I am diagnosed as skizoaffective-bi-polar. It seems that the meds I have taken for 25 or more years have brought on shakiness in my hands. It has been very noticeable by physicians/people alike and they worry as I do. However, I need all the meds that I take. I have discussed this with them. Do you have any ideas for me to discuss with my psychiatrist that may help open any new avenues of thought in bringing this problem under control? I am afraid that I have burned out my brain.
HEALTH FOR LIFE M.D.
How to Help Anxious Minds
A Harvard psychiatrist answers questions about mental illness.
Sep 14, 2008 | Updated: 2:07 p.m. ET Sep 13, 2008
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The brain is the source of thought and emotion. When things go wrong, the results are devastating. Here, a Harvard psychiatrist answers your questions.
Los Angeles, Calif.: What is the role of noninvasive brain stimulation (such as electroconvulsive therapy and rTMS) in the treatment of psychiatric disorders?
Dr. Carl Salzman: Electroconvulsive therapy (ECT) and transcranial magnetic stimulation (rTMS) are both effective treatments for serious depressive disorders; they may have uses for other psychiatric disorders, as well, but this is less clear. We do not fully understand how these treatments work, but we know they alter brain chemistry and restore normal balance among brain neurotransmitters. ECT is particularly helpful for the most severe depressions that do not respond to medications. Both treatments are modern and safe; the days of "[One Flew Over the] Cuckoo's Nest" type of treatment are long past, and ECT is not used as a punishment or to control behavior.
Sarasota, Fla.: What are the most promising drugs on the horizon for Alzheimer's disease? My grandmother is almost mentally and physically frozen. Can anything bring her back to life? Also, what are your thoughts on research showing that caffeine may help?
I wish I could be more positive in answering this question. Research into the causes of Alzheimer's disease has progressed more rapidly than the development of reliable and effective treatments. At the moment, a few drugs may slow the progression of the disease, but none cure it or reverse it. At best, we try to use medications sparingly to help the afflicted individual be more comfortable and socially active as long as possible. Families understandably hope for a new successful treatment and then find their hopes unfulfilled, leaving them angry and frustrated. We should all understand the terrible burden that this disease puts on families, loved ones as well as on the afflicted individual. We look forward to better treatments in the future. Regarding caffeine: be careful because it can cause increased agitation, restlessness and insomnia, all of which make the symptoms of Alzheimer's disease worse. Certain medicines can also worsen symptoms. If you think that may be happening with someone you love, check with his or her doctor. Also, make sure that the individual is not using excessive alcohol and is able to sleep. Lastly, in the final stages of the disease, singing songs from the person's childhood may help you maintain contact with them, at least for a few moments.
Pocatello, Idaho: What is the toll on the brain of taking psychoactive medications for 15 years or more? Can this contribute to permanent physical brain damage?
When psychiatric medications are taken as directed by a physician, there are no long-lasting harmful effects on the brain. In fact, it is clear that some medications, such as antidepressants, may actually be helpful for the parts of the brain that regulate emotions.
Meherrin, Va.: Do people diagnosed with bipolar disorder "outgrow" their illness as they age? If not, do their symptoms increase or change over time?
True bipolar disorder may persist throughout life, although its course and the severity of its symptoms can vary greatly over time. It is possible for symptoms to become less severe and be well controlled with appropriate treatment, which usually includes medications and psychotherapy. Keeping a simple daily mood chart (e.g., "today I was high, normal, low") will help determine whether the variations on mood are under good control. There is no reason why a person with bipolar disorder cannot live a full, productive and happy life.
Salzman is a professor of psychiatry at Harvard Medical School and Beth Israel Deaconess Medical Center in Boston and author of the textbook "Clinical Geriatric Psychopharmacology."
© 2008
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