Jan 06

What’s the difference between clinical depression and just having ‘sad mood’ (sadness) or ‘feeling blue’? This often-asked question is often asked and sometimes, it may indeed be hard to tell whether there are already signs of depression if someone has been feeling depressed for some time.

To try clarify this question to some extent, feel free to undergo the online test on my website, or watch the nice TED video clip below about the topic. If you feel like it, just add your experiences or observations in the comments below – maybe they can be of help for others asking themselves similar questions.

Dec 31

To a high extent, the work of a psychotherapist consists of the treatment of the various forms of depression, so I’ve always tried to improve my understanding of this particular form of mental disorder – and of its most extreme form, the idea to commit suicide. So I’ve continuously gathered data on suicide – here you will find a compendium of the information I found, a sort of overview of the currently known facts and figures on this subject.

Frequency

It is estimated one million people a year die by suicide, which equals about one every 40 seconds – but that number may actually be even significantly higher, since the official numbers released by many countries are too low. Suicide thus contributes at least 1.5 percent of the global deaths and is the tenth leading cause of death. In 2006, 140,000 people had taken their lives, that equals 11.1 per 100,000 people. People under 25 years of age are most vulnerable (there was no significan change compared with previous years), and the elderly (where a significant decline in suicides was found).

Trends in some OECD countries, graph: OECD

Regional differences: within Europe, the rates in the northern countries are generally slightly higher than in the southern ones. An effect of latitude on the suicide rate was found in Japan, suggesting an influence of the daily duration of sunshine. Nevertheless, other countries can have significantly different rates of suicide compared to Japan at the same latitudes, like Great Britain or Hungary for example. Suicide is a significant problem in the former Soviet states, and more than 30 percent of suicides worldwide occur in China, where 3.6 percent of all deaths are attributed to suicide.
Regarding the impact of light/solar radiation by correlating the suicide rate with the number of hours of sunshine a day, a seasonal clustering of cases of suicides could be proved in 2011 in a study by the Medical University of Vienna that was published in the journal “Comprehensive Psychiatry”.

Particularl attention deserves South Korea where in recent years, the suicide rates have increased drastically, namely by 172% to 21.5 per 100,000. The number of suicides by men has almost tripled from 12 per 100,000 (1990) to 32 per 100,000. With 13 of 100,000, the suicide rate among women is also the highest. The OECD attributes the rise in suicides on the economic decline, dwindling social integration and the disintegration of traditional family bonds. But it may be doubted whether this is really something that extraordinary compared to Mexico (+43%), Japan (+32%) and Portugal (+9%), which also reported an increase in the suicide rate. In Hungary, the suicide rate has declined by 41 percent, but the country, with 21 suicides per 100,000, is still second only to South Korea. Finland’s numbers are also above average with a high suicide rate of 18, followed by France (14.2), Switzerland (14), Poland (13.2) and Austria (12.6, 27/100,000 in men, in women 10/100,000). Germany, where the number of suicides compared to 1990 decreased by 37 percent, with 9.1 in the lower third. Apart from Great Britain (6.1) and Mexico (3.1) the situation appears on the Mediterranean people to do well. In Spain (6.3) and Italy (4.8), far fewer people kill themselves than in other OECD countries. And the Greeks are drawn the least to commit suicide: here, just 2.8 per 100,000 kill themselves

Conflicting data on the so-called happiness research was revealed by a remarkable study analyzing the correlations between life satisfaction and suicidal tendencies. In a comparison with the average satisfaction of people according to the “World Values ‚Äč‚ÄčSurvey” and the suicide rates according to the WHO, the suicide rate is not only very high in the Scandinavian countries in spite of their high satisfaction but also in Iceland, Ireland, Switzerland, Canada or the U.S. The conclusion of the study was that the relation between high life satisfaction and high suicide rates was independent of harsh winters, religious and cultural differences in different countries (more)

One possible explanation for this ostensible contradiction could be that in an environment where many other people are ‘happy’, own discontent, own suffering is felt more strongly. If there is also despair of beign able to achieve a change, certain personality types may see suicide as a way out.

A few more details about Austria: in Salzburg, the Crisis Intervention Center (‘Kriseninterventions-Zentrum’; of others, I don’t have any data) recorded a significant increase in patients in their teens in 2010. In Austria, about twice as many people die by their own hand than after traffic accidents every year. In 2002, 1.551 chose to commit suicide, including 50 children and adolescents aged ten to 20 years. Self-injuries in children are also on the rise. At the whole of Austria, the suicide rate of the early 1960’s has risen sharply until the mid-1980’s – to 24 suicides per 100,000 of the population. Since then, the rate decreased and it is now (as already mentioned above), at 13 per 100,000 per year. This equals about 1,300 suicides per year.

However, there are growing doubts within the Austrian scientific community as to the accuracy of these statistics, and I want to outline them a bit further to help you, the reader, understnad the underlying problems of suicide studies: fewer and fewer autopsies are performed as in Austria, which decreases the possibility to distinguish suicides from natural deaths. Thus, in countries with the highest autopsy rates as in the Baltic states or Hungary, the suicide rates are generally higher than in countries with low autopsy rates. Similarly, in countries where autopsy rates are declining, at the same time there are also increasingly fewer registered suicides (Source: Archives of General Psychiatry 2011 (Link). So with statistics like these, there is always reason to question whether such statistics can be trusted at all.

More gender-related details: is in the developed countries, the gender ratio of suicides is roughly 2-4 (men) : 1 (women) and seems to be increasing. Asian countries show a smaller ratio, but it seems to be increasing as well. Only China has more women than men dying from suicide.

Risk factors for suicide

Among the many factors that may raise the risk of suicide, the most important known ones currently seem to be:

  • male gender (OECD: 17.6 per 100,000 males, 5.2 for women)
  • a history of self harm
  • psychiatric disorders and / or
  • Alkohol-/Medikamentenmissbrauch
  • upbringing and education
  • suicide depictions in the media
  • smoking

Genetics and Neurobiology

Autopsies of suicide victims showed changes in central neurotransmission functions, such as the serotonin system (mood-regulating hormones). Low cholesterol concentrations are associated with higher suicide risk, but the risk is greater if the lower cholesterol level was reached with diets rather than by using statins. The authors suppose that this may stem from the fact that dieting people have a higher risk of mental problems, but so far, there was no corroborating evidence for this theory. Furthermore, family histories of suicide at least double the risk for girls and women. Although the evidence is scanty here as well, a number of researchers suggest that high levels of aggressive behaviors and impulsiveness may also be associated with an increased risk of suicide. Especially in young boys, suicide rates increase over the years of their growing up, while a higher suicide risk because of hereditary components was primarily detected on the maternal side.

Professional guilds

Suicide rates are higher among non-workers (unemployed, retired etc.) than among employed persons/professionals. Higher rates are also partly linked to mental illness, which in turn has a connection with unemployment.

Among the professionals, however, some groups show an increased risk: medical practitioners have a high risk in most countries, and doctors (and related jobs in the health professions) generally have the highest risk. Nurses also have a high risk. Particularly in these groups, the easy access to venoms seems to be an important factor influencing the high rates. Anesthesiologists are particularly vulnerable among physicians because narcotic drugs are used in many suicides. Several other high-risk professions are dentists, pharmacists, veterinarians and farmers.

Age Groups, Ethnicity, ..and Seasons

In most countries, suicide rates are highest amongst elder people, however, in the past 50 years, the rates among the younger population has increased as well, especially in men. Suicides are committed most frequently in spring, especially among men as well. People born during spring or early summer have an increased risk of suicide, especially women. Americans of European descent have higher suicide rates than Americans of Latin American or African origin, with this difference increasingly leveling out amongst young African Americans due to the increased suicide rate among young African Americans slowly. Indigenous groups such as Aborigines in Australia and Native Americans also have higher suicide rates, possibly due to cultural, social exclusion and greater alcohol abuse.

Suicide Methods

Quite generally, men prefer more violent means of suicide (for example, by strangulation or shooting themselves), and women ‘softer’ forms (self-poisoning), which is probably the explanation for the sharp difference in successful suicides between men and women (see above) and the suicide attempts that both sexes undergo in about equal rates. Different cultures show different preferences in methods, in South Asia for example, women typically burn themselves. Access to specific methods could be the factor that finally leads to putting suicidal thoughts into action. In the U.S., firearms are used for by far the most suicides, with the risk of using them for this purpose being the highest where guns are found in households. In the rural areas of many developing countries, the ingestion of pesticides is the most common method, which reflects the toxicity, easy availability and the lack of storage. At up to 30 percent of suicides worldwide, pesticides are involved.

Comorbidities und Connections with Mental Disorders

Mental health problems are a major factor in suicides. It is believed that of about 90 percent of people who kill themselves, they suffered from a kind of psychiatric disorder. Depression increases the risk to the 15- to 20-fold, and about 4% of patients suffering from depression die by suicide – but only about 20-30% of depression are recognized (!). But even for those, in most cases many years are passing to the correct diagnosis, and then, still, less than 50% of the diagnosed patients ever starts looking for a psychotherapy and/or receives pure pharmacological support. This means that most people suffer on a chronical basis, but don’t search – or can’t find – adequate help.

Clinical signs of suicide where depression was involved, are patients with previous self-harm, hopelessness and suicidal tendencies. About 10-15% of patients with bipolar disorder die by suicide, but the risk is highest at the beginning of the disease. About 5% of schizophrenia patients also die by suicide. Alcohol abuse, anorexia, attention deficit-hyperactivity disorder (ADHD) and body dysmorphic disorder (KDS) all increase the risk of suicide. Especially the last example explains in part why the risk increases in women after breast-enlarging surgeries.

Physical health also plays a role, but with some strange results. Surprisingly, people with higher body mass index (BMI) have a significantly greater risk of depression, however, their risk of suicide is lower (15% decrease in suicide risk per 5 kg per square meter of body surface area increase in BMI). The reasons for this are unknown. Cancers, particularly of the head and neck, HIV / AIDS, multiple sclerosis, epilepsy and several other diseases also increase the risk of suicide.

Other factors that increase the risk of suicide include physical abuse and sexual abuse over the childhood, or events that affect the entire population (such as natural disasters or the deaths of celebrities). After the death of Diana, the Princess of Wales, in 1997, the suicide rate rose by 17%, most clearly in her age group. War involvements reduce suicide rates, possibly due to the social cohesion that is generated in the communities. People who have suffered a loss by suicide, are themselves at increased risk, and suicide clusters may occur in communities or through Internet contacts. The authors add: ‘A significant proportion of the evidence shows that certain types of media that report on or present suicidal behavior, may influence suicidal behavior and self-harm in the general population.’

A ‘hot potato’ in the psychiatric community are recent studies showing that even antidepressants can induce suicidal thoughts not only in adolescents, but also in adults. I already posted a few articles related to these studies in this blog.

(Sources for the aforementioned numbers: Health at a Glance 2009: OECD Indicators; MedAustria)

Suicide und Self-Injury

In addition to rising suicide rates, there is also an increase in self-harm among young people, as pedagogues report in many Western countries. The reasons for this may be traumatic experiences in early childhood. The brain has a high plasticity and very vulnerable to external factors during this stage of development. Serious diseases, sexual abuse, neglect and lack of communication in bringing up – often caused by hours in front of the television or computer games – are also considered to be significant risk factors for later suicide attempts. They may also cause children and adolescents to harm themselves physically. Burned skin from cigarettes or scratches from knifes or razor blades must be understood as a cry for help.

While in 1950, only 40% of people who attempted suicides were under 45 according to the WHO, we were already at 55% in 2004. A reason for depression occurring at earlier stages of life might be the earlier onset of puberty and the decaying of family structures. If there is healthy communication within the family, and if common concerns and problems can be expressed and discussed, it is much easier for young people to overcome a crisis.

(Source: Der Standard, 06/2004)

How can suicided be prevented?

Suicide preventionThe claim to be able to prevent suicides would be a difficult one to fulfill because of the large number of factors that are involved until it actually comes to a suicide attempt. Strategies could be aimed at high-risk groups or trying to reduce the risks for the population as a whole. Firstly, any person with depression should be checked for suicide risk by professionals specifically asking about suicidal thoughts and plans. This shows the importance of specific training and sensitivity of physicians who are often enough the only ‘professionals’ many depressive persons might have contact to at the first place. Studies from the Nordic countries show a decline in suicide rates by 20 to 30% after general practitioners were trained to recognize depression properly and to help patients to get appropriate therapy (psychotherapy and supportive pharmaceutical measures).

In cases of high or imminent suicide risk, immediate action is necessary, including vigilance and monitoring of those affected, possibly through hospitalization. In addition, potential tools that may be used for suicide attempts have to be removed and an aggressive treatment of the associated psychiatric disorder be initiated.

A restriction of access to potentially lethal substances or tools can indeed help to prevent suicides. The introduction of security cameras on bridges and increased control of firearms, as well as the safer storage of pesticides and poisons (especially in rural areas of developing countries) has been proven to significantly reduce the risks. Education programs to improve the mental well-being as well as stricter control of the media reporting of suicides could also have preventive effects. On the objection that persons who wish to commit suicide would find ways and means to realize their goal in any case it may come as a surprise that for example when switching from toxic coal gas to non-toxic North Sea gas in the UK, the suicide numbers declined dramatically, while, for example in Japan right after the release of two films that were romantically idealizing the issue of suicide, the corresponding numbers increased significantly. Helsinki had the world’s highest suicide rate in the 90s and was able to cut it to 18 per 100,000 through prevention programs.

Because on the internet – in addition to advice and instructions for suicide in ‘suicide forums’ – a new trend had been detected in Japan to arrange collective suicides online, the government of South Korea (which had recently suffered the world’s largest increase of suicides, see above) will block related Internet sites, and there are also plans to make it more difficult to find information about suicide on Internet portals by blocking specific keywords such as suicide, ‘how can I die’, ‘collective suicide’, ‘suicide techniques’ and others. In addition the government plans to create a legal basis for the police to request the personal information of Internet users from their service providers who promote suicide or offer advice to persons willing to undergo suicide.

The challenges to prevent suicides in developing countries requires special attention, as most of the suicide-related research is done in developed countries, while the highest suicide rates are in fact found in developing countries. On nation-wide measures it is also worth mentioning that after a recent meta-analysis of randomized studies ([1], [2]) had suggested that the risk of death and suicide in people with mood disorders receiving lithium has been reduced by 60 percent, researchers have brought up the idea of adding small doses of Lithium to tap water.

Family members and the social environment in general also have an essential role. Relatives may be the first ones who can notice that someone might isolate himself or is depressed. It is of utmost importance to recognize these signs (see article about presuicidal syndrome) and to talk to the affected person about it. Nevertheless, the options and means of family members and friends are often limited – it is therefore important to involve external help (a psychotherapist, counselor, psychiatrist or at least a family doctor) if one feels overwhelmed or feels no longer able to reach the person.

Treatment of Depression

That psychological treatment can prevent a suicide in many cases is a well known fact that has been proven in numerous studies. The World Health Report 2001 already reported, quoting several studies, that some mental disorders may be chronic and of long duration, but that with proper treatment, those suffering from mental disorders can now lead a productive life and participate in their communities. Up to 60% of people suffering from severe depression can get well with the right combination of psychotherapy and antidepressants. I’ve written a detailed article on this topic in the publications section of my German-language website, which specifically describes and comments the latest standards for the treatment of depression.

(Further sources: APA, AZ, Der Standard 03.06.04, The Lancet Vol. 373, Issue 9672, p.1372-1381, 18 April 2009, Telepolis [1], see also links to sources right within the article.
This blog entry was first published in 12/2009; continuously updated as soon as I get aware of new facts. Last updated: 12/2012).

more blog articles about suicide

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Dec 29

Today, I stumbled upon an impressive and moving interview with the survivor of a suicide attempt that was published in a newspaper article in September 2000. In a state of presuicidal constriction / presuicidal syndrome, Kevin Hines jumped of the Golden Gate Bridge and survived this jump only by extremely fortunate circumstances .

Photo © Seattle Times

Bild © Seattle Times

Today he can talk about it and works in a helping profession (nurse). In his spare time, he tries to inform and educate others about the importance of an accurate and professional medical and psychotherapeutic treatment of mental illness. ‘I’d feel lucky if with my horrific experience, I can just keep only one person from taking his own life,’ he says in the NZZ interview with G. Sachse. Indeed, during the (time-limited) course of a presuicidal syndrome that may define one of the worst stages of depression but also of paranoid delusions, the way the affected person perceives, experiences and thinks about what is going on may be much different than under normal circumstances, and it may also be linked differently than usual with one’s emotions and behavior. At the end, the affected person may see no other way out than to take his/her own life. Only after the abating of the syndrome, other options can be perceived and imagined again – that is why in times of crisis it is so vital to seek professional help right away (eg by doing an emergency-call, calling in for a crisis appointment at a psychotherapist, vitising a psychiatric clinic etc.) just to overcome the most difficult time. At least, friends or other acquaintances should be called up – the idea is to “play for time”, to aim at getting over this barely endurable phase by all means, at least to get through until the next morning. If, unexpectedly, you as the suffering person would still not feel better at that time, you should contact a trusted physician. Consider, however, that for periods of serious depression, it is actually recommended to consult a qualified psychiatrist or psychotherapist, even if it has not yet already come to suicidal thoughts, or if these thoughts have already subsided – to avoid them from coming up again by treating the underlying depression.

In conversations with clients who have dealt with phases of suicidal constriction, they repeatedly confirmed how happy they were about having ‘survived’ the critical phase once they had stabilized again and how lucky they felt that they didn’t end their life before. Sometimes, they had experienced completely unexpected positive events in the time since their deepest phases of depression, but more generally, their life had taken a positive turn since they had continued with their psychotherapy, an upturn that was not forseeable.¬†“Give life a chance” – this common slogan (that is usually used in a different context) shouldn’t be forgotten especially in the phases of life where it apparently can’t get any lower.¬† As we know from economic sciences, it is systemically inherent that after a low point, it can only go upwards again. What could be worse in life than a stage in which there doesn’t seem to be any way out other than death? As paradoxical as it may sound, after successfully having weathered the worst hours of a particular night, life will most probably already feel at least an iota better the next morning. Talking to someone (especially one with a person who is professionally trained to assist in difficult phases of life), it is usually possible to develop completely new perspectives, perspectives that can give life a positive turn on a long-term scale.

To avoid being misunderstood: this is certainly not always an easy or quick process – but properly accompanied and instructed, the majority of people succeed at the end.

Further information:

Depression – Mythen und Fakten rund um eine ‘Zeitkrankheit’ (Artikel R.L.Fellner; german language)
Vier Sekunden bis zum Aufprall (NZZ Interview mit Kevin Hines 2009; german)
Lethal Beauty РA jumper [..] makes a new life  (San Francisco Chronicle 2005)
(Blog entry first published in German language (‘Gedanken eines Suizidversuch-√úberlebenden’) in 03/2009, published on English website: 12/2011)

Aug 05

Beauty surgeons and the cosmetic industry love it (critics claim that they are even doing their best to support? it): the ‘Dorian Gray Syndrome‘ describes a phenomenon where people turn into heavy users of cosmetic products and medical procedures in an attempt to preserve their youth. Oscar Wilde’s famous novel ‘The Picture of Dorian Gray’ first introduced the psychological dilemma of affected persons to the wide public: conseqently the syndrome was named after the novel’s protagonist.

While this syndrome as a whole is not scientifically acknowledged, many patients suffering from it actually show diagnosable traits of body dysmorphic disorder (having excessive concerns about perceived defects in their physical features), narcissistic character elements (like a sense of superiority or being more occupied with themselves than with others), and signs of delayed maturation in certain aspects of their psychic development. In their preoccupation with their outer appearance and difficulty to accept their aging process, DGS patients are often users or abusers of hair growth and weight-loss products, mood enhancers, medication against erectile dysfunction, they are often owners of gym membership cards and very often patients for cosmetic surgery (laser resurfacing, botox injections, aesthetic surgery etc.).

In case you happen to know someone who you think might show signs of the Dorian Gray Syndrome: this person might also have depressive tendencies which, if untreated, might trigger autodestructive symptoms if he or she tries to suppress the negative self image by using drugs or repeatedly undergoing surgeries. But who would want to define when it would be ‘justified’ to look out for help? Some might not want to live a life burdened by compulsionary thoughts of this kind, but be able to fully enjoy their lives and take life as it is – like so many others do.

But then, what can be done about it? For some of the affected persons, a personality disorder turns out as the root cause for their body dysmorphic disorder, for others it is a lack of self-esteem. While in order to improve one’s psychological balance, a personality disorder can only be managed by various means (like by medication and counseling aiming at better self management), self-esteem can be improved quite well utilizing methods of psychotherapy. This doesn’t have to be a process that requires years of ‘talking cure’ – distinctive and long-lasting improvements can usually be achieved already after a few months of regular sessions. The goal of these sessions is to work out a more confident and accepting take on what our body involves.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2011)

Aug 05

“What can I do, it’s in my genes!” In recent years, this has become a standard explanation for many of the health problems we have to face in our lives. Indeed, there are few human diseases without scientific studies trying to pinpoint ‘genetical causes’ as the root. Consequently, there are efforts to find genetic roots of mental problems as well. But 150 years after Mendel (the ‘father of modern genetics’) had outlined his ‘Laws of Inheritance’, we have still to see significant therapies that could wipe out major human burdens like cancer, addictions, diabetes or violence by purely genetical means. This is not to say that genetic science doesn’t have potential; but all the other influential factors should not be forgotten.

One of the weirdest aspects of the notion that all things human are genetically predetermined is that it takes everyone completely out of the context of their environment. We might as well not put personal or societal energies into trying to improve ourselves or others, because it’s inevitable and unchangeable anyway… But in fact there is just a very small number of very rare diseases that are truly genetically determined. Most complex conditions like ADHD, schizophrenia, a tendency to violence or addiction might have a predisposition that has a genetic component, but a predisposition is not the same as a predetermination. Genes just seem to give us different ways of responding to our environment. Some of the childhood influences and the method of child rearing in turn also affect gene expression; they can actually turn on or off various genes to put us on a different developmental track which may suit the kind of world we’ve got to deal with.

For example, a study done in Montreal with suicide victims looked at autopsies of the brains of these people and it turned out that if a suicide victim had been abused as a child, the abuse actually caused a genetic change in the brain that was absent in the brains of people who had not been abused. That’s an epigenetic effect: an environmental impact that is capable to either activate or deactivate certain genes.

So, in adaptation to the famous quote of Shakespeare, “There are more things in heaven and earth than are dreamt of in our scientific world.” And there are more things we can do to change ourselves than we might imagine.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2011)

Jan 14

When they hear the word ‘depression’, many people think of sad or hopeless individuals who can’t cope with a life event, who are living withdrawn and are often crying their existence.

But in fact this is only rarely the case. In a U.S. study published in 1996, for example, only a third of the patients suffering from depression could name a stressful or dramatic experience that took place before the disease kicked in. And it is by no means only negative events that can trigger depression in some people, but also such as the birth of a child or winning a business contract. That not all people who experience dramatic events develop depression also suggests that other factors such as stress or genetic factors may be involved. For patients themselves or their environment is therefore usually not even possible to identify a potential reason for a probable depression – which usually leads to long delays in search for the correct diagnosis for the malaise they feel in.

Physical symptoms are another, often misinterpreted facet of depressive disorders. Headaches, insomnia, reduced memory and concentration, but also other kinds of physical pain, digestive problems or a general lack of energy are typical physical symptoms of depression.

The lack of perspective that is typical for depression, quite often also leads to self harm. Most people who commit suicide previously suffered from an (often unrecognized or untreated) depression. But it doesn’t need to be suicide: other self-defeating forms of behavior, such as alcohol and drug abuse, self-destructive eating habits or risky driving are, as studies illustrate, linked to depression in about 60% of the cases.

Particularly in older men, depression often manifests on aggression, particularly of the verbal kind, like ranting, looking down or lashing out on others or constant cynicism. Again, these persons are only rarely aware that they actually suffer from depression, but explain their inner discontent and anger with external circumstances over which they usually can’t complain too loudly and often.

About 20-25% of women and 7-12% of men suffers with depression at least once in their life time. However, the real figures are probably higher due to the frequent misdiagnoses and years of suffering without a proper diagnosis and adequate treatment.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2011)

Nov 18

Bipolar Disorder: Caught between depression and excitement

John always felt that his wife was ‘changeful’ – but it took both of them years to find out that she was in fact suffering from so-called ‘bipolar disorder’. People with what was formerly called ‘manic depressive disorder’ cycle between unusually intense emotional states that occur in distinct periods: ‘manic episodes’ are defined by overly joyful or overexcited states, and ‘depressive episodes’ by extremely sad or hopeless feelings. However, sometimes symptoms of one state may also occur during the other, depending on the variation of the disorder which has been estimated to afflict about one of every 45 adults, independent of sex, culture or ethnic group.

One of the most common problems of persons dealing with this disorder is that they have serious difficulty set ting and achieving goals and maintaining stable relationships in their lives. During their manic episodes, they often experience an increase in energy, set themselves highly ambitious goals and might break up their relationships with people they consider as inferior or slowing them down. They tend to self-medicate, often through substance abuse (particularly stimulants or depressants, alcohol, cocaine or sleeping pills). Some of them tend to gambling, others might become aggressive or violent or experience a break with reality. As soon as the depressive episode kicks in, almost nothing of that remains: now, feelings of sadness, anxiety and guilt are dominating, and the person might feel isolated and hopeless. The formerly high sexual drive now almost disappears, fatigue, apathy or even suicidal thoughts may occur: The rate of bipolar patients committing suicide at certain points in their lives is very high.

Today, we still know little about the causes for bipolar disorders, but studies have indicated a substantial genetic contribution, as well as environmental influence (like an unstable or traumatic childhood). It is also likely that certain triggers are required to cause an outbreak of the disorder in some people, particularly relationship issues, cultural or job-related stress or physical illness. The basis of treatment usually consists of medication (which especially for this kind of disorder should really only be prescribed by a psychiatrist!) and complimentary psychotherapy to work on environmental triggers and efficiently learn to deal with the symptoms. The prognosis for most individuals with bipolar disorder is a good one – provided that they were diagnosed accurately and received the correct treatment.

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2010)

Sep 14

Many people enjoy gambling, whether betting on a horse or playing poker on their computer. Most of these people don’t have a problem, but some lose control over their gambling. They bet high amounts of money on card games, in casinos or playing slot machines. Today, people don’t even have to leave their homes to satisfy their drive to gamble anymore: the Internet allows one to spend unlimited hours playing games or placing bets without anyone interfering by asking uncomfortable questions – actually, many of the respective companies behind such websites try to keep people gambling as long and for as much money as possible. But once used to the rituals involved in a game, it is very hard for most to resist the urge of doing it again – if ‘only one more time’ in order to reverse their losses…

Typical signs of a serious gambling problem include:

  • Always thinking about gambling
  • Lying about gambling
  • Gambling during work
  • Spending family time gambling
  • Feeling bad after you gamble – but still not quitting
  • Gambling with money needed for other things – asking friends or family members for money or even breaking the law in order to obtain gambling money or recover gambling losses

The difference between a casual gambler and a compulsive gambler is that the latter one feels restless or irritated when they can’t gamble. They need the kick of betting money and will use gambling to relieve tension. While they may have tried to reduce gambling, they were not successful in the end. Effectively, they are losing not only money, but also valuable time from their lives, which are affected not only by the addiction itself but also by the long-term damage it causes them. An Australian study recently showed that 17% of suicidal people were problem gamblers.

Effective treatments for problem gambling involve a combination of counseling, step-based programs, self-help and peer-support. Sometimes medication is prescribed as well, however, only using one of these treatments alone is not considered to be sufficiently efficacious and no medications have been approved for the treatment of pathological gambling by the US Food and Drug Administration (FDA).

(This short article is part of a weekly series dealing with psychological expat problems and general mental health issues and was published in various newspapers and magazines in Thailand, 2010)

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