ression.seasonal,soc.support.depression.treatment
Subject: Bipolar FAQ
Date: 3 Jan 1996 18:26:48 -0800
nic:535 soc.support.depression.misc:480 soc.support.depression.seasonal:230 soc.support.depression.treatment:990

Posting-Frequency: bi-weekly
Last-modified Dec. 16, 1995 
Author: Scott Milliken ("PsyberNut")
Suggestions/Corrections to: lsm@crl.com
X-URL http://www.crl.com/~lsm/bipolar.html


    ***************************************************************** 
    * Frequently Asked Questions (FAQ) alt.support.depression.manic * 
    ***************************************************************** 

Introduction
============

Alt.support.depression.manic is a newsgroup for people who suffer from
any of the Bipolar disorders, for the people who care about them,  
and anyone else who wishes to learn more about Bipolar affective disorders.
A lot of the information posted to this newsgroup is from experts in
Psychiatry, Psychology, Psychopharmocology, Neurology, and many other
disciplines.

All material posted here is considered copyrighted by the poster, and
may not be redistributed without his or her permission.  There is still
a very negative stigma attached to all mental illnesses, including Bipolar
Affective Disorder, in modern society.  Please be discrete in the way you
use information obtained as a result of reading this newsgroup.

This FAQ (Frequently Asked Questions) is intended to help the reader 
develop an understanding of the various Bipolar disorders, their symptoms, 
and their treatments. 

Updates and corrections will be posted from time to time.  Please send 
suggestions to lsm@netcom.com

- What is Bipolar Affective Disorder? (Manic Depression)
- What is Depression?
- What is Mania?
- What is Hypomania?
- What is Cyclothymia?
- How do you tell someone with depression from someone with manic-depression?
- What should I do if someone I know has a mood disorder?
- Where can I learn more? (Internet)
  - Mailing Lists
  - USENET Newsgroups 
  - World Wide Web Sites 
- Where can I learn more? (Books) 

Q:  What is Bipolar Affective Disorder? 
--------------------------------------- 
A:  The essential feature of Bipolar Disorder is one or more Manic Episodes, 
    usually accompanied by one or more Major Depressive Episodes.  Bipolar 
    Affective Disorder, also known as Manic-Depression, involves a cyclical 
    alternation between a depressed state and a manic state.  The most 
    common symptoms of depression and mania are presented below, although 
    it is important to remember that one does not need to exhibit *ALL* 
    of the symptoms of depression to be depressed, nor does one need to 
    display *ALL* of the symptoms of mania to be manic.  Although the 
    shifts from one state to another are usually gradual, they can be 
    quite sudden.  

    It is interesting to note that although there are a few rare documented
    cases of Mania without depression, the DSM IV does not have a catagory 
    for just "Mania".  Thus, a person exhibiting the symptoms of Mania will 
    automatically be diagnosed as having Bipolar Disorder.  The general 
    feeling in the mental health community is that what goes up must 
    eventually come down.  (Even the rare cases just mentioned are 
    classified as Bipolar; the docs figure they'll come down eventually.)
   
    In summary, the key to recognizing the presence of Bipolar Affective
    Disorder is the presence of a manic or hypomanic Episode.  If mania or
    hypomania are exhibited, then a diagnosis of Bipolar Affective Disorder
    is called for.
   
    The two main types are as follows:
   
    1.  Bipolar I is the "classic" form of Bipolar Affective Disorder.  It
.involves widely spaced, long-lasting bouts of Mania followed by 
.long-lasting bouts of depression and vice-versa.
.  
    2.  Bipolar II involves at least one Hypomanic Episode and one Major 
.Depressive Episode, but never either a Manic Episode or Cyclothymia. 


Q:  What is depression?
-----------------------

A:  The essential feature of depression is either a depressed mood, or  
    sometimes with children and adolescents, irritability, or a loss of
    interest or pleasure in all, or almost all, activities which used 
    to be enjoyable.  These, and other associated symptoms last at
    least two weeks, and represent a change from previous functioning.
    The symptoms are also characteristically persistant; that is, they
    occur for all or most of the day, nearly every day, for a duration 
    of at least two weeks.

    Appetite is frequently either severely diminished or significantly
    increased.  Loss of appetite is more common, and is often severe 
    enough to result in significant weight loss.

    Sleep disturbance is also common, with the more frequent complaint
    being insomnia (inability to sleep, or waking soon after going to
    sleep) although sometimes hypersomnia (sleeping too long, sleepiness
    in the daytime, frequent naps) is present.  Sometimes, it is the sleep
    disturbance that causes a person to seek treatment, rather than the 
    depressed mood.
    
    The American Psychiatric Association defines the following criteria
    for recognizing a depressive episode:

    A.  Sad, depressed mood.

    B.  Poor appetite, and weight loss *OR* increased appetite
.and weight gain.

    C.  Insomnia (difficulty sleeping), not falling asleep
        initially, not returning to sleep after waking up
        in the middle of the night, and early morning 
        awakening.  Some depressed persons, however, want
        to sleep a great deal of the time.  This is often
        true of persons with Bipolar disorder who are currently
        in a depressed state.

    D.  Shifts in activity level, either becoming extremely
.lethargic (known as psychomotor retardation) or 
.extremely agitated.

    E.  Loss of interest or pleasure in usual activities.

    F.  Loss of energy, pronounced fatigue.

    G.  Negative self-concept.  Self-reproach and self-blame.
.Pronounced feelings of worthlessness and guilt

    H.  Complaints of difficulty concentrating which may be 
.evidenced by indecisiveness and slowed thinking.

    I.  Recurrent thoughts of death and/or suicide.

Well, the APA gives us a good starting point, but it all sounds sort of
clinical.  Here are some other symptoms of depression:

* Reduced interest in activities (like writing FAQs)

* Indecisiveness (maybe)

* Feeling sad, unhappy, or blue (pervasive attitude that life sucks)

* Irritability, dammit.

* Getting too much (hypersomnia) or too little (insomnia) sleep.

* Loss of, um, what were we talking about?  Oh yeah, concentration.

* Increased or decreased appetite  (my ex-mother-in-law's cooking 
  notwithstanding)

* Loss of self-esteem, such as my understanding that I suck.

* Decreased sexual desire.

* Problems with, whatdya call it?  Oh yeah, memory.

* Despair and hopelessness

* Suicidal thoughts.

* Reduced pleasurable feelings.

* Guilt feelings, which are all my fault anyway.

* Crying uncontrollably and/or for no apparent reason.

* Feeling helpless, which I can't do anything about.

* Restlessness, especially when I can't hold still.

* Feeling disorganized (hell, look at my desk).

* Difficulty doing things (again, like finishing this FAQ)

* Lack of energy and feeling tired.

* Self-critical thoughts

* Moving and thinking slooooooowwwwwwwly.

* Feeling that one is in a stupor, or that one's head is in a fog.

* Speeeeeeeakiiinnnnng slooooooowwwwwwwly.

* Emotional and/or physical pain.

* Hypochondriacal worries; fears or illnesses which prove to be psychosomatic.

* Feeling dead or detached.

* Delusions of guilt or of financial poverty.

* Hallucinating.


Q:   What is Mania?
-------------------

A:   Mania is an emotional state of intense but unfounded elation, in   
     which the subject exhibits extreme talkativeness, distractibility, 
     grandiose plans, and spurts of often purposeless activity.  A manic's
     speech consists of a loud and incessant stream of remarks, puns, jokes,
     plays on words, rhyming, and interjections about nearby objects and 
     happenings that have attracted the subject's attention.  This speech,
     which tends to be very difficult to inturrupt, reveals the manic's 
     flight of ideas, in which he/she shifts rapidly from topic to topic.
     A manic's need for activity may cause him/her to be annoyingly 
     sociable and intrusive.

.
     The American Psychiatric Association sets the following diagnostic 
     criteria for recognizing a manic Episode:

     A.  A distinct period of abnormally and persistently elevated,
         expansive or irritable mood.

     B.  During the period of mood disturbance, at least three of the 
         following symptoms have persisted (four if the mood disturbance 
         was mainly irritable) and have been present to a significant degree:

         1.) Grandiosity; inflated self-esteem.

         2.) Decreased need for sleep; feeling rested after only two or three
             hours of sleep.
.    
. 3.) Being more talkative than usual or feeling pressured to keep 
.     talking.  Often, there is loud, rapid, pressured speech 
.     full of jokes puns and rhymes.  This speech is often very 
.     difficult to interrupt.
.   
. 4.) Subjective impression that thoughts are racing; flight of ideas.
.     This flight of ideas, which simply means jumping from idea to 
.     idea can often be completely unintelligible in a severely manic
.     individual.

. 5.) Easily distractible; attention easily diverted to unimportant
.     events or objects in the subject's immediate surroundings.
   
. 6.) Increase in goal-directed activity, whether at work, at school,
.     socially, or sexually.  Psychomotor agitation is also a sign.

. 7.) Involvement in activities which have potentially harmful 
.     consequences.  Examples include uncharacteristic sexual 
.     promiscuity, uninhibited buying sprees, or foolish investment
.     decisions.

     C.  Mood disturbance is sufficiently severe to cause marked impairment
         in occupational functioning or in usual social activities or 
         relationships with others; OR, to require hospitalization to prevent
         harm to self or to others.

     D.  There have NOT been any hallucinations or delusions either before
         the mood symptoms developed or after they are in remission.

     E.  The diagnosis of Bipolar Affective Disorder is NOT superimposed on
         Schizophrenia, Schizophreniform Disorder, Delusional Disorder,
         or Psychotic Disorder NOS (Not Otherwise Specified)

     F.  It CANNOT be established that an organic factor initiated and 
         maintained the disturbance.  (For the purpose of this criterium, 
         somatic antidepressant treatments, including medication and electro-
         convulsive therapy which seem to precipitate a mood disturbance 
         should NOT be considered an organic factor.

     A Manic Episode is defined as including at least A, B, and C above, while
     a Hypomanic Episode is defined as including criteria A and B, but
     not C.  In other words, 'marked impairment' is a necessary criteria for
     a "full" manic episode, but not for a hypomanic episode.

Again, the APA gives us a good starting point for studying mania, but there
are some other symptoms that deserve consideration, including:

* Decreased need for sleep.

* Restlessness.

* Feeling full of energy.

* Distractability (what was that?)

* Increased talkativeness (or increased typeativeness in my case)

* Creative thinking.

* Increase in activities.

* Feelings of elation.

* Laughing inappropriately

* Inappropriate humor.

* Speeded up thinking.

* Rapid, pressured speech, that you can teach, eating a peach, while on 
  a beach.

* Impaired judgement

* Increased religious thinking or beliefs.

* Feelings of exhileration.

* Racing thoughts, which can't be taught, and can't be bought, although they
  ought, you might get caught.

* Irritability (dammit, there it is again!)

* Excitability.

* Inappropriate behaviors.

* Impulsive behaviors.

* Increased sexuality.

* Inflated self-esteem (so prove I'm NOT the world's leading authority!)

* Financial extravagance.

* Grandiose thinking.

* Heightened perceptions.

* Bizarre hallucinations.

* Disorientation.

* Disjointed thinking.

* Incoherent speech.

* Paranoia, delusions of being persecuted.

* Violent behavior, hostility

* Severe insomnia

* Profound weight loss

* Exhaustion


The following data was excerpted from the DSM IV (the fourth edition of
the Diagnostic and Statistical Manual of Mental Disorders, (C) 1994 
the American Psychiatric Association.  


Q:  What is Hypomania?
----------------------

A:  Again, a Manic Episode is defined as including at least A, B, and C 
    above.  A "Hypomanic Episode" is defined as including criteria A and B, 
    but not C.  In other words, there is no marked impairment sufficnent
    to interfere with social and/or occupational functioning is NOT 
    necessary for diagnosing a hypomanic episode.

    The distinctive feature of a Hypomanic Episode is a distinct period in
    which the predominant mood is either elevated, expansive, or irritable
    and there are associated symptoms of the Manic syndrome.  Hypomania, 
    by definition, is not severe enough to cause marked impairment in 
    social or occupational functioning or to require hospitalization,
    as is required for the diagnosis of a full-blown Manic Episode.  The
    associated features of Mania are present in Hypomanic Episodes, except
    that delusions are never present and all other symptoms are less severe
    than they would be in Manic Episodes.

Q:  What is Cyclothymia?
------------------------

A:   The most essential feature of Cyclothymia is chronic mood disturbance.  
     It must exist for at least two years for adults, or at least one year 
     for children and adolescents.  It must involve numerous Hypomanic 
     Episodes, and numerous periods of depressed mood or loss of interest 
     or pleasure in activities previously enjoyed; however, the severity 
     and duration must not be sufficient to meet the criteria for either 
     a Major Depressive Episode, or a Manic Episode.

     The American Psychiatric Association defines the following 
     criteria for diagnosing Cyclothymia:

     A.   For at least two years (for adults) or one year (for children 
          and adolescents) there must have been numerous Hypomanic Episodes 
.  (i.e. Episodes meeting all of the criteria for a Manic Episode, 
.  above, except for criterion C, which has to do with marked 
.  impairment.  There must also have been numerous periods with a 
.  depressed mood and/or loss of interest or pleasure but which 
.  were not severe enough to meet criterion A (above) for a Major 
.  Depressive Episode.

     B.   During a period of two years (one year for children and 
          adolescents) the subject never goes longer than two months at 
.  a time without either Hypomanic or Depressive symptoms.  
.
     C.   No clear evidence exists of a Major Depressive Episode or a Manic 
          Episode during the first two years of the disturbance (one year 
.  for children and adolescents.)
.
     D.   The diagnosis of Cyclothymia cannot be superimposed on a chronic 
          psychotic disorder, such as Schizophrenia or Delusional Disorder.
..
     E.   It cannot be determined that an organic factor, such as repeated
          intoxication from drugs or alcohol, initiated or maintained the
.  disturbance.

Q: How do you tell Unipolar and Bipolar Affective Disorders apart?
------------------------------------------------------------------

A: If the person is known to have had even a single manic or hypomanic episode,
   then there is no question; the diagnosis is bipolar.  If the subject is
   currently depressed, and his/her history is not known, or is incomplete,
   the following guidelines by Dr. Ivan Goldberg may prove to be useful:


      "The things that make me suspect bipolarity in a patient Dx'ed as 
      unipolar are:

.- oversleepng when depressed
.- overeating when depressed
.- a history of bipolarity in the family
.- a patient who when depressed can still joke and laugh
.- anyone with a history of frequent depressive episodes
.      .(rapidly cycling unipolar disorder)
.- success as a salesperson, politician, or actor 
..(in school or real world)
.- extreme rejection sensitivity
.- a history of having ever been dx'ed as bipolar or given
..lithium (except to potentiate antidepressants)"

   Davison & Neale (1990) agree closely with Dr. Goldberg, offering the
   following criteria for helping to distinguish a clinically depressed
   patient from a bipolar patient currently in a depressed state:

   Bipolar, when depressed, typically sleep more than usual and are lethargic.
   Unipolars, on the other hand, tend to have insomnia and psychomotor 
   agitation.

   Unipolar depression usually has a later age of onset than does bipolar
   disorder, the average ages being thirty-six and twenty-eight, respectively.

   More relatives of people with bipolar disorder have affective disorders
   than do the relatives of those with unipolar depression.

   Finally, Lithium Carbonate is more therapeutic for bipolars who are 
   currently depressed than it is for unipolars, thus making it useful
   as a diagnostic tool as well as a therapeutic agent.

   Note that these are simply rules of thumb, and are NOT ETCHED IN STONE!!
   A unipolar patient can still sleep too much, bipolar disorder can 
   surface later in life, and so on.  These are guidelines, not hard
   fast rules.

Q: How can I tell if I am depressed or just in a bad mood?

A: Frequently, it is more obvious to those around us that we are depressed
   than it is to ourselves.  Distorted judgement is part of having a mood
   disorder, so it is not uncommon for our family and friends to recognize
   signs before we do.

   This section and the next involve the Goldberg Mood Scales, by 
   Dr. Ivan K. Goldberg, M.D.  The scales ARE NOT designed to diagnose
   any psychiatric disorder, nor are they intended to replace evaluation
   by a qualified psychiatrist.  They are only intended to measure the
   severity of depressive and/or manic symptoms, and thus to help the
   reader decide whether to seek a psychiatric evaluation.  They have
   been reproduced here with Dr. Goldberg's express permission.

   The Goldberg Depression Scale, below, is a self-administered 
   questionnaire designed to measure the severity of depressive 
   thinking and behavior.


                           Goldberg Depression Scale
                           -------------------------
                        Copyright (c) 1993  Ivan Goldberg

Name______________________________________  Date__________________________




The items  below  refer  to how  you have  felt  and behaved  DURING THE
PAST WEEK. For each item, indicate the extent to which it is true, by
circling one of  the numbers that follows it.  Using the following scale:



0 = Not at all                1 = Just a little               2 = Somewhat



3 = Moderately                4 = Quite a lot                5 = Very much
==========================================================================
1.  I do things slowly.                              0   1   2   3   4   5



2.  My future seems hopeless.                        0   1   2   3   4   5



3.  It is hard for me to concentrate on reading.     0   1   2   3   4   5



4.  The pleasure and joy has gone out of my life.    0   1   2   3   4   5



5.  I have difficulty making decisions.              0   1   2   3   4   5



6.  I have lost interest in aspects of life that
    used to be important to me.                      0   1   2   3   4   5



7.  I feel sad, blue, and unhappy.                   0   1   2   3   4   5



8.  I am agitated and keep moving around.            0   1   2   3   4   5



9.  I feel fatigued.                                 0   1   2   3   4   5



10. It takes great effort for me to do
    simple things.                                   0   1   2   3   4   5



11.  I feel that I am a guilty person who deserves
     to be punished.                                 0   1   2   3   4   5



12.  I feel like a failure.                          0   1   2   3   4   5



13.  I feel lifeless - - - more dead than alive.     0   1   2   3   4   5



14.  My sleep has been disturbed---too little, too
     much, or broken sleep.                          0   1   2   3   4   5



15.  I spend time thinking about HOW I might
     kill myself.                ~~~                 0   1   2   3   4   5



16.  I feel trapped or caught.                       0   1   2   3   4   5



17.  I feel depressed even when good things
     happen to me.                                   0   1   2   3   4   5



18.  Without trying to diet, I have lost, or
     gained, weight.                                 0   1   2   3   4   5

A score of 15 or higher on the depression scale indicates the possible need
for a psychiatric evaluation.

                        Copyright (c) 1993  Ivan Goldberg
                        ---------------------------------


Q: How can I tell if I am manic or just unusually cheerful?

A: Much like depression, it is frequently more obvious to those around us
   that we are becoming manic or hypomanic than it is to us.  Impaired
   judgement is every bit as much a part of mania as it is a part of
   depression, and it is not uncommon for someone on a manic upswing to
   think they simply feel so good because the damn depression is finally
   over.  Family and friends can usually tell the difference quite easily,
   although convincing the manic subject of his/her mania can be quite a
   different matter.


   This section, like the last, involves one of the Goldberg Mood Scales
   by Dr. Ivan K. Goldberg, M.D.  Again, the scales ARE NOT designed to 
   diagnose any psychiatric disorder, nor are they intended to replace 
   evaluation by a qualified psychiatrist.  They are only intended to 
   measure the severity of depressive and/or manic symptoms, and thus 
   to help the reader decide whether to seek a psychiatric evaluation.

   The Goldberg Mania Scale, below, is a self-administered 
   questionnaire designed to measure the severity of depressive 
   thinking and behavior.


                           Goldberg Mania Scale
                           --------------------
                     Copyright (c) 1993  Ivan Goldberg


Name_________________________________________  Date_______________________



The items  below  refer  to how  you have  felt  and behaved  DURING THE
PAST WEEK. For each item, indicate the extent to which it is true, by
circling one of  the numbers that follows it.  Using the following scale:



     0 = Not at all          1 = Just a little          2 = Somewhat



     3 = Moderately          4 = Quite a lot            5 = Very much



==========================================================================
1.  My mind has never been sharper.                  0   1   2   3   4   5



2.  I need less sleep than usual.                    0   1   2   3   4   5



3.  I have so many plans and new ideas that it is
    hard for me to work.                             0   1   2   3   4   5



4.  I feel a pressure to talk and talk.              0   1   2   3   4   5



5.  I have been particularly happy.                  0   1   2   3   4   5



6.  I have been more active than usual.              0   1   2   3   4   5



7.  I talk so fast that people have a hard time
    keeping up with me.                              0   1   2   3   4   5



8.  I have more new ideas than I can handle.         0   1   2   3   4   5



9.  I have been irritable.                           0   1   2   3   4   5



10. It's easy for me to think of jokes and
    funny stories.                                   0   1   2   3   4   5



11.  I have been feeling like "the life of
     the party."                                     0   1   2   3   4   5



12.  I have been full of energy.                     0   1   2   3   4   5



13.  I have been thinking about sex.                 0   1   2   3   4   5



14.  I have been feeling particularly playful.       0   1   2   3   4   5



15.  I have special plans for the world.             0   1   2   3   4   5



16.  I have been spending too much money.            0   1   2   3   4   5



17.  My attention keeps jumping from one idea
     to another.                                     0   1   2   3   4   5



18.  I find it hard to slow down and stay in
     one place.                                      0   1   2   3   4   5

A score of 20 or higher on the mania scale suggests the possible need for
an evaluation by a qualified psychiatrist.

                       Copyright (c) 1993  Ivan Goldberg
                       ---------------------------------

Q: What if someone I know has a mood disorder?
----------------------------------------------

   Twelve things to do if your loved one has depression, manic-depression,
   or some other mood disorder:
   
   1. Don't regard this as a family disgrace or a subject of shame. 
      Mood disorders are biochemical in nature, just like diabetes, and 
      are just as treatable.
   
   2. Don't nag, preach or lecture to the person. Chances are
      he/she has already told him or herself everything you can 
      tell them.  He/she will take just so much and shut out the rest. 
      You may only increase their feeling of isolation or force one 
      to make promises that cannot possibly be kept.  (I promise I'll
      feel better tomorrow honey; I'll do it then, okay?)
   
   3. Guard against the "holier-than-thou" or martyr-like attitude. 
      It is possible to create this impression without saying a word. 
      A person suffering from a mood disorder has an emotional 
      sensitivity such that he/she judges other people's attitudes 
      toward him/her more by actions, even small ones, than by spoken 
      words.
   
   4. Don't use the "if you loved me" appeal. Since persons with mood 
      disorders are not in control of their affliction, this approach 
      only increases guilt. It is like saying, "If you loved me, you 
      would not have diabetes."
   
   5. Avoid any threats unless you think it through carefully and
      definitely intend to carry them out. There may be times, of 
      course, when a specific action is necessary to protect children. 
      Idle threats only make the person feel you don't mean what you say.
   
   6. If the person uses drug and/or alcohol, don't take it away from 
      them or try to hide it.  Usually this only pushes the person into 
      a state of desperation and/or depression. In the end he/she will 
      simply find news ways of getting more drugs or alcohol if he/she
      wants them badly enough.  This is not the time or place for a
      power struggle.
   
   7. On the other hand, if excessive use of drugs and/or alcohol is
      really a problem, don't let the person persuade you to use drugs 
      or drink with him/her on the grounds that it will make him/her 
      use less. It rarely does. Besides, when you condone the use of 
      drugs or alcohol, it ls likely to cause the person to put off
      seeking necessary help.
   
   8. Don't be jealous of the method of recovery the person chooses. 
      The tendency is to think that love of home and family is enough 
      incentive to get well, and that outside therapy should not be
      needed.
   
      Frequently the motivation of regaining self respect is more 
      compelling for the person than resumption of family 
      responsibilities.  You may feel left out when the person turns 
      to other people for mutual support. You wouldn't be jealous 
      of their doctor of for treating them, would you?
   
   9. Don't expect an immediate 100 percent recovery. In any 
      illness, there is a period of convalescence. There may be 
      relapses and times of tension and resentment.
   
   10. Don't try to protect the person from situations which you believe
       they might find stressful or depressing.  One of the quickest ways
       to push someone with a mood disorder away from you is to make them
       feel like you want them to be dependent on you.
   
       Each person must learn for themselves what works best for them, 
       especially in social situations.  If, for example, you try to
       "shush" people who ask questions about the disorder, treatment,
       medications, etc., you will most likely stir up old feelings of 
       resentment and inadequacy.  Let the person decide for THEMSELVES
       whether to answer questions, or to gracefully say "I'd prefer to
       discuss something else, and I really hope that doesn't offend you".
   
   11. Don't do for the person that which he/she can do for him/herself. 
       You cannot take the medicine for him/her; you cannot feel his/her
       feelings for him/her, and you can't solve his/her problems for 
       him/her; so don't try.  Don't remove problems before the person 
       can face them, solve them or suffer the consequences.
   
   12. Do offer love, support, and understanding in the recovery,
       regardless of the method chosen.  For example, some people 
       choose to take meds; some choose not to.  Each has advantages 
       and disadvantages (more side-effect versus higher instances of
       relapse, for example).  Expressing disapproval of the method
       chosen will only deepen the person's feeling that anything 
       they do will be wrong.


Q: Where can I learn more? (Internet)
===================================== 

A. Mailing Lists
----------------

.
     1.   Pendulum is a mailing list for people diagnosed with bipolar 
          affective disorder (manic depression) and related disorders 
.  as well as their supporters, and some professionals. To 
.  subscribe to pendulum, send a message to:

.     majordomo@ncar.ucar.edu 

          containing the line
. 
..  SUBSCRIBE PENDULUM <e-mail address>

     2.   Walkers-in-Darkness is a list for people diagnosed with 
          various depressive disorders (unipolar, atypical, and 
.  bipolar depression, S.A.D., related disorders). The list 
.  also includes sufferers of panic attacks and Borderline 
.  Personality Disorder. Please, no researchers trying to 
.  study us, etc. (Postings are copyrighted by individual 
.  posters.) 

.  To subscribe to walkers or walkers-digest, send a message to:

             majordomo@world.std.com 
         
          containing one of the following lines:

..  SUBSCRIBE WALKERS <e-mail>  for the mailing list, or

..  SUBSCRIBE WALKERS-DIGEST <your e-mail> for the digest.


     3.   MADNESS is an electronic action and information letter for 
          people who experience moods swings, fright, voices, and 
.  visions. (People Who).  To subscribe, send a message to:
.  
             LISTSERV@SJUVM.STJOHNS.EDU 
  
          with this command in the body of the message:

..  SUBSCRIBE MADNESS <first name> <last name>

B.  USENET Newsgroups
--------------------- 

alt.support.depression   

alt.support.depression.manic

alt.support.depression.seasonal

alt.society.mental.health

alt.society.mental-health



C. World Wide Web Sites
-----------------------

Pendulum Resources: http://www.csn.net/~era/pendulum
Ivan K. Goldberg: http://avocado.pc.helsinki.fi/~janne/ikg/keywords.html
Collected writings of Ivan Goldberg: http://avocado.pc.helsinki.fi/~janne/ikg

OCD server: http://www.fairlite.com/ocd
Keyword searches: http://www.fairlite.com/cgi-bin/ocdsrch/fairlight/ocd/search/ocdsrch
Medical Resources: http://www.fairlite.com/ocd/medres/
Personal Resources: http://www.fairlite.com/ocd/perres/
Medication Financial Aid: http://www.fairlite.com/ocd/medres/pma.html
Coping with depressed Spouse: http://www.fairlite.com/ocd/perres/dep_spouse.html

Interpsych: http://www.med.umich.edu/psychiatry/interpsych.html

Medical Abbreviations: http://uhs.bsd.uchicago.edu/~bhsiung/tips/names.html
Nefazodone: http://uhs.bsd.uchicago.edu/~bhsiung/tips/nefazodone.html
Effexor: http://uhs.bsd.uchicago.edu/~bhsiung/tips/venlafaxine.html#What
Pindolol: http://uhs.bsd.uchicago.edu/~bhsiung/tips/pindolol.html
Tips: http://uhs.bsd.uchicago.edu/~bhsiung/tips/tips.html

PTSD General Info: http://www.long-beach.va.gov/ptsd/stress.html
PTSD Combat Veterans Research: http://141.163.90.14/intro.htm

General Information: http://www.mentalhealth.com

Q: Where can I learn more? (Books)
-------------------------------------

Title:   Physicians' Desk Reference, 49th Editions 
Medical Consultant:  Arky, Ronald, M.D.
ISBN:  N/A
Comments:  An expensive, but worthwhile investment for anyone who's ever been
           told that ANY drug is "perfectly safe" or "without side-effects".
           Cross-indexed by manufacturers brand names, generic names, product
           identification guide, product information, and diagnostic 
           information.  A "must-have" for anyone who wishes to be an informed
           consumer.

Title:   We Heard the Angels of Madness:  One Family's Struggle with Manic
         Depresion
Author:  Berger, Diane and Berger, Lisa
ISBN:  0-688-09178-4
Comments:  Forwarded by Alexander Vuckovic, M.D. It was written by a mother who
           had a son stricken by manic-depression at 19 and the rough road they
           walked to get him the help he needed. Very heartfelt and well
           written.

Title:   A Brilliant Madness:  Living with Manic Depressive Illness
Author:  Duke, Patty "Anna" and Hochman, Gloria 
Publisher/Year:  Bantam Books; 1992
ISBN:  0-553-07256-0
Comments:  Duke and Hochman write alternating chapters, with Duke writing a
           very personal account of her struggle with manic-depression, and 
           Hochman writing about the more clinical and technical aspects of 
           manic-depression.

Title:   Call Me Anna: The Autobiography of Patty Duke
Author:  Duke, Patty "Anna" and Turan, Kenneth  
Publisher/Year:  Bantam Books; 1987
ISBN:  0-553-27205-5
Comments:  Duke and Hochman write alternating chapters, with Duke writing a

Title:  Moodswings
Author:  Ronald R. Fieve, M.D.
Publisher/Year:  1989
ISBN:  Bantam 0-553-27983-1 (paper), Morrow 0-688-08879-1 (cloth)

Title:  Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition
        (DSM IV)
Editor, text and criteria: First, Michael B. M.D.
Publisher/Year: American Psychiatri Association, 1994.
ISBN: 0-89042-061-0 (Hard) 0-89042-062-9 (Paper)

Title:  Questions and Answers about Depression and its Treatment
Author:  Dr. Ivan Goldberg
Publisher/Year:  The Charles Press; 1993.
ISBN:  ISBN 0-914783-68-8
Comments:  A 112 page FAQ on depression and manic-depression.

Title:   Manic-Depressive Illness
Author:  Goodwin, Frederick K. M.D. and Jamison, Kay Redfield, PhD.
Publisher/Year:  Oxford University Press; 1990
ISBN:  NA
Comments:  Drs. Goodwin and Jamison have set out to write "the" authoritative
           text on manic-depressive illness, and it would appear that they 
           have succeeded.  The book includes an exhaustive review of all the
           other literature currently available at the time.  Although this
           is an excellently written book, it's a bit much for some to digest.
           Remember when you were little and your mom said "now don't order
           the super-giant burger unless you know you can eat it all"?  Well
           this book is like the super-giant burger.  It retails for about 
           $75.00, and it may possibly weigh more than you do.

Title:   Touched with Fire: Manic-depressive Illness and the Artistic 
         Temperment
Author:  Jamison, Kay Redfield
Publisher/Year:  1993
ISBN:  0-0291-6030-8 (cloth) 0-060-96594-0 (paper)
Coments:  A look at a number of 19th century poets, writers, and  composers who
          were Bipolar. Comment by Dr. James D. Watson, Director of Cold Spring
          Harbor Laboratory, Novel laureate and author of The Double Helix:
         "An emphatic analysis of the creativity that emerges from a little
          madness and the horror from too much."

Title:   An Unquiet Mind: A Memoir of Moods and Madness
Author:  Jamison, Kay Redfield 
Publisher/Year:  Alfred A. Knopf.; 1995 <1st printing>
ISBN:  0-679-44374-6
Coments:  Dr. Jamison's personal testimony of her own struggle with manic-
          depressive illness since adolescence, and how it has shaped her 
          life.  She shows tremendous courage in writing the book at all,
          for the stigma attached to all mental illness, including manic-
          depressive illness is very real.  Since she herself is a professor
          psychiatry, and a world-class authority on manic-depression, this
          book represents a genuine "coming out of the closet", so to speak.

Title:  Receptors
Author:  Richard M. Restak, M.D.
Publisher/Year:  Bantam Books, NY; 1994
ISBN:  NA
Comments: "The author is an M.D. who also suffers from unipolar depression. 
           Although he's not anti-med, he doesn't claim that medications
           will solve everything either.  He writes about how our 
           neurological receptors work and about how they affect how we
           feel. Although the book is detailed, it's not so technical that 
           you need a PhD to understand what he's saying. He provides a history
           of how the different receptors were discovered, and also discusses
           how alcohol, caffeine, nicotine, heroin, cocaine, and prescription
           drugs effect us. One chapter is devoted to the discovery of lithium
           and discusses how it is used to treat people with manic depression." 


