How to Ask For Help

Earlier this month, Dr. Deb had a nice post on what it means to ask for help — and reasons people don’t do it. Here’s a short excerpt of a pithy post:

Myth: Holding things in and keeping personal issues under wraps keeps us secure.

Truth: In reality, not allowing yourself to be “known” keeps you socially isolated, and therefore, insecure. When you seek the counsel of others, you’ll not only connect with them, but you’ll also realize that you’re not alone in your struggle.
Highly successful people never ask for help. Really? Read it here.

A Diagnosis Emerges? Pediatric Bipolar

Does pediatric disorder exist? Who decides what the criteria are?

Furious seasons has a fact-filled post today on exactly this topic. What is most curious about this possibly emerging diagnosis is that it does not yet appear in the DSM. Yet officials at the FDA are claiming it is a diagnosis, by virtue of the fact that medications have been approved for treating it. Pretty circular logic. As problematic as the DSM is, it at least has the supposed backing of research (which actually turns out to be flimsy in many cases…) But this is an unusual case of a diagnosis being created outside the DSM.

Here are several paragraphs from the post:

More pointedly, McClellan told me earlier this year that the kids and teens he was seeing (he sees some very intense kids and teens at two Seattle-area hospitals) who had been diagnosed with bipolar were in fact kids with oppositional defiance disorder and conduct disorder who were largely the product of extreme, and extremely dysfunctional, environments. The leader of the Harvard group, Joe Biederman, has said kids are born this way.

McClellan is far from the only one flying red flags around the bipolar child business. Steven Hyman, a Harvard psychiatrist and former NIMH head, has publicly expressed his concerns about the meds these kids are given: “We don’t know the first thing about safety and efficacy of these drugs even by themselves in these young ages, let alone when they are mixed together.”

In 2006, Thomas Insel, NIMH director, also pointed to the meds being given bipolar kiddos as being a concern, telling the New York Times, “There are not any good scientific data to support the widespread use of these medicines in children, particularly in young children where the scientific data are even more scarce.”

In an op-ed, Larry Diller of UCSF noted: “Biederman shocked the child psychiatric world in 1996 by announcing that nearly a quarter of the children he was treating for attention deficit hyperactivity disorder also met his criteria for bipolar disorder. Up until then bipolar disorder was rarely diagnosed in teenagers and unheard of in prepubertal children. Biederman could justify his findings by simply broadening the semantic definitions of a previously more circumscribed condition contained within American psychiatry’s bible — the ‘Diagnostic and Statistical Manual of Mental Disorders’.”

Depression and Adolescents

A finding in a recent article in the Archives of Pediatrics & Adolescent Medicine. The study found that depressive symptoms are often unrecognized in adolescents. Here are some of the risk factors for adolescents:

  1. female
  2. not involved in social activities
  3. knew someone who intentionally hurt himself or herself or died a violent death
  4. were currently involved in a sexual relationship, or used street drugs

Here’s an excerpt of the findings:

A total of 967 patients were enrolled. According to the Beck Depression Inventory II, 20% (197 patients) had moderate to severe depressive symptoms. Of these, 58% recognized their depressive symptoms and 50% were recognized by their guardians as having depressive symptoms. When compared with nondepressed patients, adolescents with depressive symptoms more often were female, were not involved in organized social activities, knew someone who intentionally hurt himself or herself or died a violent death, were currently involved in a sexual relationship, or used street drugs. Race, family income, family stability, and witnessing violence were not associated with a positive depression screen result.

Exercise, Depression, Anxiety

Does exercise reduce depression? Does depression reduce exercise? Or is whether exercise reduces depression dependent on a third factor? That’s what a recent article in the Archives of General Psychiatry suggests — that it is a third factor, in this case genetic, which determines whether exercise is beneficial in reducing depression (or anxiety). The article’s title is: Voluntary Exercise Does Not Appear to Ease Anxiety and Depression. Courtesy of Ken Pope. Here are a few excerpts:

Associations observed between exercise and anxious and depressive symptoms “were small and were best explained by common genetic factors with opposite effects on exercise behavior and symptoms of anxiety and depression,” the authors note. “In genetically identical twin pairs, the twin who exercised more did not display fewer anxious and depressive symptoms than the co-twin who exercised less.” Exercise behavior in one identical twin predicted anxious and depressive symptoms in the other, meaning that if one twin exercised more, the other tended to have fewer symptoms.

Curiously, the study distinguishes between voluntary (self-motivated) exercise and other types of exercise. The implication is that therapeutically driven exercise (other-motivated) would only be effective if the person had the genetic disposition toward self-motivated exercise. Such a therapy would not have a very high success rate. But the research is preliminary, and it will be interesting to see how the findings play out.

Kalea Chapman, Psy.D.