Chris J. Tuell, EdD, LPCC-S, LICDC, Lindner Center of HOPE, Clinical Director of Addiction Services; University of Cincinnati, Department of Counseling, Adjunct Professor, Addiction Studies

 

For many of us growing-up in school, February was all about the Presidents, most notably, Abraham Lincoln. As our opinion of politicians has waned over the years, we can only wish that our political choices were of the caliber of our 16th President. Though the history books play a significant role in our perception and understanding of the “rail-splitter” from Illinois, it often becomes easy for us to forget that Abraham Lincoln was very human. Lincoln led this nation through its worst crisis, while at the same time battled his own internal war of chronic depression.

At the age of 32, Lincoln writes, “I am now the most miserable man living. If what I feel were equally distributed to the whole human family, there would not be one cheerful face on earth. Whether I shall ever better, I cannot tell; I awfully forebode I shall not; to remain as I am is impossible.”

Within the past few years, recent books and articles have addressed Lincoln’s melancholy by examining his own letters and the recorded observations of those who knew him. Lincoln scholars have clear evidence that he suffered from depressive episodes beginning in his twenties and lasting throughout the rest of his life. Lincoln’s school teacher, Mentor Graham stated, “Lincoln told me that he felt like committing suicide often.” Law partner and biographer, William Herndon, stated, “He was a sad looking man, gloomy, and melancholic.” Herndon adds, “His melancholy dripped from him as he walked.”

Depressive disorders affect approximately 18.8 million American adults or about 9.5% of the U.S. population age 18 and older in a given year, according to the National Institute on Mental Health. Depressive disorders may include: Major Depressive Disorder, Dysthymia (an ongoing, low grade depression), and Bipolar Disorder (mood swings of depression and mania). Depression can affect every aspect of one’s life: physical health, sleep, eating habits, job, and your relationships with friends and family. It affects thoughts, feelings and behaviors.

Lincoln was a man with human strengths and frailties.   His depression or melancholy did not define who he was as a person, nor can the same be said for the millions of individuals who suffer from depression every day. Depression is one of the most common and most serious mental health issues facing people today. It is also one of the most treatable.

Lincoln had much cause for sadness throughout his life. His only brother died in infancy. His mother, an aunt, and uncle died from an epidemic when he was nine years of age. Ten years later his sister died giving birth to a stillborn infant. Historical records indicate that Lincoln’s mother and father were disposed to melancholy and that one side of the family “was thick with mental disease.” According to mental health professionals, bereavement in childhood can be one of the most significant factors in the development of depressive illness in later life.

As an adult, Lincoln experienced the loss of a close friend, Ann Rutledge, of whom who he grew fond of while living in New Salem, Illinois in 1835. As a father, Lincoln experienced the death of two young sons, Eddie and Willie. As Commander-in-Chief, one can only imagine the emotional toll the Civil War had upon Lincoln and the 680,088 lives that were lost in its cause.

Before the age of psychotherapy and medication, Lincoln learned to live with his depressive disposition. He would frequently utilize humor and story-telling to elevate his mood and distract himself from his depression. Only his closest friends had any insight concerning the extent of his condition. Learning how to manage his life with his depression was his only choice. The only other option would have been for him to succumb to these adversities. It does not appear that it was in the 16th President’s persona to acquiesce. Lincoln persevered and served this country eloquently.

We can only speculate what Lincoln would say or do about our current state of political affairs, or even what thoughts he may have towards the new millennium’s understanding of depression and mental health. But now, some 150 years later, Lincoln’s historical persona continues to “belong to the ages.” Abraham Lincoln believed in the human spirit and spoke of the role we must all serve toward one another. This was no more clearly expressed than through Lincoln’s own words, “With malice toward none; with charity for all.”

© 2014National Eating Disorders Association.Permission is granted to copy and reprint materials for educational purposes only.National Eating Disorders Association must be cited and web address listed.www.NationalEatingDisorders.org Information and Referral Helpline: 800.931.2237

The goal of National Eating Disorders Awareness Week  is to put the spotlight on the seriousness of eating disorders and to improve public understanding of their causes, triggers and treatments. By increasing awareness and access to resources, we can encourage early detection and intervention, which can improve the likelihood of full recovery for millions.

This year the National Eating Disorders Association is focusing on the importance of early intervention and recognizing the diverse experiences of people personally affected by disordered eating. Too often, signs and symptoms are overlooked as insignificant behaviors when in fact many of these are early warning signs of eating disorders.

If someone is exhibiting signs or thoughts of struggling with an eating disorder, intervening during the early stages of development can significantly increase the likelihood of preventing the onset of a full-blown eating disorder. It also leads to greater chances of a full recovery. It can prevent years of struggle and can even save lives. A key goal of NEDAwareness Week is to direct individuals to a free online screening for eating disorders at MyBodyScreening.org.

Educating yourself and those around you about eating disorders is a great way to get involved. Correcting myths and spreading awareness about the facts are important steps to eating disorder prevention. Visit NEDAwareness.org to review information about how eating disorders develop and why they are so complex, as well as finding out how you can be proactive in recognizing contributing factors and being a part of the fight against these life threatening illnesses.

While eating disorders are serious, potentially life-threatening illnesses, help is available and recovery is possible. It is important for those affected, and their loved ones, to remember that they are not alone in their struggle. Others have recovered and are now living healthy fulfilling lives. Let the National Eating Disorders Association (NEDA) be a part of your support network. NEDA has information and resources available via our website and helpline: www.NationalEatingDisorders.org, NEDA Helpline: 800-931-2237.

 

Proclamation

United Against Opiate Abuse and Heroin

 

Whereas at least two people die from a prescription pain killer or heroin overdose every day in the twenty counties that surround Cincinnati;

Whereas our rates of new hepatitis C infections are higher than the national average;

Whereas our law enforcement are seeing higher rates of crime related to heroin;

Whereas the number of children born needing to withdraw from opiates or heroin continues to rise in our local hospitals;

Whereas community members have come together to address this epidemic across the region;

Now be it proclaimed that the week of February 23- March 1, 2015 be the United Against Opiate Abuse and Heroin Week. All over the region we will use this week to develop solutions to this problem and understand the role that each of us can play in eliminating opiate abuse and heroin from our communities.

By Paul E. Keck, Jr., MD
President-CEO, Lindner Center of HOPE
Frances & Craig Lindner Professor & Executive Vice Chair
Department of Psychiatry & Behavioral Neuroscience
University of Cincinnati College of Medicine
 

Bipolar disorder is common and recurrent psychiatric illness associated with high rates of morbidity, disability and mortality. In the United States, the 12-month prevalence rate of bipolar I and II disorder is estimated at 2.6%. Bipolar I disorder is distinguished from major depressive disorder by the occurrence of manic episodes. Bipolar II disorder is distinguished from major depressive disorder by the occurrence of mild manic symptoms, and depressive episodes tend to predominate the course of illness.

Symptoms of mania include: abnormally and persistently elevated, expansive or irritable mood, excessive energy or activity, psychomotor agitation, decreased need for sleep, grandiosity, excessive speech, racing thoughts, distractibility, impulsivity, and poor insight. Manic episodes often constitute a medical emergency requiring hospital admission and severe depressive episodes similarly pose a risk of suicide and need for hospital care.

Bipolar disorder frequently presents early in an individual’s life, frequently between the ages of 16-24, and often the initial mood episode may be depression, further complicating the diagnosis. Bipolar disorder is highly heritable. Clinical predictors of bipolar disorder include a family history of a first degree relative with bipolar disorder and early age of onset of depression.

Fortunately, there have been substantial advances in the evidence-based treatments of bipolar disorder over the past several decades. The goals of treatment of acute mood episodes (manic, mixed, and depressive) are rapid, complete remission in a safe environment. The goals of long-term or maintenance treatment are prevention of further episodes, eradication of sub-syndromal symptoms, and optimizing quality of life and function.

The treatment of bipolar disorder is often complicated because of a number of factors. First, bipolar disorder is the single psychiatric illness associated with the greatest degree of comorbidity. For example, addictions, anxiety disorders, eating disorders, migraine, overweight and obesity, and diabetes are all more common in people with bipolar disorder than in the general population. Thus, treatment recommendations often require addressing not only the symptoms of bipolar disorder itself, but also concurrently addressing comorbid illnesses.

Second, within the realm of bipolar disorder itself, although classified as a mood disorder, this illness is also fraught with symptoms in behavior, cognition and perception, as well as insight.

Third, treatment is further complicated by the diversity of illness presentation. For example, there are often substantial differences among patients in the pattern, frequency, and severity of mood episodes, the presence of absence of psychosis, and in acute or chronic psychosocial and other environmental stressors. Further, some medications have particular efficacy in one phase of illness but not in another, and some may actually increase the likelihood of precipitating a reciprocal mood episode.

Evidence-based treatment of bipolar disorder is generally categorized by treatment of acute mood episodes and maintenance treatment, designed to prevent recurrent symptoms and episodes. Medications with evidence of efficacy in the treatment of manic episodes include: first- and second-generation antipsychotic drugs, lithium, valproate, and carbamazepine. Medications with evidence of efficacy in the treatment of bipolar depressive episodes include: olanzapine, olanzapine-fluoxetine combination, lithium, quetiapine and lurasidone. The co-administration of unimodal antidepressants in the treatment of bipolar depression remains controversial, although clinically a substantial subgroup of people with bipolar depression appears to need such agents.

Within the many types of antidepressants, some data indicate that SNRI’s may pose a greater switch risk. Medications with evidence of efficacy in maintenance treatment include: lithium, olanzapine, lamotrigine, aripiprazole, quetiapine, and long-acting injectable paloperidone. Many people with bipolar disorder require a combination of medications to achieve and sustain euthymia. It is also important to recognize that certain medications that were once thought promising for bipolar disorder have not been proven to have efficacy in any phase of the illness. These include, for example, topiramate, gabapentin, and oxcarbazepine.

Although pharmacotherapy is the foundation of treatment of bipolar disorder, there are now evidence-based psychosocial treatments that improve outcome. These are primarily for the maintenance phase of treatment, have the greatest impact on depression and treatment adherence, and include: individual and group psychoeducation, individual interpersonal and social rhythm therapy, cognitive-behavioral therapy, and family-focused treatment.

Resources

Keck PE, Jr, McElroy SL. Pharmacological treatments for bipolar disorder. Nathan PE, Gorman JM, eds. A Guide to Treatments That Work, 3rd edition, Oxford, NY, 2007, pp. 323-350.

Miklowitz DJ, Craighead WE, Psychosocial treatments for bipolar disorder. Nathan PE, Gorman JM, eds. A Guide to Treatments That Work, 3rd edition, Oxford, NT, 2007, pp. 309-322.

http://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

DSC_0022The sixth annual Touchdown for HOPE Super Bowl Sunday event took place on February 1, 2015 at the Great American Ballpark Champions Club. With 423 attendees and $203,000 raised to enhance Bipolar and Mood Disorders Research at Lindner Center of HOPE, The Best Super Bowl Party in Town was a huge success.

Great American Ballpark provided the perfect casual environment, reminiscent of a very large family room, with numerous seating areas and televisions for watching the game, the festivities and the commercials. Guests enjoyed Cincinnati favorite foods including Skyline DSC_0035Chili, Montgomery Inn ribs and Saratoga chips, LaRosa’s pizza, and United Diary Farmers ice cream. As Arizona hosted Super Bowl XLIV, guests  were also treated to a Southwestern menu including, Southwestern Salad, Chicken Empanadas, Pulled Pork Tacos, Steak or Cheese Quesadillas and Churros with dolce de leche, cocoa powder, powdered sugar and cinnamon sugar

“Mood disorders are the most common form of psychiatric illness and are among the DSC_0048leading causes of disability worldwide,” said Dr. Paul E. Keck, Jr., President & CEO of Lindner Center of HOPE. “The study of these devastating illnesses is extremely complex. In spite of the unprecedented growth in the diagnosis of these illnesses, research continues to be under-funded; while much work is still needed to enhance our understanding of these illnesses, the risk factors and the most effective forms of treatment. We are very grateful for the support of Touchdown for HOPE in order to continue to enhance our efforts.”

A generous list of sponsors made this event possible.