Nostalgia

This morning started out as any usual one--coffee, feed dogs/bunny, check e-mail, check facebook, debate on things to do today, figure out some semblance of a schedule, eat breakfast, etc. All the day's normal. Then, out of the blue, I received this in one of my e-mail boxes:

Hello Tiptoe, I wanted to thank you for the MOST beautiful card and note...Are you training dogs?Give a call if you come to the area!LOVE, CS

I left one sentence out for privacy reasons, but just this note alone made me surprised, happy, and weepy. So, who was this person? This was my first therapist, CS (this is different from C. my former therapist, whom I have talked about before in this blog) from when I was 16 years old. I saw her from that time up until I left for college. We've kept in touch off and on for the last 15 years. It helps that my mom lives in the same city, and at one point, the psychiatrist my mom saw was in the same building as CS's. I used to feel very awkward about this close proximity, but as time has passed, it no longer matters to me.

CS has always held a very special place in my heart. Besides the fact that she was my first therapist (she specialized in eating disorders and substance abuse), I think I was one of her early clients as well. I think part of why I have always held a deep fondness for her was, because I shared quite a lot with her than I had anyone else, and she did more things for me that probably nowadays many therapist would not do for keeping a strict patient/therapist boundary. For example, (and this was many years ago), but she came to my house when I cancelled my appt., saying I did not feel well when really, I had od'ed on a bunch of pills. Yeah, I'm not too proud of that moment. She called my mom, went to the hospital, and all the rest is history. Then, she once came when I was in a psych ward for adolescents, though she did tell them I had and ED and needed to be monitored. I was not in there for an ED at that time--more depression, suicidal tendencies. The only regret I had with her was that she did not push further for me to go into a higher level of care, (of course I was in denial about this at the time) something I think now could have turned me around faster, than oh 10 years later when I finally decided to actually truly try to recover.

Anyway, this brought back some nostalgia as I had not heard from her in a long time. I usually send holiday cards and try to touch base when I'm visiting my mom, but that is typically rare, more for logistical reasons than not enjoying the visits. In the early days, like 2-3 years after I stopped seeing her, occasionally, I'd get a surprise card from her. And it always touched me in the fact that she remembered me. But as time has gone by, and we've both moved on with our lives, we've also lost touch a bit, except for my holiday cards. This is actually the first time in years that I know her e-mail address! I don't think that was intentional, but I always tried to be respectful of therapists who did not want to have e-mail contact. Now, if I was seeing one, it would likely be one of my first questions to ask just so I'd know and not always be wondering.

Besides the fact that this post made me nostalgic and kind of weepy, I think it reminds me of the impact people make on our lives. All the long-term therapists I've had over the years have in one way or another made a difference to me. I've been fortunate that I haven't had to go through a slew of them to find ones that I connected with, whether that was as a therapist or other professional. And for that, I'm always thankful. This isn't to say that these are the only ones who have made impacts on my life, these are just people who I've shared much more of my personal life with.  And for that I'm really thankful they were there at that specific time in my life.  I just hope too that in my chosen profession I can make that much of a difference as well.

Do you have therapists that have made strong impacts on your life?  Do you keep in touch with them through letters, e-mails, etc.?

The pitfalls of psychiatry

Earlier in the week, I heard a snippet on NPR's Fresh Air about the pitfalls of psychiatry. Dave Davies who filled in for host Terry Gross interviewed Dr. Daniel Carlat, psychiatrist and author of the new book Unhinged: the trouble with psychiatry.

Dr. Carlat touched on a number of different topics, but the one that has always troubled me was that so many psychiatrists typically do not do any counseling at all. Instead, it's literally a 15-20 minute med check where only questions of whether you had any side effects are asked, a decision of med adjustment is made, and then you are on your way. There are never questions of what is going on in your life, how you are truly feeling, etc., because that is left up to the therapist whom hopefully you are also seeing.

Now, I know this is not always the case, and there are psychiatrists who also counsel, but in reality, the number is few and far between. (1 in 10 or a measly 11 % is cited in his new book based on a Columbia University survey who give counseling to all their patients) I think psychiatrists are missing out a lot in not looking at the whole patient. They miss that the patient may be drinking alcohol while also taking a sleeping medication. Or the patient may be purging their medication or not eating enough to make the medication effective, etc. How does that help the patient in the end? Why is it difficult to ask the right questions that would enable the most amount of information? Even more so, if you are seeing a therapist, there is rarely communication between the two.

Just think how much better the off the patient would be if there was more collaborative efforts between professionals. This is not to say this never happens, but the majority of time, everything must be separate, at least in the case of outpatient care.

I realize with the way insurance us set up, the idea for most psychiatrists is to see as many patients as possible, and if they were to do an hour long session with each one, they would have less patients. Still though, as many psychiatrists are seeing hundreds of patients a week, how are they even to remember who you are in the first place?

Maybe I'm slightly biased here, because I never had great relationships with the psychiatrists whom I saw versus my therapists. They just did not have the time, and there was always a feeling of a rush to get you out the door. Even years ago when I had wanted to go to medical school, I had decided that if I were to be a psychiatrist, I would not become a pill pusher but rather do a combination of both meds and therapy.

It's funny how this issue is still at the forefront and probably even more so. It'll be interesting to see what will happen in the field of psychiatry.

What are your thoughts and experiences with psychiatrists? Have yours offered therapy and should they?

Links to listen to the story: "A psychiatrist's prescription for his profession" or to read the transcript.

Girls State

Last weekend, I went to an all day dog seminar. Since it fit in so nicely with what we are doing at the new facility which officially opens June 1st, it would have been a shame to have missed it. It was also not far from me, so it was a win-win situation. I talked my boss into going as well.

We both enjoyed it and got some good suggestions and ideas of how to run our facility. During one of the breaks after lunch (an unplanned pizza moment), a girl sitting in the front row (there were only about 20 people) turns to me and says my name. Then, she asked whether I went to Girls State. Immediately, when she said this, I placed her. I knew she had looked familiar but wasn't sure if I had randomly seen her at another dog conference or what. She told me her name, and then I completely remembered her.

It was one of those "what a small world" moments. We had both attended Girls State in Virginia nearly 14 years ago, now lived in nearby states, and worked with dogs. Well, her day job is working for NASA and dog training is her side job, but still it was very cool to say the least. If you're not familiar with Girls State, it's a week long program for girls who are rising seniors from all over the state. They are placed into different groups and form a mock government as a way to learn the responsibilities of being adult citizens. Each state but Hawaii has one. At my school, two girls (and boys too--there is a Boys State) were nominated to go. Now, I really had no desire about government, but I thought it was such a good honor to go and represent my school there.

Overall, I did have a good experience there, but at times, it was overshadowed by the ED (more on that below). I met some wonderful girls there who had many aspirations. One was determined to be the first woman Navy SEAL. I don't think that one happened due to the SEAL's stringent, traditional policy of remaining all male, however, I wouldn't doubt it if this particular girl wound up going into the Naval Academy. Others dreamed of medical school, law, engineering, and other esteemed professions.

For awhile, many of us kept in touch with senior photos of each other, snail mail and e-mail letters, etc., but like many people that age, we drifted off. There are some I remain wondering what became of their lives as these were all girls with so much potential.

Despite that this was such a great event for me, I think I missed out on a bit of it due to my mental functioning at the time. This event struck at one of the worst times in my life. Several weeks prior to that event, I had cut my wrist out of a fit of anger.. I was seeing a doctor at the time, was honest with him, and said that I didn't feel safe with myself. Little did I know that those words would put me in a locked up adolescent ward for almost a week. (I may have talked about this before in earlier posts but it has been awhile) I really hated that place. The ED was full force there, so all I ate was salad and cereal at night. I was horribly cold, constantly wore sweatshirts, was depressed, and could not stay awake for the life of me during actual therapy sessions. The other things I remember about that experience are an angry, young boy, the sobs of a girl who ran away to be with her boyfriend, a cutter, a boy there for substance abuse, the movie The Color Purple which was constantly played over and over, finding coloring therapeutic, night checks with a light flashed into the room, weighing myself on scales (they didn't know I had an ED until my therapist came to visit me one day and told them, then they kept doing blood pressure readings and threatened me with Ensure during the last few days of my stay), and deciding to run around the gym x number of times partly due to boredom and fear of gaining weight.

I also remember during one my visit with my parents, there was so much tension in the room, it could have easily been cut with a knife. The only thing that broke this tension was that my father brought one of my good friends in to see me. At first, I was horribly ashamed, but also felt really happy that she came to visit. She even brought a teddy bear with her.

So where does this go with Girls State? Basically, I almost didn't go, because I would have been stuck at that locked ward. When I found this out, I sort of whittled my way into getting to go, nodding my head that I had a plan of action if I felt overwhelmed, that I would take my medication, that I would talk to the nurse there if I felt worried, that I'd remain safe, etc. It wasn't pure lying per se, but I knew that place was of little help to me, and the best thing to do would be to get out.

Luckily, I was granted that wish. And as I said before, I did have a good time. But, there were those pesky ED issues. I feared food so much--either that I'd binge or eat nothing at all. I had thoughts of purging constantly but was so afraid of someone finding out (the bathrooms were a suite style). I had an Asian roommate was so incredibly smart, funny, could dance hip hop like you wouldn't believe, and was so tiny. I just felt a constant comparison which I'm sure was all in my head anyway. I worried about not getting any exercise and gaining weight. I realize this is stuff that plagues most ED people, and I'm no different. These issues were severely exacerbated a number of times during big events. I think this particular setting was the first time I was out of my environment and had to try to deal (or not deal) with the ED.

I guess my point here is that I probably could have had an even better experience had I not been so food/body obsessed. I think we can all understand this to a degree--how the ED robs us of a FULL experience of life. I really hadn't thought much about this event or prior to it until I saw this girl at the seminar. It's kind of sad too that that is what pops up into my mind rather than what Girls State was all about.

I doubt that the girl even knew I really had an issue, but I could be wrong. Often times, when we think we're being secretive and hiding things well, it's just the opposite. In any case, I'm going to try to keep in touch with this girl who lives a few hours away from me. It's hard to find people my age in the dog training industry as so many of them are older and have dog training as a side business or as a second career, so it's good to snag them while I can. ;-)

Did anyone else go to Girls State and what were your experiences there?

Deconstructing "myths about suicide"

A few days ago, NPR's Talk of the Nation spoke with Thomas Joiner of Florida State University, a prominent researcher in suicidal behavior, on deconstructing "myths about suicide" Joiner has a new book out called Myths about Suicide in which he talks about this very thing.

Though I've posted about suicide before, I think it is still an important issue to discuss, especially as May is Mental Health Awareness Month. Like with many other disorders, suicide is often stigmatized as well.

There were several points in this conversation that Joiner made which really struck out to me. One was the myth that suicide is a selfish act. He explained that to those on the outside this is how it appears, but really what the suicide sufferer is thinking is, "my death will be worth more than my life to others." Although this thinking is mistaken, to the sufferer, it is true.

This often rings similar to those with eating disorders. On the outside, people think "how could someone with anorexia think they are fat? Can't they see they are not?" (I know this isn't the case for everyone, but just an example) Or it is like when we say we are "feeling fat" to someone, and they say "fat isn't a feeling." This may be correct, but to that individual, it feels real at the time.

Another point Joiner makes is that suicide is not an impulsive act. He says that even though suicide appears out of the blue for some people, often times, there has been a long built up process to it. If you think about it, it is really hard to kill yourself. Your body's natural reaction is to fight back and resist. For some, it is one reason why their body doesn't let them commit suicide.

He also mentions the film The Bridge, the controversial documentary about the San Francisco Golden Gate Bridge, a place where many have gone to commit suicide. For one year, the director and his crew, filmed people walking across the bridge, trying to determine which ones were vulnerable to jumping. In the end, they could not tell who would or would not. This deconstructs the myth that suicides are easy to tell. Even those that seem to be functioning well outwardly, inside the person is a mess and in misery. Again, this is so similar to eating disorders. How many times do people think we are okay just because we are weight restored, functioning, or look "normal"

One other myth Joiner discussed was the idea that if someone was really going to commit suicide, they would. He felt that physical barriers were important and was an underappreciated means of suicide prevention, especially as high railings have been installed at other historic buildings like the Empire State Building which dramatically reduced the number of suicides.

Since callers were invited into this show, there was one guy who had had several members of his family commit suicide. This led into the question of genetics which Dr. Joiner agrees contributes to suicides. He feels that genes, risk factors, personality traits, etc. operate via three aspects of his model which are learned fearlessness, burdensomeness, and alienation. He explains his model as:

I think that there are two main processes that have to develop and that have to collide to end in this catastrophe that is suicidal behavior. One has to do with the-I think very basic insight that death is inherently fearsome and daunting. Therefore it requires a kind of fearlessness, a fearlessness specifically about physical pain, physical injury and death, in order to enact it. So that's one process that's unfolding. It takes time to develop.

So does the other process, which has to do with: Why would people desire suicide in the first place? And I think it has to do with states of mind having to do with the idea - two ideas, actually one, that you're a burden, and one other - that's what I meant when I was referring to death being worth more than life kinds of thoughts; the other is that you're hopeless alienated, cut off and isolated from others. When these two processes combine, the desire for suicide spurred by alienation and burdensomeness, when all when that collides with learned fearlessness, that's when you see these catastrophes.

This makes sense to me and again resonates with eating disorder sufferers. There is the fearlessness of becoming malnourished, starved, unhealthy, or even dying. Then, there is the burden factor where we feel like we are burdens on our families and may not communicate how we feel to them or that we really need help. And with alienation, we often cut ourselves off from people and isolate to feed our disorders.

These same aspects could also be why a number of those with eating disorders do wind up committing suicide. These traits, brain chemistry, and feelings all collide, leaving the sufferer to feel suicide may be the only way.

I think this is one reason why I think education is important. Mental illnesses, in general, have so many stereotypes and we need to de-stigmatize and deconstruct the myths behind them.

Lastly, if you feel suicidal, please get help or call 1-800-SUICIDE, 1-800-273-TALK

FYI: the Discovery Health Channel is broadcasting "Six Nights of Understanding" series, showcasing individuals' experiences with Anxiety, Rage, Dissociative Disorder, Schizophrenia, Addiction, Bipolar Disorder, Hoarding, and Obsessive Compulsive Disorder. Thanks Dr. Deb for posting this!

Art and DID

Super tired but read this article on a woman, Kim Noble of London, with DID. She is using art as a way of therapy to help cope with her 12 different personalities. She says that "Painting is a way that some of the personalities can come together so it has really helped me. It is something many of them have in common and a way for them to bond".

Her artwork is incredibly interesting--all very distinct. One personality has anorexia, so a painting of her perceptions of reality and the mirror is shown. Apparently, a documentary is in the work and set to air next year.

Personally, I haven't had that much exposure to art therapy, and honestly, I am a horrible drawer, painter, etc. I know the point is not how good you are at it, but that type of art was never for me. However, art therapy does help many individuals in dealing with pain, grief, and other mental health issues. Just like many of us use metaphors for explaining how we feel, art is similar but on a visual scale.

Do any of you do art (I know several bloggers off the top of my head)? Is it for therapy, personal expression or something different?

Ranting on mental health

I don't get it, why is our mental health system so problematic? If you have studies like this that say 5% of the general population suffers from persistent depression and/or anxiety with only a small percentage actually receiving adequate care, or this one, saying that half of young adults experience a mental disorder, why isn't mental health services at the top of the agenda? I know the passage of the recent mental health parity law is certainly a good thing, but still, there's just so much further to go.

I wish the government, insurance companies, and otherwise would understand how valuable it is to really have a sound mind. Just think how much more productivity there would be within the general population. Maybe, we'll get there some day when everyone can have the mental health coverage they deserve and need. Until then, I'll be holding my breath.

Another look at SAD: possible genetic mutations

Well, we're now officially off daylight saving's time, so the days are now shortened with less light. I must admit even though this time comes around every year, the first few days definitely leave me a bit jolted. During the spring and summer, I got heavily used to running in the evenings, so with less light at this time, I have to readjust my body to afternoon running (I rarely run in the morning) when I find myself the most tired. I also have to be aware with less light, there is the issue of possible mild depression which many people experience in Seasonal Affective Disorder (SAD).

Awhile back, I posted about brain imaging studies and SAD individuals. Recently, an interesting study in the Journal of Affective Disorders looked at SAD and a possible genetic mutation in the eye, involving the gene melanopsin. Melanopsin is a photopigment in the retina which regulates circadian rhythms, hormones, and sleep.

In inidviduals who may have a melanopsin mutation, sensitivity to light is more pronounced. Therefore, more light is required to continue normal functioning during the winter months.

This study found that out of 220 individuals (130 had SAD, 90 no mental illness), 7 participants had two copies of the melanopsin mutation. All belonged to the SAD group. This gives evidence that those who carry a single copy of this genetic mutation may have a predisposition to SAD, while others who have two copies, have a strong likelihood to be afflicted with SAD.

In the end, understanding the genetics behind these illnesses can only lead to improved screening and testing which is the hope for those who may suffer.

Risks

I recently wrote about my bridge in my mouth coming out after eating Nips. Earlier in the week, I went to see my dentist and had the bridge glued back into my mouth. Putting the bridge back in was not as easy as it would seem, because my teeth had apparently shifted in 36 hours. Who knew that your teeth can move in as little as 24 hours? My dentist was able to grind the bridge down to the appropriate fit, however, the bad news is that there is a hole and a piece of porcelain is missing. I knew about the porcelain, but since it was not visible, I didn't worry about it.

This essentially means that I need to get a new bridge for this side of my upper mouth, so I was a good girl and set up an appointment for this week. Well, after thinking about it some more, I called the office and canceled the appointment. My main rationale was the expense. Even after my insurance covered a measly part of the cost, I would still owe over $2,300. I just paid off the left side bridge earlier in the year which wound up having to be removed anyway. Therefore, I really didn't want to have another expense, especially with the busy month I had and the holidays coming up.

I did not say this to the receptionist, but she was not too happy with the cancellation. Actually, I felt quite peeved at her tone of judgment. She ended with the words, "good luck, I hope the temporary stays." In my head, I thought, "well, I'm taking that risk."

Later, I spoke briefly with my mom about the bridge. She felt I should go ahead and get it done, because it needed to be done. I reiterated my thoughts about the financial issue at hand and ended the conversation again with the words that I was taking the risk.

So with that last thought, it reminded me about the concept of risk taking. You think about it, everything in life is a risk. Each action we do is some form of a risk. Some risks seem minimal while others are dangerous and cause us harm.

It's ironic, because throughout my eating disorder years, I was willing to risk my health in a variety of ways--restricting, purging, overexercising, depriving myself of sleep, overworking, overdosing on caffeine, etc., but yet, a risk such as moving, changing jobs, applying to school, taking a test, etc. felt like such a higher risk And these latter risks all had the potential to be positive whereas all the ED risks turned out negative.

I know I'm certainly not the only one in the same boat. I've seen people who fight tooth and nail for a job, an award, a research grant proposal, a coveted internship, etc., but yet, when it came to their health and well being, it took a back seat--that risk wasn't seen as important. Or I should say it was not given as high a priority.

I think at some point or another, many of us have fallen into this trap. It's not an easy one to come out of either. How do we decide what and when to risk? Why is risking so hard, albeit whether its a positive or negative thing?

All about weight awareness campaign

Even though this title, "all about weight" is very off putting, I think this Pennsylvannia campaign itself is actually promising. In conjunction with KidsPeace, a 126 year old private children's charity which helps kids overcoming various crises, and their web affiliate TeenCentral, their goal is to help children with the emotional roots of overeating or undereating, an often overlooked problem.

This campaign will reach 1000+ schools throughout PA and provide free access to TeenCentral.Net's websources, study and workshop guides, and TeenCentral's safe, anonymous online resource. Their online "all about weight" awareness campaign includes information on eating disorders, exercise, nutrition, genetics, body image & self-esteem, what's eating you?, and obesity & overweight.

I really like the fact that these experts are looking at not only the physical aspects of weight but also the emotional lives of teenagers. These days, it's hard being a teenager--trying to navigate issues of normal teenagedom as well as deal as with family, social, and environmental issues. I think this is a population that is often not given enough importance, so I'm really glad that there is a resource like this out there for them.

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I took a look through their website to see what it was all about. For the most part, I thought it was well done and age appropriate. There are several interactive gadgets to keep kids interested as well as good information on a number of topics. The new health "all about weight" module provides quizzes, graphics, and information arranged on a virtual scale. Their emphasis is, "sometimes it's not what you're eating, it's what's eating you!" My only qualm is that they do not address overexercising in the exercise portion.

I think the part I found most compelling was the "share a teen" story. This is where teens write in with a problem and receive advice from TeenCentral.Net's counselors. There were stories of dealing with divorce, relationships, sexuality, cutting, depression, eating disorders, and many more related to the angst of teenagehood. It's one of those nostalgic reminders of how much I hated being a teenager and couldn't wait until adulthood. Not that adulthood hasn't presented itself with it's own set of problems, but there is just more of an awareness now. It's where you wish you could tell any one of those teenagers to get help and to know that they can get through this difficult time period in their lives.

Anti-depressant prescriptions increase

According to US government, prescriptions for anti-depressants have increased over the last three years. The Agency for Healthcare Research and Quality spoke with people in-persona and over the phone who had received anti-depressant prescriptions. The interesting finding is WHO wrote the prescriptions.

29% of prescriptions were filled by psychiatrists (physicians who specialize in mental health disorders)
23% were from general practitioners (physicians who provide general care and are specialty trained)
21% came from family practitioners (physicians who provide primary care and completed a family medicine residency)
10% were from internal medicine specialists (physicians who focus on diseases in adults and have completed an internal medicine residency)

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When I think about this report, there are a few things that run through my mind. First, it's a good example of how there is a growing trend in primary care physicians treating mental health disorders. I think it is good in some sense that people are going to their primary care physicians for all aspects of their health (just getting people to go is a good things), however, at the same time, many primary care, general/family practitioners do not have enough knowledge in mental health disorders to really know which medication to dispense as there are often a lot of factors involved. I'm sure there are many general/family practitioners who continue their medical education, but it's hard to say the exact number.

The other problem with primary care physicians treating mental illness is that many patients do not follow up with their physician to make sure they are not having side effects or that the medication adjustment is correct. Of course with personalized medicine, in the future, tests may be on the horizon to eliminate some of the guesswork of which medication to prescribe.

This report also reminds me about the few instances when I saw a nurse practitioner. Usually, I was going to some other ailment and the depression/eating disorder would come up as an aside. I'd tell her how I was feeling, and then she'd ask me what I'd like to try as if it was candy. She mentioned wellbutrin once, but I told her no since it was contraindicated with those who had bulimia. She did not know this fact and would have easily prescribed it to me had I not piped up at all. I had told her I liked to stay current on eating disorder research, and her reply was that I'd know better than she would about these things. While it's true I certainly like to think of myself as an informed consumer, I really thought the wellbutrin/bulimia contraindication was just a well known fact.

You may wonder why I didn't see a psychiatrist at the time. I probably fell into what other people have--not really finding the mental health side of me that important and seeing my regular, convenient doctor for another ailment with the happen to bring up the depression/eating disorder. Plus, I liked my nurse practitioner, I just know now not to go to her if I want to really talk mental health.

I think this is another reason why more general practitioners are filling prescriptions. Many people want the convenience of an all-in one stop shop. However, with mental health, I do think we all need to think about it more closely. That and general, family, and internal specialists continue their education in the world of medications. It's not a huge part of medical school, so it truly is important for them to stay on top of the research. In the end, it makes for better health of the patient and more knowledge for the physician.

Pharmacogenetics and depression

A few weeks ago, the Mayo Clinic recently published a new study on phamacogenetics (the study of how people's genetic makeup affects their response to medication) and depression. Researchers genotyped DNA from 1,914 individuals from a sample of the Star-D study (Sequenced Treatment Alternatives to Relieve Depression Study), a seven year study that analyzed treatment of depression in adults. In this particular study, they looked at the serotonin receptor gene, SLC6A4, and the likelihood to respond to the anti-depressant, citalopram (celexa). The results showed that there are two variations in the gene which determine who may respond to this anti-depressant.

The researchers also investigated among racial populations of white, black, and hispanic individuals. They found only the white patients with the two distinct variations in gene were more likely to have remission of depression symptoms as compared to the other two groups.

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Personally, I find pharmacogenetics really fascinating. It's essentially an extension of personalized medicine. If you have read this blog before, you know I'm a big advocate of this. I talk about it in this post awhile back with rEEG and eating disorders. There's just so much out there that we don't know about the very nature of our own human genetic make-up--what works, what doesn't, etc., but we continue to learn everyday new discoveries for implications in a variety of disorders. The chairman of the Mayo Clinic, Dr. Mrazek, sums it up nicely in regards to this study.

He says, "Each step is a step toward greater accuracy in prescribing the right medication for each patient. "First, we started with trial and error - which feels like flipping a coin to select a medication. The Holy Grail would be to be able to consider the implications of variations in many genes. Ultimately, we hope to be able to determine with great accuracy which patients will respond to specific antidepressants and which patients will almost certainly not respond."

He also estimates that within two years there will be more extensive tests available which will focus on more than one gene. I guess this is a stay tuned for now to see what new research will emerge.

Madness

amazon

I just finished the book, Madness, by Marya Hornbacher. Most of you will know that she also wrote Wasted, published ten years ago, about her ordeal with anorexia and bulimia. As with most books, the reviews are mixed with some people praising the book, while others feel like she has sensationalized her illness. My personal opinion falls more towards understanding and appreciating her candor. I think reading this book after having read Wasted when it first came out, her behaviors make more sense to me. I remember when there was so much talk going on about Wasted, rumors had spread she had relapsed into her ED and been hospitalized. When it reality, it was really for the bipolar, not her ED at the time though there were some relapses.

Personally, I've always liked her style of writing, and this book really captivated me. Her writing makes you feel like you are there right with her, feeling the flow of her highs and lows. In all honesty, I'm amazed she is still alive with everything she has done/been through. Listening to her in an interview on psychjourney, I just don't get the impression she is out there to really "sensationalize" herself, just more that this is her daily life and how she manages/mismanages it.

Sometimes I've wondered whether I would fit bipolar disorder, more along the lines of bipolar II or soft bipolar, however, sometimes it's hard to distinguish how much of it would be from an actual disorder versus a semi-starved/starved state. I've never sought after a diagnosis but just know that anti-depressants in general didn't do much for me when I was younger. Perhaps, the wrong ones or maybe a different disorder. Hard to tell, but right now, I seem to be "okay," or at least not feeling like the world would end or something.

Within the last few years, there has been more research on bipolar disorders, especially in diagnosis. It's been concluded in many studies how bipolar has been misdiagnosed for another psychiatric disorder. The need for receiving the right treatment is contingent upon a correct diagnosis. It's my hope as more awareness is out there for bipolar and its various forms, more people receive the treatment they much need. And as with many mental illnesses, that it is treatable and manageable.

APA releases fact sheet on eating disorders

The APA recently released a fact sheet on eating disorders
Overall, I like their revisions, especially addressing the prevalence of EDNOS. I was surprised they did not mention dental/teeth erosion problems in the physical consequences section. I also liked what the APA recommended in terms of addressing eating disorders. Let's hope they follow through with these suggestions as it is a much needed area of treatment.

Also, The House passed Paul Wellstone Mental Health and Addiction Equity Act of 2007. Basically, this act requires insurance to cover mental and physical illnesses when policies cover both. This is a big step in terms of mental health parity. You can read more about it here.