0 When recovery from depression seems hopeless, are there other options? A patient's perspective

By Andy Behrman, Guest Blogger

My experience with electroconvulsive therapy (ECT) began in 1995, when I opted for ECT as a last resort for treating my bipolar disorder. For so many people who were termed medication resistant and suffering with depression or bipolar disorder, ECT was the “last stop” when it came to treatment. But the variety of medications and other treatments now available to patients suffering from depression has expanded dramatically over the last 17 years.

I recently became extremely curious about a treatment for depression called TMS (transcranial magnetic stimulation). I was surprised to discover that even though TMS is a non-invasive outpatient procedure with few side effects, does not require anesthesia, and was approved by the FDA as far back as 2008, it is still very much “under the radar” and is a treatment which many patients are not very familiar.

According to Kira Stein, M.D., psychiatrist and medical director of Los Angeles-based West Coast TMS Institute, “In a recently published multicenter naturalistic study, 58% of patients significantly responded to TMS treatment, with 37% undergoing complete remission."

Today, TMS is primarily being used to treat those of us suffering with depression. The statistics for depression are alarming: 1 in 6 people experience it in their lifetime, which means that more than 50 million Americans are likely to struggle with clinical depression. Unfortunately, of this population, only 1 in 4 people get adequate treatment. One of the biggest concerns is the risk of suicide, as more than 36,000 people in the United States take their lives every year. Untreated depression, which causes disability at work and disrupted family and interpersonal relationships, can also lead to self-medication with drugs and alcohol. Depression has reached epidemic proportions and has become a silent killer.

When I speak to audiences about mental illness, I always encourage people who suffer from depression to seek advice from a mental health professional. Sometimes, getting people to overcome the stigma of suffering from depression is one of the hardest jobs I have to do. It is often the patient who resists seeking help, often because of the stigma, who really ends up at risk. But today, there are more treatment options than when I was ill. Technology is giving doctors more tools, and patients much more hope, for recovery.

Andy Behrman is the author of “Electroboy: A Memoir of Mania,” a personal story about his bipolar disorder, his experience electroconvulsive therapy (ECT), and his recovery from drug and alcohol addiction. Behrman advocates for mental health awareness and suicide prevention. He speaks to college audiences, health care professionals, and local and national mental health support groups working to stop stigma surrounding mental illness.

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0 Mental Illness or Muse? Amy Winehouse and Historic Artists with Bipolar Disorder

By Mohammad Alsuwaidan, MD 



We have no doubt lost a profound musical talent in the tragic death of Amy Winehouse this week.  Her public struggle with substance abuse and bipolar disorder (commonly known as manic depression) has reignited curiosity about possible links between creativity and mental illness. In such unfortunate circumstances, it serves well to draw upon the lessons of history in making meaning out of sorrow.



A little more than 120 years ago, a misfortune befell another budding talent. A young painter entered a psychiatric hospital in Saint-Rémy-de-Provence, Southern France. Known by his neighbors in town as “fou roux" (the crazy redhead), he had been troubled with mental illness throughout his life. A few months prior, he had reached a crisis point and during his breakdown, he rushed to a brothel to see his friend - a prostitute named Rachel. He handed her a small wrapping of newspaper - telling her to “keep this object carefully” and ran off. Unwrapping it, she was shocked to find the freshly cut and still bloody lower portion of his left ear!

Vincent van Gogh holds legendary status in Art and his influence has crossed cultures and eras. To gaze onto the vivid colors and hypnotic swirls in his work is to be transported into another world - a morphed view of reality that can only be seen through his eyes. There is a tendency to romanticize van Gogh’s mental illness – which most respected psycho-biographers believe to have been bipolar disorder.



The notion that there is a fine line between creative genius and “craziness” is not new and has existed since ancient times. Most of this interest has focused on bipolar disorder; many famous figures have been speculated to have suffered from this mental illness: Beethoven, Edgar Allan Poe, Emily Dickinson, Victor Hugo, Charles Dickens, Edvard Munch, and many more. We continue to see this pattern in the modern day among celebrated actors, poets, painters, and musicians like Ms. Winehouse. Yet, despite our modern methods, illuminating the “line” or “link” between mental illness and creativity remains elusive.  Studies show that a certain level of melancholy or mixed emotions may be needed to access the creative spring. Unfortunately this negative emotion may also underlie some of the symptoms seen in bipolar disorder. 



Herein lies the eternal dilemma in the field of medicine – balancing benefits of treatments against their risks. Could some bipolar treatments dampen the creative drive? The evidence, both anecdotal and empirical, says yes.



Yet research also reveals that when individuals with bipolar disorder receive treatment, their overall productivity, focus, and organization improve. We know that the poet Robert Lowell produced the largest portion of his work after receiving lithium treatment for his bipolar disorder. And though some critics argue that his “pre-lithium” work is more striking in its poetic beauty, they admit that had it not been for the stabilizing effects of his treatment leading to many more – still beautiful – poems, we may have never known Lowell and his artistic mastery at all.



The message to mental health professionals is clear in my mind; we should attempt to treat highly-creative individuals with mood disorders with all the latest advancements including medications. BUT we should listen carefully and work with our patients to understand what effect treatment is having on their creative drive. Perhaps some individuals need some degree of discontent to “kindle the creative fire,” and we should step up to the challenge of helping them achieve a tolerable and productive balance.



At the young age of 37, after a manic episode of creating many paintings, Vincent van Gogh walked into an empty field outside his home, aimed a loaded revolver into his chest, and pulled the trigger. His famous last words, as he lay dying in his brother Theo’s arms, were "La tristesse durera toujours" (the sadness will last forever).



Perhaps had he not suffered some degree of sadness, you and I would have never heard of van Gogh. Perhaps had he lived longer, his influence would have been even greater. Perhaps the next van Gogh or Poe or Winehouse will walk into a mental health clinic next week suffocated by their sadness, yet possessed by creative inspiration. The questions are complex scientifically, ethically, and philosophically. But I believe that a balance can and should be reached (or at least approached) and that tragic endings can be re-written. 



Dr. Mohammad Alsuwaidan is a psychiatrist with expertise in Mood Disorders at the University of Toronto and a Master of Public Health candidate at Johns Hopkins University. Learn more: http://www.mohammadalsuwaidan.com/





References:

KR Jamison, Touched with Fire: Manic Depressive Illness and the Artistic Temparment, Free Press Paperbacks (New York 1993). p.85

AW Flaherty, Frontotemporal and Dopaminergic Control of Idea Generation and Creative Drive. Journal of Comp. Neurology 493:147-153 (2005).

Santosa C.M. et al. Enhanced creativity in bipolar disorder patients: A controlled study. J. Affect. Disord. (2006), doi:10.1016/j.jad.2006.10.013

Flaherty, A. (2011). Brain illness and creativity: mechanisms and treatment risks. Canadian journal of psychiatry. Revue canadienne de psychiatrie, 56(3), 132.





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