Having a bipolar family member brings a lot of challenges. Get insights and advice on caring for and supporting someone with bipolar disorder plus tips for taking care of yourself. For family members and friends.

Bipolar Family Support Articles

These articles focus on supporting a bipolar family member and how bipolar disorder affects the family unit.

• Role of Family and Friends in a Bipolar Person's Life
  The challenges of living with bipolar disorder are not limited to those who have the disease.
• What Does Bipolar Support Really Mean?
  Advice from consumers, friends and family members on what 'true' bipolar support really is.
• Family Consideration: Effects of Bipolar Disorder on the Family
  The family of someone with bipolar disorder will be affected in many ways.
• The Effects of Bipolar Disorder on Family and Friends
  Bipolar disorder affects not only the lives of the patients themselves, but also the entire social setting in which he/she moves; marriage, family, friends, job, society at large.

How to Deal with Bipolar Person

Dealing with a bipolar family member can be challenging. These articles provide guidelines for giving bipolar family support.

• A Guide for the Bipolar Caregiver
  Caring for someone with bipolar disorder can be overwhelming. Read about ways to cope effectively.
• Loving Tough: Dealing with a Bipolar Person
  It's often pretty rough trying to cope with a manic-depressive loved one.
• Dealing with Bipolar Mania: Help for Caregivers
  What caregivers need to know about symptoms of mania, medications to treat mania and caring for people with bipolar disorder.
• Bipolar Anger: How To Handle Your Bipolar Relative's Anger
  If your relative is angry and you are not, learn coping mechanisms
• Do's and Don'ts When Supporting Someone with Bipolar
  Suggestions for difficulties arising from bipolar and depression.
• Best Things to Say to a Person With Bipolar Disorder
  Learn things to say that may be helpful to a person suffering from Bipolar Disorder.
• Worst Things to Say to a Person With Bipolar Disorder
  Learn what things that, when said, could be demeaning or degrading to a person suffering from Bipolar Disorder.
• 12 Things To Do If Your Loved One Has Bipolar Disorder
  Twelve things to do if your loved one has bipolar disorder.

Bipolar Spouses: Coping with a Bipolar Spouse

In addition to the bipolar support information above, bipolar spouses face some unique challenges. The articles are for people living with a bipolar spouse.

• Help for Surviving Your Spouse's Mental Illness
• The Other Half - Spouses of Bipolar Sufferers
  Spouses are often caretakers and caregivers in the relationship.

Bipolar Family Help, Bipolar Family Support Groups

Caring for and supporting a bipolar family member can be wearing. Here are some self-care suggestions for bipolar caregivers as well as information on finding support groups for bipolar family members.

• Dealing with Bipolar Disorder in the Family
  No one is to blame and you cannot cure a mental disorder for a family member.
• Bipolar Guilt: Feeling Guilty. My Family Member Has Bipolar Disorder
  Nearly all relatives of the mentally ill feel guilty
• Bipolar Family Support - Relieving Stress, Finding Support
  There are positive actions that can be taken to make life more bearable when a family member has bipolar disorder.

Bipolar Help

Information on bipolar self-help, where bipolar family members can turn for help and what it's like living with bipolar disorder.

• Bipolar Help: Self-Help For Bipolar and How to Help a Bipolar Loved One
• Living with Bipolar and Living with Someone Who Is Bipolar

Dealing with stigma of bipolar disorder is a challenge that almost every person with bipolar disorder faces (What Is Stigma?). Whether you’re dealing with bipolar I or bipolar II, the stigma society has about serious mental illness can make that job harder. However, there are ways of dealing with bipolar stigma and not let it derail your recovery.

Dealing with Bipolar Stigma – What Is Stigma?

According to Dictionary.com, stigma is a noun defined as:

“A mark of disgrace or infamy; a stain or reproach, as on one's reputation.”

However, when stigma is talked about with regards to something like mental illness, what it really refers to is the perception of stigma by many in society about those with a mental illness. In other words, some people perceive those with bipolar disorder to be “stained” or “disgraceful”.

And while “stigma” is the common word used for the negative feelings some have against those with a mental illness, the word prejudice is, perhaps, more accurate. Dealing with bipolar disorder stigma is really dealing with the negative prejudgments people make against those with bipolar disorder.

Dealing with Bipolar and Self-Stigma

Some people with bipolar deal with self-stigma. Self-stigma is a feeling that one has about him or herself that he or she is somehow damaged or lessor because of the bipolar disorder. Self-stigma often occurs because of the mental health stigma in society. Essentially, people internalize the stigma that they see around them.

But you can fight self-stigma. You can feel good about yourself even though you have bipolar disorder.

According to the Depression and Bipolar Support Alliance (DBSA), you can fight self-stigma by:

• Focusing on your strengths and not your limitations
• Knowing the facts about your biological illness and reminding yourself of them
• Spending time with others who have mental illnesses
• Discussing self-stigma feelings with those who understand such as a therapist or in a bipolar help group
• Volunteering to help you feel good about yourself
• Finding out what brings your joy and going after it
• Sticking with a treatment that works for you

How to Deal with Being Bipolar in the Face of Stigma

What’s important to remember is that just because stigma against those with mental illness exists, it does not define you. As philosopher Dr. Wayne Dyer said:

“What other people think of me is none of my business.”

You can’t know what others are thinking of you and you can’t change yourself because of it.

You need to focus on dealing with your bipolar depression, mania, and anxieties in spite of any stigma you experience. What’s important is your wellness and not the unfair judgments others may make about you. Also, remember not everyone feels negatively about those with mental illness, and those are the people you need in your life.

Other Help You Can Give

Dealing with hospitals or insurance companies, filling out forms, and looking up records can be difficult even if you are well. Many people with AIDS need help with these tasks.

Getting a ride to the doctor's office, clinic, drug store, or other places can be a problem. Don't wait to be asked, offer to help.

Keeping a diary of medical events and other information for the person you are taking care of can help them and any other people who are helping. Be sure the person you are caring for knows what you are writing and helps keep the diary if they can.

Keeping a record of medicine and other care for the doctor or the other people providing care can help a lot. Make sure you know what drugs the person is taking, how often they should take them, and what side effects to watch out for. The doctor, nurse, or pharmacist can tell you what to do. People who are sick sometimes forget to take medicine or take too much or too little. Divided pill boxes or a chart showing what medicines to take, when to take them, and how much of each to take can help.

If the person you are caring for has to go into the hospital, you can still help. Take a special picture or other favorite things to the hospital. Tell the hospital staff of any special needs or habits the person has or if you see any problems. Most of all, visit often.

Parkinson's caregiver tips are a great source of help and information. While the role of a caregiver is incredibly rewarding, it also comes with challenges and difficulties – particularly when a loved one reaches the advanced stages of Parkinson's disease. For this reason, it's important to make time for yourself outside of your caregiving duties and learn to spot the signs of Parkinson's caregiver burnout. With this in mind, here are five helpful Parkinson's caregiver tips.

5 Parkinson’s Caregiver Tips

As a caregiver, your primary responsibility is to look after your loved one and improve his or her quality of life. However, it's important not to neglect your own needs in the process. Here are our top tips for Parkinson's caregivers to ensure you get the balance right:

1. Take control of your own health

The role of a caregiver comes with many physical and emotional demands. Therefore, you’ll need to look after your own health and wellbeing so that you can fully engage in your caregiving duties.

If you are the sole caregiver to your loved one, you may struggle to find time for exercise and relaxation. Some caregivers try to do everything for their loved ones because they think it is the right thing to do. However, ignoring your own physical and mental health is a fast track to burnout. You may need to seek help from other family members or ask your healthcare provider about additional care options. For instance, you might decide to hire a care nurse for a few hours a week so that you can take time for yourself. If that's not an option, you can try exercising at home with a DVD or YouTube video. Just make sure that you eat well and attend your medical check-ups and appointments.

2. Seek support from other caregivers

Other caregivers can be an invaluable resource when you're caring for someone with Parkinson's disease. By attending a Parkinson's support group for caregivers or talking to others online, you can share Parkinson's caregiver tips, information and resources.

You may also find yourself relying on other caregivers for emotional support as your loved one’s PD progresses. Looking after someone who is very ill can be isolating, frustrating and depressing, however much you might want to do it. Therefore, it’s important to link up with a support group early on so that you have a support system in place.

3. Stay organized

As a Parkinson's caregiver, it may be your job to organize your loved one's medication, appointments, paperwork and legal documents. Parkinson's disease medications can sometimes cause confusion and memory loss, even in the early stages of the disease. Therefore, you will need to keep records to bring to medical appointments and make sure your loved one receives consistent care.

A medication chart is an absolute must. You also may find it helpful to keep all of your loved one's paperwork in a folder, along with their appointment letters and medical documents. A binder with separators will help you find paperwork more easily. Another tip is to carry a small notebook with you at all times so that you can jot down questions, symptoms or issues to raise with your loved one's doctor. You should also keep a calendar or diary for all of your loved one's appointments.

4. Learn how to communicate with doctors

As your loved one’s caregiver, you will need to be their sole advocate when it comes to healthcare. Your loved one may be too proud to ask for additional help or support, or they may become confused about their symptoms or side-effects. Problems can easily be missed through lack of communication, so you will need to be confident, prepared and organized when communicating with doctors. Don’t be afraid to follow up after an appointment or ask for a second opinion.

Caregiver Action has some great tips for Parkinson’s caregivers who want to become better communicators, such as:

• Be prepared with questions before an appointment
• Make your presence known as a member of the healthcare team
• Introduce yourself and what your role is
• Establish rapport
• Be proactive and participate in all discussions
• Clearly state your purpose: what do you and your loved one want to get out of this appointment?

5. Give yourself credit

Many people struggle with the lack of positive endorsement from caregiving. If your loved one has Parkinson’s disease, nothing you do will make them better or prevent their symptoms from progressing. However, your role is crucial in ensuring their condition is well-managed and that they enjoy a good quality of life. Caregiving is a choice, so give yourself credit for that choice – you’re doing an amazing job.

It's not always easy to look after someone with Parkinson's disease. These Parkinson's caregiver tips aim to make your day-to-day duties a little easier so that you can take pride in your role and enjoy caring for your loved one.

article references

General Definition

There are several drugs and medications that may contribute to low sexual desire. Many medications, even the most common, can adversely affect sexual response. Some of the most common are:

Anticancer drugs: Tamoxifen, prescribed to delay the recurrence of breast cancer can cause vaginal bleeding, vaginal discharge, menstrual irregularities, genital itching and depression.

Anticonvulsants: Anti-seizure drugs including phenobarbital (Luminal) as well as Dilantin, Mysloine, and Tegretol can cause sexual dysfunction.

Antidepressants: Tricyclic antidepressants like clomipramine (Anafranil) and some selective serotonin reuptake inhibitors (SSRI) such as Prozac, and Paxil are known to cause sexual dysfunction.

Antihypertensive agents: Traditional medications prescribed for high blood pressure; beta-blockers marketed under the names Inderal, Lopressor, Corgard, Blocadren, and Tenormin.

Anti-ulcer drugs: Cimetidine or Tagament have been shown to cause impotence in men. We do not know the sexual side effect in women as yet.

Birth control pills: Some women who take progestin-dominant pills complain of a loss of libido and vaginal dryness because of hormonal shifts.

Neuroleptics: Antipsychotic drugs like Thorazine, Haldol and Zyprexa can cause sexual dysfunction and emotional blunting in some patients.

Sedatives: Medications like Xanax, prescribed for anxiety, can cause loss of desire and arousal.

What Can You Do?

Talk to your doctor. Not only may there be alternatives to the medications you are taking, but you may be a candidate for another medical treatment that will counteract the negative sexual side effects you are experiencing. For instance, several studies have indicated that Viagra seems to counteract the negative sexual side effects of SSRI's. However, it is crucial to realize that while it is important to know how your medications may be playing a role in your sexual function complaints, it is important NOT to stop any medication without talking to your doctor first.

The best way to deal with depression just might be to not deal with it at all. Depression is hateful, and of course, no one wants it in their lives. The natural reflex is to focus on it, giving it attention and what little energy we have. In an attempt to lessen depression, we often restrict our very lives, avoiding people, places, situations, and activities that heighten our depression. In trying to control depression this way, we end up intensifying it.

When our attention is on depression, even when that attention is on trying to get rid of depression, that’s where our thoughts, feelings, and behaviors are. The field of positive psychology offers another way, maybe the best way to deal with depression: shift our focus (Peterson, 2006).

Instead of seeking to get rid of depression, focus on building wellness. Rather than trying to do less of what’s wrong, do more of what’s right. How you approach your mental health and wellbeing shapes the result. The best way to deal with depression is to pay attention to wellness and living the life you want to live. What do you want more of?

One of the Best Ways to Deal with Depression- Focus on Lifestyle

Regarding depression, what is your goal? Many people initially respond by stating that their goal is to be depression-free. That makes sense. However, as a life goal, it falls a bit short. Think in terms of a broader objective: what kind of lifestyle do you want?

Among the best ways to fight depression is by focusing on lifestyle:

• Create positive experiences every single day; even during those inevitable horrible days, you can create good moments.
• Each day notice people experiences, and feelings for which you are grateful, and pause to reflect on them each night before going to sleep (many people find that keeping a gratitude journal helps them deepen this focus).
• Identify your strengths, and intentionally use them in your daily life.

Creating a lifestyle around building the positive rather than destroying the negative is one of the best ways to deal with depression.

The Best Ways to Deal with Depression?

Values, Meaning, Purpose, Satisfaction. You know what you don’t want: depression. But do you know what you do want? Our values represent what we care most about in our lives. Values are what give our lives meaning. Once you are fully aware of your values, you can build your lifestyle around them. Again, your focus will be on what you do want your life to be about rather than on the depression you don’t want.

Values give our lives meaning and a sense of purpose. Meaning and purpose, in turn, create joy and deep satisfaction. Living a valued life of purpose and meaning is much richer than living a life focused around getting rid of depression. Meaning and satisfaction aren’t moods but instead are states of being. With a state of being that is meaningful at its core, depression quietly fades into the background.

Another Best Way to Deal with Depression: Experience Awe

Awe is part of a lifestyle of values, meaning, purpose, and satisfaction. As such, it counts as the best way to deal with depression. Awe is a deeply meaningful experience that takes us out of ourselves and into the greater world around is. Awe involves amazement and wonder.

The experience of awe is the opposite of the experience of depression. Where depression is confining, awe is expansive. Where depression zaps motivation, awe inspires it. And where depression pulls us down, a sense of awe pulls us up out of depression. Awe is the opposite of dealing with depression because, with awe, you’re focusing on something greater than yourself.

Living a Life Worth Living: The Absolute Best Way to Deal with Depression

Shifting the focus away from depression isn’t the same thing as ignoring or avoiding it. The best way to deal with depression involves replacing it with something better. What do you value? What creates meaning and satisfaction and gives you a sense of purpose in your life? Concentrating on these things, building on them, is a great way to deal (or, rather, not deal) with depression and instead live a life worth living.

article references

Introduction

Sexual dysfunction is common among individuals with major depressive disorder. For instance, a study by Kennedy and colleagues[1] revealed that of 134 patients with major depression surveyed, 40% of men and 50% of women reported decreased sexual interest; 40% to 50% of the sample also reported reduced levels of arousal. Sexual dysfunction is also a common side effect of antidepressant treatment, particularly pharmacotherapy with serotonin reuptake inhibitors (SRIs). Treatment-emergent SRI-induced sexual dysfunction ranges from approximately 30% to 70% of patients treated for depression.[2-4] Bupropion (Wellbutrin) and nefazodone (Serzone) is no longer on the market), in contrast, are associated with lower rates of sexual dysfunction.^[2]

Antidepressant-induced sexual dysfunction becomes an important issue in the context of treatment effectiveness, as antidepressant medications are helpful only insofar as patients take them. Intolerable side effects may be one reason that patients are noncompliant with antidepressant treatment.^[5] Given the important clinical implications of premature discontinuation -- for example, higher rates of relapse and recurrence -- increasing attention is currently being devoted to the management of antidepressant-induced sexual dysfunction and other unwanted side effects of pharmacotherapy for depression.

The issue of sexual functioning in the context of depression was discussed by a number of clinical researchers at the 156th annual meeting of the American Psychiatric Association in San Francisco, California. Topics included a comparison of the rates of treatment-emergent sexual dysfunction across various SRI antidepressants as well as strategies for managing antidepressant-induced sexual dysfunction, such as adding as-needed sildenafil to SRI pharmacotherapy for remitted depressed patients.

Assessment and Risk Factors for Sexual Dysfunction in the Context of Major Depression

The sexual response cycle consists of 4 phases: desire, arousal, orgasm, and resolution, and, as explained by Anita Clayton, MD,^[6] Professor and Vice Chairman, Department of Psychiatric Medicine, University of Virginia, Charlottesville, the phases of the sexual response cycle are affected by reproductive hormones and neurotransmitters.

For example, according to Dr. Clayton, estrogen, testosterone, and progesterone promote sexual desire; dopamine promotes desire and arousal, and norepinephrine promotes arousal. Prolactin inhibits arousal, and oxytocin promotes orgasm. Serotonin, in contrast to most of these other molecules, appears to have a negative impact on the desire and arousal phases of the sexual response cycle, and this seems to occur through its inhibition of dopamine and norepinephrine. Serotonin also appears to exert peripheral effects on sexual functioning by decreasing sensation and by inhibiting nitric oxide. The serotonergic system, therefore, may contribute to various sexual problems across the sexual response cycle.

Dr. Clayton recommended that clinicians conduct a thorough assessment with patients when attempting to ascertain the etiology of sexual dysfunction. Factors to consider include primary sexual disorders, such as hypoactive sexual desire disorder, as well as secondary causes, such as psychiatric disorders (eg, depression) and endocrine disorders (eg, diabetes mellitus, which may cause neurologic and/or vascular complications). Physicians should also inquire about situational and psychosocial stressors (eg, relationship conflict and job changes), as well as the use of substances known to exert a negative impact upon sexual functioning, such as psychotropic medication and drugs of abuse, such as alcohol.

Antidepressant-induced sexual dysfunction is common but underreported. For instance, only 14.2% of depressed patients taking selective SRIs (SSRIs) for depression spontaneously report sexual complaints; however, if queried directly, nearly 60% of patients report sexual complaints.^[7] Using standardized instruments, such as the Arizona Sexual Experiences Scale (ASEX) and the Changes in Sexual Functioning Questionnaire (CSFQ-C), and asking phase-specific questions may facilitate the clinicians' assessment of patients' sexual dysfunction.

There are a number of patient risk factors for sexual dysfunction. These include age (being 50 years old or older), having less than a college education, not being employed full-time, tobacco use (6-20 times per day), a prior history of antidepressant-induced sexual dysfunction, a history of little or no sexual enjoyment, and considering sexual functioning as "not" or only "somewhat" important..^[2] Gender, race, and duration of treatment, in contrast, do not appear to predict sexual dysfunction.

Clinicians may employ several strategies to manage antidepressant-induced sexual dysfunction.^[4] One is waiting for tolerance to develop, although, according to Dr. Clayton, this is typically not successful, as only a small portion of patients report improvement in sexual functioning over time during SSRI pharmacotherapy.^[7,8] Another option is to reduce the current dose, but this may result in subtherapeutic doses of medication. Drug holidays may provide relief from SSRI-induced sexual dysfunction,^[9] but, cautioned Dr. Clayton, may result in SSRI discontinuation symptoms after 1 to 2 days or encourage medication noncompliance.

The use of sildenafil (Viagra), bupropion (Wellbutrin), yohimbine, or amantadine may be helpful as antidotes, but, as yet, these agents are not indicated specifically for this use.^[4,10] Switching to antidepressants with little risk of inducing sexual dysfunction -- for example, bupropion, mirtazapine, and nefazodone (no longer on market) -- may be a successful strategy for some patients,^[3,11,12]] although there is the risk that depressive symptoms may not respond as well to the second agent as they did to the first.

References

---

New Research Regarding the Evaluation of Serotonergic Antidepressants With Respect to Sexual Functioning During Treatment for Major Depression

Duloxetine (Cymbalta) Vs Paroxetine (Paxil)

A study comparing the incidence of treatment-emergent sexual dysfunction among depressed patients treated with duloxetine (Cymbalta), a serotonin-norepinephrine reuptake inhibitor (SNRI) currently under US Food and Drug Administration (FDA) review for the treatment of depression (ed. note: Cymbalta was approved by the FDA in 2005), vs paroxetine (Paxil), an SSRI, suggests that duloxetine is associated with lower rates of treatment-emergent sexual dysfunction than paroxetine is.^[13]

Researchers pooled data from 4 eight-week, randomized, double-blind clinical trials designed to evaluate the efficacy of duloxetine vs paroxetine for depression during the acute phase of treatment. Pooling data from the 4 studies yielded the following treatment conditions: 20-60 mg of duloxetine twice per day (n = 736), 20 mg of paroxetine once daily (n = 359), and placebo (n = 371). Two of the studies included 26-week extension phases in which acute treatment responders received duloxetine (40 or 60 mg twice per day; n = 297), paroxetine (20 mg/day; n = 140), or placebo (n = 129). Sexual functioning was assessed using ASEX, a 5-item questionnaire that taps sex drive, arousal, and ability to achieve orgasm.

The authors reported the following findings: (1) Significantly higher rates of sexual dysfunction were observed with both duloxetine and paroxetine compared with placebo, but the incidence of acute-phase treatment-emergent sexual dysfunction was significantly lower for patients treated with duloxetine than those treated with paroxetine. (2) Female patients treated with duloxetine had a significantly lower incidence of acute-phase, treatment-emergent sexual dysfunction compared with those receiving paroxetine. (3) More duloxetine-treated patients reported long-term improvement in sex drive and arousal than did paroxetine-treated patients.

Mirtazapine Fast Dissolving Tablets Vs Sertraline

Sexual functioning, as measured by the CSFQ, was compared between depressed patients receiving mirtazapine fast dissolving tablets and those treated with Sertraline.^[14] At the beginning of treatment for depression, 171 patients received mirtazapine (mean daily dose of 38.3 mg), and 168 received sertraline (mean daily dose of 92.7 mg). Findings indicated that by the second week of treatment, patients treated with mirtazapine showed a significantly greater decrease in depressive symptoms, as measured by the Hamilton Depression Scale (HAM-D), compared with those treated with sertraline.

Data regarding sexual functioning were available for a subset of the patients receiving mirtazapine (n = 140) and sertraline (n = 140) during the depression efficacy trials. By the end of 8 weeks of treatment, patients treated with mirtazapine appeared, on average, to show normal sexual functioning, whereas patients treated with sertraline, on average, were below the CSFQ cutoff for normal sexual functioning. This pattern of findings was observed for both male and female patients. Other findings included the observation that males treated with higher doses of mirtazapine (more than 30 mg/day) showed significantly greater improvements from baseline on overall sexual functioning by the fourth, sixth, and eighth week of treatment compared with males treated with higher doses of (more than 100 mg/day).

Gepironee

Gepirone, a 5-HT_1A agonist not yet approved by the FDA (ed. note: Gepirone was rejected by the FDA in June 2004) for the treatment of depression, has also been evaluated with respect to its effect on sexual functioning among patients treated for major depression. In an 8-week, randomized, double-blind, placebo-controlled trial, gepirone-ER 20-80 mg/day was administered to outpatients diagnosed with major depressive disorder.^[15] Sexual functioning was assessed using the Derogatis Interview for Sexual Functioning Self-Report (DISF-SR), a 25-item questionnaire that assesses cognition/fantasy, arousal, behavior, orgasm, and drive.

Patients receiving gepirone-ER (n = 101) demonstrated a significantly greater mean change from baseline on the HAMD-17 compared with those receiving placebo (n = 103) at weeks 3 and 8, suggesting that gepirone is an efficacious antidepressant. Sexual functioning total scores were then evaluated in a subgroup of patients who had completed the DISF-SR at baseline and at end point. Results indicated that, on average, patients treated with gepirone-ER (n = 65) showed significantly greater improvements from baseline to end point with respect to sexual functioning compared with patients who received placebo (n = 73). This pattern of results was observed when data from male and female patients were combined and when analyses were conducted separately for females. However, statistically significant improvements were not observed for males treated with gepirone-ER compared with those who received placebo. According to the authors, the lack of statistically significant differences between the male groups may have been due to the small number of men in the gepirone-ER subgroup.

References

---

New Research on the Treatment of SRI-Induced Sexual Dysfunction With Sildenafil

Sildenafil (Viagra) for SRI-Induced Male Sexual Dysfunction During Continuation Treatment for Major Depressive Disorder

George Nurnberg, MD,^[16] of the University of New Mexico School of Medicine, Albuquerque, presented new research on the use of for SRI-induced sexual dysfunction. Participants were male patients with remitted major depression who were receiving a stable dose of continuation SRI antidepressants and also suffered from treatment-emergent SRI-induced sexual dysfunction (n = 90). They were then randomized to placebo or sildenafil (50 mg, which could be increased to 100 mg) for 6 weeks. Sildenafil is a phosphodiesterase type-5 inhibitor that is FDA-approved for the treatment of erectile dysfunction. The main results, summarized in a study by Nurnberg and colleagues,^[17] were that sildenafil-treated patients showed significantly greater improvements in sexual functioning relative to patients receiving placebo, as measured using the International Index of Erectile Function (IIEF).

Responders from the initial trial were discontinued from sildenafil for 3 weeks. Once it was determined that sexual dysfunction occurred in the absence of sildenafil (which suggests that previously observed improvements were, as hypothesized, due to sildenafil treatment rather than the passage of time per se), these patients then received 8 weeks of additional open-label sildenafil. They continued to show improvement in sexual functioning, and there were no relapses or recurrences of major depressive disorder.

Patients from the double-blind study who had shown a partial response or no response (defined as scoring higher than 2 on the CGI; n = 43) repeated the initial 6 weeks of sildenafil treatment and then received 8 additional weeks of open-label sildenafil, just as the original responders had. This group of patients, some of whom had originally received placebo, showed improvement with continued treatment that was comparable to that achieved by responders in the sildenafil double-blind group.

Sildenafil for SRI-Induced Erectile Dysfunction in Men With Remitted Depression

Maurizio Fava, MD,^[18] Director of the Depression Clinical and Research Program, Massachusetts General Hospital, and Professor of Psychiatry, Harvard Medical School, Boston, Massachusetts, presented results from a prospective, multicenter, randomized, double-blind, placebo-controlled study of sildenafil for SRI-induced erectile dysfunction. Participants were males with remitted depression (HAMD !--=1 0) and the absence of clinically significant anxiety symptoms (Beck Anxiety Inventory 10). Patients (mean age of 51 years) had been taking a serotonergic antidepressant for at east 8 weeks or more at a stable dose for at least 4 or more weeks, and they had no previous history of erectile dysfunction. Seventy-one patients were randomized to sildenafil (50 mg on an as-eeded basis, flexible to 25 mg or 100 mg), and 71 were randomized to placebo.

Ninety-four percent of patients in the sildenafil group and 90% of those in the placebo group completed treatment. No patient discontinued in the study due to the study drug. At the end of treatment, sildenafil-treated patients reported significantly higher rates of frequency of penetration and maintenance of erection after penetration, as measured using the International Index of Erectile Function (IIEF), compared with patients receiving placebo. Patients in the sildenafil group also reported significantly higher levels of quality of life with respect to sexual functioning compared with those receiving placebo. The most frequently reported adverse events during treatment were headache (9% sildenafil vs 9% placebo), dyspepsia (9% vs 1%), and facial flushing (9% vs 0%).

Sildenafil for SRI-Induced Female Sexual Dysfunction

Nurnberg and colleagues presented results from an open-label extension phase of a double-blind, placebo-controlled trial of sildenafil treatment for SRI-induced female sexual dysfunction.^[19] Women with remitted major depression and SRI-induced sexual dysfunction were randomly assigned to receive sildenafil (50 mg, which could be increased to 100 mg) or placebo for 8 weeks (n = 150). Sexual dysfunction was characterized by arousal dysfunction or orgasmic dysfunction that interfered with sexual functioning for 4 or more weeks. The double-blind phase of the study was followed by 8 weeks of single-blind sildenafil. Results were presented for the first 42 patients who completed the extension phase of the study.

At baseline, the women in this subgroup of patients were taking fluoxetine (42%), sertraline (28%), paroxetine (10%), citalopram (10%), venlafaxine (5%), nefazodone (5%), and clomipramine (1%), and the most commonly reported aspects of sexual dysfunction were decreased libido (95%), orgasm delay (70%), decreased satisfaction (68%), and difficulties achieving lubrication (55%). At the end of the double-blind phase of the study, 39% of the 42 women were considered responders, defined as

Conclusions

Sexual dysfunction commonly occurs in the context of major depressive disorder. Although sexual dysfunction is not a symptom of major depressive disorder per se, decreased sexual desire and arousal may be characteristics associated with depression-related anhedonia. Sexual dysfunction is also a common side effect of treatment with serotonergic antidepressants and may be a reason that patients on SSRIs and other serotonergic medications discontinue treatment prematurely.

Given the importance of continuation and maintenance treatment for major depression, researchers are devoting increasing attention to understanding which treatments may be helpful or, alternatively, unhelpful with respect to sexual functioning so that compliance may be maintained and treatment optimized. Clinically, this suggests that as additional data regarding the differential impact of certain medications on sexual functioning in the context of depression become available, clinicians may be able to make more empirically informed decisions regarding which antidepressants might be effective for a given patient at the beginning of treatment. They may also have an empirically informed selection of "next-step" strategies to employ in the event that treatment-emergent sexual dysfunction develops over the course of pharmacotherapy.

References

---

References

1. Kennedy SH, Dickens SE, Eisfeld BS, Bagby RM. Sexual dysfunction before antidepressant therapy in major depression. J Affect Disord. 1999;56:201-208.
2. Clayton AH, Pradko JF, Croft HA, et al. Prevalence of sexual dysfunction among newer antidepressants. J Clin Psychiatry. 2002;63:357-366.
3. Ferguson JM. The effects of antidepressants on sexual functioning in depressed patients: a review. J Clin Psychiatry. 2001;62(suppl 3):22-34.
4. Rosen RC, Lane RM, Menza M. Effects of SSRIs on sexual function: a critical review. J Clin Psychopharmacol. 1999;19:67-85.
5. Lin EH, Von Korff M, Katon W, et al. The role of the primary care physician in patients' adherence to antidepressant therapy. Med Care. 1995;33:67-74.
6. Clayton ALH. Sexual dysfunction in depression. Tricks of the trade in the long-term treatment of depression. Program and abstracts of the American Psychiatric Association 156th Annual Meeting; May 17-22, 2003; San Francisco, California. Abstract IS 17B.
7. Montejo-Gonzalez AL, Llorca G, Izquierdo JA, et al. SSRI-induced sexual dysfunction: fluoxetine, paroxetine, sertraline, and fluvoxamine in a prospective, multicenter, and descriptive clinical study of 344 patients. J Sex Marital Ther. 1997;23:176-194.
8. Ashton AK, Rosen RC. Accommodation to serotonin reuptake inhibitor-induced sexual dysfunction. J Sex Marital Ther. 1998;24:191-192.
9. Rothschild AJ. Selective serotonin reuptake inhibitor-induced sexual dysfunction: efficacy of a drug holiday. Am J Psychiatry. 1995;152:1514-1516.
10. Ashton AK, Rosen RC. Bupropion as an antidote for serotonin reuptake inhibitor-induced sexual dysfunction. J Clin Psychiatry. 1998;59:112-115.
11. Kavoussi RJ, Segraves RT, Hughes AR, Ascher JA, Johnston JA. Double-blind comparison of bupropion sustained release and sertraline in depressed outpatients. J Clin Psychiatry. 1997;58:532-537.
12. Gelenberg AJ, McGahuey C, Laukes C, et al. Mirtazapine substitution in SSRI-induced sexual dysfunction. J Clin Psychiatry. 2000;61:356-360.
13. Brannon SK, Detke MJ, Wang F, Mallinckrodt CH, Tran PV, Delgado PL. Comparison of sexual functioning in patients receiving duloxetine or paroxetine: acute and long-term data. Program and abstracts of the American Psychiatric Association 156th Annual Meeting; May 17-22, 2003; San Francisco, California. Abstract NR477.
14. Vester-Blokland ED, Van der Flier S, Rapid Study Group. Sexual functioning of patients with major depression treated with mirtazapine orally disintegrating tablet or sertraline. Program and abstracts of the American Psychiatric Association 156th Annual Meeting; May 17-22, 2003; San Francisco, California. Abstract NR494.
15. Davidson JRT, Gibertini M. Effect of gepirone extended release on sexual function in patients with major depression. Program and abstracts of the American Psychiatric Association 156th Annual Meeting; May 17-22, 2003; San Francisco, California. Abstract NR473.
16. Nurnberg HG. Maintaining compliance and remission in MDD with sildenafil prescription for SSRI-SD. Issues in the treatment of depression and sexual dysfunctions. Program and abstracts of the American Psychiatric Association 156th Annual Meeting; May 17-22, 2003; San Francisco, California. Abstract S&CR110.
17. Nurnberg HG, Hensley PL, Gelenberg AJ, Fava M, Lauriello J, Paine S. Treatment of antidepressant-associated sexual dysfunction with sildenafil: a randomized controlled trial. JAMA. 2003;289:56-64.
18. Fava M, Nurnberg HG, Seidman SN, et al. Efficacy and safety of sildenafil citrate in men with serotonergic-antidepressant-associated erectile dysfunction: results of a prospective, multicenter, randomized, double-blind, placebo-controlled trial. Issues in the treatment of depression and sexual dysfunctions. Program and abstracts of the American Psychiatric Association 156th Annual Meeting; May 17-22, 2003; San Francisco, California.
19. Nurnberg HG, Hensley PL, Croft HA, Fava M, Warnock JK, Paine S. Sildenafil citrate treatment for SRI-associated female sexual dysfunction. Program and abstracts of the American Psychiatric Association 156th Annual Meeting; May 17-22, 2003; San Francisco, California.

Self-help books for bipolar disorder can be very helpful in learning new bipolar disorder coping skills and learning in-depth insights about an illness that is very complex. If you have been newly diagnosed or you need to learn more about bipolar disorder, I would strongly suggest this bipolar disorder self-help book, Introductory Guide to Bipolar Disorder. It's a free, downloadable eBook from HealthyPlace.

In no particular order, here are the best self-help books for bipolar disorder.

The Bipolar Disorder Survival Guide, Second Edition: What You and Your Family Need to Know by David J. Miklowitz (2010)

This book delivers practical problem-solving strategies, true stories of those with bipolar and straight talk on bipolar disorder. This second edition has an expanded discussion on parenting issues, and a new chapter, "For Women Only."

Key Redfield Jamison PhD, the most well-known bipolar memoirist, has this to say, “A practical, straightforward book that will be a great help to those who have bipolar illness, as well as their families. I could not recommend this book more highly.”

This book is available in hardcover, softcover, eBook and audible formats.

The Bipolar II Disorder Workbook: Managing Recurring Depression, Hypomania, and Anxiety by Stephanie McMurrich Roberts, Louisa Grandin Sylvia, Noreen A. Reilly-Harrington, with a forward by David J. Miklowitz PhD (2014)

Written by a team of bipolar experts, this book is designed to help you manage the powerful emotions of bipolar disorder, including anxiety, which is not always mentioned in bipolar self-help books.

According to its description,

“The convenient workbook format combines evidence-based cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), and other mindfulness-based exercises to help you manage your emotions, track your progress, and ultimately live a happy and more productive life.”

This book is available in paperback and eBook formats.

Welcome to the Jungle: Everything You Ever Wanted to Know About Bipolar but Were Too Freaked Out to Ask by Hilary T. Smith (2010)

This book aims to answer the questions that people with bipolar really want to know such as, “Am I the same person if I take medications,” “Can people tell if I have bipolar?” and “Can anything ever be the same again?

This book is designed to be upfront and empowering with both humor and honesty.

The first edition of this book is available in paperback and audible formats and the second version is available in paperback and eBook formats.

Not Just Up and Down: Understanding Mood in Bipolar Disorder (The Bipolar Expert Series) (Volume 1) by John McManamy (2015)

This book is different than most other bipolar disorder self-help books because it focuses on bipolar disorder less as an illness comprised of just mania/hypomania and depressive episodes, but more an illness of a brain that is always in motion. This book is written by an award-winning mental health journalist and, according to its description, “You will also gain insights into: The bipolar spectrum, which overlaps with depression and anxiety and personality.”

This book is available in softcover and eBook formats.

Lost Marbles: Insights into My Life with Depression & Bipolar by Natasha Tracy (2016) *

This book is written by an award-winning writer and it uses her own life as examples of what to and what not to do when dealing with bipolar disorder. This book is chock-full of coping skills for bipolar disorder and offers insights beyond what medical information can offer.

According to Jim Phelps MD, noted bipolar specialist:

“This is the book that medical students should read, not the DSM. This is the real thing -- powerfully, bravely stated . . . Tracy helps readers understand some of the furious battle that is going on inside the minds of people with severe bipolar and depression, mostly invisible yet nearly all-consuming. She is a one-woman stigma-busting machine.”

This book is available in softcover and eBook formats.

A Self-Help Book for the Partners of Those with Bipolar Disorder

Loving Someone with Bipolar Disorder: Understanding and Helping Your Partner (The New Harbinger Loving Someone Series) by Julie A. Fast and John D. Preston PsyD ABPP (2012)

While this book is not aimed at those with bipolar disorder specifically, it is extremely helpful for partners. It helps partners of those with bipolar disorder understand their partner and offers “step-by-step advice for helping your partner manage mood swings and impulsive actions, allowing you to finally focus on enjoying your relationship while also taking time for yourself.”

See Also:

Depression Books that Help Others Understand Your Depression

* Editorial note: The author of this article is the same author as Lost Marbles: Insights into My Life with Depression & Bipolar. Its inclusion on the list was based on reviews, Amazon ranking, and date of publication.

Parkinson’s caregiver burnout is a reality for many people – especially those caring for someone in the advanced stages of the disease. We all know we should find time for ourselves, but how is that possible when someone we love has such complex needs? Unfortunately, if burnout goes unchecked, you could get sick yourself. Therefore it’s in yours and your loved ones best interests that you get the help and support you need. Learn how to spot the signs of Parkinson’s caregiver burnout and what to do when it strikes.

What Is Parkinson’s Caregiver Burnout?

Caregiver burnout refers to a state of physical, mental and emotional exhaustion. It often occurs when caregivers try to do more than they are able. Sometimes, caregiver burnout comes with an extreme change in attitude – you might go from optimistic and hopeful to feeling very cynical and uncaring in a short space of time. This doesn’t mean that you’re a bad person or that you’re not cut out for caregiving. It may just be a sign that you need to slow down.

Signs of caregiver burnout include:

• Withdrawing from friends and family
• Losing interest in social events, hobbies and activities
• Feeling depressed, anxious or both (Parkinson’s caregiver depression and burnout have similar symptoms)
• Increased feelings of stress
• Fatigue and/or difficulty sleeping
• Reduced immunity – getting sick more often
• Changes in appetite and/or weight
• Irritability
• General feelings of exhaustion

Sometimes, caregiver burnout and stress makes people feel like they want to hurt themselves or the person they're caring for; this is usually a result of depression or anxiety brought on by the burnout. However, you should always report these kinds of feelings to your doctor, as you may need immediate mental health support.

What Causes Parkinson’s Caregiver Burnout?

Parkinson's disease caregiver burnout is simply the result of doing too much. When you care for someone else – particularly someone with complex needs – it's easy to neglect your own mental and physical wellbeing. You may not be eating or sleeping correctly or exerting yourself more than you should. You may also struggle with the emotional impact of loving someone with Parkinson's disease.

As a caregiver, you are more likely to experience burnout if:

• There is role confusion: If you're new to caregiving, it can be tough to adjust to the role.
• You have financial stress: Becoming a caregiver can have all kinds of financial implications. Worrying about money adds to what is already a very stressful time, making you more prone to burnout.
• You have lost your independence: As a new caregiver, you might resent the loss of your freedom or feel like you've lost control of your life. This can lead to anxiety and depression, which are common signs of Parkinson's caregiver burnout.  
• You place unrealistic expectations on yourself: Many caregivers expect way too much of themselves, or else they believe that their care will have a positive impact on their loved one and make them better. Parkinson’s can progress quickly despite proper treatment, medication and care, and there is only so much you can do to help the person you love.

Caregivers: What to Do When Burnout Strikes

Parkinson’s caregiver burnout is a sign that your body and mind need a rest. You won’t do anybody any favors by not addressing your burnout, so it’s important to stop and take note of your symptoms. Here are some tips to help you overcome caregiver burnout:

• Ask for help: In the first instance, you should see your doctor so they can help you deal with your burnout. You might also decide to ask friends or family members to help with your caregiving duties so you can recover.
• Consider additional help: If you're struggling with the demands of caregiving, it might be time to bring some extra support into the home. Discuss other care options with your healthcare providers.   
• Find your own support system: Caregivers need support too, so make that a priority. Whether you lean on friends or family members or join a local Parkinson’s caregiver support group, make sure you have somewhere to go when you need practical or emotional help.
• Don’t stop your own life: Although you may not have as much free time as you used to, nobody benefits if you stop doing the things that make you happy.
• Look after yourself: Keep to your medical appointments and be sure not to neglect your physical or mental health.
• Seek positive endorsement: Many caregivers get frustrated because their loved ones are unable to give them the positive feedback they need to feel their efforts are worthwhile. People don't get better from Parkinson's disease, and this can be hard to accept. Therefore, you may need to seek positive endorsements from elsewhere, such as from a caregiver's group or guidance counselor.

See Also:

5 Helpful Tips for Parkinson’s Caregivers

Help for New Parkinson’s Caregivers

article references

Specific symptoms of Bipolar Depression separate it from plain old Depression. Learn about the symptoms of Bipolar Depression so you get the correct treatment.

The following examples will help you (or someone who cares about a person with depression) get really clear on the type of depression you experience. This can lead to the right treatment plan.

1. Have you ever been depressed and thought, "What is going on? I felt fantastic just last month! I had so much energy and life was great. I don't understand this. Nothing happened? What's wrong with me? Who am I?" and then you feel fine again a few months later. (BIPOLAR Depression with rapid cycling between mania and depression.)
2. You went through a job loss and got depressed for the first time and then the depression went away when you got another job. (Situational Depression.)
3. You were depressed, took an antidepressant and then suddenly things got better. You felt your head clear and even your vision got razor sharp where colors were gorgeous and people looked beautiful. Life was full of hope and you couldn't wait to make plans for the future. If someone said you seemed abnormally upbeat, you said, "I finally found a medication that worked and now you want me to go back to being depressed?" (Antidepressant-induced mania.)
4. After a down mood for over a year, you went through months of feeling great where you partied a lot, made friends easily, worked effortlessly and had a lot of ideas. The good mood raised a lot of confusion in your friends and family, but not enough to see it as an illness. You thought, "This is the real me! The depression is finally gone!" (A manic episode after a long BIPOLAR Depression.)
5. Felt depressed and uncomfortable with agitation, trouble sleeping and the fear that someone was following you. Your thoughts were racing and your patience was low. You felt a lot of suspicion, heard voices and yet you had a lot of energy. You sometimes had suicidal thoughts. (Mixed episode with depression, mania and psychosis.)
6. People commented on your down mood and seemed confused as to why you were always depressed when you had so much to live for. You had trouble getting out of bed, had no enthusiasm for life, cried a lot and felt hopeless. Your work and relationships suffered. You had either been like this for months or had a low-level depression for years. You found an antidepressant that worked and have not experienced depression again. (Unipolar depression)
7. You're depressed and have tried five antidepressants. They don't help at all and you feel more and more despondent. Your health care professional says, "I have no idea why these meds aren't working. There is a drug called Lamictal that works with depression, let's see if that will help." You take the Lamictal and feel better. The doctor asks, "Have you ever had a mood where you were filled with energy and didn't sleep much but were not tired at all the next day?" This question finally leads to a discussion about Bipolar Disorder and you both realize the medications didn't work because you have BIPOLAR Depression and have had mild mania for years without knowing what it was. Eventually, the illness was stabilized with Lamictal and an antipsychotic. And you can truthfully say, "I finally feel like the real me." (BIPOLAR Depression)

What above situation describes you (or the person you care about)? Is treatment correct and adequate? The answer to these questions can help you take charge of your BIPOLAR Depression so that you can get an official diagnosis, find the right combination of medications and create a treatment plan that is Bipolar Depression specific. It may be scary, overwhelming and confusing to realize you have Bipolar Depression, but the diagnosis is a life saver. It makes sense to spend a few years finding the right treatment plan than experiencing a lifetime of depression. The results can lead to a stable life that is filled with great relationships, productive work, a true sense of purpose and joy.

A final note from Julie. This is the kind of article I love to write. It's my specialty and I have great confidence in my ability to do a good job. What's frustrating is that just having a short assignment such as this one brings on Bipolar Depression symptoms. It took me just under 20 hours to write this article over the past week. For at least 10 hours outside of the writing, I had to take care of myself in order to stay well enough to write the article without too much distress. I started to wake up too early and felt a cascade of worried thoughts. I fretted that my work would be rejected and that my writing career would be over. I also felt a lot of anxiety. I heard songs over and over in my head and had trouble focusing. When this started, I know exactly what it was and I used the treatment plans I write about on HealthyPlace.com and in my books. I got to sleep earlier. I took my anti-anxiety meds as needed. I skipped karaoke (The one night I went caused even more songs in my head!) and replaced the unrealistic and negative thoughts brought up by writing the article with realistic thoughts. I said to myself, "You will be fine Julie. Your life is fine. Do your best, finish the article and get on with your life." So that is what I did and met my deadline even while crying from the stress. You can learn to do the same.

References:

John Preston, PsyD is the author of over 20 books on the topic of mental health. His most recent books include.

• Child & Adolescent Psychopharmacology Made Simple
• Bipolar 101: A Practical Guide to Identifying Triggers, Managing Medications, Coping with Symptoms, and more
• Counseling Survivors of Traumatic Events: A Handbook for Pastors and Other Helping Professionals
• Loving Someone with Bipolar Disorder
• Handbook of Clinical Psychopharmacology for Therapists
• Clinical Psychopharmacology: Made Ridiculously Simple
• Get It Done When You're Depressed
• The Complete Idiot's Guide to Managing Your Moods
• Integrative Treatment for Borderline Personality Disorder: Effective, Symptom-Focused Techniques, Simplified For Private Practice
• Consumer's Guide to Psychiatric Drugs
• Make Every Session Count: Getting the Most Out of Your Brief Therapy
• Lift Your Mood Now: Simple Things You Can Do to Beat the Blues
• Shorter Term Treatments for Borderline Personality Disorders