Ask the Author: Living Well with Depression and Bipolar Disorder

An interview with John McManamy, Expert Patient and author of a book about coping successfully with bipolar disorder and depression.

Expert patient John McManamy, who has battled bipolar disorder, is taking his voice to a new level. His informative and provocative book, Living Well with Depression and Bipolar Disorder: What Your Doctor Doesn't Tell You . . . That You Need to Know, published by HarperCollins, was recently released and is available at all major book stores and on Amazon. Below, he tells us a bit about his new book.

Why don't we start at the very beginning? What do you say to a patient who has just been diagnosed?

JOHN MCMANAMY: You are not alone. This is a treatable illness. You are amongst friends. You are entitled to lead a full, rewarding, and productive life, even if you have to change some of your expectations. I won't sugar-coat it. There may be heartbreak and frustration ahead of you. The meds will only get you part way to recovery, but the good news is you can take an active part in your own recovery through the choices you make.

What are some of those choices?

JOHN MCMANAMY: These include important lifestyle regimens such as proper diet, exercise, and sleep, maintaining a regular schedule, avoiding stress and managing the stress you can't avoid, developing a support network, picking up new coping skills, and being vigilant about subtle changes in mood and behavior and energy.

And patients can ask their doctors about all this?

JOHN MCMANAMY: That's the point. Doctors and psychiatrists don't have time. They tend to send patients out the door with nothing more than a prescription and then act amazed that the meds don't work or that the patient has gone off his or her meds. Then they blame the patient, which is a cruel double blow.

So doctors aren't doing their jobs ...

JOHN MCMANAMY: To be fair to the medical profession, they are medications experts. They're the ones to go to for diagnostic advice and medications treatment. Managed care - or mangled care - won't let them be anything else. Nor do they have the time during a typical office visit. Talking therapists can pick up the slack and so can nutritionists and other professionals, but not everyone can afford this type of professional care, especially when managed care doesn't pick up the tab.

So patients are left to their own devices ...

JOHN MCMANAMY: And fortunately we're getting smarter. That's what LIVING WELL WITH DEPRESSION AND BIPOLAR DISORDER is all about. Getting smarter. All of us need to become expert patients. Yes, we need to partner with our clinicians, and they have the professional expertise, but if we're the passive and stupid ones in the relationship then our path to recovery is problematic.

What do you mean by recovery?

JOHN MCMANAMY: Return to where you were before your illness, namely no symptoms and full functioning. This may not be possible in the early going, but I don't care how hopeless we may appear, no doctor has a right to give up on us. We shouldn't have to settle for anything less than recovery. Mind you, your doctor isn't going to wave a magic wand for you. As patients, we have to take responsibility for our own recovery

A lot of patients complain of side effects ...

JOHN MCMANAMY: And being turned into stupid zombie eunuchs and metabolic catastrophes shouldn't be regarded as a fair trade-off for getting our moods under control. We are entitled to feel better, period. Mind you, many side effects are temporary. But if they persist, patients need to work with their doctors on finding the right meds at the right doses. It is my belief that doctors tend to err on the side of overmedicating us, but if we don't inform them that this is going on, then two things can happen: We can stay miserable on meds, or we quit on our meds and throw ourselves to the tender mercies of our illness.

So what is the correct medications strategy?

JOHN MCMANAMY: Every patient is unique, so what works for one individual may not work for another. Moreover, my MD stands for manic depression, not doctor of medicine. But a couple of general observations: One -meds get us maybe fifty percent better. The rest is up to us. Most days, I operate at about 80 or 90 percent, which is doable. Two - when you're in a crisis, medications overkill is justified. But there is a huge difference between medicating a patient out of danger and medicating a patient into recovery.

In your book, you say you experienced depression when you were a child and had manic episodes in college. Yet you say you were first diagnosed with bipolar disorder at age 49. Why did it take so long?

JOHN MCMAMANY: Who wants to admit they're crazy? I kept telling myself I was normal, but my mind had other ideas. When I finally did see a psychiatrist during a suicidal depression, he misdiagnosed me with clinical depression. After all, I didn't look like the type who danced on tables.

And this happens all the time?

JOHN MCMANAMY: Fortunately for me, my psychiatrist caught his mistake fast and got me the right diagnosis and on the right meds. But between our natural state of denial and our ignorance in not knowing what has hit us, and our doctors often failing to pick up the obvious, we are often talking a period of a decade between when we first notice things not being right and seeking help, and a decade again for many people in finally getting the right diagnosis.

That's amazing. Are there any studies on that?

JOHN MCMANAMY: Yes, quite a few. And the people who are at special risk are those with the less obvious symptoms, people who appear depressed all the time, but may cycle imperceptibly up into short periods of feeling normal or better than normal. These are people right smack dab in the middle of the mood spectrum.

Tell me about the mood spectrum?

JOHN MCMANAMY: It's a very old concept, but it's now gaining new force. Think of a continuum with depression at one end and mania at the other. In the middle, depression and mania tend to converge and mix it up. These depressions tend to cycle while the manias have elements of depression. We tend to think of depression and bipolar disorder as two separate illnesses, but in my book I maintain that they are part of the same unifying and overlapping phenomenon that also includes psychosis, anxiety, and behavior.

Your book is one of the few that has depression and bipolar disorder in the title.

JOHN MCMANAMY: Precisely, because separating out the two is artificial. This is not my idea. The leading experts have been writing and discussing this for years. I've been reading their medical journal articles and talking to them. In my Newsletter and on my Web site, I have been writing about this in language patients can understand. I think I was the first one. Now the public is catching on. One book came out this year with one take on the spectrum, and my book has my take on it.

Why is it so important that patients know about the mood spectrum?

JOHN MCMANAMY: Because getting the correct read on our illness with the correct treatment is not possible unless we know exactly where we are situated on the mood spectrum at any given time. Depressed patients, for example, who have what I describe as novel depressions, may experience better results on bipolar meds than on antidepressants. These novel depressions may explain why antidepressants don't work for many people with depression.

So the spectrum is the whole story.

JOHN MCMANAMY: Actually, it's only part of the story. If mood were only just about mood. Unfortunately, mood tends to come loaded with co-occurring illnesses such as anxiety and substance use. Also, people with mood disorders experience a lot of non-mood symptoms, some recognized by psychiatry, some not.

Tell us more about those symptoms.

JOHN MCMANAMY: Sleeping and eating thrown out of whack, inability to concentrate, loss of motivation, maybe too much motivation for some, anger, road rage, feeling like you're crawling out of your skin, unexplained pain. Rather than think of depression and bipolar disorder as mood disorders, it's perhaps more helpful to think of depression and bipolar disorder as a feeling of not being ourselves. This is critically important, for if we're no longer showing mood symptoms then our doctors may think we're doing well. But if we still can't think and function and we're still experiencing problems with relationships and work then we still have a long way to go.

You're painting a pretty bleak picture.

JOHN MCMANAMY: Only if you think that remaining ignorant is going to get you better. Just the other day someone passed on a quote to me attributed to C Everett Koop. "No prescription is more valuable than knowledge." My mission since day one when I started to write about my illness nearly seven years ago is "Knowledge is Necessity." It applies with equal force to my book. By being smart, we are not helpless bystanders. We can manage our illness rather than our illness manage us. We may not be able live FREE from depression and bipolar disorder, but we can live WELL with depression and bipolar disorder. Living well is the goal.

Any final thoughts?

JOHN MCMANAMY: Yes. You may have a terrible illness, but you are not powerless. Learn everything you can and apply your knowledge to fighting your illness with everything you've got, with every weapon available. Measure personal success on your own terms, not on society's. And never give up hope. Hope may be a nonstarter in the throes of a severe depression, but be assured - just living with this illness is testament to your strength and courage. Mentally ill? Perhaps. Mentally tough? You better believe it.

John McManamy's book is available in all major book stores and on Amazon.