health condition – and that in any one unwound." year about 1 million Australian adults will have depression. This unravelling of the stigma surrounding depression, and mental health in general, is These are not figures from the margins of welcome. society. In recent times, the experience of one young man has thrown into stark relief Mental Health Australia says that people the troughs of depression and the possible "report that fear of stigma and discrimination paths to recovery. is a key reason for not seeking help early". Changing perceptions, it says, breaks down "I know how alone and isolated you feel, but the barriers that stigma erects. please don't hide away at war with yourself. You're not alone." For one in a gruelling physical sport such as Australian rules, to admit to a perceived These are the deeply heartfelt words of weakness, such as depression, is especially Mitch Clark, the AFL footballer who was hard. But it is a sign of a growing maturity diagnosed with depression last year. that such an admission is now seen as a sign As a member of the most scrutinised sport in of strength. As it should be. the city, and arguably the country, Clark has Sportspeople in this country at the elite level had to fight a private battle, and he has had are put on pedestals. They do not, however, to do it in the public eye. He has shown on this ascension become less human than

Even Keel Bipolar Support Disorder Association Inc. Page 9 THROUGH DIFFICULTIES TO THE STARS AUTUMN 2015 anyone else. Few could not have been moved by the opening of grief from Australian cricket captain Michael Clarke on the death of Phillip Hughes. Pippa Grange, a performance psychologist who has worked with AFL clubs, says that players like Mitch Clark who show their vulnerability were in fact a "a good demonstration of courage and strength". We agree. Depression is not shameful. It should not be borne in silence or solitude.

Source: watoday.com.au

Mental Health Week Arts Exhibition sponsored by The Samaritans

The Arts and Mental Health Network bring you its annual exhibition displaying beautiful, original and inspired artworks from people in WA. These stunning paintings are available for sale during the the two week exhibition period at the YMCA in Leederville, which attracts hundreds of people from all over Perth to view the talented artists' work. This year artists with a lived experience of mental health issues will paint on canvas to the 2015 Mental Health Week theme, 'Act- Belong-Commit'. A celebration night will be held on 9 October, featuring live music, guest speakers and your chance to put in a bid on your favourite artwork. This arts exhibition as part of Mental Health Week 2015 is proudly sponsored by Samaritans Crisis Line. Location: YMCA, Leederville WA Cost: Free

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Tasmanian man describes the "I can feel it like butterflies. I know it's inside highs and lows of living with me and I know it may get worse, and I try to persuade myself that 'here comes the bipolar disorder depression so I'd better have happy feelings' and I try to keep busy," Mr Linton said. Latrobe resident Chris Linton recently walked around Tasmania to raise awareness "It just gets a hold of you and drags you of bipolar disorder. down and no matter what you do it takes you, and then you just have to wait and hope But now that the media spotlight has left him that you're going to get through it without in the dark, he is thinking about his next self harm." challenge, while fighting off thoughts of depression. For Mr Linton, the low periods of his condition are very low, and after being in a Mr Linton was diagnosed with bipolar manic state for a long period after walking disorder early this year but before hearing it around Tasmania, Mr Linton is worried about from a doctor, he knew something was not how the next few months will play out. quite right. "It was quite a high when I finished the walk, "I knew I had the depression part of it but I there was a lot of media coverage and there wanted to get [it] labelled so that I could was a lot of people cheering me on," he said. make sense of what was going on," he said. "Now there seems to be a bit of a void, I'm While going about his everyday life, Mr not sure what to do. I have a book that I want Linton was making decisions the same as to start but the depression is in there a little most people would, just on occasions the bit, and getting started on it is a bit of a decisions would be taken to extremes. problem." "[I was] making decisions that didn't make Mr Linton has been visiting doctors and sense to other people, [and] taking actions practitioners for years, and said that finding to do things that were a bit challenging or the right doctor to suit your needs can take could endanger my life," he said. time. Mr Linton said bipolar disorder is like a "Don't give up. If you find a GP or lifelong struggle between the very good and psychiatrist or a psychologist that doesn't fit the very bad with no pattern or regularity. the character or personality that you have, "You go between being happy about you need to keep trying to look for everything and that you can achieve someone," he said. everything," he said. With an impressive resume filled out with "You feel like superman and you feel like things completed during his manic state, there's nothing that can stop you, or you looking back Mr Linton said his bipolar won't allow things to stop you; [you feel] that disorder has shaped his life and he would every challenge has a solution." not change a thing. Once the manic or high state of the disorder "Doing these things ... including walking comes to an end, then the depression will around Tasmania and meeting all these slowly creep in and take away all of the Tasmanians has made me who I am," he said. passion and energy for life. Source: abc.net.au

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Mädchen Amick, pictured here with her son, Sylvester Amick-Alexis, rose to fame on Twin Peaks (and will reprise her role for the show’s reboot). She has also appeared in Gossip Girl, Mad Men, Damages, and Californication, among other shows. (Photos: Courtesy of Mädchen Amick)

What One Star Learned From Raising a Bipolar Son

My son was diagnosed with bipolar disorder as a young adult, and I’m telling our family’s story as part of Discovery Life Channel’s Psych Week, a series of thought-provoking documentaries that shed light on a spectrum of mental illnesses. My husband and I thought we had equipped our son with all the tools needed to become a “successful” adult. He entered college with exceptional grades, had an athletic scholarship, and for a while many considered him the “golden boy.” In hindsight, there were indications that our son was battling the onset of bipolar disorder and that we, as a family, lacked the mental health knowledge to identify his symptoms.

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After four agonizing years of our son going his mania. As his parents, we struggled to through multiple hospitalizations and eight understand why he would jeopardize his rehab centers, he has finally found the right scholarship and academic career after balance: He’s been properly diagnosed, he’s having worked so hard for them. What we med-compliant, and he has a good support later found out, and not until we were in the system. Now, that he’s working hard to get throes of his hospitalizations and treatment his life back on track, I’m able to look back programs, was the impact of the biochemical and reflect on the things I wish I had known imbalance that occurs with his illness. In earlier on. most cases, the onset of a mental illness first shows itself from the teenage years up to the Beware of Misdiagnosed Learning mid-20s. I want other parents to know that Disorders while it may seem “normal” for college kids At one point, high school counselors called to experiment with drugs and alcohol and us in for a family meeting because of push boundaries, sometimes there are concerns that our son might have Attention deeper issues, and kids might be self- Deficit Hyperactivity Disorder (ADHD). At the medicating in order to attempt to gain time, we considered this hysteria and control of their feelings. overdiagnosing. Therefore, we took our time, Finding the Right Treatment Facility did some research, spoke with other professionals, and as a family decided to not We have yet to find a true “dual-diagnosis: medicate but to closely watch his symptoms. substance abuse and mental illness” facility. This was the right decision for us. We have Tough love from family and friends for since learned that medications to treat people who are struggling with addiction ADHD or depression can trigger the early can be important in motivating them to seek onset of a psychotic episode (if one has an sobriety. However, when someone is having underlying mental illness). I point this out not a mental episode (mania or depression), a to discount the legitimacy of learning different approach may be needed. People disorders but merely to encourage families who are in the swing of a psychotic episode to educate themselves about mental health. I are experiencing delusional thinking worry that when educational counselors and because the biochemicals in their brain teachers call in families with concerns about aren’t allowing them to think rationally. It can a child having a learning disability, we aren’t be so confusing when you’re dealing with always looking at the complete picture. In two separate illnesses at the same time, as the same way that our school system feels we were in our son’s case, since his disorder strongly about requiring vaccinations and initially presented itself as addiction. The annual physicals, I feel strongly that it is behavior of a person who is intoxicated and essential to add a mental health component a person having an episode can appear to that annual physical. similar, but this is when family or friends who are familiar with the person’s “baseline” need Watch for Signs of Self-Medicating to intervene and make sure their loved one In college our son began to derail from his gets immediate medical attention. goals because of excessive partying. At the Unfortunately, so far, our medical field has time, we didn’t realize he was actually self- divided treatment for addiction and mental medicating the onset of a mental illness. Our illness, and quite frankly, there is very little son was unknowingly using alcohol to battle funding for the mental health side. This has severe depression and marijuana to counter created a situation in which the money lies in

Even Keel Bipolar Support Disorder Association Inc. Page 13 THROUGH DIFFICULTIES TO THE STARS AUTUMN 2015 addiction treatment and the facilities can get for his or her struggle. The latest research additional funding if they meet the “dual proves that the five major mental illnesses — diagnosis” standard, which is very low. This depression, bipolar disorder, ADHD, means the responsibility to seek out the schizophrenia, and autism — are genetically appropriate treatment center lies in your based. It just happens to affect the brain hands! Do your research to make sure that instead of another organ. Be sure to keep a the facility is primarily a mental health calm attitude and an attentive approach to treatment center. Be prepared to appeal to your loved one’s needs. You are going to your insurance company and fight for an have to learn to separate your loved one’s adequate facility. rational thinking from their biochemically induced delusional thinking. Remember that Trial and Error even though people in the medical One in four people will be affected by a profession have good intentions, they don’t mental illness in the course of their lifetime. know your loved one the way you do. Family, The biggest advice I can give loved ones friends, and significant others are the ones who are supporting someone navigating a who know his or her baseline. This is an newly diagnosed mental illness is: patience, essential key to the doctors’ ability to patience, and patience. It can take up to a evaluate what medications and/or therapies year for the brain to recover from the are working. It is imperative to establish neurological damage of a single manic or routines, and it is just as important to avoid depressive episode, so prevention of triggers. multiple episodes is crucial. Medical The Importance of Healthy Living professionals will need to evaluate your loved one for an extended period of time in As parents, we knew that sleep and exercise order to give proper diagnoses. It will then were essential to our family’s health, but we take some frustrating trials and errors to find didn’t necessarily know how important they a successful combination of medications and were to preventing mood swings. In some psychotherapy. Once a balance of people, like our son, not getting enough medication, therapy, and healthy living has sleep can trigger mania. In fact, if you notice been achieved, the work begins. Setting up a your loved one getting less and less sleep, support system, being “med-compliant,” and it’s a strong indication they may be entering ongoing communication with a psychiatrist is a manic phase. On the other end of the essential. Also, remember that as the spectrum, regular exercise has proven to biochemicals in the body naturally change, combat our son’s depression. We also knew t h e m e d i c at i o n s m a y a l s o re q u i re that a good diet was needed for our bodies’ adjustment. As much as I wish there were overall health, but like most people, we some magic pill to make it all go away, there didn’t necessarily know the importance of just isn’t. This is a lifestyle adjustment for the eating specific “brain-healthy” foods. We whole family, and the sooner you can accept raised our kids with a focus on balance, that, the sooner you and your loved one will structure, and routine, and even though we heal and begin to flourish. were sometimes accused of being the “strictest parents in town” by our children, we Stay the Course have since learned that these are key When someone is diagnosed with an illness elements in not only the recovery from like cancer, heart disease, Alzheimer’s, or addiction but also maintaining mental Parkinson’s, we immediately feel compassion stability.

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In closing, I feel that the media can tend to and effort, but it’s vital in order to maintain a sensationalize and only report the very healthy relationship where you can support dramatic and tragic events surrounding your loved one without letting their illness mental illness. I choose to focus on the many, affect your own life. Here are some tips for many success stories. It is possible and very living with someone with bipolar disorder: common to overcome and manage a mental 1. Do your research. Having bipolar disorder illness. There isn’t any one type of person can be an extremely lonely experience. It’s that it can affect; it doesn’t discriminate. You easy to feel like no one understands what would be shocked at how many extremely you are going through. That often makes successful individuals are not “suffering depressive phases worse. Learn as much as from” but “living with” a disorder. Although, you can about bipolar disorder so that you it is important to accept a diagnosis and understand what they’re going through. In work toward recovery, a label alone doesn’t turn, they’ll feel like they’ve got someone on define anyone. I hope to be joined by many their side. others to work together to erase the stigma around mental illness and have an open and 2. Take note of their symptoms. See if you brave conversation about how important can work out their cycle. While some people mental health is for everyone! with bipolar disorder may have up and down periods that come in waves just once every 10 Tips for Living with a Bipolar couple of years, others may have a Person continuous cycle from one to the other. Keep an eye on it and you should be able to Living with bipolar disorder can be predict their behavioral patterns. extremely challenging, but living with 3. Listen carefully. It’s really important to someone who has bipolar disorder can also listen to what someone with bipolar disorder have its difficulties. Growing up I lived with has to say. When they’re in a depressed my mother and grandfather, both of whom state, you may find it difficult to understand had bipolar disorder. For years they hid it why they’re so sad. The best thing you can from me, I suppose hoping I would never do is to listen. If you struggle to understand find out. But sooner or later it all came to the what they’re feeling, ask them to explain it to surface and everything started to make you. Your interest in what they’re going sense. through may help make them feel better. Finding out about their illnesses was 4. Watch out for the mania. Bipolar disorder possibly the best thing that could have involves both depression and mania. While happened in that circumstance. Living with symptoms of depression are usually quite people who have bipolar disorder and not similar, levels of mania can vary from person even knowing about it can cause a lot of to person. A manic period can be friction. It’s easy to jump to conclusions surprisingly difficult to deal with. Someone in about their behavior. the midst of mania can be extremely After taking the time to do some research on enthused and not always aware that their bipolar disorder, I began learning how to illness is the cause. All-nighters on the deal with it myself. At first I made lots of computer and elaborate ideas are all part of mistakes and it made my life a lot harder the parcel. Try not to judge or reason with than it needed to be. Learning how to them. If you want to try to calm them, it’s best support and live in harmony with a person not to draw attention to their behavior, but with bipolar disorder isn’t easy. It takes time

Even Keel Bipolar Support Disorder Association Inc. Page 15 THROUGH DIFFICULTIES TO THE STARS AUTUMN 2015 rather distract them from it with an activity 9. Find your own support. Living with a that you can do together. person with bipolar disorder can be difficult. Find someone you can talk to and vent your 5. Ask how you can help. There may be problems to. A professional counselor can instances where someone with bipolar help. disorder can’t look after their children or take care of things at work. Ask if you can help. It 10. Give yourself a break. Know when could be something as simple as cooking enough is enough. While your support will dinner. mean the world to your loved one, you must know where your limits lie. Being around 6. Don’t judge. Bipolar disorder is not their illness all the time can take its toll on something you can just switch on and off. you. Keep your own needs in mind as much Don’t be pushy. as possible. 7. Encourage them to take their medication. Source: psychcentral.com Because bipolar disorder comes and goes in waves, it’s easy for those with it to feel that they don’t need their medication. While it may make them feel better in the short run, they will probably soon nosedive into severe mania or depression. 8. Talk to them about your feelings, too. While it’s important to listen to what they have to say, it’s also important to tell the person with bipolar disorder how you feel. They need to know how their illness is affecting you just as much as you need to know how it is affecting them.

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How to talk to your teen about listen,” says Constantinides. “It says a lot depression, suicide about the strength of the relationship between the parent and child that they feel like they can talk to them in the first place. The statistics on teen suicide are incredibly Listening without judgement creates an sobering. According to the CDC, an average opportunity to learn more about what’s of 8 percent of American teens will attempt going on. We tend to think as listening as suicide every year. It’s the second leading being a passive action. However, truly cause of death for children and youths aged listening to a person is an act of validating 10 to 24. In fact, more teenagers die each their experience and feelings.” year from suicide than from cancer, heart disease, AIDS, birth defects, pneumonia and Try not to freak out. “The first time a teen influenza combined. And yet the stigma says something to a parent it is in some ways surrounding suicide in particular and mental a test to determine what their parent can health in general is so huge that these issues ‘handle,’ ” says Constantinides. Hearing that rarely get the coverage they deserve, a fact your child is thinking about killing that can lead parents of youth struggling themselves is scary, and it’s hard for parents with mental health crises feeling like they not to let their own feelings take over when have little in the way of support or resources. their child discloses that they are suicidal. Unfortunately, reacting in a way that How should parents react if their teen overwhelms your child could scare them into discloses that they are suicidal? In what ways silence, which makes figuring out how to can parents reassure their kids that they are help them even more challenging taking them seriously? What can parents do to manage their own feelings about the So how should parents react? situation without adding to their child’s “Staying calm, listening, asking questions, distress? taking them seriously, affirming their feelings D r . D a m o n C o n s t a n t i n i d e s , a (saying, for example, ‘Yes, that must feel psychotherapist at Relationship and Sex terrible’) are all ways to let a teen know that Therapy Associates in Philadelphia, who their parent that can handle talking about specializes in anxiety, identity and sexuality, hard things,” says Constantinides. “Thinking offers some advice for parents whose about [discussions like this] ahead of time teenagers who are experiencing suicidal and making hard conversations a regular feelings. part of parent/teen communication will make it easier to navigate if the teen does talk Actively listen to your child and validate about suicide.” what they feel. Having your child recognize that you are hearing and understanding what Ask your child clarifying questions to get a they’re telling you is incredibly important. better idea of what the situation is. Says You can practice active listening by using Constantinides, “When someone comes to body language that shows you’re paying us with a problem, we often want to tell them attention, occasionally summarizing the how to solve it. But you have to know what speaker’s comments, and asking questions the problem is first. What do you mean when to clarify points. you say suicide? How often do you feel this way? Suicidality is scary because saying that “When a teenager or child talks to a parent you want to kill yourself can mean so many about mental health concerns or thoughts things – for example it can be a way to about suicide the best thing to do is to

Even Keel Bipolar Support Disorder Association Inc. Page 17 THROUGH DIFFICULTIES TO THE STARS AUTUMN 2015 explain how bad things feel, it can be a way Know the risk factors. There are a lot of to talk about needing something you’re not variables that can increase the risk that a getting, it can be a way to saying you don’t teen will attempt suicide, such as race, want to feel anything, or it could mean that sexuality, gender identity, and socio- you’ve already planned how to take your life. e c o n o m i c c l a s s . B u t a c c o rd i n g t o Thoughts about suicide should always be Constantinides, the top thing that puts teens taken seriously.” at higher risk for attempting suicide is not having the support of their parents. “A Let your teen have plenty of input on what teenager’s job is to push against their their treatment plan looks like. “Teenagers parents, and the job of a parent of a should have as much input in an action plan teenager is to hold tight and be present,” he as possible,” advises Constantinides. “When says. “It’s not an easy dance.” He adds that we’re teenagers we stand at a crossroads of other risk factors include “lack of friends and having no actual control of our lives and community (often due to bullying), access to wanting nothing more than to have control means, and other mental health issues such of our lives. This is normal adolescent as depression and anxiety. I always assess to development. A teen is more likely to follow see if the teen has a plan and if they have a plan if they helped make it. Not only access to acting out that plan. Those two because it’s more likely to meet their needs if things tell me a lot about how that teen is they participated, but also because they own thinking about suicide.” it, it’s theirs.” Know the warning signs. Hormonal changes Figure out a communication system that m e a n t h a t a d o l e s c e n c e i s o f t e n works for you. Once you, your teen and your accompanied by mood swings and a certain family doctor have figured out a treatment amount of sullen, withdrawn behavior. How plan, make sure that you have a workable can parents differentiate between normal way to exchange information about it. Some teen moodiness and signs of something teens will be fine with talking, whereas more? Says Constantinides, “One thing to others will find that idea overwhelming. look for is, does your child still enjoying the Remember that communication can happen things that they used to enjoy? Or, are there in lots of different ways; it may take a few any things your child enjoys? Apathy and tries before you discover what works for your hopelessness are two signs of depression.” family. “If talking is too hard, what is another way that you can communicate? I’ve worked Know what to ask. This can be tricky, with youth who have thoughts of suicide and because asking the wrong questions can don’t like talking to their parents, so they shut down the discussion entirely. Parents come up with a plan. This might be a code need to find a balance between making sure word, or writing it down on a marker board their child is safe and not making them feel in the kitchen. And when the teen does as if they’re being interrogated. communicate in this alternative way, what’s “Parents can ask about their child’s feelings, the plan? Is it that they need to email their although not all teens can clearly identify or therapist? Or schedule a visit? Having a talk about their feelings. Parents can also therapist that the teen likes can be a way to point out things about the child’s behavior help them find other coping skills for dealing that are different and say that they’re with stress, depression, or anxiety. It’s concerned,” he says. “Long before parents important that it’s someone that the parent are having these conversations with their and teen like.” teen they can be setting the groundwork for

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them. If parents and teens talk often about any rules, what they need most is boundaries feelings, values, and ideas then having a and stability. Parents get to be the safe, conversation about mental health is a natural affirming and accepting place that teens extension.” come home to after they’ve tried something new and different.” He adds that parents shouldn’t be concerned that serious talks about mental Find support for yourself. You need to be health will somehow suggest suicide to safe and healthy in order to help your child, teens. “Adults are often worried that if they so self-care should be a priority. Try to figure talk about suicide it will put the idea into out a support network of friends and family their kid’s head. This just isn’t how it works. If who can step in and take over when you you can talk openly and honestly about need a break. Not only will this be helpful to suicide with your child then they know that you, but your teen will almost certainly you’re not going to freak out if they come to appreciate having someone to talk to who’s you about it.” not their parent. Be a safe place for your teenager. This is a “Hearing that someone we love, especially a parent’s most important job, one that child, is struggling in a way that we can’t help becomes even more crucial (not to mention can be terrifying,” Constantinides says. challenging) when kids become teenagers. “Parents need to make sure that they have Even as teens break rules and push their own places to get support. Having a boundaries, what they need to know most of friend or family member that you can freak all is that their parents will love them no out to allows you to be able to concentrate matter what they do or who they are. on your child and what’s going on for them.” “Being a teenager is both exciting and Anne Thériault is a Toronto-based writer and terrifying, teens are figuring out who they are cat enthusiast who blogs about feminism, and how they feel about everything in the mental health, and parenting. You can follow world, including their parents,” says her on twitter at @anne_theriault or her blog Constantinides. “And although teens feel like at The Belle Jar. they want to be on their own and not have Source: washingtonpost.com

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Feeling Bipolar Disorder In Your nerves and basically runs the show as far as Gut digesting your food. However, it does more than direct your digestive tract to take your cheeseburger from mouth to toilet. In fact, Despite the way we’re taught in school, the multiple neurotransmitters associated with body doesn’t think of itself as divided up into mental health are generated by the micro- systems. It doesn’t realize it has a nervous biome in the gut. system and an endocrine system, a respiratory system and a digestive system. Selective serotonin re-uptake inhibitors, There is really only one system that has to anyone? If this type of medication sounds work together to keep you alive. So it’s familiar, then you know the importance of unsurprising that psychological illness can what these neurotransmitters do. Since over be related to, or co-morbid with physical 50% of bipolar sufferers are also diagnosed disorders that might not seem relevant at with at least one anxiety disorder, many of us first-glance. In fact, the “digestive system” rely on SSRI’s in addition to any mood has an enormous effect on the brain and stabilizers or antipsychotic medications in vice-versa. Familiar with the term “hangry”? order to function with bipolar disorder. So it Well, there’s a reason that being hungry stands to reason that if this link is disrupted makes you angry at everything else. It’s all in a way that affects mood, we might be a entangled. link to gastrointestinal disorders as well. I happen to be unfortunate enough to have a g a s t r o i n t e s t i n a l d i s o r d e r c a l l e d gastroparesis. It’s pretty much what it sounds like. There is nerve damage that causes the muscles in my stomach to either function very slowly or seize according to their pleasure. It causes nausea, vomiting, fatigue, and pain. It also does not help my depression. I was surprised, though, when my doctor prescribed gabapentin to help treat the disorder. Gabapentin is also a mood-stabilizing anticonvulsant and is used in treating bipolar disorder. So, wait. The same drug I’m using for my stomach can also work on my bipolar disorder? Pretty much. Mine is far from the only example of gut/ psychological disorder comorbidity. Gastritis, and gastroesophageal reflux There’s another system in the body that you disease have also been associated with may not have heard of that describes this mental illness. In these disorders, mucosa link. It’s called the “enteric nervous system.” (the slimy tissue) in the digestive tract tends Basically, a brain for your gut. This nervous to produce a higher inflammatory response. system is a subset of the central nervous Now, inflammation is a good thing. It’s part system. It’s connected to the brain in your of our immune response to infection and head via nerves like the vagus and pelvic disease, but in cases of chronic stress and

Even Keel Bipolar Support Disorder Association Inc. Page 20 THROUGH DIFFICULTIES TO THE STARS AUTUMN 2015 illness, like chronic gastritis and GERD, it discuss what you’re going through and how keepsthe body in that stress response. That to deal with it can do a whole lot more. It bodily stress response can eventually roll helps to regulate the emotional/mental part over into mental stress response, anxiety, of the illness, rather than just treating the and depression. symptoms. It’s not just the upper GI tract that takes part It goes back to the example I gave of my in this cycle. The lower GI tract can have just particular problem. It’s all intertwined, so you as much of an impact on health, both mental may find help where you least expect it. I and physical. Certain antibodies present in think it’s great that the therapies I use for my higher levels in bipolar patients are also bipolar disorder can help my gut out too, known to be higher in those with Crohn’s and the other way around. It’s all in the same Disease. Patients with bipolar disorder may body, and we’re all just trying to do the best also have an increased risk for gluten we can. sensitivity and celiac disease. Now, I know Edit: Clarification on use of SSRI’s: SSRI’s are not that the gluten-free movement has been recognized for use in treatment of bipolar taking hold and is almost now considered as disorder, but are often used for co-morbid anxiety trendy as hula hoops and just as useful, but, disorders. it is real and millions of people do suffer Source: blogs.psychcentral.com from these disorders. Now, it turns out, people with mental illnesses like bipolar Ed: Also see “Study shows anxiety may be caused disorder and schizophrenia may be at by the gut” (http://www.foodrenegade.com/ greater risk than the population-at-large. study-shows-anxiety-may-be-caused-by-gut/) Remember the immune response I “To confirm that bacteria can influence behaviour, mentioned earlier? That plays a role here the researchers colonized germ-free mice with too. Gluten contains the protein gliadin. bacteria taken from mice with a different When patients with bipolar disorder are behavioural pattern. They found that when germ- exposed to gliadin, there is an increased free mice with a genetic background associated immune response when compared with the with passive behaviour were colonized with general population. This response is similar bacteria from mice with higher exploratory to the response seen in celiac disease. behaviour, they became more active and daring. Similarly, normally active mice became more More research is needed to get to the passive after receiving bacteria from mice whose bottom of the chicken and egg problem that genetic background is associated with passive bipolar disorder and GI illnesses present. behaviour. Hopefully the studies will lead to better answers in both areas. In the meantime, a fun While previous research has focused on the role bacteria play in brain development early in life, fact: Collins said this latest research indicates that Not only can you see a therapist for your while many factors determine behaviour, the bipolar disorder, but it may help with a GI nature and stability of bacteria in the gut appear disorder as well. When you go to a doctor to influence behaviour and any disruption, from and are diagnosed with any type of disorder, antibiotics or infection, might produce changes you’re likely to be handed gobs of in behaviour. pamphlets and directions to information on Bercik said that these results lay the foundation the web to learn all about your new-found for investigating the therapeutic potential of friend. Knowing what you’re facing can probiotic bacteria and their products in the absolutely help, but seeing a therapist to treatment of behavioural disorders. “

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Researchers work to understand standpoint,” says Mark Frye, chairman of the difference between bipolar psychiatry at the Mayo Clinic in Rochester, Minn. “That’s why clinicians still reach for disorder and regular depression those antidepressants.”

Distinguishing between regular depression Fran O’Loughlin, 48, of Green Bay, Wis., says and bipolar disorder is one of the toughest she has had bouts of depression since high calls psychiatrists face. The symptoms are school and was finally diagnosed with often similar, but medications that ease bipolar disorder about five years ago. She depression can make bipolar patients worse has been on more than a dozen medications by triggering manic episodes. that provided relief only temporarily, often making her feel manic and then crash even The dilemma is fueling new research efforts lower. One such episode last year left her to understand how the two conditions differ hospitalized for seven days. and how to predict which patients will respond to which drugs. Scientists at the Mayo Clinic, which treats some 3,000 patients a year with bipolar disorder, are HOW DEPRESSIONS COMPARE collecting DNA samples, blood tests, brain Distinguishing bipolar disorder from regular scans and clinical information in hopes of depression could lead to earlier diagnosis and identifying genetic risk factors, or better therapy for bipolar patients. Some biomarkers, that can lead to earlier differences: diagnoses and individualized treatments. LIFETIME PREVALENCE (ALL FORMS): Researchers at the University of Pittsburgh Medical Center and elsewhere are using Bipolar disorder: 4% of U.S. adults; Depression: 17%. neuro-imaging studies to understand how depression differs in the brains of patients AVERAGE AGE OF ONSET: with and without bipolar disorder. Bipolar: 25; Depression: 32.

Depression in bipolar disorder can look very SYMPTOMS: much like regular depression, known as unipolar depression. Patients might feel Bipolar: Periods of sadness, similar to depression, hopeless, sluggish, irritable and have with bouts of racing thoughts, extreme energy, risky behaviors thoughts of suicide. The manic side of Depression: Sadness, hopelessness, irritability, bipolar disorder includes periods of frenzied fatigue, weight and appetite change, thoughts of energy; racing, irrational thoughts and suicide. sometimes dangerous behavior. These might not appear for years, or patients might not TREATMENTS: recognize the symptoms, leading to delayed Bipolar: Mood stabilizers, anticonvulsants, diagnoses. antipsychotics, antidepressants, psychotherapy; Depression: Antidepressants, including SSRIs, Even when patients are diagnosed with S N R I s a n d t r i c y c l i c s ; p s y c h o t h e r a p y ; bipolar disorder, as many as 50% of them are electroconvulsive therapy. treated with antidepressants, studies of medical practice patterns show. Source: National Institute of Mental Health “We don’t have a lot of treatment options for the depression phase of bipolar disorder, which is very troubling from a public-health

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to 25% of patients, more often in young people than adults. Some studies suggest that antidepressants can increase the instability of those mood-regulating chemicals, creating more up-and-down cycles. “Essentially, they are the worst thing you can take for the illness,” says Nassir Ghaemi, head of the mood disorders clinic at Tufts University and co-director of a long running study of “My doctor and I have both been very aware treatments for bipolar disorder funded by and very cautious about introducing an the National Institute of Mental Health. antidepressant into the mix. I just can’t find happiness and we keep hoping the Concerns that antidepressants might spark antidepressants will bring that to me,” Ms. manic episodes were first raised in the 1960s O’Loughlin says. with the use of tricyclic antidepressants. Newer depression medications such as The incidence of bipolar disorder—formerly bupropion (Wellbutrin) and selective known as manic depression—has risen serotonin re-uptake inhibitors, such as steeply in the past 20 years to an estimated fluoxetine (Prozac) and sertraline (Zoloft), 4% of the U.S. population. That is due in part seem to pose less of a risk of mood shifting. to rising awareness and a broadening definition. (Bipolar I involves at least one Mood stabilizers such as lithium are usually episode of mania lasting seven days or the first medications clinicians prescribe more; bipolar II is less severe, with significant when bipolar disorder is diagnosed. depression but milder “hypomanic” Anticonvulsant drugs such as lamotrigine episodes that don’t necessarily interfere with (Lamictal) or antipsychotic drugs such as daily functioning.) Some experts say the olanzapine (Zyprexa), quetiapine (Seroquel) sharply expanding use of antidepressants— and lurasidone (Latuda) can also help slow up 400% since 1988, according to racing thoughts. But most of those drugs government surveys—may also have have significant side effects and are only triggered some cases of bipolar disorder. marginally effective at controlling depressive symptoms. So some psychiatrists say they Scientists aren’t sure how antidepressants cautiously add antidepressants as well. can bring on a manic episode, called mood- switching, in some bipolar patients. The “I’ve had patients with bipolar disorder who disorder is believed to involve dysfunction in get well and stay well on a single mood neurotransmitters, the chemical messengers stabilizer. But if the depression is not lifting, in the brain. Many antidepressants target sometimes you try an antidepressant as those same neurotransmitters, and may well,” says Milena Smith, a psychiatrist in overcompensate, some experts suggest. Annapolis, Md., who teaches at Johns Studies show mood-switching occurs in 10% Hopkins University School of Medicine.

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“Clearly some people with bipolar disorder anterior cingulate gyrus—involved in do better with a combination of a mood decision-making, empathy, impulse control stabilizer and an antidepressant, and we and emotion—than people with unipolar don’t know in advance who those will be,” depression. Dr. Phillips and colleagues were she says. able to identify, with about 80% accuracy, which patients had which form of depression Recommendations issued in 2013 by the by looking at their brain images. That raises nonprofit International Society for Bipolar the prospect brain scans could someday Disorders say that for patients with a history help with diagnosing. of mania or hypomania, antidepressants should be prescribed only in conjunction Therese Borchard says her bipolar disorder with mood-stabilizing medications, and involves far more depression than mania. “I discontinued if patients show signs of mania love being manic, to a certain extent. You or increased agitation. feel alive-but then you crash afterward,” says Ms. Borchard, who founded an online But patients may not remember manic community called Project Beyond Blue for episodes. “Memories seem to be laid down people with intractable depression. She has differently during manic or hypomanic been on a shifting combination of mood episodes,” says Dr. Smith. She says she often stabilizers and antidepressants. “What’s asks friends or family members if a patient difficult is finding the right amount so you she is evaluating has had periods of rapid are lifted from the depression but don’t have energy or decreased need for sleep. cycles of mania,” says Ms. Borchard, who also Mayo Clinic scientists earlier this year writes the “Sanity Break” column for identified a gene variation that may protect EveryDayHealth.com. bipolar patients from developing manic Ms. Borchard, 44, of Annapolis, Md., symptoms while taking antidepressants such recommends some lifestyle steps to help as Prozac. “Our hope is that further studies keep people with bipolar disorder on an like that can help clinicians understand for even keel. Among them: A vigorous aerobic which bipolar patients antidepressants might workout for 45 minutes, at least three times a be helpful, not helpful or even harmful,” Dr. week, can keep runaway thoughts and Frye says. emotions in check. And getting at least eight At the University of Pittsburgh Medical hours of sleep at regular time is critical, she Center, psychiatrist Mary Phillips and finds. “Mania feeds on insomnia,” she says. colleagues have observed that the brain’s Dr. Smith also suggests patients track their prefrontal cortex, which regulates thoughts moods regularly in a journal or software and behavior, communicates differently with program to help discover what triggers the amygdala, the center of emotions, in emotional shifts. An app called Mood 24/7, bipolar depression, unipolar depression or a developed at Johns Hopkins University, healthy state. The patients’ brains “may look sends users a text every day asking them to the same, but they are not functioning in the rate their mood from 1 to 10 and then tracks same way,” says Dr. Phillips, who is director it on a graph that patients and their of the Mood and Brain Lab at the UPMC therapists can evaluate. Western Psychiatric Institute and Clinic. In another study, they found patients with bipolar disorder had less blood flow to a region of the prefrontal cortex called the

Even Keel Bipolar Support Disorder Association Inc. Page 24 Please Come And Join Us For A Chat, Cuppa And A Muffin Caffisimo 30 Fielder Street, East Perth Friday 9 October 2015 at 10 am Cost : $6.50

This Is A Wonderful Opportunity To Celebrate Mental Health Week With The Staff And Other Members Of Even Keel. RSVP: Corrine or Tanya Phone 9425 2005 by Friday 2 October

We hope you can make it ! .

Monday 5 October 2015 10.30 am 76 Wittenoom Street EAST PERTH

RSVP: Corrine or Tanya Phone 9425 2005 by 12 pm on Wednesday 30 September 2015 Even Keel Busselton Even Keel Membership Form Support Association Caring Friends Support Group Type of Membership Requested: (08) 9425 2005 Salvation Army Hall, 94 Kent Street Busselton PO Box 260, Busselton 6280  Concession $ 10.00 76 Wittenoom Street Every Wednesday 10am-4pm. EAST PERTH WA 6004 Individual support 10am-12pm  Full Member $ 20.00 Office Open Friday and Monday Workshops and Group Meeting 1-3pm  9.30 am to 2.30 pm Office (Wednesday only): 9751 5866 Corporate Member $ 50.00 We meet at: Email: [email protected]  Donation Made: $ _____ Riverton McDonalds High Rd Riverton Inpatient Information Sessions: TOTAL PAID $ _____ 6-8pm, 2nd Tues of each month Sir Charles Gairdner Hospital Method of Payment: Contact: Lyn 0404 022 902 (after hours) Ward D20 Fremantle Hospital  Cheque Yokine Alma St Centre, Ward 5.1  EFT—Direct Deposit Yokine Community Centre Royal Perth Hospital  Cash 287 McDonald Street, Yokine Ward 2K 1-2pm, 3rd Saturday of each month Bentley Hospital  Invoice Me—Corporate Only Contact: Corrine 0408 202 747 Mills Street Graylands Hospital All Donations Over $2.00 Are Tax Deductible. Rockingham Frankland Centre Contact: Ingrid 0412 522 387 Mimidi Park EFT Details : BSB: 306-041 Account: 0606892 for Location, Day and Time PaRK Mental Health Service, Elanora Dve Name: Marian Centre Joondalup Cambridge Street, Wembley ______JOC Wellness & Recovery 1/20 Mercer Lane, Joondalup We aim to: Address: 1pm, 1st and 3rd Thursday of each month ______Contact: Freddie 0439 804 061  Provide understanding, awareness and ed- ucation for people diagnosed with a Email: Cannington mental illness, their family/friends/carers, The Leisure Plex, cnr Wharf & with a focus on mental health and ______Sevenoaks Sts, Cannington emotional wellbeing. Telephone Number: 12pm to 1pm, last Saturday of each month Contact: Corrine 0408 202 747  To promote awareness in the community ______in order to increase understanding and Midland assist with the elimination of stigma. Midland Women’s Health Care Place 4 The Avenue. Midland  To provide an information centre that is Carer or Friend’s Name: 10-11am, last Saturday of the month full of literature obtained from national ______Contact Jessica on 0439 522 140 and international sources. Can we contact this person in case of emergency? Mandurah 1pm-3pm, 3rd Wednesday of each month Membership Includes: Yes / No (Please circle) Contact: Glenys 0418 828 387 for Location. Quarterly Newsletter. Phone: Fremantle Access to library resources ______The Meeting Place, and borrowing facility. 245 South Tce, South Fremantle Email: 1-2pm, First Saturday of each month Contact: Lee 0449 629 228 ______