Vitamin B12 aka Cobalamin is helpful in preventing depression and alzheimer's disease. Learn about the usage, dosage, side-effects of vitamin B12.

Also Known As: Cyanocobalamin

• Overview
• Uses
• Dietary Sources
• Available Forms
• Precautions
• Possible Interactions
• Supporting Research

Overview

Vitamin B12, also called cobalamin, is one of eight water-soluble B vitamins. All B vitamins help the body to convert carbohydrates into glucose (sugar), which is "burned" to produce energy. These B vitamins, often referred to as B complex vitamins, are essential in the breakdown of fats and protein. B complex vitamins also play an important role in maintaining muscle tone lining the digestive tract and promoting the health of the nervous system, skin, hair, eyes, mouth, and liver.

Vitamin B12 is an especially important vitamin for maintaining healthy nerve cells and it aids in the production of DNA and RNA, the body's genetic material. Vitamin B12 also works closely together with vitamin B9 (folate) to regulate the formation of red blood cells and to help iron function better in the body. The synthesis of S-adenosylmethionine (SAMe), a compound involved in immune function and mood, depends on the participation of folate and vitamin B12.

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Similar to other B complex vitamins, cobalamine is considered an "anti-stress vitamin" because it is believed to enhance the activity of the immune system and improve the body's ability to withstand stressful conditions.

Vitamins B12, B6, and B9 (folate) work closely together to control blood levels of the amino acid homocysteine. Elevated levels of this substance appear to be linked with heart disease and, possibly, depression and Alzheimer's Disease.

Deficiencies of vitamin B12 are usually caused by a lack of intrinsic factor, a substance that allows the body to absorb vitamin B12 from the digestive system. Such a deficiency can cause a range of symptoms including fatigue, shortness of breath, diarrhea, nervousness, numbness or tingling sensation in the fingers and toes., People with the blood disorder pernicious anemia do not produce sufficient intrinsic factor and must take high doses of vitamin B12 to maintain their health. Similarly, people who have had stomach surgery (for example, for a severe ulcer) are at risk for vitamin B12 deficiency and pernicious anemia. They require lifetime B12 injections after the surgery.

Others at risk for B12 deficiency include vegetarians who follow a strict vegan or macrobiotic diet; those with certain intestinal infections such as tapeworm and, possibly, Helicobacter pylori (an organism in the intestines that can cause an ulcer); and those with an eating disorder.

 

Vitamin B12 Uses

Pernicious Anemia
The most important use of vitamin B12 is to treat the symptoms of pernicious anemia. These symptoms include weakness, pale skin, diarrhea, weight loss, fever, numbness or tingling sensation in the hands and feet, loss of balance, confusion, memory loss, and moodiness.

Heart Disease
Many studies indicate that patients with elevated levels of the amino acid homocysteine are roughly 1.7 times more likely to develop coronary artery disease and 2.5 times more likely to suffer from a stroke than those with normal levels. Homocysteine levels are strongly influenced by B complex vitamins, particularly vitamins B9, B6, and B12.

The American Heart Association recommends that, for most people, an adequate amount of these important B vitamins be obtained from the diet, rather than taking extra supplements. Under certain circumstances, however, supplements may be necessary. Such circumstances include elevated homocysteine levels in someone who already has heart disease or who has a strong family history of heart disease that developed at a young age.

Vitamin B12 for Alzheimer's Disease
Vitamin B9 (folate) and vitamin B12 are critical to the health of the nervous system and to a process that clears homocysteine from the blood. As stated earlier, homocysteine may contribute to the development of certain illnesses such as heart disease, depression, and Alzheimer's Disease. Elevated levels of homocysteine and decreased levels of both folate and vitamin B12 have been found in people with Alzheimer's Disease, but the benefits of supplementation for dementia are not yet known.

Vitamin B12 for depression
Studies suggest that vitamin B9 (folate) may be associated with depression more than any other nutrient. Between 15% and 38% of people with depression have low folate levels in their bodies and those with very low levels tend to be the most depressed. Low folate levels tend to lead to elevated homocysteine levels. Many healthcare providers recommend a B complex multivitamin that contains folate as well as vitamins B6 and B12 to improve symptoms. If the multivitamin with these B vitamins is not enough to bring elevated homocysteine levels down, the physician may then recommend higher amounts of folate along with vitamins B6 and B12. Again, these three nutrients work closely together to bring down high homocysteine levels, which may be related to the development of depression.

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Burns
It is especially important for people who have sustained serious burns to obtain adequate amounts of nutrients in their daily diet. When skin is burned, a substantial percentage of micronutrients may be lost. This increases the risk for infection, slows the healing process, prolongs the hospital stay, and even increases the risk of death. Although it is unclear which micronutrients are most beneficial for people with burns, many studies suggest that a multivitamin including the B complex vitamins may aid in the recovery process.

Osteoporosis
Keeping bones healthy throughout life depends on getting sufficient amounts of specific vitamins and minerals, including phosphorous, magnesium, boron, manganese, copper, zinc, folate, and vitamins C, K, B6, and B12, and B6.

In addition, some experts believe that high homocysteine levels may contribute to the development of osteoporosis. If this is the case, then there may prove to be a role for dietary or supplemental vitamins B9, B6, and B12.

Cataracts
Dietary and supplemental vitamin B complex is important for normal vision and prevention of cataracts (damage to the lens of the eye which can lead to cloudy vision). In fact, people with plenty of protein and vitamins A, B1, B2, and B3 (niacin) in their diet are less likely to develop cataracts. Plus, taking additional supplements of vitamins C, E, and B complex (particularly the B1, B2, B9 [folic acid], and B12 [cobalamin] in the complex ) may further protect the lens of your eyes from developing cataracts.

Human Immunodeficiency Virus (HIV)
Blood levels of vitamin B12 are often low in people with HIV. It is unclear, however, what role vitamin B12 supplements would play in treatment. If you have HIV, your levels of vitamin B12 should be followed over time and B12 injections may be considered if levels get too low, especially if you have symptoms of B12 deficiency.

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Breast Cancer
Population based studies of postmenopausal women suggest that low vitamin B12 levels in the blood may be associated with an increased risk for breast cancer. It is not clear whether supplementation with vitamin B12 reduces the risk of this disease, however.

Male Infertility
Studies suggest that vitamin B12 supplements may improve sperm counts and sperm mobility. Further studies are needed to best understand how this can help men with a low sperm count or poor sperm quality.

 

Vitamin B12 Dietary Sources

Good dietary sources of vitamin B12 include fish, dairy products, organ meats (particularly liver and kidney), eggs, beef, and pork

 

Vitamin B12 Available Forms

Vitamin B12 can be found in multivitamins (including children's chewable and liquid drops), B complex vitamins, and are sold individually. It is available in both oral (tablets and, capsules) and intranasal formssoftgels, and lozenges. Vitamin B12 is also sold under the names cobalamin and cyanocobalamin.

 

How to Take Vitamin B12

People whose daily diet includes meat, milk, and other dairy products should be able to meet the recommended daily requirements without taking a vitamin supplement. Vegetarians who do not eat any animal protein should take a vitamin B12 supplement with water, preferably after eating. Elderly people may need greater amounts of vitamin B12 than younger people because the body's ability to absorb vitamin B12 from the diet diminishes with age.

People considering B12 supplements should check with a healthcare provider to find out the most appropriate dosage.

Daily recommendations for dietary vitamin B12 are listed below.

Pediatric

• Newborns to 6 months: 0.4 mcg (adequate intake)
• Infants 6 months to 1 year: 0.5 mcg (adequate intake)
• Children 1 to 3 years: 0.9 mcg (RDA)
• Children 4 to 8 years: 1.2 mcg (RDA)
• Children 9 to 13 years: 1.8 mcg (RDA)
• Adolescents 14 to 18 years: 2.4 mcg (RDA)

Adult

• 19 years and older: 2.4 mcg (RDA)*
• Pregnant females: 2.6 mcg (RDA)
• Breastfeeding females: 2.8 mcg (RDA)

*Because 10-30% of older people may not absorb B12 from food very efficiently, it is recommended that those older than 50 years meet their daily requirement mainly through either foods fortified with vitamin B12 or a supplement containing B12.

 

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Precautions

Because of the potential for side effects and interactions with medications, dietary supplements should be taken only under the supervision of a knowledgeable healthcare provider.

Vitamin B12 is considered safe and non-toxic.

Taking any one of the B complex vitamins by itself for a long period of time can result in an imbalance of other important B vitamins. For this reason, it is generally important to take a B complex vitamin with any single B vitamin.

 

Possible Interactions

If you are currently being treated with any of the following medications, you should not use vitamin B12 supplements without first talking to your healthcare provider.

Antibiotics, Tetracycline
Vitamin B12 should not be taken at the same time as the antibiotic tetracycline because it interferes with the absorption and effectiveness of this medication. Vitamin B12 either alone or in combination with other B vitamins should be taken at different times of the day from tetracycline. (All vitamin B complex supplements act in this way and should therefore be taken at different times from tetracycline.)

In addition, long-term use of antibiotics can deplete vitamin B levels in the body, particularly B2, B9, B12, and vitamin H (biotin), which is considered part of the B complex.

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Anti-ulcer Medications
The body's ability to absorb vitamin B12 is decreased when taking stomach acid-reducing medications such as omeprazole, lansoprazole, ranitidine, cimetidine, or antacids that are often used to treat gastroesophageal reflux, ulcers or related symptoms. This interference is most likely to occur as a result of prolonged use (more than one year) of these medications.

Chemotherapy Medications
Blood levels of vitamin B12 may be reduced when taking chemotherapy medications (particularly methotrexate) for cancer.

Metformin for diabetes
Blood levels of vitamin B12 may also be reduced when taking metformin for diabetes.

Phenobarbital and Phenytoin

Long-term treatment with either phenobarbital and phenytoin for seizure disorders may interfere with the body's ability to use vitamin B12.

Supporting Research

Adachi S, Kawamoto T, Otsuka M, Todoroki T, Fukao K. Enteral vitamin B12 supplements reverse postgastrectomy B12 deficiency. Ann Surg. 2000;232(2):199-201.

Alpert JE, Fava M. Nutrition and depression: the role of folate. Nutrition Rev. 1997;5(5):145-149.

Alpert JE, Mischoulon D, Nierenberg AA, Fava M. Nutrition and depression: focus on folate. Nutrition. 2000;16:544-581.

Antoon AY, Donovan DK. Burn Injuries. In: Behrman RE, Kliegman RM, Jenson HB, eds. Nelson Textbook of Pediatrics. Philadelphia, Pa: W.B. Saunders Company; 2000:287-294.

Bauman WA, Shaw S, Jayatilleke E, Spungen AM, Herbert V. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care. 2000;13(9):1227-1231.

Booth GL, Wang EE. Preventive health care, 2000 update: screening and management of hyperhomocysteinemia for the prevention of coronary artery disease events. The Canadian Task Force on Preventive Health Care. CMAJ. 2000;163(1):21-29.

Bottiglieri T. Folate, vitamin B12, and neuropsychiatric disorders. Nutrition Rev. 1996;54(12):382-390.

Bottiglieri T, Laundy M, Crellin R, Toone BK, Carney MW, Reynolds EH. Homocysteine, folate, methylation, and monoamine metabolism in depression. J Neurol Neurosurg Psychiatry. 2000;69(2):228-232.

Boushey CJ, Beresford SA, Omenn GS, Motulsky AG. A quantitative assessment of plasma homocysteine as a risk factor for vascular disease. JAMA. 1995;274:1049-1057.

Brattstrom LE, Hultberg BL, Hardebo JE. Folic acid responsive postmenopausal homocysteinemia. Metabolism. 1985;34(11):1073-1077.

Bunker VW. The role of nutrition in osteoporosis. Br J Biomed Sci. 1994;51(3):228-240.

Carmel R. Cobalamin, the stomach and aging. Am J Clin Nutr. 1997;66(4):750-759.

Choi SW. Vitamin B12 deficiency: a new risk factor for breast cancer? [Review]. Nutr Rev. 1999;57(8):250-253.

Clarke R, Smith AD, Jobst KA, Refsum H, Sutton L, Veland PM. Folate, vitamin B12, and serum total homocysteine levels in confirmed Alzheimer disease. Arch Neurol. 1998;55:1449-1455.

Committee on Dietary Allowances. Recommended Dietary Allowances. National Academy of Sciences. Accessed at www.nal.usda.gov/fnic/Dietary/rda.html on January 8, 1999.

Dastur D, Dave U. Effect of prolonged anticonvulsant medication in epileptic patients: serum lipids, vitamins B6, B12 and folic acid, proteins and fine structure of liver. Epilepsia. 1987;28:147-159.

De-Souza DA, Greene LJ. Pharmacological nutrition after burn injury. J Nutr. 1998;128:797-803.

Eikelboom JW, Lonn E, Genest J, Hankey G, Yusuf S. Homocyst(e)ine and cardiovascular disease: a critical review of the epidemiologic evidence. Ann Intern Med. 1999;131:363-375.

Ekhard ZE, Filer LJ, eds. Present Knowledge in Nutrition. 7th ed. Washington, DC: ILSI Press; 1996:191 - 201.

Fugh-Berman A, Cott JM. Dietary supplements and natural products as psychotherapeutic agents. Psychosom Med. 1999;61:712-728.

Howden CW. Vitamin B12 levels during prolonged treatment with proton pump inhibitors. J Clin Gastroenterol. 1999;30(1):29-33.

Hurter T, Reis HE, Borchard F. Disorders of intestinal absorption in patients treated with cytostatic chemotherapy [in German]. Z Gastroenterol. 1989;27(10):606-610.

Ingram CF, Fleming AF, Patel M, Galpin JS. The value of intrinsic factor antibody test in diagnosing pernicious anaemia. Cent Afr J Med. 1998;44:178 - 181.

Kaptan K, Beyan C, Ural AU, et al. Helicobacter pylori - is it a novel causative agent in vitamin B12 deficiency? Arch Intern Med. 2000;160(9):1349-1353.

Kass-Annese B. Alternative therapies for menopause. Clin Obstet Gynecol. 2000;43(1):162-183.

Kelly GS. Nutritional and botanical interventions to assist with the adaptation to stress. Alt Med Rev. 1999;4(4):249-265.

Kirschmann GJ, Kirschmann JD. Nutrition Almanac. 4th ed. New York: McGraw-Hill;1996:127-136.

Kris-Etherton P, Eckel RH, Howard BV, St. Jeor S, Bazzarre TL. Lyon diet heart study. Benefits of a Mediterranean-style, National Cholesterol Education Program/American Heart Association Step I dietary pattern on cardiovascular disease. Circulation. 2001;103:1823-1825.

Kuzminski AM, Del Giacco EJ, Allen RH, Stabler SP, Lindenbaum J. Effective treatment of cobalamin deficiency with oral cobalamin. Blood. 1998;92(4):1191-1198.

Lederle FA. Oral cobalamin for pernicious anemia. Medicine's best kept secret? JAMA. 1991;265:94-95.

Lee AJ. Metformin in noninsulin-dependent diabetes mellitis. Pharmacotherapy. 1996;16:327 - 351.

Louwman MW, van Dusseldorp M, van de Vijver FJ, et al. Signs of impaired cognitive function in adolescents with marginal cobalamin status. Am J Clin Nutr. 2000;72(3):762-769.

Malinow MR, Bostom AG, Krauss RM. Homocyst(e)ine, diet, and cardiovascular disease. A statement for healthcare professionals from the nutrition committee, American Heart Association. Circulation. 1999;99:178-182.

McKevoy GK, ed. AHFS Drug Information. Bethesda, MD: American Society of Health-System Pharmacists, 1998.

Meyer NA, Muller MJ, Herndon DN. Nutrient support of the healing wound. New Horizons. 1994;2(2):202-214.

Nilsson-Ehle H. Age-related changes in cobalamin (vitamin B12) handling. Implications for therapy. Drugs Aging. 1998;12:277 - 292.

Nutrients and Nutritional Agents. In: Kastrup EK, Hines Burnham T, Short RM, et al, eds. Drug Facts and Comparisons. St. Louis, Mo: Facts and Comparisons; 2000:4-5.

Omray A. Evaluation of pharmacokinetic parameters of tetracylcine hydrochloride upon oral administration with vitamin C and vitamin B complex. Hindustan Antibiot Bull. 1981;23(VI):33-37.

Remacha AF, Cadafalch J. Cobalamin deficiency in patients infected with the human immunodeficiency virus. Semin Hematol. 1999;36:75 - 87.

Schnyder G. Decreased rate of coronary restinosis after lowering of plasma homocysteine levels. N Engl J Med. 2001;345(22):1593-1600.

Schumann K. Interactions between drugs and vitamins in advanced age. Int J Vit Nutr Res. 1999;69(3):173-178.

Sinclair S. Male infertility: nutritional and environmental considerations. Alt Med Rev. 2000;5(1):28-38.

Snowdon DA, Tully CL, Smith CD, Riley KR, Markesbery WR. Serum folate and the severity of atrophy of the neocortex in Alzheimer disease: findings from the Nun Study. Am J Clin Nutr. 2000;71:993-998.

Termanin B, Gibril F, Sutliff VE, Yu F, Venzon DJ, Jensen RT. Effect of long-term gastric acid suppressive therapy on serum vitamin B12 levels in patients with Zollinger-Ellison syndrome. Am J Med. 1998;104(5):422-430.

Verhaeverbeke I, Mets T, Mulkens K, Vandewoude M. Normalization of low vitamin B12 serum levels in older people by oral treatment. J Am Geriatr Soc. 1997;45:124-125.

Wang HX. Vitamin B12 and folate in relation to the development of Alzheimer's Disease. Neurology. 2001;56:1188-1194.

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Wu K, Helzlsouer KJ, Comstock GW, Hoffman SC, Nadeau MR, Selhub J. A prospective study on folate, B12, and pyridoxal 5'-phosphate (B6) and breast cancer.
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(published by Three Rivers Press/Crown, a division of Random House)

Addiction-Proof Your Child A Realistic Approach to Preventing Drug, Alcohol, and Other Dependencies Stanton Peele, Ph.D, J.D.

$14.95 / Family & Relationships—parenting $19.95(CAN)

Will your kids drink or smoke marijuana? Quite possibly. But don't panic. In a world where binge drinking, recreational and prescription drug abuse, chronic overeating and anorexia, and internet gambling and pornography are all too common among teens, it's time to rethink conventional wisdom about addiction. We clearly need something more than "just say no." This book is the alternative.

Parents are being misled—and disempowered. So says Dr. Stanton Peele, author of the groundbreaking Love and Addiction, in this controversial but research-driven book. Brainwashed by the constant refrains that addiction is a disease, that abstinence is the only solution, and that any drug or alcohol use requires treatment, society and parents aren't being presented with the successful tactics they can use to make their children addiction-proof—and to keep them safe if they do use drugs or drink, as so many will.

Dr. Peele explains that, despite what parents have been told, it's normal for most kids to try alcohol and drugs, and that the large majority will not become addicts or ruin their lives—if they are armed with real-life motivators to keep them addiction free: independence, critical thinking, responsibility, and the ability to enjoy life. In simple, clear terms, Addiction-Proof Your Child shows parents how to instill these qualities: by teaching children to take pride in achievement and other bedrock values, learning how to be calm questioners and tolerant listeners, fighting the urge to overparent, and (if the parents drink) teaching kids how to drink in moderation at home.

Addiction-Proof Your Child offers realistic options for parents who are tired of hearing depressing statistics and who want to make a difference in their children's lives. Whether your child has never drunk a drop, has experimented with alcohol or drugs, or is already abusing them, this is the family's go-to book for practical, helpful resources and techniques.

STANTON PEELE, Ph.D., J.D., is an internationally recognized addiction expert and father of three. His books include 7 Tools to Beat Addiction and Love and Addiction.

next: Book - The Meaning of Addiction
~ all Stanton Peele articles
~ addictions library articles
~ all addictions articles

Online stock investment firms such as National Discount Brokers have already realized the addictive nature of Day Trading. Answer "yes" or "no" to the following statements to see if you may be addicted to online trading:

1. Do you need to trade with increasing amounts of money in order to achieve the desired excitement?
2. Are you preoccupied with stock trading (thinking about it when offline, anticipating your next online session)?
3. Have you lied to friends and family members to conceal extent of your online trading?
4. Do you feel restless or irritable when attempting to cut down or stop online stock trading?
5. Have you made repeated unsuccessful efforts to control, cut back, or stop online trading?
6. Do you use trading as a way of escaping from problems or relieve feelings of helplessness, guilt, anxiety, or depression?
7. Have you jeopardized or lost a significant relationship, job, or educational or career opportunity because of online trading?
8. Have you committed illegal acts such as forgery, fraud, theft, or embezzlement to finance online activities?

If you answered "yes" to any of the above questions, you may be an obsessive online trader. These are signs that you have lost control, lied, or possibly stole money just to support your trading behavior.

Why wait until it is too late to seek out help? Contact our Virtual Clinic today to receive fast, caring, and confidential advice for dealing with obsessive online trading. Our Virtual Clinic is also designed to help family members deal with the obsessive on-line trader in your home. Professional help is available directly with Dr. Kimberly Young, Founder and President of the Center for On-Line Addiction.

 

And read Caught in the Net, the first recovery book for Internet Addiction. Click here to order Caught in the Net.

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next: Are You Addicted to Online Auction Houses?
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Thoughtful quotes about progress and making progress in our lives.

Words of Wisdom

 

"It was probably a presumptuous error to confuse the progress of science with the progress of humanity." (Andre George)

"So it is not what comes but what is coming that makes for troubled sleep. The white man, ever moving forward, never looking back, is now the inheritor of his progress." (Gerald Hausman)

 

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next:Risk

Mother-author offers advice for surviving being a parent of a bipolar child.

Being the Mom of a child with mental illness is a tough calling that nobody knows better than Judith S. Lederman, author of The Ups & Downs of Raising a Bipolar Child: A Survival Guide for Parents (Simon and Schuster), and mother of a child who was diagnosed with bipolar disorder, a.k.a., "manic depression," at the age of eight. She calls for moms of children with mental illness to reclaim their lives. Lederman took her own advice and lost 80 pounds during the course of writing her book and makes time each day for self-care.

"While every mother has difficult challenges to face, the mother of a child with mental illness too often plays the martyr," explains Lederman, who co-wrote her book with child psychiatrist, Dr. Candida Fink. "These moms feel overwhelmed. The illness is not one they publicize and so they lack support. They frequently must deal with hospitalizing their child, criticism by a public that just doesn't understand the nature of mental illness, and because mental illness is a congenital condition, they often come from family situations where they've had to deal with abuse and denial. All in all, it doesn't make for a Happy Mother's Day."

Lederman offers the following "makeover tips" for mothers who are dealing with mentally ill children:

• • Find support wherever you can get it—and that goes for emotional as well as physical aid. Talk to sympathetic clergy, a neighbor, or your child's schoolteacher. If you can afford to, pay a therapist and work through your issues as a mother and a woman, one by one.
  • Reclaim yourself physically. It is easy to fall into a punishing pattern when you are overwhelmed by your situation. In a word, don't. Instead of reaching for the cookies, go for a long walk or join a gym. If you can afford to, hire a personal trainer to get you started on an exercise regimen.

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• Watch your sugar intake. Sugar is addicting and while we may find it comforting in the short-term, it actually will bring your own mood down. Any mom who is used to monitoring her child's mood, should also be very aware of her own moods. Cutting the sugar can actually give you more energy. And the mom of a mentally ill child will need every shred of energy she can get.
• Stay in the No-Martyr Zone. Make up your mind here and now that no matter how difficult your child is, you will not enter a self-destructive mode of thinking. Face your challenges without self-pity. Remember that if you don't take care of yourself, you won't be able to be the best for your child.

Source: NewsReleaseWire.com

Deparate mother sells everything to help bipolar sons, but county agency still refuses to step in.

Everything spent, and no help

After 14-year-old Matthew Mikolic chased his younger brother with a knife, his mother asked Lake County officials to pay to send him to a psychiatric center. They refused.

"They said he wasn't violent enough, that he had only tried to kill his brother once," Susan Mikolic says.

Now, the Eastlake, Ohio, mom lives in fear that next time, Matthew, who is now a 220-pound, mentally ill 16-year-old, will succeed. She hides tools and poisonous household cleaners in a locked fishing tackle box in the garage. She started locking up kitchen knives after Matthew tried to stab Brian, then 12.

"Brian locked himself in the bathroom, called me and said, 'Get home, Matthew's got a knife and he's trying to kill me,' " Mikolic, 44, recalls. "I called the police, and a whole SWAT team came. By the time I got there, Brian was crying in the driveway, and Matthew had his hands in the air."

Mikolic sought help from the county because she had no money left for more care. When her insurance ran out, she sold her $287,000 suburban home to cover treatment for both of her sons, who have bipolar disorders that cause them to swing from overly hyper to depressed or violent.

At first, the boys needed weekly counseling, but insurance only covered half the cost of 20 sessions with a psychiatrist a year at $125 each per child. Eventually, Mikolic and her husband were shelling out more than $20,000 a year for family therapy. They took out three home equity lines of credit to pay for treatments, including lightbox therapy, music therapy and anti-psychotic drugs.

For Mikolic, the pressures finished off her marriage and forced the couple to sell their home to pay off their loans. In the end, she was left with just enough to put a small downpayment on a modest white house that needs a $3,000 roof.

She also developed diabetes and such deep depression that she could no longer work as a nurse.

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"It was a process of letting go, selling the house, the furniture, everything," she says. "I've had relatives look at me and say, 'How could you lose your home, your husband, your job?' And I say, 'Where would you have stopped? What would you do to save your kids?' "

Mikolic says what happened to her shows just what families with mentally ill children are up against. She and other advocates are pushing Ohio lawmakers to pass a bill that would force insurance companies to cover a mental illness in the same way they cover a physical illness.

If her sons had leukemia, Mikolic reasons, she wouldn't have had to sell her home. "Why should it be different for us because they are bipolar?" she asks.

Roberta Barb, an administrator of child protection services in Lake County, says her agency opted not to send Matthew to a treatment center because, "As a group, we decided he was not in need of placement. We can't make everybody happy, and we're not placing a kid in treatment just because a parent believes he needs to go."

The teen has tried everything to get his emotions under control, even shock treatments that applied electric jolts to his brain. So far, nothing's worked. He refused more shock treatments after he was given two drugs during a procedure - one to paralyze him and one to put him to sleep. The drug to paralyze him took effect first.

"I could hear the machine start, but I couldn't tell them I was awake," Matthew says. "I kept thinking, 'I should put my hand up, but I couldn't. It was scary. Once they started the procedure, I didn't know if I'd feel it."

He's frustrated but grateful for his mom for refusing to give up on him. "If it weren't for her, I'd be dead. If she didn't support me, I would have killed myself."

He pauses and lowers his voice.

"The illness puts that in your head," he says. "People say you can control it, but I don't think so. I know I can't control it."

Source: The Enquirer

"I don't have a creative bone in my body". Those are the words uttered to my art teachers when asked to draw, paint, or write for a class assignment. I excelled at sports. I preferred sports, the competition and instantaneous gratification of winning. Because of sports, I have been driven and focused all my life, it's a gift that I didn't know I had or how to use."

I grew up in a Midwestern city. I say this only for reference as I sit here typing away in my New York City Greenwich Village apartment. To quote a New York lover, "You've come a long way baby".

Upon reflection it really all began when I was born. It makes perfect sense. All of the experiences I've had led me to my "Birthquake" seven years ago. That was the big one. I've experienced a number of "aftershocks" since then.

Seven years ago I had the "Life". I called it the "American Dream" minus the wife and kids. I had a good paying job, drove a nice car, even had leather furniture to go with my condo. A single guy who had it all. But there was a nagging unhappiness, an emptiness that followed me everywhere. I kept trying to buy it off somehow. I'd buy a real nice stereo or a real nice suit to go with my other real nice suits that hung in closet in my condo. Or I'd buy artwork from a local artist.Somehow to be associated with an artist by purchasing his paintings, in a funny way satiated my unhappiness. Meanwhile life went on. I wanted to expand beyond my little world somehow. So I went and saw a play called "Death of a Salesman" with some friends. Did I mention that I was in sales.? I quite enjoyed the experience and proceeded to go to other theatrical events. On this one occasion, we saw an improv troupe. I was amazed by their talent. After the show, someone was handing out flyers offering classes. I took one of the flyers and stuck it in my pocket. About a week later, on a beautiful clear summer day, I was standing on a street corner waiting for the traffic light to change when out of the blue I got this image of a bullhorn and heard this voice that said, "acting, acting, acting". It came deep within in from a place that I'd never heard a voice before. I mean my head has many voices, many more now I might add, but this was loud, clear and new to me. I rushed home, found the flyer in my pant pocket called the number and left a message on the answering machine saying, "I'd like to take the class and I don't know what I'm doing, I've never done this", etc. A month later, I was in class on stage doing warm-ups, exercises and scenes. I enjoyed it so much that I went on to study with a prominent regional theater company. It was there that my life was to really change.

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At this point, I was still successful at my job. My life continued down that "American Dream" path. I was a bit happier. I had gotten a taste of creativity. But it was like being at the best restaurant and only sampling the food. It was okay, but I knew there was more. But how, where and when? Then it happened. I started another acting class.

On the first night, for an acting exercise, the teacher paired me up with a woman. We were to rehearse throughout the week for the next class. We got to know each other and became friends. After class, we would hang out, go to a coffee shop, a bar or watch movies.

About a month into our friendship, something began to stir deep within. I was getting images in my mind's eye of a blossoming rose. I had no idea what was going on. Then one day after class, we went to our usual bar and ordered food and drinks. The usual talk of acting and class. I knew at this point that I was having feelings for her. In fact, I remember saying to myself, "there is no way that I am going to water this rose, I do not have feelings for her". I have since found out that I am not in control. That night I looked at her a certain way and it happened! I gave over to it, I fell in love with her. For me, that was the "Birthquake".

It started with a crack in my foundation, an image of a clam. When a clam is shut, it is really shut, you can't open it. But when a clam opens, it's in the form of a heart. The moment I fell in love with her, my heart cracked opened with a flood of blinding light emanating from that "place". The very place I heard the calling to follow acting. I had no idea what to do, I'd never felt this way about someone. I couldn't tell her how I felt, she was only in town for a few months and had a boyfriend back home. And my concept of love was shattered.

I had always thought I was in control of who or when I could love. Love to me was, I do something for you, you do something for me. After the shock wore off, I started asking my close friends what to do. Their response was, "I didn't know you were taking acting classes" and "really that's nice". So I called a former girlfriend of mine. We'd remained friends and I thought she might know what to do. We met for dinner one night and I told her my dilemma. She told me I had to tell this woman how I felt. I had to do it for myself regardless of how she felt and I had to do it soon or I would never do it.

She was right. But it felt like jumping off a cliff in the dark. When I was younger, I had excelled at ski jumping. I used to soar 200 plus feet in the air. Needless to say, I've experienced fear. That did not compare to the fear I felt having to tell someone that I am in love with them. That same night, I called her and we met at our usual bar and I told her. It was like a weight had lifted. She was surprised. She was very matter of fact, explaining that she had a boyfriend and that she was leaving. The very same rational reasons I had for not pursuing it.

Well, two days later I got a call late in the night from her. She had been crying all day and night. Apparently, when the words "I am in love with you" sank in, she felt the same way. We spent three incredible days and nights together before she left. We ended up having a long distance relationship lasting six months. After the breakup, I never experienced so much pain in all of my life. It was never ending. They say that pain is a teacher. Well I learned a lot from this teacher.

Two years after the breakup, I sold everything I owned, quit my job and moved to New York City. The impact of that relationship which happened over five years ago has had such profound effects today. The healing process was not necessarily about the relationship but my life. See, I had all of these facts about life that I was taught early on by my parents, friends and society. The calling, relationship and experiences since then have helped me see that life is not about facts. Life is a living organism. Life is shaped by our experiences and environment, and we are free to choose how to shape it. We can go with the "herd", or we can follow our own path. You know what I mean when I say herd. You see it everyday all around you. You can see it in people's eyes. The settling in for the long haul soulless look. I recognize it because I've been there. Your own path takes more work but is more rewarding. Following this path you never really get there.

For me each day is an adventure. Sure I live in New York City and that helps. New York is a difficult city to live in. I call it the training ground for spirituality. Why? Because reality is in your face everywhere you go. Everything from materialism, to poverty. I've simplified my life in order to survive. Five years ago, my spirit was in a coma. It's been revived by people and experiences. I am revived daily. To me that's what life is all about. Today I do many things. I act, write, play guitar, meditate. I am a friend, lover and worker among workers. But more importantly, I am a human being on this planet. And I want to do my part to help others realize that there is more out there than the "American Dream". Find out for yourself. We all have the calling at a number of times in our lives. Listen for the voice, it may be a whisper at first but when you slow down and pay attention it gets louder.

What will become of my life? Just when I have a handle on it, it slips between my fingers so I've given up pretending to know. I do know that I will continue to take actions daily. I want to do great things. I want to help change the world. I will in my own way. I have a vision but how I get there is a mystery that I live one day at a time.

The beauty of the internet is that we can form a worldwide community. I am here for anyone wishing to follow their path. Stepping out into the unknown is a difficult undertaking and it takes support. I applaud anyone with the courage to do so. Feel free to e-mail me at alindskoog@bimage.com. I will end with this given to me by one of my many supporters. "In a dream you saw a way to survive and you were full of joy".

About the author: Allen Wayne is a native Minnesotan, now residing in New York City. He is a film, commercial and theater actor and screenplay writer.

next:Essays and Stories: A Dedication...

"But you hate kiwi!" - protests my girl - "How can anyone detest kiwi and then eat it so eagerly?". She is baffled. She is hurt. To some extent, she is even frightened to find herself with this kiwi-guzzling stranger.

How can I tell her that, in the absence of a self, there are no likes or dislikes, preferences, predictable behaviour or characteristics? It is not possible to know the narcissist. There is no one there.

The narcissist was conditioned - from an early age of abuse and trauma - to expect the unexpected. His was a world in motion where (sometimes sadistically) capricious caretakers and peers often engaged in arbitrary behaviour. He was trained to deny his true self and nurture a false one.

Having invented himself, the narcissist sees no problem in re-inventing that which he designed in the first place. The Narcissist is his own creator.

Hence his grandiosity.

Moreover, the narcissist is a man for all seasons, forever adaptable, constantly imitating and emulating, a human sponge, a perfect mirror, a non-entity that is, at the same time, all entities combined.

The narcissist is best described by Heidegger's phrase: "Being and Nothingness". Into this reflective vacuum, this sucking black hole, the narcissist attracts the sources of his narcissistic supply.

To an observer, the narcissist appears to be fractured or discontinuous.

Pathological narcissism has been compared to the Dissociative Identity Disorder (formerly the Multiple Personality Disorder). By definition, the narcissist has at least two selves. His personality is very primitive and disorganized. Living with a narcissist is a nauseating experience not only because of what he is - but because of what he is NOT. He is not a fully formed human - but a dizzyingly kaleidoscopic gallery of mercurial images, which melt into each other seamlessly. It is incredibly disorienting.

It is also exceedingly problematic. Promises made by the narcissist are easily disowned by him. His plans are ephemeral. His emotional ties - a simulacrum. Most narcissists have one island of stability in their life (spouse, family, their career, a hobby, their religion, country, or idol) - pounded by the turbulent currents of a disheveled existence.

Thus, to emotionally invest in a narcissist is a purposeless, futile and meaningless activity. To the narcissist, every day is a new beginning, a hunt, a new cycle of idealization or devaluation, a newly invented self.

There is no accumulation of credits or goodwill because the narcissist has no past and no future. He occupies an eternal and timeless present. He is a fossil caught in the frozen lava of a volcanic childhood.

The narcissist does not keep agreements, does not adhere to laws, regards consistency and predictability as demeaning traits. The narcissist hates kiwi one day - and devours it passionately the next.

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next: Dr. Jackal and Mr. Hide

Today I wrote to someone:

"The biggest source of personal strength is loneliness. The fountain of vigour and clarity and tranquility and creativity erupts from extreme deprivation. It is when we cannot rely on others, nor depend on them (not even for our sexual fulfillment), when we neither expect, nor wish, nor dream - that we are invincible. It is when we lose everything purposefully - that we gain it back. Naked, in the moonlight, we extend a hand to the stars and are one with them, primordially and unconditionally.

When we discover ourselves - we naturally shed the world. We have no need for it, this empty shell of failed communication. We are perfectly and entirely neutral - not sad, nor elated, not scared and not proud. A state of nothingness contrasted to the former and depraved state of being. We crave no more. Are are at peace.

I congratulate you on your independence."

I am constantly envious of people. This is my way of interacting with the world. I begrudge others their success, or brilliance, or happiness, or good fortune. I am driven to excesses of paranoia and guilt and fear that subside only after I "act out" or punish myself. It is a vicious cycle in which I am entrapped.( Cronos and his Children - Envy and Reparation).

"Envy is forever looking upwards. It does not look sideways.

In 'Facial Justice,' Hartley (1960) describes a life after a catastrophic war. A Dictator has decreed that envy is so destructive that it has to be eliminated. The citizens are coerced to be as alike each other as possible.

The worst crime is not envy itself but to excite envy.

'Equality and Envy - the two E's were...the positive and negative poles on which the New State rotated '(p.12). In order to exterminate envy everything that was enviable has been destroyed. Of course, that, in itself, is the very essence of envy.

Neither envy nor equality are spoken of as words but referred to as Good and Bad E's. All tall buildings had been destroyed in the war except the tower of Ely Cathedral and none are allowed to be built - a horizontal view of life is required. No comparisons are to be made, women are encouraged to undertake an operation so they all looked alike, to be pretty would excite envy. The result is that the populace loses its humanity and becomes a non-thinking mass. The independently minded heroine, Jael, visits the Ely and looks up at the tower and leads a dance round it. She pays the price of having her more than averagely pretty face (an Alpha face) changed to a Beta face by cosmetic surgery and so made indistinguishable from the others."

From "Cronos and His Children - Envy and Reparation" by Mary Ashwin - Chapter II "Everyday Envy"

The New Oxford Dictionary of English defines envy as:

"A feeling of discontented or resentful longing aroused by someone else's possessions, qualities, or luck."

And an earlier version (The Shorter Oxford English Dictionary) adds:

"Mortification and ill-will occasioned by the contemplation of another's superior advantages".

Pathological envy - the second deadly sin - is a compounded emotion. It is brought on by the realization of some lack, deficiency, or inadequacy in oneself. It is the result of unfavorably comparing oneself to others: to their success, their reputation, their possessions, their luck, their qualities. It is misery and humiliation and impotent rage and a tortuous, slippery path to nowhere. The effort to break the padded walls of this self visited purgatory often leads to attacks on the perceived source of frustration.

There is a spectrum of reactions to this pernicious and cognitively distorting emotion:

SUBSUMING THE OBJECT OF ENVY THROUGH IMITATION

Some narcissists seek to imitate or even emulate their (ever changing) role models. It is as if by imitating the object of his envy, the narcissist BECOMES that object. So, narcissists are likely to adopt their boss' typical gestures, the vocabulary of a successful politician, the views of an esteemed tycoon, even the countenance and actions of the (fictitious) hero of a movie or a novel.

In his pursuit of peace of mind, in his frantic effort to alleviate the burden of consuming jealousy, the narcissist often deteriorates to conspicuous and ostentatious consumption, impulsive and reckless behaviours and substance abuse.

Elsewhere I wrote:

"In extreme cases, to get rich quick through schemes of crime and corruption, to out-wit the system, to prevail is thought by these people to be the epitome of cleverness (providing one does not get caught), the sport of living, a winked-at vice, a spice."

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DESTROYING THE FRUSTRATING OBJECT

Other narcissists "choose" to destroy the object that gives them so much grief by provoking in them feelings of inadequacy and frustration. They display obsessive, blind animosity and engage in a compulsive acts of rivalry often at the cost of self-destruction and self-isolation.

In my essay "The Dance of Jael", I wrote:

"This hydra has many heads. From scratching the paint of new cars and flattening their tyres, to spreading vicious gossip, to media-hyped arrests of successful and rich businessmen, to wars against advantaged neighbours.

The stifling, condensed vapours of envy cannot be dispersed.

They invade their victims, their rageful eyes, their calculating souls, they guide their hands in evil doings and dip their tongues in vitriol....

(The envious narcissist's existence is) a constant hiss, a tangible malice, the piercing of a thousand eyes. The imminence and immanence of violence.

The poisoned joy of depriving the other of that which you don't or cannot have."

SELF-DEPRECATION

From my essay, "The Dance of Jael":

"There are those narcissists who idealize the successful and the rich and the lucky. They attribute to them super-human, almost divine, qualities...

In an effort to justify the agonizing disparities between themselves and others, they humble themselves as they elevate the others.

They reduce and diminish their own gifts, they disparage their own achievements, they degrade their own possessions and look with disdain and contempt upon their nearest and dearest, who are unable to discern their fundamental shortcomings. They feel worthy only of abasement and punishment. Besieged by guilt and remorse, voided of self-esteem, perpetually self-hating and self-deprecating - this is by far the more dangerous species of narcissist.

For he who derives contentment from his own humiliation cannot but derive happiness from the downfall of others. Indeed, most of them end up driving the objects of their own devotion and adulation to destruction and decrepitude..."

COGNITIVE DISSONANCE

"...But the most common reaction is the good old cognitive dissonance. It is to believe that the grapes are sour rather than to admit that they are craved.

These people devalue the source of their frustration and envy. They find faults, unattractive features, high costs to pay, immorality in everything they really most desire and aspire to and in everyone who has attained that which they so often can't. They walk amongst us, critical and self-righteous, inflated with a justice of their making and secure in the wisdom of being what they are rather than what they could have been and really wish to be. They make a virtue of jejune abstention, of wishful constipation, of judgmental neutrality, this oxymoron, the favourite of the disabled."

AVOIDANCE - THE SCHIZOID SOLUTION

And then, of course, there is my favourite solution: avoidance. To witness the success and joy of others is too painful, too high a price to pay. So, I stay home, alone and incommunicado. I inhabit the artificial bubble that is my world where I am king and country, I am the law and yardstick, I am the one and only. There, in the penumbral recesses of my study, my flickering laptop for company, the only noises are electronic and I am the resident of my own burgeoning delusions. I am happy and soothed. I am what I can dream and dream my very being. I am no longer real, simply a narrative, an invention of my fervent mind, a colourful myth - sustaining and engulfing. I am content.

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next: The Discontinuous Narcissist

How to request workplace accommodations under the Disability Discrimination Act 2004 (UK).

Employer Assistance When You Have A Disability

The Disability Discrimination Act (DDA) 1995 revised 2004 requires employers to provide reasonable accommodation in the workplace to qualified employees and applicants with disabilities, unless such accommodations would pose an undue hardship (e.g. too costly, too extensive, too substantial, too disruptive). Generally, the applicant or employee with a disability is responsible for letting the employer know that an accommodation is needed to participate in the application process, to perform essential job functions, or to receive equal benefits and privileges of employment. Employers are not required to provide accommodations if they are not aware of the need.

Although an accommodation request does not have to be in writing, if you are an individual with a disability you might find it useful to document accommodation requests just in case there is a dispute about whether or when the requested accommodation was made. A request in writing is a good way to document this.

There are not specific guidelines or forms to be completed when requesting accommodations. Some employers have developed forms of their own. If so, you should use the employer's forms when available. Otherwise, you may use any method that is effective to request an accommodation.

If you plan to write a letter to request accommodations from your employer, please be sure to include the following information:

• identify yourself as a person with a disability
• state that you are requesting accommodations under The Disability Discrimination Act (DDA) 1995 revised 2004
• identify your specific problematic job tasks
• write your accommodation ideas
• request accommodation ideas from your employer
• refer to attached medical documentation to establish you are a person with a disability
• request that your employer respond to you in a reasonable amount of time

For a sample accommodation request letter go to http://www.jan.wvu.edu/media/accommrequestltr.html.

Workplace Accommodation Ideas for People with ADHD

Before deciding on specific accommodations for people with ADHD, it is important for both employer and employee to have a clear understanding as to what the individual's job duties are, which ones are problematic, and exactly what the person has trouble doing to fulfill his/her duties. This is called pinpointing the problem areas.

Some examples may be:

• spelling problems
• reading problems
• short-term memory deficits (are they due to lack of attention, difficulty with focus, distractibility, confusion, etc.)
• organizational difficulties
• distractions in the environment

Once the problem has been pinpointed then specific accommodations can be considered.

For example:

Deficits in Reading:

• recording for the Blind-books on tape
• tape recorded directives, messages, materials
• reading machines
• screen reading software for computer use
• color-coded manuals, outlines, maps

Deficits in Writing:

• personal computers/laptops
• voice recognition software
• spell checking software
• grammar checking software
• carbonless notetaking systems

Deficits in Mathematics:

• appropriate calculators
• large display screens for calculators, adding machines, etc.

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There are various other accommodations which can be agreed between an employer and employee for many other things below are a few that have been agreed by some folk in the past to give an idea of how some things can be worked out:

• If focus is a problem it can be agreed to have the person get up from a desk every half hour or so without any fuss and walk round the office or outside for 5 minutes - thing is when you come back you do twice as much work and therefore the employer is normally getting a good deal there!
• Getting phone calls done can also be something that gets put of by those who procrastinate so sometimes a closed office room with do not disturb on the door for a half an hour in the morning and same in the afternoon to go to with a list of calls to make and then in peace and quiet with no distractions these will all get done - if focus stops this then maybe someone popping a head into the room after quarter of an hour to see how it is going can be discussed
• Same with specific paper work as above a quiet office for a certain time in the day to do this
• Lists written up and taped somewhere visable
• An alarm or organiser or even a watch with alarm on to schedule things into - maybe an employer will agree to purchase one of these such as Motivaider or Watchminder from our Books and Resources Section!
• A good secretary or a good mentor is also a very good idea

Any other ideas which people have tried we are always keen to hear about.

Sample Accommodation Request Letter

The following is an example of what can be included in an accommodation request letter and is not intended to be legal advice.

Date of Letter
Your name
Your address
Employer's name
Employer's address

Dear (e.g. Supervisor, Manager, Human Resources, Personnel):

Content to consider in body of letter:

a. Identify yourself as a person with a disability
b. State that you are requesting accommodations under The Disability Discrimination Act (DDA)
c. Identify your specific problematic job tasks
d. Identify your accommodation ideas
e. Request your employer's accommodation ideas
f. Refer to attached medical documentation if appropriate*
g. Ask that your employer respond to your request in a reasonable amount of time

Sincerely,
Your signature
Your printed name

Cc: to appropriate individuals

* You may want to attach medical information to your letter to help establish that you are a person with a disability and to document the need for accommodation.