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

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