A case for mixed depression with Bourdain

Mixed depression according to some researchers is rather common but for some reason people don't think of it when someone like Bourdain commits suicide. Perhaps the depression goes unrecognized since the person's behavior isn't consistent with depression and the hypomanic symptoms are not meeting some arbitrary threshold. According to Targum:

“Mixed” depression is a clinical presentation in which a patient meets the full criteria for MDD and, at the same time, has a mixture of other features that are consistent with hypomania or mania. However, when only two or three of these manic symptoms are present, the duration fails to meet current criteria for hypomania (4 days) or mania (7 days), and therefore the diagnosis does reach the full criteria for a hypomanic or manic episode.²  

One hypomanic symptom would be Bourdain's restlessness and consistent traveling in search of the perfect meal in Parts Unknown. This is at odds with depression but his affect while doing so often seemed depressed to me. His commentary for the most part rather acerbic/cynical but punctuated with periods of levity.

A second sign of hypomanic symptoms was his suicide. It is fairly well known that suicide increases with mixed states. A mixed state is often a high energy state combined with a depressed mood. What constitutes high energy though is somewhat debatable. Most see it as an increase in physical activity which is productive but I contend from personal experience that one can have an extremely restless mind and be quite fatigued at the same time. In addition to the high energy there is often insomnia which might be attributed to stress or depression and not a symptom of hypomania.

A third sign of bipolar disorder was that Bourdain also seemed irritable which is another symptom of hypomania but most would probably see it as consistent with agitated depression. Depressed people can be irritable but it is usually not combined with excess goal orientated energy.

A fourth indication of bipolar was he was an ex addict. Addiction is more common among people with bipolar and could be due to a need to medicate or control an agitated and unhappy mind. What is unknown is had he relapsed or was he taking any antidepressants which might have precipitated the suicide. Antidepressants are known to aggravate bipolar depression and it is not a stretch to think they might have been involved.

A fifth sign was that he was married twice and in a relationship with a third woman. Multiple marriages are more consistent with bipolar tendencies. Irritability, grandiosity and restlessness is obviously going to cause more conflict.

And finally, his success as author, journalist and chef supports someone with a tendency towards hypomania. On average individuals with bipolar tend to be more productive and creative people which he certainly was. He wrote numerous books and was a famous TV personality.

Symptoms can fluctuate to quite a degree in bipolar disorder/unipolar depression and if that happens within a day this is often just attributed to what is know as diurnal variation. Personally, I experienced a very pronounced variation when younger. Somewhat of a mixed state early in morning, around 3am- 6am and then an improvement as the day went on. At night I often felt much better and was considerably more productive. This was considered as still consistent with Dysthymia according to my doctor.

What really seems to confound a diagnosis of "mixed depression" or bipolar disorder is how one evaluates what is "high energy". Is it always productive or can it be nonproductive as in anxiety? Dr. Phelps is one doctor who challenges how excessive energy is evaluated. How can one measure a racing mind which can occur in mania or depression with mixed features. It sounds like it often depends on self report and a rather subjective evaluation of a patient's symptoms.

Managing stress while using social media

I find social media to be somewhat of a double-edged sword in regards to mental health. It helps one to feel more connected to others but it also brings one into contact with numerous trolls who obviously make stress worse. What is the solution? Well, I think for one thing anything that gives one more control online is helpful. Here are a few ideas that will create boundaries:

1.Limiting the time spent online in any form of social media. Instead of staying on Facebook/Twitter all day perhaps limit to a couple of hours.

2. Using lists on FB or Twitter is also helpful. Lists on Twitter reduce the amount of material to peruse. Lists on FB do the same.

3.Carefully select one's audience on FB . There are always a few people who are predictably annoying so I tend to limit who I share with

4. I never comment on public pages on FB. The pages that discuss politics are full of opinionated people who will never change their minds, so why bother.

5. I generally don't engage with trolls. I see many people who however possibly because they can't tell if the person is serious or not

6. I limit the amount of information to the greatest extent when it comes to the general public and also to so called "friends". Why help out the all the scammers/ data miners/stalkers.

7. Find groups with like minded individuals who help reduce stress. I joined a few mbti groups for introverts which help me feel less strange and isolated.

8. I tend to not follow posts after commenting due to numerous notices. Lately though FB will give a notice on threads that I deliberately unfollowed. Facebook's strategy according to one article on Ideapod is to make people spend all day on the site and they do this partly through excessive notifications.

"I think we have created tools that are ripping apart the social fabric of how society works. The short term, dopamine driven feedback loop we've created have destroyed how society works," former Facebook Vice president of user growth Chamath Palihapitiya, told students at Stanford Graduate Business school, last November.

People with depression have more difficulties than the average person although. Depression is associated with problems with excessive stress and rumination. One negative comment can cause me to waste many hours obsessing over an anonymous and often ignorant person. Years ago one had only to deal with real life people, now one has to deal with people who have an artificial and anonymous identity.

Of course, the down side of increasing control is that one reduces the fun of debate and spontaneity so one doesn't want to over do it.

Job discrimination and mental illness

Recently I've applied for a number of library government positions in southern Oregon where I'm fairly sure I met the minimum requirements but was never even asked for an interview. The basic requirements were the following: a high school degree and some experience working in a library.I wonder if there is some way to report discrimination at the level of a job application if it was due to age, mental illness(I admitted a disability) or gaps in employment? I have a recent seven-year gap in employment due to illness of parents and self. My father had heart problems and died in 2011 and my mother has dementia since 2009 due to a stroke. I additionally experienced a psychotic episode in 2010. During that period( 2010 - 2017) I volunteered for two years in a college library, assisted a person with research on a book and have taken care of my mother who has a moderate level of dementia.

Since I have a bachelor's degree in Biochemistry/Psychology, five years experience working in a library(OHSU/ Lewis and Clark) and two years experience supporting systematic type health reviews in the Portland VA, I feel more than qualified for a position that could be filled by some one with lower qualifications. I have also applied for some office assistant positions at a university which I'm sure I met the minimum qualifications but was never even asked for an interview. I think my gaps in employment in addition to age ( which can easily be looked up) prevented an interview. I think when employers see large gaps they sense something is wrong health and or personality wise. I love how people are angry at the unemployed/disabled while at the same time discriminating unjustly against them. An excerpt from a medscape article  and a second article summarizes it best.

Work is a major determinant of mental health and a socially integrating force that is highly valued. No single social activity conveys more of a sense of self-worth and social identity than work. To be excluded from the workforce not only creates material deprivation but also erodes self-confidence, creates a sense of isolation and marginalization and is a key risk factor for mental disability.

“Once they heard that word that’s it. Sometimes I think it’s worse than telling them you’ve been in jail. Once you mention that their face changes and their body language changes and you know you won’t get the job”.
“I applied for a government job and they said the mental state wasn’t quite what they were looking for.”

I believe that discrimination due to mental illness was at play also when I lost my last position with the VA. I overheard conversations toward the end about me which strongly hinted that my health was problematic and that they needed to be cautious about getting rid of me. This came from a medical doctor who should be more enlightened on the topic. In the end, they gave much of my work to an intern who was doing it for free and when I protested my position was eliminated.

Is there any recourse here? Obviously if one reports discrimination he/she will probably not get the position or even if he/she did probably wouldn't want to work there because of potential retaliation. This issue bothers me on principle and also obviously for financial reasons. Reporting employers like this would feel like time well spent but in the long-term might be bad strategy. I think employers know this and this is why this crap persists.

Is it possible to be chronically depressed and optimistic at the same time?

A couple of months ago I came across an article in Elite Daily about people who tend to run late and one common feature was that they were optimists. I am one of those people and I tend to run around 5 minutes late for most of my appointments. I can remember being late for school in fifth grade and having to sprint to school most days. A positive byproduct of this was I won a number of awards in track and field. Despite the lack of awards for most of my life this pattern continues and for some reason it is hard to break. 

What struck me as odd when I read the article was that it seemed inconsistent/at odds with being Dsythymic. Aren’t depressed people negative about everything or at least most things? From my perspective I am negative about most things however when it comes to multitasking and estimating time I am curiously rather optimistic.

According to the article one common feature of the chronically late is that they tend to be optimistic. Somewhat unexpected. I have usually thought of people who run late as possibly unmotivated/ self absorbed /undisciplined /unorganized /disagreeable but never as optimistic. More specifically, people who are late are apparently bad at estimating how much time it takes to do something and tend to be more big picture types of people.

A second article in the NYT said that the chronically late tend to either be addicted to the adrenaline rush of a deadline or feel good about accomplishing so many tasks in a short period of time. Many late people tend to optimistic and unrealistic, she said, and that affects their perception of time.

They really believe that they can go for a run, pick up the clothes at the dry cleaners, buy groceries and drop off the kids at school in an hour. They remember that single shinning day 10 years ago when they really did all those things in 10 minutes flat, and forget all those other times when everything took much, much longer. (NYT 2007)

In a third article on the topic, by the same researcher as the one in the NYT, mentioned some more characteristics.

DeLonzor identified links between chronic lateness and certain personality characteristics, including anxiety, low self-control and a tendency toward thrill-seeking( Huffington Post 2013)

The researcher mentioned two additional reasons for chronic lateness. A third group consists of absent minded professors who might have ADD. The fourth group consists of the rebel who likes to annoy people with their lateness and this could be due to feelings of inferiority. Making others wait makes them feel more important. The fourth group is the least common.

When thinking about myself the adrenaline rush makes some sense in regard to depression since my depression is the low energy variety where anything that causes an adrenaline rush would conceivably correct for the defect. I remember writing most of my papers for English literature the night before. I simply could not be creative without the threat of a deadline. I can also identify with the type who tries to accomplish many things with in a short period of time. I t makes me feel very efficient and productive. Either explanation could give a depressive a nice dopamine rush. The rebel explanation is also somewhat relatable too however in my case it has more to do with rebelling against societies values. In my opinion being five minutes late isn’t that terrible and there are more important things to focus on in life such as solving problems and being creative. What is also interesting here is the fact that being on time is of more importance with people who have lower rank in society. Medical doctors are notoriously late but are not chastised like others with lower status.

The idea that late people hold onto or focus on a time in their life when they were the most productive is rather interesting and I can definitely relate. Even though I have chronic depression, I still do focus to a great extent on my euthymic periods when I was very productive. I don’t hear this from most Dsythymics who seem to embrace their depression to a greater degree. This makes me wonder in turn if my real personality is quite different than my Dsythymic one.

It also occurred to me also that arriving too early for an appointment causes me anxiety and one article supported the idea of mental illness playing a role. Sitting somewhere and waiting without anything to do tends to heighten my anxiety. If one is running late one is occupied with doing something on the way to an appointment. Additionally, it annoys me to a degree that my life revolves around other people that I often don’t like. I guess the remedy for this would be to take along a book so that I am doing something I enjoy while waiting for an appointment.

Is there a correlation between Dysthymia, personality and the MBTI?

I have been diagnosed with Dysthymia (Persistent Depressive Disorder) in the past and I was reluctant to accept the diagnosis. Even though I have spent most of my life dealing with depressive like symptoms, for some reason I refused to identify with the label completely. In the past, when a teenager and young adult, I experienced mostly depression and occasionally normal/ hypomanic periods. As I have stated in my about section, I experienced severe depression in the morning and normal/hypomania in the evening with quite a regularity. Many clinicians would describe this as diurnal variation in the context of a mood episode but I am not so sure. 

In my mind over identifying with the depressive symptoms didn’t make sense since along with a depressed temperament I experienced many physical symptoms that suggested something other than temperamental problems. I have rarely read about people with Dysthymia mentioning much in the way of physical problems(insomnia/over sleeping,lack of appetite, fatigue). There seemed to be much more of a focus on how they felt emotionally and most of them identified strongly with being depressed for as long as they could remember. I however identified to quite a degree with the brief euthymic/hypomanic periods when I was quite productive and when I had no physical problems.

The other day though, I came across a Youtube video on the topic of INFP and the MBTI. In the video the person described a personality type that describes me when depressed and consequently I could identify with it to quite a degree. This made me ponder the difference between personality and Dysthymia. This topic has been debated for quite some time. In the past a Depressive personality type was accepted but once Prozac was introduced and successfully treated Dysthymia that changed. The DSM doesn’t have a label of Depressive Personality Disorder anymore but Persistent Depressive Disorder(Dysthymia) still remains. Despite the change the debate about a depressive personality hasn’t been resolved entirely. Many psychologist still view depression as more of a character flaw while psychiatrists are more open to the idea that there is something biological. The following excerpt supports my contention that my form of depression is more biological in nature and doesn’t overlap with Depressive Personality Disorder.

Many researchers believe that depressive personality disorder is so highly comorbid with other depressive disorders, manic-depressive episodes and dysthymic disorder, that it is redundant to include it as a distinct diagnosis. Recent studies however, have found that dysthymic disorder and depressive personality disorder are not as comorbid as previously thought. It was found that almost two thirds of the test subjects with depressive personality disorder did not have dysthymic disorder, and 83% did not have early-onset dysthymia.(Wikipedia)

I still tend to favor the idea of a biological explanation but have not entirely excluded the idea that a depressive personality might exist. This has been supported to a minor degree by an individual studying the MBTI and mood disorders named Janowski. He found depressed people tended to prefer introversion, feeling, and perceiving. Another small survey on McMan’s Depression and Bipolar Web found that most people with bipolar disorder identified with INFX as a MBTI type.

Unipolar Depressed patients were significantly more often Introverted, Sensing, Feeling, and Perceiving single-factor types respectively, and Introverted-Sensing-Feeling-Perceiving, and Introverted-Intuitive-Feeling-Perceiving four-factor types. The male Introverted-Sensing-Feeling-Perceiving four-factor type was the most dramatically over-represented.(Janowsky DS, 2002)

My conclusion from this small amount of information is that there might be an association between MBTI type and Depressive Personality Disorder but not so much with Dysthymia which has more of a physical basis. Hopefully more research will illuminate the debate regarding personality and clinical depression.

Mentally ill rights tied to women’s rights

I've noticed there is an association between depression and female traits in many people's minds. People with depression are often seen as overly sensitive, weak, indecisive, unstable and perhaps just neurotic. Many of Freud's patients were women who were often seen in a negative light and that still continues today.

Yesterday I came across an article in the Atlantic regarding how women like Hillary are viewed as candidates. Generally strong women like her are viewed in a negative light and when I say strong, I mean being the opposite of clinically depressed. Hillary is a woman with more male characteristics and Trump supporters are attacking her at the moment for being overly male, “Trump that bitch”, and somewhat ironically also for being weak as well when focusing on her health. According to some psychologists the reason might be that some men feel emasculated by a women leader.

To understand this reaction, start with what social psychologists call “precarious manhood” theory. The theory posits that while womanhood is typically viewed as natural and permanent, manhood must be “earned and maintained.” Because it is won, it can also be lost. Scholars at the University of South Florida and the University of Illinois at Urbana-Champaign reported that when asked how someone might lose his manhood, college students rattled off social failures like “losing a job.” When asked how someone might lose her womanhood, by contrast, they mostly came up with physical examples like “a sex-change operation” or “having a hysterectomy.”

In the end women like Hillary can’t win, if they appear feminine, they are seen as poor leaders and if they display more male characteristics they are out to neuter the male population. How does this tie into mental illness? The mentally ill are seen by a good segment of the population as weak-willed and neurotic much like women. In job interviews they tend to come off poorly, lacking enthusiasm, confidence and motivation. For some reason it is perfectly acceptable to discriminate against a person based on a lack of enthusiasm or confidence. I think this has happened to me quite a few times.

An interesting thing that I’ve noticed about conservatives/libertarians vs. liberals is that conservatives/libertarians,who are more likely male, seem to have more of an internal locus of control than liberals. In other words, they seem to believe that they have more power over a given situation and psychologists say that people with a greater internal locus of control tend to be happier. This can be good because in some situations we do have more control than others and internal locus types are quick to act however there are other situations where we don’t, such when suffering mental illness. I am willing to bet supporters of Trump have doubts about the veracity of mental illness and would have little sympathy for such a feminine illness. Women by the way are at a much greater risk for depressive disorder than men.

What is notable, as well, is the fact that female’s depression often starts around puberty and this is when society starts to control women’s behavior to a greater degree. For some reason fertile women are seen as more dangerous. Perhaps this due to the perception that fertile women have the potential to disrupt family units when they have affairs and consequently destabilize society. Women start to realize at puberty that their value revolves mainly around their looks and reproductive value. This means that they have less control over their lives than men do and that can lead to higher stress levels.

How can female candidates like Hillary change these negative perceptions? Perhaps she should model herself after Sarah Palin a little. Palin was accepted by conservative males and females by emphasizing her role as a mother and a champion of gun rights. She pacified males by looking like a model, acting like their mother and protecting their right to fire arms, She made them feel secure while Hillary does not. A second female whose leadership is accepted is Oprah. She also gives off a strong maternal vibe while also championing women’s rights

When I was younger I remember not really caring whether my behavior feminine or masculine. I remember being reprimanded for being arrogant when quite young. I think it was because I refused to read a children’s bible. I didn’t like how religion constantly made people feel guilty about everything. My father was incredibly upset but it was rather impossible to force someone to read something they don’t want to. Perhaps depressed people should be a little more rebellious and state their beliefs even if it makes them sound arrogant or bitchy. They should additionally embrace their feminine side which might be perceived as a little neurotic. Health,like most things in life, is about maintaining a balance and in the case of depression, it is somewhat of a male/female balance.

Is there a connection between migraines, seizures and depression?

For most of my life I've experienced fatigue and headaches. It wasn't until relatively recently though that it occurred to me that my fatigue might be related to having migraines. In 2009 after reading about the connection between mood disorders and migraines I convinced my GP to let me try Valproate to prevent migraines. During that time though I experienced a psychotic reaction and the focus on treating the migraines was some how lost. I also tried Propanolol but it had such a sedating effect I couldn't tolerate it for long. I felt like I was about to pass out the entire time I was on it.

A young woman holding her painful head

Recently after some reflection it occurred to me that the symptoms that I was experiencing for most of my life in addition to the fatigue were those of a migraine. A few of those symptoms include the following: problems with temperature regulation, stiffness in neck and jaw, sensitivity to light, sensitivity to sound, tingling sensation, problems finding the right word, stomach problems and sleepiness. According to research people with chronic fatigue are more likely to experience migraines. These studies according to Healthrising support my hypothesis to a degree.

Two studies suggest as many as 75% of people with chronic fatigue syndrome experience migraines and that most migraines in ME/CFS are undiagnosed.  Agreeing that migraines are common in ME/CFS, WebMD, which has very little to say otherwise about chronic fatigue syndrome, states ME/CFS is one of five disorders  with high migraine rates.
Given the long list of migraine symptoms and the considerable overlap with ME/CFS symptoms (visual disturbances, sensitivity to light/sound, weakness, pins and needles, speech problems, nausea, vomiting, increased urination, etc) .the low diagnostic rates may not be surprising.

What additionally supports my hypothesis is that my chronic fatigue started around age twelve which coincided with the start of menstruation. Women according to statistics are more likely to have migraines, depression and chronic fatigue. Oddly, I also occasionally experienced a brief remission of depression and fatigue during menses.

I think my migraine like headaches started when I was rather young, age six. Around that time I experienced a concussion after falling off of a bike. My pediatrician thought at the time that my headache was related to diet- specifically chocolate. At this time after reading about head trauma and migraines I think my condition might have something to do with the concussion and it might be exacerbated by diet and hormone levels.

There is also an epileptic or kindling connection here. According to some recent research migraines are a type of seizure and kindling in the past has also been used to try to explain the recurrent nature of major depression. This is an excerpt from a 2014 study that examined the relationship between seizures and migraines.

What they found was completely unexpected. Adding basic conservation principles to the older models immediately demonstrated that spikes, seizures and spreading depression were all part of a spectrum of nerve cell behavior. It appeared that decades of observations of different phenomena in the brain could share a common underlying link.

The idea though that my fatigue could be a low level migraine is controversial because it differs from the definition of a chronic migraine. A chronic migraine includes many of the symptoms that I listed above however it includes moderate pain as a criteria. I generally experience the pain as mild. Perhaps I should try to more aggressively and persistently pursue this migraine hypothesis. I generally don't have much faith in my insights but maybe I should since many have been supported in the past.

Boundaries of mental illness

Isn't everyone a little mentally ill? This seems to be the prevailing idea on my FB feed via memes. One of these memes says, " relax...we're all crazy, its not a competition". When I see this I feel annoyed but at the same time I wonder is there a clear boundary between normal and abnormal? As someone who has experienced psychotic depression, OCD and Dysthymia I'm annoyed because that large of a spectrum invalidates my difficulty to a large degree. I think these people mean well because they are trying to include me as normal but on the other hand  saying that I don't have much to complain about.

The competition part of the meme is particularly interesting since this is the feeling that I get from many people regarding mental illness or any other condition like chronic fatigue which is hard to distinguish from normal. I have long learned not to bring up my problems in anticipation of competitive people. Unfortunately this includes medical doctors who think they are more fatigued than anyone else.

The ability to function well has often been where the line has been drawn between normal and abnormal. This is probably the most practical way to make a distinction however I always wonder function at what level? Are you talking about brushing ones teeth or doing calculus? What complicates this further is that depression often strikes when ones abilities are uncertain, often in college.

People on the antipsychiatry side, such as Moncrieff, are not helping this problem either since they emphasize the lack of objective physical evidence for mental illness. This is good in a way since it will encourage new and innovative thinking regarding mental illness but bad because it reinforces the idea that people with mental disorders some how lack will power.

While it is true that physical evidence is lacking via lab tests this doesn't mean that at some point in the future there won't be some test. I find this obsession with the past and present on the part of antipsychiatry somewhat odd. Jung might say these people tend to prefer sensing because they focus mainly on the past and present while people who prefer intuition focus more on the future.

As someone who prefers intuition I tend to focus on recent research and consequently the future. At present there appears to be some hope regarding research focusing on inflammation, the microbiome, sleep, diet and a variety of genetic studies.

Here is an excerpt from one article discussing research on inflammation and it's relationship to glutamate. The idea that glutamate plays a major role in mental illness is not new but it's relationship to inflammation and depression is new and exciting to me.

"Our results suggest that inflammation markers can guide us to which depressed patients respond best to glutamate blockers," says lead author Ebrahim Haroon, MD, assistant professor of psychiatry and behavioral sciences at Emory University School of Medicine and Winship Cancer Institute. "This could be an important step toward personalizing treatment for depression."
"Still, we think that one of the ways that inflammation may harm the brain and cause depression is by increasing levels of glutamate in sensitive regions of the brain, possibly through effects on glia," he says.
We focused on the basal ganglia because we had previously seen that a treatment for hepatitis C virus that arouses inflammation and can trigger depressive symptoms could also increase glutamate levels there," Haroon says.

Most recently a gene that is involved in synaptic pruning has been recently implicated in schizophrenia. So, there is still some hope and reason to believe eventually there will be a physical basis for mental disorders. Perhaps the boundaries of pathology will have to change as well since there is still much that we don't know about the nervous system.

Mental illness and mass shootings

Recently a well known psychiatrist, Dr. Gail Saltz, and Obama stated that most mass shooters aren't mentally ill. I'm a little perplexed about this since the most recent shooter, Chris Harper Mercer, and many others have at least a personality issues if not an actual personality disorder. A personality disorder is considered a mental disorder and according to Wikipedia mental illness and mental disorder are used interchangeably.

Most mass shooters are angry loners, not mentally ill. Mentally ill more likely to be victims #givestigmatheboot

According to Saltz they tend to be loners with anger issues. Seems fairly obvious but I'm guessing there is more. They tend to often have a preoccupation with becoming famous and getting some kind of revenge against an unfair world. This could indicate some issues with narcissism and antisocial behavior. Additionally, there seems to be some depression however not the clinical variety. All of these mass shooters know they will not survive so the act is essentially suicide.

One solution to this problem could be to somehow screen students using psychological tests such as the MMPI when they are matriculated into college. After that ones that showed a tendency towards that behavior could be monitored closely. I'm sure at this point psychologists have a profile of this type of person.Many would claim an invasion of privacy but so is getting shot at. The rights of the individual have to be balanced against the rights of the group. At the moment they are too much in favor of the individual.

According to DSM-IV, a mental disorder is a psychological syndrome or pattern, which occurs in an individual, and causes distress via a painful symptom or disability, or increases the risk of death, pain, or disability; however it excludes normal responses such as grief from loss of a loved one, and also excludes deviant behavior for political, religious, or societal reasons not arising from a dysfunction in the individual.^[

It's interesting, looking at this DSM-V definition of what a mental disorder/ mental illness is, how it has to cause distress to the individual. What about relatives and society? Perhaps if these mass shooters don't fit any definition the DSM-V needs to add a label just for them.

edit:

Here are a few articles I've read since writing this post that discuss the same topic. It appears one could profile these mass shooters but the description could apply to a lot of people. Mental health is part of the picture but not necessarily the most beneficial thing to focus on. A history of violence appears to be a better predictor.

What We Actually Know About the Connections Between mental Illness, Mass Shootings, and Gun Violence

Mass Murders Fit Profile, as Do Many Others who don't Fit Profile

How to Stop Violence

Manic depressive controversies

An interesting lecture from Nassir Ghaemi on the bipolar spectrum concept. According to him unipolar and bipolar used to both be encapsulated under the phrase "Manic Depression". "Manic Depression" meant someone who either experienced severe depression or mania. "Bipolar disorder" is defined by an individual having both depression and mania/hypomania. The two phrases differ only by a conjunction....something I hadn't paid attention to before. Additionally, according to Kraepelin, a well known historic authority on the topic, individuals displaying mixed states were more common than the ones who had more pure states of either depression or mania. This has been noted more recently by other researchers such as Benazzi who published a number of articles about people who experience mixed depression.

Prevalence of mixed depression, a combination of depression and manic or hypomanic symptoms, is high in patients with bipolar disorders. Controlled studies are needed to investigate treatment of mixed depression; antidepressants can worsen manic and hypomanic symptoms, and mood stabilising agents might be necessary

My experience with mixed depression

While my depression has been more chronic I have experienced periods of time when it lifted and I felt normal and productive. There has also been a pattern to some of these "remissions". They often occurred during my menses and when ever I altered my sleep schedule to a minor degree. These remissions weren't long enough by DSM standards to qualify for hypomania however as Ghaemi states, the threshold for hypomania is to a large degree arbitrary.

I have noticed as well that my depressions didn't seem pure. They often included good amounts of irritability, insomnia, racing/crowded thoughts, hypersexuality, and a little grandiosity. Somewhat interestingly these symptoms tended to occur in the late evening to the early morning hours. This has been noted by some researchers who study ultra rapid cycling in children. Many clinicians would probably categorize my experience as someone who is experiencing a pronounced diurnal variation but I am reluctant to think that since diurnal variation usually means a slight remission of symptoms throughout the day without hypomanic-like symptoms.

Manic-depressive insanity in the sense here delimited is a very frequent disease. About 10 to 15 per cent, of the admissions in our hospital belong to it. The causes of the. malady we must seek, as it appears, essentially in morbid predisposition.-- Kraepelin

Ghaemi's historical perspective different from DSM

Ghaemi's perspective much like Kraepelin is based on the big picture of evidence and history, not mainly on image. At the moment the DSM-V seems to be ruled by people who are primarily concerned with the public's image of them. They mainly don't want to appear like they are over prescribing and over pathologizing normal behavior. The fact that bipolar is no longer grouped with major depression under Mood disorders is one example of their over reaction to anti-psychiatry.

In conclusion Dsythymia not all that accurate

As someone who has experienced chronic depression with a moderate severity, I am tired of hearing how my so called Dysthymia is defined as mild and at one time in the past, a personality issue. Bipolar disorder has been generally viewed as more incapacitating and more endogenous while unipolar depression is more neurotic. Ghaemi and Kraepelin's theories make sense to me in light of my experience with depression. It has been for the most part, quite incapacitating, miserable and briefly quite pleasant.

The impact of a previous mental illness diagnosis on other health problems

A couple of weeks ago I went to the doctor due to some problems with my sciatic nerve and some other mysterious nerve sensitivity in my hands, face and feet. Googling my symptoms indicated the possibility of nerve damage which gave me some anxiety and I thought possibly there was some treatment for my sciatic problem. The doctor wasn't my regular one but another one since it was  a walk in clinic. I had initially intended to go to my regular doctor but she insisted that I go immediately to the clinic that day and that she didn't have any time to see me. My understanding was that my mysterious nerve symptoms overlapped with a description of  someone having a stroke so I indulged her anxiety and went in the clinic that same day.

Once I got there however they treated me like the neurotic one and the doctor insisted in the end that I should go to a psychiatrist despite the fact that I have no insurance coverage for mental disorders. For some reason the male doctor fixated on my irritated hands which were slightly red and dry(possibly due in part to the sun). Judging by his thinking he seemed to think I had OCD and or possibly Lupus. The Lupus could have been due to admission of some joint pain and my previous diagnosis of depression. His impression of my sciatic nerve problem was that it wasn't enough of a problem for him to treat it at all. I inquired about muscle relaxants (anti-anxiety meds) but he didn't want to prescribe for some reason. The philosophy of this clinic seems to be that anti-anxiety meds should be prescribed by a psychiatrist.

I have had a similar experience before like this. I mentioned some mysterious nervous symptoms and was referred to a psychiatrist. It seems like when a doctor can't find a suitable diagnosis they immediately try to label the person as unstable...not terribly logical but it apparently saves them from confronting their own ignorance. Admittedly, part of this problem could be due to an error in communication. Here is an excerpt from an article on the topic of mental health stigma.

From a public standpoint, stereotypes depicting people with mental illness as being dangerous, unpredictable, responsible for their illness, or generally incompetent can lead to active discrimination, such as excluding people with these conditions from employment and social or educational opportunities. In medical settings, negative stereotypes can make providers less likely to focus on the patient rather than the disease, endorse recovery as an outcome of care, or refer patients to needed consultations and follow-up services.

At this point, I still have problems with my sciatic nerve and can't walk for more than 15 minutes or so without resting due to the pain in my lower leg. Additionally, I have unusual sensitivity in my hands and feet which makes typing at the moment somewhat unpleasant. I am quite sure my previous diagnosis of psychotic depression is giving this doctor an excuse to not take my symptoms seriously and I am not sure what to do about it. Stigma due to mental illness is frustrating and it can impact other health problems which aren't taken seriously.

update: tests don't confirm Lupus