Mental Health Awareness

Bipolar Disorder at work

Bipolar Disorder Exacts Twice Depression’s Toll in Workplace

Productivity Lags Even After Mood Lifts

Bipolar disorder costs twice as much in lost productivity as major depressive disorder, a study funded by the National Institutes of Health’s (NIH) National Institute of Mental Health (NIMH) has found. Each U.S. worker with bipolar disorder averaged 65.5 lost workdays in a year, compared to 27.2 for major depression. Even though major depression is more than six times as prevalent, bipolar disorder costs the U.S. workplace nearly half as much — a disproportionately high $14.1 billion annually. Researchers traced the higher toll mostly to bipolar disorder’s more severe depressive episodes rather than to its agitated manic periods. The study by Drs. Ronald Kessler, Philip Wang, Harvard University, and colleagues, is among two on mood disorders in the workplace published in the September 2006 issue of the American Journal of Psychiatry.

Their study is the first to distinguish the impact of depressive episodes due to bipolar disorder from those due to major depressive disorder on the workplace. It is based on one-year data from 3378 employed respondents to the National Co-morbidity Survey Replication, a nationally representative household survey of 9,282 U.S. adults, conducted in 2001-2003.

The researchers measured the persistence of the disorders by asking respondents how many days during the past year they experienced an episode of mood disorder. They judged the severity based on symptoms during a worst month. Lost work days due to absence or poor functioning on the job, combined with salary data, yielded an estimate of lost productivity due to the disorders.

Poor functioning while at work accounted for more lost days than absenteeism. Although only about 1 percent of workers have bipolar disorder in a year, compared to 6.4 percent with major depression, the researchers projected that bipolar disorder accounts for 96.2 million lost workdays and $14.1 billion in lost salary-equivalent productivity, compared to 225 million workdays and $36.6 billion for major depression annually in the United States.

About three-fourths of bipolar respondents had experienced depressive episodes over the past year, with about 63 percent also having agitated manic or hypomanic episodes. The bipolar-associated depressive episodes were much more persistent — affecting 134-164 days — compared to only 98 days for major depression. The bipolar-associated depressive episodes were also more severe. All measures of lost work performance were consistently higher among workers with bipolar disorder who had major depressive episodes than those who reported only manic or hypomanic episodes. The latter workers’ lost performance was on a par with workers who had major depressive disorder.

“Major depressive episodes due to bipolar disorder are sometimes incorrectly treated as major depressive disorder,” noted Wang. “Since antidepressants can trigger the onset of mania, workplace programs should first rule out the possibility that a depressive episode may be due to bipolar disorder.”

Future effectiveness trials could gauge the return on investment for employers offering coordinated evaluations and treatment for both mood disorders, he said.

Also participating in the study were: Dr. Kathleen Merikangas, NIMH; Dr. Minnie Ames and Robert Jin, Harvard University; Dr. Howard Birnbaum, Paul Greenberg, Analysis Group Inc.; Dr. Robert Hirschfeld, University of Texas; Dr. Hagop Akiskal, University of California San Diego.

The National Institute on Drug Abuse (NIDA), Substance Abuse and Mental Health Services Administration (SAMHSA), Robert Wood Johnson Foundation and John W. Alden Trust provided supplemental funding.

In a related NIMH-funded study in the same issue of the American Journal of Psychiatry, Drs. Debra Lerner, David Adler, and colleagues, Tufts University School of Medicine and Tufts-New England Medical Center, found that many aspects of job performance are impaired by depression and that the effects linger even after symptoms have improved.

The researchers tracked the job performance and productivity of 286 employed patients with depression and dysthymia, 93 with rheumatoid arthritis and 193 healthy controls recruited from primary care physician practices for 18 months. While job performance improved as depression symptoms waned, even “clinically improved” depressed patients performed worse than healthy controls on mental, interpersonal, time management, output and physical tasks. The arthritis patients showed greater impairment, compared to healthy controls, only for physical job demands.

Noting that 44 percent of the depressed patients were already taking antidepressants when they began the study and still met clinical criteria for depression — and that job performance continued to suffer despite some clinical improvement — the researchers recommended that the goal of depression treatment should be remission. They also suggest that health professionals pay more attention to recovery of work function and that workplace supports be developed, perhaps through employee assistance programs and worksite occupational health clinics, to help depressed patients better manage job demands.



© 2001-2007 National Institute of Mental Health. All Rights Reserved


A therapeutic resource…
Kathy Broady, LCSW

3630 North Josey Lane, Suite 100
Carrollton, TX 75007


  • has been developed as an innovative site for the online treatment of trauma, sexual abuse, dissociative disorders, post traumatic stress disorder, depression, bipolar, anxiety, and self injury. Our depths of understanding and creative approaches to healing are truly unique.
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  • addresses the needs for support peoples who are, even though they may be totally overwhelmed, genuinely interested and invested in the recovery of their loved one from the effects of abuse.
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The Deadly Duo
December 17, 2008, 3:44 am
Filed under: depression | Tags: , ,

The Deadly Duo: Depression and Depression Fallout   Anne Sheffield

Excerpted from Depression Fallout: The Impact of Depression on Couples and What You Can Do to Preserve the Bond (Quill/HarperCollins, New York, 2003)

Love and depression speak different languages. Every man and woman in a relationship touched by depression comes face to face with this unpleasant truth. Although each believes that he or she is living through a unique situation, the behavior of both parties conforms to a predictable pattern. One participant acts according to the dictates of his or her depression: Be critical, unpredictable, sullen, illogical, angry, touchy, put-upon, distant yet occasionally tender, and deny there is anything wrong with you. The other follows the rules governed by depression fallout: Be confused and bewildered, blame yourself for the relationship’s problems, become thoroughly demoralized, then get angry and resentful, and, finally, yearn to escape.

Few people are well informed about the dynamics of depression and its companion, depression fallout, despite the unhappiness they cause. Ask most people to conjure up the image of someone who is depressed and they will envision a huddled figure sitting passively in the corner and murmuring about how sad he or she feels. No wonder, since most lists of depression’s symptoms begin with “a persistent sad, ’empty,’ or anxious mood,” followed by “loss of interest or pleasure in ordinary activities, including sex.” While these symptoms do describe how depression sufferers feel, they are not matched by the expected passive behavior. Indeed, the depressed often become unpleasantly aggressive, argumentative, and faultfinding without provocation. This disconnect causes innumerable depression-clouded relationships to unravel and become mired in conflict and misunderstanding. When previously attentive, warm, demonstrative partners turn irritable, distant, and thoughtless, mates are unlikely to attribute the change to a psychiatric illness, even though they may have read about depression in the abstract. Instead, they jump to what seem to be more likely explanations: a waning of affection, dissatisfaction with the marriage or love affair, a clandestine liaison with somebody else, a selfish preoccupation with work, or a reluctance to share deep, dark secrets that concern both partners.

Since the true culprit is an illness that afflicts no less than nineteen million Americans at any given moment, why don’t depressed partners speak up and explain what is going on in their minds and hearts? Surely anyone whose life has turned inexplicably gray and hopeless would choose to talk about it with his or her intimates, thus paving the way for answers and solutions. But that is not depression’s way. Indeed, depression’s most insidious trait is the ease with which it seduces its sufferers into blind alleys signposted Lousy Relationship, Bad Karma, Weak Character, Stress Overload, and other misleading names.

All those battered by depression fallout are convinced that their situation is unique and their reactions to it aberrant. Having enjoyed a gratifying and seemingly solid partnership beset by no more than the usual ups and downs, they find themselves living with an unwelcome stranger masquerading behind a familiar face. Not only does this newcomer no longer behave as expected, but he or she appears to have undergone a personality change for the worse. Tenderness and support have been traded in for grumpiness and irritability; sharing for secretive distance; patience and reason for volatility and antagonism; and good habits for bad ones. Threatening though this is, fall-out partners do not seek solace or advice from family and friends. Convinced that they are somehow responsible for the transformation, or that its explanation is perhaps embarrassing and best kept hidden from others, they guard their secret. This extracts a costly price.

Isolated in self-imposed solitary confinement, unable to coax explanations or apologies from their mates, fallout sufferers start shelving their lingering suspicions of personal responsibility and take to building protective ramparts in the form of negative reactions to and feelings for their partners. Loosening the knot of love, loyalty, and companionship formed over time takes a toll, and that toll is at least partially paid by fallout partners in guilty self-recriminations for being a “bad” or selfish person who can be counted on for support in good times but not in rocky ones. They indulge in tit-for-tat, parrying criticism with criticism, and although this temporarily relieves their feelings of frustration, it brings them no closer to an understanding of what is happening to the relationship.

The first gift the Message Board [This refers to Anne Sheffield’s website Message Board. Link below] delivers to new arrivals is assurance that they are neither malcontents nor misfits. They quickly learn that even those Board posters whose partners have been diagnosed and are being treated for depression share the same problems and are subject to the identical negative thoughts. Even in the presence of such empathetic company, first-time Board visitors often lace their posts with “I know you won’t believe this, but … “ or “He [or she] said the strangest thing to me … ” and are instantly welcomed and reassured that what they had thought unbelievable and strange is commonplace. When oldtimers respond like a well-rehearsed chorus — “Oh, yes, we know, we’ve been there, too, and we understand” — the dam of reticence gives way, allowing pent-up emotional turmoil to flow freely. In short, the single most important fact for a depression fallout sufferer to grasp and take to heart is that his or her particular brand of misery, far from being unique, is shared by a minimum of nineteen million others in the United States alone, and so are their far-from-aberrant emotional reactions.

Excerpted from: Depression Fallout: The Impact of Depression on Couples and What You Can Do to Preserve the Bond by Anne Sheffield (Quill/HarperCollins, New York, 2003).

(c) 2003 Anne Sheffield. All rights reserved. Reprinted by permission of the publisher.

In addition to Depression Fallout (Quill/HarperCollins, 2003), Anne Sheffield is the author of two other well received books on depression, How You Can Survive When They’re Depressed (Harmony, 1998) which won a a Books for a Better Life Award as well as the 1999 Ken Award from the New York City affiliate of National Alliance for the Mentally Ill, and Sorrow’s Web (Free Press, 2000) which deals with the topic of motherhood and depression. She has worked as a scientist at the Population and Development Program of the Battelle Memorial Institute and has run her own consulting firm. She lives in New York City. Her official website is located at 


A couple links..
December 15, 2008, 9:10 am
Filed under: Resources, stigma | Tags: , , ,


For a Pdf. of more posters and banners like this.. go here..

For a confidential depression screening.. go here..

Healing from depression
December 13, 2008, 10:08 pm
Filed under: Education | Tags: , , , , ,

Healing from Depression

By Judene Shelley

Recent publicity for Mental Health Awareness Month and Depression Screening Day encouraged people of all ages and walks of life to become more aware of mental health and to go to a depression screening if they felt the need. A common feature at a depression screening is a checklist. The one I was given was printed by a large drug company and had 20 items to respond to. If I said yes to 5 or more of the feelings and felt that way for two weeks or more, I would likely be diagnosed with “major depression.” One media report stated that 70 percent of those who attend a depression screening will go on to receive treatment. What kinds of treatment will be offered? Treatment for depression today often consists of going to a professional who will give therapy and/or medication.

I agree with each of us pausing to assess our emotional well being, yet I am concerned with how quickly medication is given to individuals as the “quick fix” solution to problems. No single profession, culture, or book has all the answers. Some people feel medication helps with difficult times, and some find strength and comfort in counseling with a professional. Some people find different paths to emotional health. My view of helping would be assisting a person to see increased options in finding one’s own to path to health. I don’t know all the answers to the complete state of depression, but many factors contribute to what people feel. One could look at a range of contributing factors as well as a variety of solutions when looking at any difficulty in life.

Some professionals look at depression as the need of people to feel greater connection-to family, friends and the community, to the world around them. We need to have healthy relationships with others. We need to feel control over what is happening in our lives. We need to feel we have choices about what we can do each day.

Some see a link between society’s messages and depression. As a growing girl I was taught to let others talk first, to be kind and polite, to expect men to hold leadership and make decisions, to be concerned with my appearance, to place others first and myself last. I received little support to pursue a career that I felt passionate about. Do we wonder why girls who receive many of those messages end up feeling hopeless and unable to make decisions? Many women try to “do it all” at work and at home. Are we then surprised when they feel overwhelmed or guilty? When senior citizens feel worthless, are they not reflecting how society too often views them? Each of these feelings are listed as symptoms of depression. Is something wrong with the minds of these people or with what our society gives them?

My view of health is that it is all right to feel sad, lonely, tired, upset, or hurt. Periods of sadness can be overwhelming and incredibly dark. Yet it is okay to spend some days lying in bed or walking on a beach thinking, relaxing, and figuring out what to do. One’s physical and emotional body needs a rest and is crying out the need to do something different. Out of our periods of hopelessness, desperation and grief will come our own answers – solutions to what is causing despair and what we can do differently.

Some people find lifestyle changes helpful, such as increased sunlight, exercise, daily affirmations, visualizations, talking with friends, getting a pet, attending a workshop, reading a book, or making a career change. Writing, speaking up, and working to change what is bothering us, or working for rights of oppressed people, can make a difference. We can encourage people to ask for help, which may include letting someone else cook food, being relieved of household duties, or going for a walk with a friend. Professional counseling might promote self-awareness, positive relationships and choices. Numerous magazines and books promote ideas that people have found helpful for improving moods and relieving depression. Many people today find help from alternative approaches such as self-help books, acupuncture, yoga, and meditation.

I look forward to a time when instead of indicating something is wrong with my feelings, the checklist for depression will include questions such as these:

Do you have time for regular exercise that you enjoy?

Do you have relationships where you both give and receive support?

Do you have access to healthy foods, including carbohydrates, fresh fruits and vegetables?

Do you have safe opportunities to try something new, seek an adventure, or accept a challenge?

Do you have things to look forward to each week?

What do you have control over in your life?

What kinds of things prevent you from doing what you want?

Do you have opportunities to pursue interests you enjoy?

Do you feel comfortable asking for help in time of need?

What would help you to achieve your dreams?

Then the treatment for depression could include helping people to overcome barriers-both internal and external-that are preventing them from living the full life that they would like. A book I read to my children tells of Florence Nightingale becoming depressed when her parents objected to her goal of becoming a nurse. She later went on to fulfill her dream.

My wish for mental health awareness month is that we would each look at ourselves, not judging our feelings or the things we are doing as wrong, not in fear of symptoms and labels, but in congratulating ourselves on how well we are doing given the stress and difficulties we live through each day. Mental health is not about finding a neighbor, relative or friend and getting them to seek professional help, but in reflecting on how we can each bring our own lives into better balance. We could evaluate for ourselves when we should ask for help so that we end more days feeling we have contributed something to those around us and yet met our own needs, too. I believe mental health success comes not when more people are depending on medications or one helping person to get through their days, but when more people are finding their own answers to what makes a day worth living.

Judene Shelley is a mother with a Master’s of Public Health Degree in Health Education. She has found writing to be one of her paths to health and to overcoming the disabling label given to her by well-meaning “helping professionals.” She dedicates this article to the psychiatrist in the mental ward who said “Have you stopped writing things down? That is a clinical sign of your problem” and “You should be on medication for the rest of your life.”

From the National Empowerment Center

Mental health resources


The following organizations provide information and resources for mental illness:

Severe Anxiety
Overcoming Social Phobia One Step At A Time
A well-written site about Social Phobia, resources for help, advice for dealing with the illness, and links to many other sites. “Severe social anxiety is one of the most difficult disorders to overcome. It can literally destroy your life in a matter of months. People do no realize that their is no real treatment to rid yourself of social anxiety, sure there is medication that is available through your family doctor. But how on earth does someone with severe social anxiety get this medication when their number one fear is in social interaction?”

Center for Mental Health Services
Substance Abuse and Mental Health Services Administration
Phone: 301-443-8956

Resource Center to Address Discrimination and Stigma
ADS Center
11420 Rockville Pike
Rockville, MD 20852
Toll Free Phone: 1-800-540-0320

Drug Abuse Information and Treatment Referral Line
(Sponsored by the Center for Substance Abuse Treatment)
TollFree: 800-622-HELP (4357)

Health Resources and Services Administration Information Center (HRSA)
TollFree: (888) 275-4772

National Institute of Mental Health
Office of Communications
Phone: 301-443-4513
Toll Free: 1-866-615-NIMH (6464)
TTY: 301-443-8431

American Foundation for Suicide Prevention
Phone: 212-363-3500
Fax: 212-363-6237
Toll Free: 888-333-AFSP

American Psychiatric Association (APA)
Phone: 703-907-7300

American Psychological Association
Phone: 202-336-5510
Toll Free: 1-800-374-2721

Anxiety Disorders Association of America
Phone: 240-485-1001

Borderline Personality Disorder Research Foundation (BPDRF)
New York State Psychiatric Institute
Phone: 212-543-6247

Child and Adolescent Bipolar Foundation
Phone: 847-256-8525

Depression and Bipolar Support Alliance (DBSA)
Phone: 312-642-0049

Depression and Related Affective Disorders Association (DRADA)
Phone: 410-583-2919

Freedom from Fear
Phone: 718-351-1717

National Alliance for Research on Schizophrenia and Depression (NARSAD)
Phone: 516-829-0091
Toll Free: 800-829-8289

National Alliance for the Mentally Ill (NAMI)
Phone: 703-524-7600
Toll Free: 1-800-950-NAMI (6264)

National Eating Disorders Association
Phone: 206-382-3587

National Mental Health Association (NMHA)
Phone: 703-684-7722
Toll Free: 1-800-969-6642
TTY: 800-443-5959

Substance Abuse and Mental Health Services Administration
National Mental Health Information Center
Toll Free: 800-789-2647
TTY: 866-889-2647

The Reach Institute

The Reach Insitiute

 This 501c3 non-profit has the CEO’s of many of the family advocacy organizations on its board. It’s mission is to ensure that the latest interventions are available in every community by ensuring that health care providers can get trained in the latest methods.

Peter S. Jensen, MD
President & CEO, The REACH Institute
REsource for Advancing Children’s Health

The Alpha-Stim- Microcurrent electrical therapy
Alpha-Stim treats anxiety, insomnia and depression with cranial electrotherapy stimulation (CES). CES produces beneficial changes in the brain’s electrical activity and can induce pleasant and relaxed feelings.

The Alpha-Stim SCS treats anxiety, depression, and/or insomnia with microcurrent using a method called cranial electrotherapy stimulation (CES).

The treatment is very simple. The current is applied by easy to use clip electrodes that attach on the ear lobes. You may feel a slight tingling sensation under the electrodes, but it is not necessary to feel this in order to achieve results.

Used just 20 to 60 minutes every day, every other day, or on an as-needed basis, CES can help induce a pleasant, relaxed feeling of well being.

The Alpha-Stim SCS is well tolerated and very safe in contrast to drugs used in the treatment of mood disorders, many of which have been proven to have undesirable side effects and can be addictive.
Unlike drugs, the Alpha-Stim SCS leaves the mind alert. Anxiety reduction is usually experienced during treatment. Depression and insomnia control is generally experienced after several weeks of daily treatment. CES can also help treat the underlying mood disorders associated with pain.

The Alpha-Stim SCS may be used as an adjunct to medication and/or psychotherapy. After treatment, there are usually no physical limitations imposed so the majority of people can resume normal activities immediately. Maintenance of a relaxed, yet alert state

is generally achieved with treatments three times per week. As a result, the Alpha-Stim SCS is suitable for clinical or home use.

Treated conditions:
Examples of situations where CES can provide relief:
Dental visits
Fear of flying and other phobias
Insomnia due to anxiety or stress
Performance anxiety
Jet lag recovery
Use during behavioral therapy sessions
Bereavement and healing
Loss of job, divorce
Hospice and palliative care
Alpha-Stim advantages:
Low incidence of adverse effects
More efficacious than most other forms of therapy
Relatively easy to learn
Alternative in cases refractory to conventional care
Reduces or eliminates need for addictive medications
No tolerance
May be applied on schedule or PRN
May be self-administered by patients
Highly cost effective


A brief history of CES

Electrosleep treatment (an older name for CES), involving less than one milliampere of current, came into the USA from Japan in the late 1960s, which, in turn had borrowed it from Russia and other East Block countries. Since the electricity was directed across the head, the FDA renamed it Cranial Electrotherapy Stimulation (CES) in 1978, and now allows its marketing in the USA for the treatment of anxiety, depression and insomnia.

A major use of CES has been in the drug abstinence syndrome in which people are withdrawing from various substances of addiction, such as nicotine, alcohol, prescription drugs, cocaine or heroin. All such patients have anxiety, depression and insomnia as defining symptoms of the syndrome, and the vast majority benefit dramatically from the use of CES during the withdrawal period. The medical use of CES is becoming more widely indicated in the USA as these and stress from a myriad of other sources continue to build up in our society. Read more about the mechanism of Alpha-Stim CES.

What scientific research has been conducted with CES?


At present, there are over 126 research studies on CES in humans and 29 experimental animal studies. The overwhelming majority of the scientific research is extremely positive. No significant lasting side effects have been reported.

Harvard University School of Public Health, Department of Health Policy and Management found: “The meta-analysis of anxiety showed CES to be significantly more effective than sham (P<.05).” (Meta-analysis of randomized controlled trials of cranial electrostimulation: efficacy in treating selected psychological and physiological conditions by Dr. Sidney Klawansky et al. Journal of Nervous and Mental Disease, 183(7):478-485, 1995).