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MANIC DEPRESSION
Broadcast starting week of October 12, 1998

Host Dr. Fred Goodwin is especially familiar with manic depression, having studied it closely during his thirty-three years as a clinical psychiatrist, researcher, and later as head of the National Institute of Mental Health. Today it's also known as bipolar disorder, referring to the swing between two 'poles': the highs of mania and the lows of depression.

Donna, 26, has been living with manic depressive illness for 10 years. During her manic periods, which could last between two weeks and five months, Donna experienced "a natural high." Although she felt very capable, and could get by with very little sleep, she was often self-destructively impulsive. She has only recently sought treatment.

Dr. Joseph Hibbeln is a psychiatrist, lipid biologist and chief of the outpatient clinic at the National Institute on Alcohol and Alcohol Abuse, part of the National Institutes of Health. He studied epidemiological data about the rates of diseases and average diets in different parts of the world, and learned of an astonishing link between Omega 3 fatty acids in our diet, and mood disorders like manic depression and depression. Dr. Hibbeln found that diets high in fish were very strongly correlated with freedom from depression. We eat very differently from our ancestors over the last two to three million years, who consumed far less saturated fats and much more Omega 3 unsaturated fatty acids, which occur in leafy green vegetables and fish. In the last hundred years we've seen a radical increase in coronary heart disease, commonly understood to be linked to dietary changes. Dr. Hibbeln attributes the parallel increase in depression to a dietary lack of Omega 3 fatty acids. He cites a recent study of unstable bipolar patients, just discharged from the hospital. In the group receiving a placebo, eight out of fifteen relapsed, but in the group receiving the Omega 3 fatty acids, only one out of fifteen relapsed. (Both groups were on common antidepressant drugs.) Dr. Hibbeln finds that other epidemiological studies show a link between high fish consumption and a low incidence of post-partum depression. He notes that infant formulas in the U.S. are very low in the Omega 3 fatty acids. Since the fatty acids are selectively depleted from the brain by alcoholism, their lack may worsen other disorders in alcoholics. He recommends substituting olive oil for corn and soy oil, and eating fish every one or two days. It should be baked, broiled, poached, but not fried. The highest food source of Omega 3 fatty acids is caviar, with sardines coming in second. Mackerel, halibut, and salmon are all good sources.

For more information, Dr. Hibbeln suggests the book The Omega Plan, by Artemis Simopoulos, published by Harper Collins.

Congresswoman Lynn Rivers, from Ann Arbor, has represented Michigan's 13th District since 1994, and serves on the House budget and science committees. On weekends, she returns home to her husband and two daughters. She has grappled with bipolar disorder for more than 20 years. Her experience of depression was not of sadness, but an inner deadness and a lack of hope that left her pained, without energy or interest in doing things. Ms. Rivers was relieved when she was finally diagnosed as having a mental illness. For years, she thought her troubles were due to a flaw in her character. The treatment was very expensive, and she and her husband had to work extra jobs to afford it. It took almost ten years from start to finish to find the proper mix of drugs, but now, she is symptom free. As a member of Congress, Ms. Rivers has become an outspoken advocate of parity legislation, which would guarantee equal health care coverage for mental as well as physical illness.

You can write to Congresswoman Lynn Rivers at 106 East Washington, Ann Arbor, Michigan, 48104. More information about depression and manic depression, and about support in your community, is available through the National Depressive and Manic Depressive Association at 800-826-3632.

Dr. J. Raymond DePaulo is professor of psychiatry and director of the affective disorders clinic at Johns Hopkins School of Medicine in Baltimore. He explains that there is an entire range of diagnoses that fall into the spectrum of bipolar mood disorder. Besides the typical manic depressive syndrome, now called bipolar type one, a new classification, called bipolar type two, combines depression with brief states of mild elation or irritation. Its milder symptoms are more difficult to recognize as an illness requiring treatment. Cyclothymia is typified by brief elevations and depressions in mood, causing subtle impairments. A caller asked if treatment decreases the suicide rate for manic depression. Drs. Goodwin and DePaulo refer to a recent review of 28 studies all showing that lithium reduces suicide by a factor of six. Dr. DePaulo tells another caller that going off lithium usually results in the return of symptoms, and that as long as there are no side effects, the drug can be safely taken for many decades. Although the illness is cyclical, there is a slight tendency for it to get worse over time. Stigma surrounding a diagnosis of mental illness still exists, but is less of a barrier for people seeking treatment. Dr. Goodwin says that only a few years ago, one out of three people with manic depression were getting treatment, but now two out of three get help. However, the average delay between the onset of symptoms and a diagnosis of manic depression is still ten years. Patients having difficulty returning to normal life should check with their doctor if they are still depressed. It can be hard to recognize when depression has returned, and to acknowledge that there can be degrees of depression. Dr. DePaulo recommends getting involved with a support group, to meet other people who have survived episodes and are still functioning. The high suicide rate, he says, is due to the disorder's dangerous combination of symptoms: distorted, negative perceptions of oneself; the hopelessness and self-loathing of depression; and the energy of mania. 60% of bipolar patients will meet the criteria for alcohol or drug abuse, which in turn can increase the risk of suicide. You can write to Dr. Ray DePaulo at Johns Hopkins University Medical Center, 600 North Wolsey Street, Baltimore, Maryland, 21287.

For more information on suicide prevention, you can call the American Foundation for Suicide Prevention at 888-333-2377.

 

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