Introduction

Moodswing - Dr. Fieve on Depression: The Eminent Psychiatrist Who Pioneered the Use of Lithium in America Reveals a Revolutionary New Way to Prevent Depression
by Ronald R. Fieve, M.D.

Fifteen years ago, this groundbreaking book provided new hope for those whose lives were devastated by moodswings and depression. Now, in this newly revised and updated edition, Dr. Ronald R. Fieve, the pioneer in the treatment of depression in America, offers an even brighter prognosis. Major advances in drug therapy have provided dramatic chemical "cures" that alleviate symptoms faster, more efficiently, and at a lower cost that ever before.

In this revised and expanded Moodswing, Dr. Fieve sheds new light on the causes and symptoms of specific mood disorders, including manic depression, seasonal depression, and PMS. Then, through case studies, he illustrates the effective use of the latest diagnostic methods and drug treatments. He also provides fascinating information on:

• Why creative types are often prone to manic-depressive disorders - the results of a fifteen-year follow-up study.

• How manic depression, alcoholism, and substance abuse go hand in hand.

• How presidents, Pulitzer Prize-winning playwrights, and Wall Street wizards can benefit from "manic advantage," but crumble when their moods crash.

• The revolutionary uses of one of psychiatry's greatest wonder drugs: lithium, as well as new material on the latest antidepressant drugs.

• Why teenage and adult suicide is on the upswing and what friends and family can do to prevent it.

• Why traditional psychoanalysis in the treatment of depression is, in many cases, no longer necessary.

When I wrote the first edition of Moodswumg, it was to tell the story of my search for antidepressant treatments for those suffering from manic and suicidal feelings and of the breakthrough that my use of lithium achieved.

In the years since Moodsuring was first written, the treatment of mental illness has undergone major changes. No longer are most depressions treated with long and expensive courses of psychotherapy. A wide array of safe and effective antidepressants is now available to treat chemical imbalance.

New modes of health care have sprung up. Practitioners known as psychopharmacologists, who are experts in using medications to treat chemical imbalance, now treat depressions, panic and anxiety disorders, eating disorders, attention deficit disorder, alcoholism, and addictive disorders. Today these disorders are better understood by the general public, and they are best treated by the psychopharmacologist rather than by the general psychiatrist or clinic.

The hour spent weekly talking to the psychiatrist is largely obsolete. It has been replaced by a fifteen-minute visit with a psychopharmacologist-once a week in the beginning, and later once a month. During these visits the blood levels of drugs are measured if necessary, side effects are checked, and medications adjusted. In addition, the patient may discuss stresses and problems with a psychologist or therapist and meet with a peer support group. The cost of this treatment is far less than that of traditional psychotherapy, and quality care is available to all segments of society, including patients in remote areas.

We continue to search for biological markers to give the clinician a blood or urine test by which to determine whether a major depressive disorder or manic-depression is present. The genetics of mood disorders and behavior responses to medications are also being studied in a number of clinical laboratories throughout the world. These include my own at the Atchley Pavilion, Columbia-Presbyterian Medical Center, and groups we collaborate with in midtown Manhattan, elsewhere in the U.S., and abroad.

There have been major advances in diagnosis, including the concept of dual diagnosis, the notion that the patient has an underlying major psychiatric illness, superimposed on which is another major illness, such as alcoholism or drug abuse. One of the most common problems seen by physicians in the 1990s is substance abuse. But many people suffering from such abuse are actually victims of an underlying depression or panic disorder they may be trying to medicate on their own with addictive substances. In most cases, once the underlying disorder is treated with antidepressants, the addiction, which is usually slow and difficult to cure by itself, can be eradicated more easily with the help of twelve-step programs, such as Alcoholics Anonymous, and support group treatments.

The concept of depression has been expanded to include more than a blue mood or suicidal thoughts. Today we are seeing more and more patients with mild chronic depression, lack of pleasure in life, low energy, and low self-esteem. These individuals are often shy, with a tendency to social phobia. Such men and women suffer from a very harmful form of depression called dysthymia, literally "bad mood." These people, who often have been in psychotherapy for years, are usually chronic underachieves, unhappy on the job and at home. They and their physicians usually do not recognize that they have a treatable depression.

As for lithium, it has gained worldwide use and popularity since Moodswing was first written. It is now the standard treatment for manic-depression and many other forms of depression, and it is used by most psychopharmacology specialists throughout the world. Lithium has helped patients and their families avoid untold weeks and years of disruption and emotional suffering. I would estimate that the use of psychotherapy and psychoanalysis alone to treat depressed patients has decreased by at least 50 percent.

With each year, researchers come closer to understanding how brain neurotransmitter hormones (such as seratonin and norepinephrine) control the nervous system and affect mood and behavior. It is now widely accepted that much of our behavior is affected by our individual biochemical profile. As the stigma is removed from mental illness many new issues need to be addressed. Will our judicial system eventually be more forgiving of behavior that is biogenetically caused (and which eventually can be biochemically corrected)? How accountable for his or her behavior is an individual with a biochemical imbalance? How do we monitor the mental health of some of our national leaders?

Surprisingly, some mood disorders can be at times highly beneficial. As I pointed out in the first edition of Moodswing, there have been throughout history and are today many highly productive and creative individuals who suffer from manic-depression or depression. Outstanding figures in government, finance, the arts, business, and science often succeed because they have what I call the bipolar llB advantage. These men and women have a milder form of bipolar manic-depressive illness. They benefit enormously from the periods of high mood and high functioning that often accompany this form of the mood disorder. One day researchers may demonstrate that this beneficial form of bipolar illness has its own biogenetic and behavioral profile. In my practice I have seen hundreds of outstanding men and women who contribute enormously to society who suffer from mild moodswings. However, these often spectacular achievers only come to see me for help when their beneficial highs have cycled into a low.

Today the outlook for a patient suffering from depression is bright, for he or she is experiencing a treatable biochemical imbalance. Researchers are constantly looking for new antidepressants that work faster, more effectively, and with fewer side effects, and many new medications continue to appear on the market each year.

No one needs to live with depression. Most depressions are curable with the right treatment. If you or someone you care about is suffering from painful or even suicidal depressed feelings, I recommend consulting a psychopharmacology specialist.

There is more hope than ever for the millions who suffer from the debilitating emotional illness of mood disorders- and in this revised edition I have tried to share it all with you.

© 1989 by Ronald Fieve, M.D.

About the Author

Internationally renowned psychiatrist Ronald R. Fieve, M.D. is the pioneer in the use of lithium for manic depression in America. A graduate of Harvard Medical School, he served his residencies in internal medicine at New York Hospital and in psychiatry at Columbia-Presbyterian Medical Center. He is professor of clinical psychiatry at Columbia University, the founder of the former Foundation for Depression and Manic Depression and current executive medical director of the new Foundation for Mood Disorders. He is the author of Prozac: Questions and Answers for Patients, Family and Physicians. Dr. Fieve maintains private practice and research offices on the east side of Manhattan and at the Atchley Pavilion at Columbia-Presbyterian Medical Center.