X-Message-Number: 3717 Date: 21 Jan 95 18:32:13 EST From: Michael Riskin <> Subject: More on Depression In any discussion of depression, or really much mental illness, the concept of a "sub-clinical" syndrome is very important, but often overlooked. Manic -depressive illness is a classic example of this. In addition to the clearly diagnosible situations, there are many others who are sub-clinical M-D. This means that they have lower grade symptoms that are often interpreted as falling into a "normal range", not requiring treatment as such or dismissed as merely neurotic. However, these people are very vulnerable. It is exactly this population that occassionally leaps from "the normal" to extremes of behaviour and mood (representative of M-D illness), that makes observers say things like "(s)he seemed so normal, how could this happen?". Yes...may of these people self medicate...with alcohol, drugs (legal or otherwise), or other substances, and a variety of behavioural and emotional coping mechanisms that are viewed as "eccentric", obsessive-compulsive, or addictive. They are often "difficult to deal with" but tolerated if not downright embraced, due to the brilliance displayed in their marginal or full blown manic period. One classical medical treatment for M-D illness is the use of lithium. It is commonly accepted that the daily effective dose of lithium falls into a fairly narrow range of 1500 to 2100 mg for an acute manic episode. Above that, lithium is quite toxic and produces serious side effects. Even at the recommended dosage, bothersome side effects may be noted. It is also generally accepted that daily doses below 900 mg for maintence purposes are ineffective, and the suggestion to many physicians that 600 mg or less can be desireable will be met with scorn. However, they are flat out wrong. Additionally, lithium at 600/ day mg or less can be particularly effective for sub clinical depression control with no drug induced side effects. The fact really is , that for the possibly many millions of sub clinical M-D people, these lesser doses are extremely effective. And, many such people, properly understood and treated, lead vastly improved lives, particularly if the person is sub-clinical unipolar depressive manic depressive. Most of these people "like" the manic feeling and are reluctant to give it up..but are usually glad to be rid of the oppressive cyclical depression. The problem is that understanding and treatment of sub clinical mental illness is lacking. Michael Riskin Rate This Message: http://www.cryonet.org/cgi-bin/rate.cgi?msg=3717