Depakote

Byline: Norman E. Rosenthal, M.D.

Norman E. Rosenthal, clinical professor of psychiatry at Georgetown University Medical School, was online Tuesday, Dec. 20, at 11 a.m. ET to field your questions and comments about cyclothymia, bipolar disorder and seasonal affective disorder (SAD).

Rosenthal's newly revised book is titled "Winter Blues: Everything You Need to Know to Beat Seasonal Affective Disorder" (Guilford Publications, 2005)

From The Post:

A Sudden Shift in Moods (Post, Dec. 20)

Graphic: Moody or Manic? It Can Be Hard to Tell the Difference

The Transcript follows.

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Norman E. Rosenthal, M.D.: Hello everyone; nice to be here

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Washington, D.C.: If you suspect you may have some sort of mental or emotional disorder, what is the best course of action?

Norman E. Rosenthal, M.D.: I recommend that you see a mental health professional, who might be a social worker, psychologist, licensed counselor or psychiatrist

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College Park, Md.: Thank you for doing this chat. My wife has bulimia, this is the third time it has "flared up," and the first in about 4 or 5 years. She is 24 and her first episode with bulimia was when she was about 12. She smoked cigarettes for about 10 years and quit just over a year ago. Her bulimia "flared up" again about 4 months after she quit smoking, which I'm sure acted as a catalyst for the eating disorder. She has tried hypnotism, seeing a therapist and on and off fasting to try and cleanse her body and mind. She is depressed because of the eating disorder and eats to dull this depression, vomits, cries, is fine for a day or two, then repeat. We have looked into eating disorder specialists, but none of them are in-network for our insurance, which is a large national insurance company. She has seen an in-network psychiatrist, but personally I think she needs to see a specialist. Do you have any recommendations? I'm sure this scenario is not unique. Again, thank you for your time.

Norman E. Rosenthal, M.D.: Bulimia is a really tricky condition. It definitely warrants finding a good psychiatrist and may even be worth going out of network to find someone good. Medications such as antidepressants can be very helpful. One little known fact about bulimia is that it gets much worse in winter for many people and that light therapy may be helpful in its treatment. But treatment needs to be a combination of therapy and medications as well.

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Sacramento, Calif.: How do you know if what you have is SAD or something more serious? Is it length of time?

Norman E. Rosenthal, M.D.: SAD vs. The Winter Blues is really a matter of severity. People with SAD often have trouble with a number of different important functions - eating, sleeping, concentrating on work, socializing - so that they really have a disorder that warrants medical treatment. People with the Winter Blues have a milder impairment in quality of life of creativity or productivity. This isn't a hard and fast distinction and someone might have SAD one winter and Winter Blues the next depending on circumstances

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Arlington, Va.: About five years ago, in college, I was diagnosed with OCD and depression. For the majority of the time since, I was on 60-80 mg of Prozac. I tried Paxil and Wellbutrin, but neither was as effective. About a year ago, I discussed the side effects with my doctor (feeling "flat", nonexistant libido) and she switched me to Cymbalta. For the most part, I love it. My mood is pretty stable, but I still have a mood - as opposed to Prozac which just made me dull - and my sexual appetite is back. However, I've been able to take a closer look at the patterns of my depression, since the Cymbalta just takes the edge off them, but doesn't mask them completely, and I think I may have something closer to bipolar. The "highs" aren't as high, and the "lows" aren't as low - but otherwise the symptoms fit. Unfortunately over the past month, I feel as though I've been fighting off a particularly bad set of "lows". This makes me nervous, as I've almost had to be hospitalized in the past, and I'd really like to avoid getting into that situation. Any thoughts?

Norman E. Rosenthal, M.D.: I'm delighted that you found an antidepressant that works for you. It sounds as though you are having mood swings that might benefit from a mood stabilizer (for example, lamictal, depakote or lithium). Do consult your psychiatrist as to whether one of these drugs might be suitable for you

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McLean, Va.: I have a mood disorder that doesn't cycle high/low, but more like sort-of-okay/very low about every 2-3 weeks. After much experimentation with a very good doctor (formerly at NIMH) we figured out a "cocktail" that involves an SSRI (zoloft), an antiepileptic (topamax); and Welbutrin, which seems to be hitting all the right neurotransmitters. For the first time in many many years, I feel stable and happy. My reason for writing is to make the observation that stabilizing mood disorders is not easy; it's often not just a matter of taking one pill; and unless one is seeing a doctor who has serious expertise with meds, one can spend a lot of time taking meds that will either do no good at all or make matters worse. Who would have thought that an antiepileptic drug -- Topax -- would act as a mood stabilizer? But reports coming in from docs in the field, and some preliminary studies, are showing that it does work as such for a certain group of people. Just thought I'd share.

Norman E. Rosenthal, M.D.: I'm so glad you shared your story - and totally agree with your conclusion. Finding the right mix of medications can be tricky and it is worth finding the right professional, who has the patience and expertise to work with you until you get things right.

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Madison, Wis.: Are there any similarities between someone with Borderline Personality Disorder (the so-called "Walking on Eggshells" disorder--that is, those around persons suffering from the disorder feel as if they're walking on eggshells, unable to anticipate the next blow-up or irrational move by the sufferer) and someone with Seasonal Disaffective Disorder? My spouse claims to suffer from SDD (based on several psychiatrist visits), but she acts the same unpredictable and irrational way the entire year, no matter what the season. Thanks for your response.

Norman E. Rosenthal, M.D.: Borderline personality disorder and Seasonal Affective Disorder are two very different conditions - but it is quite possible to have both of them

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Washington, D.C.: Are there any safe ways to treat bipolar disorder or its uncomfortable symptoms (anxiety, irritability) during pregnancy? I am having a very hard time finding information on this topic.

Norman E. Rosenthal, M.D.: Using drugs during pregnancy is always tricky - and no drug is 100% safe, by which I mean that you can guarantee that the fetus will not be affected. That having been said, some drugs are safer than others and it is always worth doing a careful cost-benefit analysis to determine whether to medicate and, if so, which drug is best. Remember, it may be unsafe to leave a mood disorder untreated. As always, your own doctor is the best person with whom to discuss this complex question

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Washington, D.C.: My spouse was diagnosed with BPD. I'd say 5% of the time, what I'd describe as irrational reactions/behaviors, surface. How do I deal with this in the most effective way? Are there strategies that I can use?

Do I need to go to a Psychologist, Psychiatrist, or Therapist myself to learn coping skills?

Or do these periods of highs/lows/anger have to run their own course?

Norman E. Rosenthal, M.D.: I think one can learn a great deal from life - or books - without the help of a professional. The question of when to involve a professional depends on how bad the situation is and how well you think you can cope on your own. Sometimes the best way to cope is to get better help for your spouse in terms of mood control. Stable moods are conducive to a stable marriage and vice versa

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Alexandria, Va.: My wife has been diagnosed Bi-Polar. It has been managed with a drug cocktail of Depacote, Wellbutrin, Topamax etc. The Depacote has at times been a very high dose (1600-1800 milligrams a day). This in conjunction with talk therapy has worked wonders.

My Questions are:

Why does the cocktail seem to work better than just one drug?

and

What are the long term effects of a cocktail (mental and physical)?

Are there any good books or resources on the long term management of this disease?

Comment: I glad modern medicine has been successful in finding ways to manage this disease. Should I be keep my expectations in line with management of a chronic illness or are there options on the horizon for anything like a cure.

Thanks for your time!

Norman E. Rosenthal, M.D.: Lots of questions. Sometimes one drug works and, if so, that is usually preferable. But often one drug doesn't work, perhaps because it influences only one neurotransmitter system predominantly - e.g. zoloft and serotonin. In that case another drug, e.g. wellbutrin, which influences dopamine and norepinephrine may be a useful addition because it recruits these additional neurotransmitter systems.

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Burke, Va.: Thanks for addressing these issues.

My wife has been (for the last year or more) irritable, snappish, annoyed, poor self-image, and poor general outlook. She has lots of stresses in her life but has not been willing to attribute her current troubles to anything but the "world out to get me," or "I deserve all this." How do you get someone who is obviously depressed to recognize that their depression is clouding their judgment on how much they need outside help? Mid-30's seems way too early to go through a mid-life crisis, or maybe she's got too much testosterone - awfully defensive and aggressive. No history of disorders but not the best family relationships since childhood. Our current home situation isn't that great either - me: on SSRI and ADHD meds. I've finally started dealing with my own long term depression through therapy and meds, but my wife's reactions and outlook seem to be more deeply rooted in depression than just a reaction to overwhelming circumstances. Is there a fine line between "depression" and general unhappiness? How does one explore the difference?

Norman E. Rosenthal, M.D.: It is very difficult to deal with someone who has problems but externalizes them, i.e. always sees them as someone else's fault. Sometimes this defense mechanism breaks down and a person is willing to admit some role in her own unhappiness, but often it doesn't. In this situation, the spouse has to distinguish between what he can and cannot control. You might try to gently point things out - I'm sure you already have - but beyond a certain point you have to realize that you are banging you head against a wall and focus on your own mental health.

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Alexandria, Va.: Mr. Rosenthal, I have been recently diagnosed as Bipolar type 2 and with PTSD. It's been attributed to my experiences in Iraq. Well, my question is do these conditions get better with time and will or can they go away? I am having a difficult time with military doctors because it seems that they don't have the answers nor the time to really sit with me. I have been rated disabled but I don't want to be disabled. Is there something I can do to speed the healing or something. I'm tired of it.. Thank you

Norman E. Rosenthal, M.D.: I would not assume that these conditions will just go away. They need active help. I would really work with the system to make it clear that you are not getting the help you need. If you can't get proper help within the system, try going outside the system. But whatever you do, don't just leave it. There are many ways to help both bipolar disorder and PTSD. For the latter, you might want to take a peek at my book, The Emotional Revolution, which outlines many ways of treating PTSD

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Central Virginia: Hello! Thank you so much for running this chat, especially at this time of year.

I am an adult child of a paranoid schitzophrenic, and I've been dealing with the effects of a toxic childhood ever since I reached adulthood. I am fortunate enough to have escaped that syndrome, but do you know if there are any other conditions to which I might be predisposed? I know that we're still learning about mental health, and I'm not up on all the latest research.

I do have SADS, as does my sister, but I find that plenty of indoor light -- grow bulbs especially help, plus the plants like really them -- and some outdoor exercise really alleviate the low-level depression. But I am wondering if there is anything else for which I should be on the look-out.

Thank you, and have a wonderful holiday!

Norman E. Rosenthal, M.D.: If you have any other disorder, you would probably know it - disorders manifest in the form of symptoms of one kind or another. If you don't have any symptoms, don't borrow trouble. You may just have been lucky enough to escape the pain of emotional illness - enjoy it.

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Washington, D.C.: How sure is a "standard" evaluation to properly diagnose various mental illness? Do you believe in detecting these mental disorders through brain scan? There was talk that Mayo Clinic does this.

Norman E. Rosenthal, M.D.: I think brain scans to detect mental illness have been oversold. Most mental illnesses are diagnosed by history - and there is no substitute for a thorough consultation with a competent mental health professional to establish such a diagnosis. Brain scans are most helpful when there is a clear organic reason for symptoms

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Washington, D.C.: Has it been your experience that some psychiatrists, therapists, etc., do not take "minor" mental illnesses such as dysthymia and cyclothymia as seriously as a major depressive episode or full-blown bipolar? I've probably been dysthymic for 15 years now, but I've gotten a sense of "You're not suicidal, you can get up and go to work (most days at least), so what are you complaining about?" from some practitioners.

Norman E. Rosenthal, M.D.: dysthymia - chronic, low grade depression - can be extremely disabling and deserves treatment

Now here's a tip for everyone out there - if you are not happy with you doctor - maybe he or she is dismissive, lacks the time or competence to deal with someone else - find another one. There are so many professionals out there. You MUST find one whom you trust to care about you in a competent and caring way

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Washington, D.C.: I have been diagnosed with SAD. The light therapy helps, along with my regular therapy, but I go through the ups and downs. My boss, however, does not believe this is a real thing. She thinks I just get lazy around the holidays. How can I convince her that my concentration fails and I get really depressed and that it's seasonal?

Norman E. Rosenthal, M.D.: Maybe you can't convince her. You can only do so much - perhaps show her a professional article, bring her a doctor's note etc. But in the end, if someone is pig-headed it may be impossible to convince them of anything.

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Rosslyn, Va.: I have a general question about mental health. How do you know if you're suffering from depression or might have bi-polar disorder. Admittedly, my parents are becoming increasingly worried about my 'attitude' saying I've become angry at the world. I was on an antidepressant for a year or more (fluoxatine, I think), but it didn't seem to help. How can you tell if you have depression?

Norman E. Rosenthal, M.D.: There are some standardized self-administered questionnaires that can be helpful, but the best way is to consult a mental health professional. I would take your parents seriously. In my experience it is rare for caring parents to suggest the possibility of an illness if there is no basis for the suggestion whatsoever.

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Madison, Wis.: The recognition of mania is just as important as the depression. I was initially treated for depression, yet it was my family doctor who listened to me describe manic cycles of not sleeping, doing crafts all night, and rages against family who sent me to a psychologist/psychiatrist team. Now, I'm using Lamictal and Celexa in tandem with talk therapy, and my moods, which still have peaks and valleys, are within my acceptable range of emotion.

Norman E. Rosenthal, M.D.: Totally agreed! And people are often reluctant to acknowledge mania - or hypomania (its less severe variant) because they often feel good - superenergized and upbeat - during those periods. But mania or hypomania can be very destructive and often herald depression. Therefore they should be treated.

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Virginia: There is a woman at my work who said to everyone she has DID. I thought it was multiple disorder personality.

Norman E. Rosenthal, M.D.: Dissociative disorders are linked to multiple personality disorder - they are extremely complicated and interesting problems - perhaps too much to answer in this forum

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Washington, D.C.: I'm Bipolar II, on meds and in therapy. I'm relatively well-managed, but sometimes still have mild to moderate issues with my moods.

My father was bipolar I and committed suicide.

My question: I have a lovely 4-year-old and want to be a good example to her. Any general tips for bi-polar parents on how much they should tell their kids about their mental illness? And any general tips about being a good parent while dealing with your own mental health issues?

Norman E. Rosenthal, M.D.: It's great that you are aware of your mood issues and getting treatment for them. That tells me you are already being a good parent. Watch your moods is the first tip I would offer. Be sure not to take out your downs on others - especially the children - and also be careful of your highs. During high periods parents may minimize things and not pay enough concern to their children's issues. Use your therapy to work on minimizing the impact of your moods on your children

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Columbia, Md.: Why is Pyschiatry the only medical specialty that ignores, or is completely indifferent to weight gain-even to the point of obesity and inducement of diabetes? To say nothing of increased risk of some cancers, osteoarthitis, and cardiovasular disease. When I sought out another Pdoc (VERY hard to accomplish since I was on Medicaid then), I said I was not going to take lithium and depakote anymore. I have rapid cycling Bipolar I. We, the new Pdoc and I chose topamax and then lamictal plus the wellbutrin I was always on. I lost 40 pounds in 13 weeks. I lost another 25 in the next 8 months. I am 5"7" and now weigh 158 pounds. I also refused any of the atypicals. Now they all have warnings about weight gain, hyperglycemia and so on. Again, why does every other type of doctor so insistent about reaching and maintaining normal weight; but psychiatrists are oblivious and the majority of people who carry my diagnosis AND take their meds are FAT!!!?

Norman E. Rosenthal, M.D.: It's a bit unfair to say "psychiatry" doesn't pay any attention to weight gain. Maybe it would be better to say SOME psychiatrists don't. But many do and everyone SHOULD because of the huge impact of obesity on physical and mental wellbeing

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Fairfax, Va.: What should be done to help an adult family member who has sudden, often unexplained mood swings from sweet and thoughtful to angry, even violent, rage, often because of small or no provocation? What if that same family member denies that there is a problem with this and refuses to seek counseling or evaluation?

Norman E. Rosenthal, M.D.: Patiently but persistently point out the behaviors and illustrate the inconsistencies. Remember the story about how drops of water can drill a hole in a stone. In just that way persistent gentle observations can sometimes break down even the toughest denial.

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SAD and "eveningness": Ever since October, I've been finding it harder to get up in the mornings, get stuff done at work, and I seem listless and depressed. I suspected I might have SAD, and in an article published last week in the Post, there was a link to a quiz that determined your circadian rhythms. After answering the questions truthfully, it seems as though my melatonin production doesn't start until 1 am, and as a result I won't really feel awake, hungry, and productive until much later than my ideal wake-up time. This was like a lightbulb going off for me. Half an hour of light-box therapy with a 10,000 lux unit around 7:30 AM is recommended for me, but I can't seem to find any models which are endorsed by any scientific or government institutions. Do you have any recommendations here? Many thanks.

Norman E. Rosenthal, M.D.: Fascinating question. ONe of the best things you can do is to wake up in an illuminated room, either by putting a light on a timer or by using a special dawn simulator. In my book, Winter Blues, I list several good light box companies. You can also find them via a link on my Web site www.normanrosenthal.com

Use only white light sources and in general I prefer the larger boxes. As you imply in your question, earlier is usually better for light therapy

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Indpls, Ind.: Finding caring and competent mental health care is next to impossible. Extremely expensive, long waits, and if it doesn't work out? Start the whole process over again. I'm paying off $3,000 worth of 'mental health care' co-pays from treatment in June. I'm no better off, no worse. I've learned to accept myself as I am which is not such a bad person. Please consider the extreme financial hardships some of us endure. Not everyone's wealthy.

Norman E. Rosenthal, M.D.: This is unfortunately very true. You can get a great deal of help from self-help books. One of the reason that I have written my own self-help books is to bring assistance to those who cannot gain access to top quality help. But your note has a tone of despair. I would encourage you to keep trying. There are good people out there and the best ones are not always the most expensive.

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Washington, D.C.: What books would you recommend regarding bipolar disorder? I would love some help in better understanding my mother-in-law, and things I can do to deal with her manic and depressive episodes.

Norman E. Rosenthal, M.D.: I like the book by Papoulos and Papoulos, but there are other good books out there too.

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Anonymous: Hi Doctor,

HELP!

That walking-on-eggshells feeling is a very accurate description for how my spouse and I feel about two members of our family, a mother and son.

Both have trouble keeping or staying at their jobs (mother has held nearly 15 jobs in 6 years), they have little concept of money (irrational spending) and are basically unable to plan or anticipate the future.

This has caused us much havoc as major events like holidays and weddings are proceeded with massive disruptions -- for instance, right now, both are saying they'd rather spend Christmas alone than come visit us, even though we purchased their non-refundable plane tickets months ago (with their knowledge and consent). Similar upheaval occurred before our wedding, with fights, accusations, refusals to come, etc.

It's taking all the fun out of major events and driving us insane, because we are constantly putting out fires and bailing them out of horrendous situations. Neither has good health insurance (the job situation again) and neither believes they have a mental illness. They do not take criticism well, and would not accept us telling them they need to see doctors. What in the world can we do? These are close family members; we can't just write them off. But we cannot keep living like this.

Norman E. Rosenthal, M.D.: Sometimes you just can't "fix" someone else - mostly you can't. Just realize that these people are struggling with terrible psychological issues. It can be awfully hard for someone who is suffering like that to sit through a Christmas dinner, making pleasant conversation. Maybe they are making the best decision for themselves - and for you all - though I sympathize with losing those non-refundable tickets

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Columbus, Ohio: I have two sons with bipolar disorder, age 21 and 18. The second had his first manic episode, pyschotic break and hospitalization within the last 10 days. We went though the same thing with his brother exactly three years ago

The thing that continually amazes me about this health condition is how common it is-1% of the population. (Another 1 percent suffers from schizophrenia.) That's a lot of people! How can we get seriously address the need for better health care services and treatments when the stigma of mental illness causes the scope of the problem to so often be swept under the carpet?

Norman E. Rosenthal, M.D.: I think that we must get parity for mental health coverage. So far we have been unsuccessful in doing so despite valiant attempts in the house and senate. Mental health organizations such as NAMI have fortunately become increasingly powerful, but it seems as though they are still no match for the insurance lobby.

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Fairfax, Va.: I'm in my late 20s and early last fall I had my fourth major depressive episode. Therapy helped a great deal in identifying patterns and behavior, but it wasn't until I was on medicine that I actually felt like I was lifting out of it. The medicine also helped increase my sex drive, which was not only low because of the depression, but because I am on birth control. I stopped taking my meds rather abruptly because of a change in job and insurance so I know that probably wasn't a wise thing. My question is this... I feel guilty going back on medication if I'm not currently in a depressive episode, but it helped me concentrate, raised my sex drive and energy levels. Going off birth control isn't an option, despite the correlation between that at depression-noted in myself also. Is it a bad thing to take medication to stave off depression and use it for its milder benefits? Have their been any long-term studies on effects of Wellbutrin? Many thanks for your thoughts.

Norman E. Rosenthal, M.D.: It sounds like going back on your medicine is just what the doctor should order - though I am not your doctor and you had best check with your own. There are side-effects to all medications, wellbutrin included, but I know of no long term (as opposed to short term) side effects of the drug

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Elgin, Pa.: For over one year my husband has symptoms of paranoia, I don't know whether in his case, its an anxiety disorder or a personality disorder or part of a larger problem. He is highly educated, very logical and intelligent, so its quite obvious when he becomes irrational. He knows enough to realize people will think he is going mad if he expresses his feelings to others, so he only tells me, occasionally. He has become very withdrawn and avoids most social gatherings. Any advice on how to get help or where to start?

Norman E. Rosenthal, M.D.: I would start by talking to your doctor, who can refer you to a suitable local therapist or psychiatrist. If your husband is reluctant to go on his own, present it as a couple issue (which in part it is) and go along to keep him company and help him face up to what sounds like a difficult situation, but a treatable one

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Washington, D.C.: Dear Dr. Rosenthal,

My brother is 22 and suffers from possible bipolar disorder, ADD and OCD. I say possible because the countless doctors who have examined him have a hard time definitively diagnosing him. Having said that, most agree on the above three possibilities. He is also not very emotionally developed for his age and suffers from very poor self-esteem. We have tried everything with him (countless doctors, albeit he doesn't want to go to therapy, and also countless medications). He is now through with the medications, which left him as a zombie. He is doing better off the medications, but still can't hold a job and doesn't engage in any extra-curricular activities.

Do you have any suggestions for next steps for such a difficult case in which medications don't really help and actually worsen his situation and anxiety? Any suggestions for self-help groups or other venues that may help him? Any suggestions for excellent doctors in the D.C. area that may be of service? Any excellent resource for getting information?

Thank you!

Norman E. Rosenthal, M.D.: You might try DRADA, a Hopkins based self-help group in the DC area, geared towards mood and anxiety disorders. You might also try the Ross Center for Anxiety Disorders in DC (Tel: 202-363-1010) which has many excellent therapists of different disciplines.

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Chicago, Ill.: I suffer from mild depression and was on effexor for over a year and suffered horrible side effects and head aches. Are there any homeopathic or natural "cures" or treatments for depression for people who are aware they suffer but have issues taking the medications?

Norman E. Rosenthal, M.D.: St. John's wort is an effective herbal treatment for depression (I actually have a book out on that topic) but I wouldn't despair of pharmaceutical solutions based only on one unsuccessful experience. A skillful doctor may help you by trying other types of medications. Therapy, such as cognitive behavior therapy is a drug-free option for treating depression

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Arlington, Va.: The article on cyclothymia describes my girlfriend to a degree of accuracy that is almost frightening. She has seen doctors and therapists and has had diagnoses ranging from bipolar to depression. Her behavioral tendencies never seemed severe enough for bipolar, nor did they seem to fit mere depressive symptoms. The description of cyclothymia in the article was dead on. Thankfully, she is now on Lamictal, and that helps, but she still has significant ups and downs. My question is: are there other treatments emerging for cyclothymia that would complement the Lamictal?

washingtonpost.com: A Sudden Shift in Moods (Post, Dec. 20)

Norman E. Rosenthal, M.D.: I still love lithium - an oldie but a goodie

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Washington, D.C.: If someone with bipolar disorder has had success with lithium, what are the chances of increased manic episodes once he transitions off the lithium (or stops taking it altogether)?

Norman E. Rosenthal, M.D.: Very high

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Washington, D.C.: I suspect I may have a mood disorder that is affecting my relationships. I don't have health insurance or any regular doctor or anything, so I was hoping you could tell me how to find the right person to talk to? I don't really know where to start, and when I called the Depression and Bipolar Support Alliance, I was referred to someone else, who referred me to someone else, etc...I ended up with nothing but frustration -- zero help.

Norman E. Rosenthal, M.D.: You might want to try a clinical research trial. In these trials, new drugs are being tested, but they are often tested against conventional drugs. After such a trial the clinical research center often provides free treatment for a period of time. It is sometimes a very good way to get quality help free of charge. I run such a clinical research organization in the Bethesda-Rockville area. You can give us a call at 301-770-7375 and check out whether there is a trial available that might be suitable for you

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Minneaolis, Minn.: How important are genetic factors in the 3 affective disorders?

What is the risk of developing such disorders in the children of such cases?

Norman E. Rosenthal, M.D.: Genetics play a very prominent part in mood disorders. For example, if one parent has bipolar disorder, there is a one in four chance that a child will have a mood disorder.

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Arlington, Va.: Dr. Rosenthal, My friend and I were both battling with depression and bonded because we had similar situations. When I finally overcame it, we seemed to drift apart, and while still friends I saw her continue to get worse. She was in therapy and her medications kept increasing but to no avail. Eventually we stopped speaking because I wasn't supportive enough in her eyes, in my eyes I was emotionally drained from worrying about her so much. While I am not a medical professional, I truly believe that she needs inpatient care. I didn't know her one surviving family member or how to get ahold of them, nor did I know what to do if I did. So my question is, if you truly believe a non-family member is in danger of hurting themselves or others unless under constant supervision, how should you proceed?

Norman E. Rosenthal, M.D.: Your story is very moving and you ask a good question. You can't have someone committed unless you think they are an imminent danger to themselves (i.e. that they will hurt themselves today, not next week). If you think a person is an imminent danger, you can call 911 - but it is very difficult to prove, will often only result in a brief admission to hospital and could destroy a relationship. Nevertheless, it can also be life saving. So it's a judgment call. Perhaps you don't have to resort to that but can use your powers of persuasion or do an intervention by involving others who care as well

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Dupont, Washington, D.C.: How do you go about finding a MH professional that will be a good match for your situation? What questions should I ask? Where do I begin--the phonebook, my insurance company's list of providers? It seems like a really important decision, how can I make an educated one?

Norman E. Rosenthal, M.D.: Check with your regular doctor. Show him or her your list of in plan providers; that might be the best way to start

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Studio City, Calif.: How do you maintain a relationship (whether it's work, friend or otherwise) with someone who is bi-polar? In my experience, their insecurities usually sabotage the relationship. Since we are surrounded by this and many people with other mental illnesses, I would like to know how to relate.

Thank you.

Norman E. Rosenthal, M.D.: Good mood control is the key. Also, it takes a special type of person to be willing to ride out the highs and lows, but often the bipolar person has other wonderful qualities that make it all worthwhile

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Washington, D.C.: Do you know of any groups for people suffering depression? Similar to AA, where there's someone to call if one is having a depressive episode. It's hard to talk to family during one, especially if they've never experienced an episode.

Norman E. Rosenthal, M.D.: As I mentioned, DRADA, out of Hopkins is an excellent local group

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Anonymous: I have been taking a cocktail of buprophion, celexa and tradazone for about 5 years and have never felt better. My doctor is reluctant to tell me my diagnosis because she says it doesn't matter. It matters to me, though. Can you tell me what she probably thinks is wrong?

Norman E. Rosenthal, M.D.: I agree with your doctor that diagnoses are overvalued. But she would have to have something to put on your insurance form - so there must be a diagnosis, at least nominally. Often there is a mixture of anxiety and depressive symptoms that makes it hard to say whether something is a mood or anxiety disorder

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San Diego, Calif.: What, if any, correlation exists between bipolar depression and ADD?

Norman E. Rosenthal, M.D.: I have been struck by the very high correlation between bipolar disorder and ADHD

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Capitol Hill, Washington, D.C.: Does the medical community know why antiepileptic medications work for bipolar disorder? Is there a link between epilepsy and bipolar?

Norman E. Rosenthal, M.D.: Theories abound but nobody knows for sure. One way to think of it is that episodes of mood instability may reflect seizure type activities in those parts of the brain that regulate mood. Antiseizure drugs may stabilize these spikes of activity

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Downtown Washington, D.C.: Doctor:

Thanks for taking my question. I recently switched sun boxes from a 10,000 lumens tilted overhead to a 10,000 lumens desktop that shines directly at me. Same reputable manufacturer in Gaithersburg. The new box does not seem to work as well for me even though I use it for about the same amount of time. Is there a difference in the results depending on how the light shines?

Norman E. Rosenthal, M.D.: Different boxes may surely differ in efficacy. My favorite model is the SunSquare. The tilt allows you to get closer to the light source without being bothered by the glare, which may explain the superior efficacy of the tilted fixture. Also, bigger is usually better when it comes to light boxes

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Arlington, Va.: I have noticed with the women on my mother's side of the family that there is an obvious anxiety problem that worsens with age to the point where my grandmother no longer leaves the house, and my aunt cannot get behind the wheel of a car. My mother is also becoming very anxious regarding everyday tasks. I know that I have problems with anxiety, but it is pretty mild currently. What can I do to prevent this from becoming debilitating as I age?

Norman E. Rosenthal, M.D.: Awareness is a key. If you find yourself becoming increasingly anxious, get help. And be sure to tackle phobic and avoidant symptoms which enhance the disability associated with anxiety disorders

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Rockville, Md.: I have a friend who believes that actors are conspiring to take over the world with help from the British Royal family and assorted other groups. I took to a crisis center and they have committed her. She believes nothing is wrong and refused medication. She has no place to stay. no means of support. Do you have any suggestions as to what can be done for her.

Norman E. Rosenthal, M.D.: This is a really sad story and I don't have a good answer. All the help resources I have mentioned might be useful here - NAMI, clinical trials, psychotherapists etc

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Chapel Hill, N.C.: Do you know of any national equivalents to DRADA if someone doesn't live in the D.C area?

Norman E. Rosenthal, M.D.: Contact the Depression and Bipolar Alliance at

www.dbsalliance.org

They should be able to help you

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Norman E. Rosenthal, M.D.: Also, DRADA can be reached at

www.drada.org

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Norman E. Rosenthal, M.D.: I am afraid I am going to have to go shortly

It has been very rewarding talking with you all today

Thanks for the interesting questions and enjoyable discussion

And happy holidays to all of you

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