Mind, Mood, and Medications

The Mind/Mood Pill Book
by Robert E. Hales, M.D., Dianne Hales

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Why do I feel this way? Why am I so moody? Is there anything I can do to feel better? Can anyone help?

At some point in life, almost everyone asks these questions. We all experience sadness, worry, rage, self-doubt, even despair. Often these feelings are short-lived, but sometimes they continue for days or weeks, coloring the way we view ourselves and the world. A life crisis - an accident or illness, a huge financial setback, the loss of someone dear - may be responsible. In other cases, gloom or anxiety may descend for no apparent reason.

Like physical problems, persistent emotional aches and pains can affect every aspect of life. More than 1 in every 4 Americans suffer from a mind/mood problem so severe that it interferes with their ability to keep up with their daily routines, do their jobs, care for their families, or relate to others as they once did. No one, regardless of age, gender, education, or income, is immune.

According to the National Institute of Mental Health's (NIMH) landmark Epidemiologic Catchment Area (ECA) Survey, about 27 million adults and 7.5 million children in the United States have a diagnosable mental disorder; this is more than the combined total of individuals with cancer, heart disease, and lung disorders. In another major study, the National Comorbidity Survey (see Table 1-1), almost half of those queried reported having at least one mental disorder over the course of their lifetimes; almost 30 percent had been troubled by a disorder in the previous twelve months. Adults are not the only ones affected. According to some reports, the number of troubled children has increased to as many as 11 to 14 million youngsters.

Table 1-1: How Common Are Mind/Mood Disorders?

Anxiety disorders (panic disorder, agoraphobia, social anxiety disorder, specific phobia, generalized anxiety disorder)
Affected in a given year: 17.2%
Affected in some point in life: 24.9%

Depressive disorders (major depression, manic depression, dysthymia)
Affected in a given year: 11.3%
Affected in some point in life: 19.3%

Alcohol dependence or abuse
Affected in a given year: 9.7%
Affected in some point in life: 23.5%

Drug dependence or abuse
Affected in a given year: 3.6%
Affected in some point in life: 11.9%

Any mental disorder
Affected in a given year: 29.5%
Affected in some point in life: 48.0%

Source: Kessler, R., et al.: "Lifetime and 12-Month Prevalence of DSM-III-R Psychiatric Disorders in the United States." Archives of General Psychiatry, vol. 51, January 1994.

The most surprising - and disheartening - fact is not that so many people are troubled but that so few get help. According to NIMH statistics, 7 in every 10 Americans with a mental disorder do not receive any treatment. These individuals may never realize why they cannot function the way they once did or why their lives have become difficult and joyless. They may try to tell themselves that they are simply overworked or stressed out. Even when they suspect that something more serious is wrong, many hate to admit, even to themselves, that they have a problem. They blame themselves, as if becoming anxious or depressed or feeling out of control is somehow their fault in a way that a medical condition such as diabetes or arthritis could never be. Often they fear that no matter where they might turn, no one will be able to help them. And nothing could be farther from the truth.

During the last two decades the mental-health field has undergone a quiet but profound revolution that has produced new forms of help and new reasons for hope. We now have a much better understanding of how the mind and the brain work and of what can go wrong and why. We know more about the complexity and variety of problems that can develop. We have identified patterns of vulnerability and the biological components of many mental illnesses. And we have an impressive collection of highly specific, carefully tested, and scientifically proven medications that can help most of those who seek treatment.

Diagnostic Developments

In 1840, in the first official attempt to gather information about mental illness in the United States, the Census Bureau recorded the frequency of a single category: idiocy/insanity. By the beginning of the twentieth century, early psychiatrists had identified more than a dozen mental illnesses. For decades, however, American psychiatry viewed all mental illnesses, as psychiatrist Karl Menninger put it, "as being essentially the same in quality, although differing quantitatively and in external appearance." This view has since given way to a search for greater specificity and precision in both diagnosis and treatment.

One of the major advances in the quest came in 1980, not in the form of theory, technique, drug, or doctrine, but in a book: the third edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, or DSM, as it is commonly called. A revised version of this edition, published in 1987, and a completely overhauled fourth edition, DSM-IV, published in 1994, spell out explicit characteristics, or diagnostic criteria, for almost 300 disorders. Rather than focusing on the whys of mental illness, DSM emphasizes the whats - the specific signs and symptoms that characterize various psychiatric disorders. As a result, even when mental-health professionals disagree about or do not know the possible causes of a disorder, they can agree on how it manifests itself, and this common base enables them to assess treatments most likely to bring about recovery. DSM has given mental-health professions a shared language. Because its criteria are widely accepted, physicians, psychology, psychiatry, and social work trainees, and medical and nursing students use DSM as a textbook. Insurance companies base reimbursements on it. Research agencies and foundations fund investigations according to the DSM criteria.

New Treatments

Mental illness, as well as attempts to cure it, dates back to the oldest societies. The ancient Greeks pushed depressed individuals from the tops of cliffs into the sea to shock them out of their despair. In the Middle Ages, priests used exorcism to cast out the "demons" of madness. With the dawn of modern psychiatry, treatments were developed that were more humane but not necessarily more helpful. Only in recent years have mental-health professionals been able to offer a wide range of therapies - more numerous, more varied, and more precisely targeted than ever before - that have proved effective against common and often crippling disorders. These include new psychiatric medications that correct chemical imbalances in the brain and new psychotherapies that use cognitive, interpersonal, behavioral, and other techniques to produce lasting benefits within weeks or months. The combination of drug and psychological treatments - an approach that, not very long ago, many doubted would ever work - has proved even more helpful for many individuals than either psychotherapy or medication alone.

Although most people do not realize it, treatments for severe mental illnesses, such as major depression, bipolar (manic-depressive) illness, panic disorder, and schizophrenia, are as effective as or more effective than those available in other branches of medicine, including surgery. Therapies tailored to an individual's particular condition and needs can help 70 to 80 percent of those who suffer from depression, bipolar disorder, or panic disorder. More than 60 percent of those with schizophrenia can be relieved of acute symptoms with proper therapy, and advances in medication are pushing this percentage even higher.

The revolution that has brought so much excitement and hope to the mental-health field is far from over. The coming years will undoubtedly yield new insights, advances, medications, and therapies to treat common disorders and prevent recurrences. In the past, those with manic-depressive illness typically spent half of their adult lives disabled, often in psychiatric hospitals. Thanks to medications that prevent debilitating mood swings, 75 to 80 percent now live essentially normal lives - a change that has saved the United States economy more than $40 billion since 1970. Similar progress has been made in major depression. As recent studies have shown, as many as 80 percent of those who become depressed experience a recurrence within ten years and face increased risk of job loss, marital breakups, and suicide. Maintenance treatment with antidepressants can prevent these terrible problems and keep individuals well.

The Mind/Mood Center: The Brain

To understand how medications work requires some basic information about the brain. The last and greatest biological frontier, more complex and more challenging than anything else in the entire universe, the brain represents the sum of human knowledge, emotion, memory, experience, and creativity. It enables us to think and talk, to remember and anticipate, to work and play, to express our needs and control our desires. Some describe the spongy mass of gray and white matter within the skull as an enlightened machine that combines the analytic ability of a computer, the organizational skills of a filing system, and the communications network of a telephone switchboard. Yet no machine or invention, however sophisticated, can crack a joke, dream of daffodils, write a poem, believe in a hereafter, or fall in love.

The brain has intrigued scientists for centuries, but only recently have its explorers made dramatic progress in unraveling its mysteries. Leaders in neuropsychiatry, the field that brings together the study of the brain and the mind, note that 95 percent of what is known about brain anatomy, chemistry, and physiology has been learned during the last decade. These discoveries have reshaped our understanding of the organ that is central to our identity and well-being, and they have fostered great hope for more effective therapies for the more than 1,000 disorders, psychiatric and neurological, that affect the brain and the nervous system.

There is so much scientific excitement centering on the exploration of the brain that some mental-health professionals worry that the powers and potential of the mind will be neglected. In fact, the study of the brain is not only changing our understanding of mental illness, but it is also challenging the conventional view that the mind and brain are distinct from each other. We are learning that these two aspects of consciousness work as one, and that mental experiences affect brain processes, and vice versa. The more we discover about the molecular mysteries of the brain, about the energy that causes tiny clumps of cells to make an idea blossom or a feeling form, the more we understand about how we think, learn, create, communicate - in essence, how the mind does all the things that make human beings unique.

Excerpted from The Mind/Mood Pill Book by Robert E. Hales, M.D., and Dianne Hales Copyright © 2000 by Robert E. Hales, M.D., and Dianne Hales. Excerpted by permission of Bantam, a division of Random House, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.

About the Author

Dr. Hales is a renowned adult psychiatrist who specializes in neuropsychiatry, clinical psychopharmacology and mental health services research. The author or editor of 36 books, Dr. Hales has appeared annually in The Best Doctors in America since 1992, American Health's Best Doctors in the U.S. Dr. Hales is co-founder and deputy editor of The Journal of Neuropsychiatry & Clinical Neurosciences, Editor in Chief of the American Psychiatric Publishing, Inc. and has received numerous professional honors and military accolades.

Dianne Hales is the author of thirteen trade books and the leading college health textbook, a contributing editor to Parade, and a freelance writer for a wide range of national magazines. She lives in the San Francisco Bay area.