Can anyone shine light onto something I have been wondering about? (The Shrink especially if he’s reading?)
Is there a greater risk for developing dementia (which I know is a catch all term and I do mean it generally) in later life higher for people who have experienced long, recurrent periods of mental illnesses such as depression, bipolar disorder and schizophrenia?
I ask because I read this and I’m curious as to if there’s anything in it that’s noteworthy, and as to what you’d make of it. Obviously any health care people out there know a lot more than I do about this kind of thing.
(Clearly internet stupidity when one person reads one study and worries about it).
In fact, I shouldn’t read anything at all, ever. Due to curiousity (and, when I was diagnosed, being told to learn as much as possible about it), I’ve read up a lot on manic depression and find conflicting answers on things that frighten me. Two things are that a) it gets worse as you get older (although I imagine this has a lot to do with finding treatment that works for you and if you’re poor, physically unwell or socially isolated, your quality of life will diminish) and b) your “prognosis” is worse if you started to become unwell when you were young, have rapid cycling and have had a lot of episodes. Well, I don’t want this to get worse as I get older and I became ill very young, have had more episodes than I can count and I have rapid-cycling. Reading stuff like that- and I am not even sure that they are true- panics me as it makes me wonder if the worst is yet to come, while my rational side conveniently forgets how general these theories actually are. I’m a person, not a study, nor a statistic, but I can’t help but wonder where this is going.
On every website or book where this information is available, they should have a little doctor pop-up and tell you the actual facts so that you don’t go away wondering if it’s even worth it to keep trying. More useful than that, maybe, would be a hand reaching out of the monitor to slap you across the head. I have written a lot on the danger of internet diagnosis and research but it doesn’t mean that I’m immune to it, alas.
Fascinating edit! I just rang my GP for my first prescription of Effexor, and I need more Seroquel and Lamictal. I usually pick up prescriptions once a month, but he’s just told me that they’re only giving me weekly prescriptions from now on, because the psychiatrist thinks I might take an overdose. I’m actually a little touched by his concern, but slightly annoyed because I always find it a bit embarrassing picking up my prescription. The chemist, who is a lovely man, has a habit of shouting, “QUETIAPINE? SEANEEN MOLLOY, QUETIAPINE?” into the waiting masses. Luckily most people don’t know anything about psychiatric medications but I always worry that there’s going to be one person who gives me that look while shuffling slowly away from me, pulling their child by the hand as they do so.
In other, other news, one of my cats has just walked in proudly carrying an empty sheet of Zopiclone in their mouth.
Filed under: Bipolar 1 Disorder, Bipolar Disorder, bipolar, coping with manic depression, dementia, depression, manic depression, mental illness | Tagged: bipolar, Bipolar Disorder, depression, manic depression, mental illness
Stumble It!
I read that study too, and it gave me the chills, because I work with people with dementia of various kinds every day. I don’t see a large number of the elderly with bipolar disorder, but they may be just the whole stigmata of diagnosis thing that exists for that generation. I’ve also read the kindling theory (you have more episodes the older you get), but as a woman in her 40s, I don’t think I’ve had any more episodes the older I’ve gotten than I did as a person in my 20s. It’s something I think about now and then, but I don’t ruminate over it too much, because it is what it is, yanno?
Had that with the GP. I was in an appt with not-my-usual GP to get some quetiapine, lamotrigine and venlafaxine when she read of my notes and saw that I had been in hospital due to an overdose.
She suddenly got very concerned looking and told me that I could have the pills dispensed weekly if I found the temptation to great.
I think my mental note not to OD on psychotropic medicines was a little too narrow. It has since be significantly more broadly revised.
Weird you got no option
The part about the hand out of the monitor to slap you, is my theory of how it should be, internet diagnosis is very worrying and not the case more often than not.
My GP reduced my dose from 29 days, 14 days, 7 days then 4days, now nothing……….which is the case given my past history over the last couple of months. Until go through further other treatment.
The chemist, prescription, yeah, when they know your first name and call you by it and everyone else is Mrs…or Miss…kind of gets me thinking…….
Very good topic! This is a scary thing. One of the things I value the most about myself is intelligence and is frightening to think that even if I survive all of this, that intelligence could go down the drain when I’m older because of depression.
I finished medical school but I don’t have an especialization or extensive experience in neuropsychiatry so I’ll only do my best (I know a bit about what articles matter more than others depending on the methodology, I know the basis of physiology and neurology and some psychiatry because of the courses I took, and of course there is my own personal interest).
I downloaded the full text of the study you posted and read it. Seems like they reviewed a good number of cases and the findings suggest an correlation. However, this is still just a longitudinal study (in the medical world this is only powerful enough to suggest a correlation). It also mentions a couple of controlled follow up studies that also support the correlation.
Causality hasn’t been proved in the studies I found. It’s even harder to say how the association works. Maybe people with significant risk factors for dementia also were predisposed to have depression when younger. There’s correlation of dementia with many other things like head trauma, brain tumors, infections, and since depression and manic depression have been found to be associated with structural changes in the brain aswell, the association wtih dementia to me is a possibility that makes sense. But the degree and the nature of this seems to be unknown.
They didn’t mention anything about treatment (they aknowledge this in the last part of the article). Can’t rule out if dementia could be associated with the medication more than with depression itself.
My conclusion is that the study posted has too many methodological limitations to say anything conclusive. Although I also agree when they say
Also the references of this study are relatively old (pre 2000). I would like to know what they’re saying these days….
I’m using my medical school password to find more relevant studies but even then the coolest ones seem to be restricted so I might ask my psychiatrist next time I see her.
I think It would be interesting to have brain images of people with depression and manic depression when they’re young, and then compare these scans with new ones taken at older age, use controls and find out if there’s more athrophy in the depression group than the control group. Methodologically though, it is very complicated…
i have no idea about dementia i’m afraid
my old chemist used to yell out my name and medications too – like you i was thankful that no one in tooting seemed to have a clue what they were actually for.
how are you finding lamo and sero these days? i still find sero pretty good for me, it makes me sleep anyway which is a start. there was a vague idea that i should be on lamo too, just because i’ve been so crippled (in the vaguest sense) by lithium. on the other hand, lithium does seem to work and i don’t want to mess with it.
oh ps – hope the zopiclone blister pack was empty before the cat got to it!!
Just to add to the paranoia – I think there is a link between stress and dementia – people I have cared for with dementia have often had “a cow of a life” – no proof for this, however, my mother had a cow of a life and demented in her sixties and maybe I like the theory because it gets me off the genetic predisposition hook a bit
)
I ended up on weekly scripts for venlafaxine when the dose was increased earlier this year. It’s cardiotoxic in overdose, which is why the NICE guidelines for it have changed (now only used as a second line treatment initiated by someone with an interest in mental health) and is why you had to have an ECG before you started it.
As a related topic to the ECG – I keep finding the sticky pads they put on you in all my laundry and on my floor from all the ECGs they gave me when they admitted me weekend before last. They are evil things, especially now they make you take your bra off. When I’ve had ECGs before they’ve worked round my bra, but lying there with it all hanging out and a nurse placing little stickers on you is a very bizarre experience.
I never heard that in medical school. And remember, a lot of the whole kindling-getting-worse-over-time thing is from drug companies, saying that you have to treat everyone young and early lest something horrible happen…in order to sell more drugs. Not really evidence based.
Thank you, chaps!
Nessa and Nurse Exec, thanks for the science bit. I’m guessing the conclusion is “not sure”…
Harrie:
how are you finding lamo and sero these days
Alright but I’m not sure what the Lamictal is actually doing for me. My mood isn’t different from when I wasn’t taking it.
I’ve used effexor for serious depression and it does a wonderful job.
However, when it’s time to quit it was very difficult for me (and many others) to handle the withdrawl symptoms. I just want you to be aware, forewarned and all that. I finally decided that the withdrawl was worth using effexor to be rid of the depression, but it was a close call!
Hi there,
It’s a big question, “Does depression lead to dementia?”
The answer’s sadly big too, in a long and waffly kind of way.
What depression? If mild, or reacting to life being grim, then probably not.
If severe, and a chemical disorder within the brain, which goes on for years and years, then probably yes.
We know that being stressed is not good. Being stressed and frazzled for long periods of time (i.e. longer than it takes to run away from or kill that lion, as your body goes in to flight-or-fight mode) is unhealthy. It causes us to have high levels of stress hormones (catecholamines from our adrenal gland, like adrenaline). These give us an extra edge, so we can deal with that lion. But the flame that burns twice as bright burns half as long . . . having that adrenaline etc around day after day when we’re in a permanently stressed out state (physiologically stressed or mentally stressed by the depression) takes its toll.
The toll’s harsh. The hormones are neurotoxic, that is they’ll kill brain cells. So over time, if serious depression’s untreated, you’ll cause brain loss. ECT is contentious as a treatment for serious depression, with folk thinking it can cause memory problems . . . when it’s been looked at and folk with the same sort of depression didn’t have ECT they’ve had similar memory problems. It’s being very depressed for a long time that’s unhealthy.
I know one psychiatrist who thinks psychiatry shouldn’t treat depression. He thinks physicians like neurologists should. He thinks it’s too serious an illness to have someone sit down and whitter on about, “So tell me, how do you feel about this?” when week after week their brain’s being affected.
So our evidence to date is that severe depression and severe anxiety sustained over a long time can affect cognition, so you’d see symptoms of dementia sooner than you otherwise should. Also, in Alzheimer’s disease and most dementias the bit of the brain that’s damaged first is your limbic system, the bit that affects your mood. So the opposite’s true . . . folk with dementia will almost always have mood disturbance before they even start with memory problems!
Hmmm I could have a look around the journals which are paid subscription only (’cause, afterall, why let everyone look at research when you can make MONEY out of it? ((end auto-rant))) …. but I have a feeling if it’s not wound up on wiki or a news page they probably aren’t certain.
Also – when it comes to journals involving people (rather than working with genes/proteins) you’ll tend to find that they’re working on a rather small group, where conclusions are hard to draw (What was the selection criteria? Maybe it’s only people on certain drugs/who have a certain socio-economic status/or other factors I’m not familiar with since I usually work with molecular models).
However…. Even if you could be certain you are going to get dementia, what can you do about it? Might get hit by a car before it happens. You might be a Terry Pratchett type, and grind a couple of books out and have a world-wide mass fanclub before then.
On an unrelated note, I’m on 150mg of Effexor and had no ECG before starting it. And was suicidal at the time. Maybe my consultant is trying to cut waiting times and get me off his list permanently?
Thank you The Srhink!
Couldn’t agree more.
Andrew Solomon (Noonday Demon http://www.amazon.co.uk/Noonday-Demon-Andrew-Solomon/dp/0099277131/ref=sr_1_1?ie=UTF8&s=books&qid=1222949225&sr=1-1) describes neural damage as a result of repeated periods of depression/ mania although he is not specific how that damage manifests itself. My belief has always been that it becomes apparent as a form of “cognitive dulling” which could be synonymous with dementia. Trouble is long term use of neuroleptics to control mania appear to have much the same long term effect. So you pays your money and takes your pick.
Thanks, the Shrink and everyone else. Interesting, but depressing. And I agree that depression should be treated as a physical illness.
Don’t frett! Most people who konw about pyschiatric medication are the people who have friends or family with a mental illness or they work in the mental health field, so they won’t turn their nose up at you for being mentally ill.