Ken Duckworth, M.D.: How Do You Move Beyond Blue?

Excellent podcast, and well worth the listen. (Although the audio quality is poor -- which perversely made your transcription so difficult and simultaneously makes a further transcription helpful to BB readers ... sigh.)

A couple of thoughts:

1. I don't think the idea that mental illness is "chronic" automatically makes it "untreatable." But there's no objective question that it is chronic (note Dr. Duckworth's chilling remark about how 1 in 10 lives of the seriously mentally ill ends ...) and, as Dr. Duckworth would note, just because mental illness is treatable, and that some or even many patients do well, doesn't mean the treatments are perfect or even particularly well-targeted, to say the least.

2. There is another side to the question of faith and depression. Just as for many people, their faith is the only consolation that keeps them going, for others (yours truly), their depression causes them to question the religious and theological teachings of a lifetime. I would agree with Dr. Duckworth that a therapist/psychiatrist not addressing these questions on EITHER end is a form of malpractice, morally if not legally.

Most medications besides lithium used as mood stabilizers for people with bipolar disorder, of course, were originally developed for epilepsy.

We know they "calm" the brain. As Dr. Duckworth basically said, we have no idea WHY :-(

Actually, I don't think lithium was ever used for epilepsy -- only the class of anti-seizure drugs like Depakote, Tegretol, Lamictal, Neurontin, Topamax, etc.

Lithium is chemically different -- a natural salt. There are towns in the South called "Lithia Springs" where people once soaked in spas with lithium-filled water to get "healing" -- and probably, from what we know now about lithium, some no doubt did!

(In fact, just as Coca-Cola once had cocaine in trace amounts, 7-Up once had lithium in trace amounts from such lithium-filled water!)

There were thoughts in the late '40s and early '50s of making lithium a low-calorie substitute for table salt to prevent heart disease. Unfortunately, as we know now, if you sprinkle a bunch of lithium on your french fries, the dose can be extremely dangerous. (As I recall, I think some of the "food testers" may even have died ... ugh.)

The difference between lithium's "therapeutic range" (where it helps treat manic depression) and its toxic range where it poisons the body is very small -- thus the need for periodic blood tests. As a result, lithium was banned in the U.S. for many years -- despite some simultaneous research showing incredibly promising results in Australia ...

... which ultimately resulted in lithium coming to be used to treat bipolar disorder. This is just the simplified version of a truly fascinating story:

http://en.wikipedia.org/wiki/John_Cade

Amazing that such an interesting and mostly positive story (despite its ups and downs) has resulted in such a stigmatized drug. (Sigh.)

I would definitely classify myself as the faith sustained depressive. When I am at my darkest is when I have moved the furthest from God. He never leaves...I do. Luckily He's always waiting patiently when I return from "The Dark Side" I remember when my favorite uncle died. The whole family was there at his passing by his bedside. His son Michael said "It's okay to go, you can let go now" It was the most unexpectedly peaceful thing I have ever witnessed. I could see the Christ figure in him at that moment. He was a faithful christian. I felt the sorriest for my aunt. It's always the hardest on those left behind. When I was alone for a moment in the cemetery I heard a voice. It was the most beautiful sound, of a young man and he said "Let your soul be at peace, for I am with you...always" If you are a believer, no explanation is neccesary. If you are not...no explanation is possible. (that doesn't make me sound like a lunatic) I BELIEVE!

Patricia:

Even though (if you read BB) you know I'm not the most faithful of believers, believe me when I say I pray you stay in your recovery. You are doing an amazing and incredibly difficult thing. I understand meth is, chemically, one of the most addictive substances on the planet. As you're probably already being told, one day at a time.

There is an incredibly high rate of "dual diagnosis" (substance abuse occurring simultaneously with mental illness such as bipolar disorder and/or ADHD). Precisely because, as you said, it's a way people who know they have something "wrong" but don't have a diagnosis can "self-medicate."

And, as the difficulties you are going through probably have already silently "told" you, people with dual diagnosis are more likely to slip back into substance abuse than those who have a substance abuse problem but not a mental health diagnosis. You have a hard row to hoe -- again, as I know you know.

I am just plain lucky (or should I say, blessed?). Yes, I have bipolar disorder, but I could easily have had a dual diagnosis like you. My father is an alcoholic and I was headed down that road (binge-drinking my way through college) when a friend of mine did an intervention on me at age 23. I've been a teetotaler now for more than 15 years (without AA, although I did attend Al-Anon for several years).

Speaking of which ... mental illness support groups may be extremely helpful for you, both to get some perspective from other people in your "boat," and perhaps to get resources to find another doctor who is more familiar with treating dual diagnosis patients.

In addition to the many resources Therese puts on her site (including of course, nami.org, the Web page for Dr. Duckworth's organization), might I suggest the organization that sponsors my support group:

http://www.dbsalliance.org

Again, we are all thinking about and praying for your continued recovery and mental health.

PS -- Some substance abuse support groups will encourage you to give up psychiatric medications since they too are "drugs" in their opinion. Personally speaking, I strongly oppose that view; and if anyone in a support group encourages you in that direction, I'd suggest at least that you speak to a doctor (even your current doctor you don't really like) first. Just IMHO.

Let me begin by telling you all that I am a high school teacher and live in a rural, conservative, suicide-stigmatizing culture. A little over two years ago, my beloved youngest brother, who was a high school guidance couselor, completed suicide. I have always struggled with low grade chronic depression, but this trauma sent me over the edge into what my psychiatrist has dg as chronic severe depression, panic disorder and PTSD. All of those were latent in me until my brother took his life and suddenly the whole world stopped, except my intense depression and constant grief. This, combined with an exacerbation of my rheumatoid arthritis, kept me out of the classroom for the first semester after his death. Since then, my grief and therapy journey has been active, not always straightforward, but cyclical and I have begun to speak out. I wrote an article for our local paper in which I wrote about his suicide and invited the public to attend a suicide survivors' group I was starting with my therapist and another clinical social worker. The group attendance was low, I now believe, because we chose to hold it in the conservative stronghold community of the area and feel that if we try to move it to a local university town, our attendance would improve. In addition, I have spoken to university classes about my loss and the warning signs, the grief, etc. and have been very open with my 12th grade classes. No one in the school community has complained, perhaps because I'm a vet, and well-respected as a teacher. I agree so much with the advice here. Meds need to be tweaked until the right combo is found. It's frustrating by I'm now on celexa supplemented by cytomel and use clonezapam for threatening anxiety attacks. My startle reflex comes and goes now, and I am still seeing my therapist with regularity. The loss I experienced blew the top off of the volcano of my unconscious and since then I've been processing my life and growing spiritually into a new person. Reconstruction is like reincarnation and it hurts! But so worth the effort to be honest, to struggle, to weep and to laugh, to meditate and be thankful. All spiritual paths lead us to one unity and there are many "good red roads" in this world we live in.

Blessings!

yes, please post the rest i am very depressed and would enjoy reading more of it

please type out the rest of the interview so that I am able to read it when I have more time to go over it again and again. (while on the bus to work, during lunch break ect)
As a Family Member and conservator of a dual diagnosis patient I am always looking for anyone with compassion towards Mentaly Ill people.
Let a lone a doctor like Dr, Duckworth with education and experience as well as compassion.

Please post the rest,Iám really researching depression and bi polar now, as Í have been on meds for 15 years and still have lots of problems, I also have fibromyalgia and that's what they thought the depression was from due to so much chronic pain. The more I read the more I feel like I have bi polar tendencies and others in my family have mood disorders also. My 8 yr old grandson was just diagnosed as bi polar and put on meds. This is such a confusing illness, and it's hard to find good docs to help that really care. Let's all keep plugging along to understand mental health and hope that more people become caring docs in the near future. Bless you all and don't lose faith! My grandkids call me gra "moo"instead of grandma.If any one else suffers from fibromyalgia and has serious depression from it I would like to hear from you. I have horrible SAD in the Summer, where I live it is so hot and the heat makes my Fibro really bad. I also have SAD really bad around the holiday months when the weather is really changing where I'm from.

I would like to read more. I am severly depressed right now and seriously thinking about not taking my medicine so I can die. I have diabetes, congestive heart failure, and end stage renal failure. I am going to have to go on dialysis in the very near future and I'm scared. I have a daughter who hates me and claims my husband (her step-father) molested and raped her repeatedly all of her life and that I knew it and let it happen. Everywhere I move to, she comes along and tells her story. I moved here to be close to my parents and sisters after my husband died and now my parents have passed on and my daughter came up and told my sisters her story and now they have turned against me.I thought my older sister was on my side but tonight she told me exactly what she thought of me and called me a b---- and other things and said what a horrible mother I had been and on and on and on. I have been crying for hours and I just want to die. I have nothing left to live for.