BS: Depression and impulse control

Subject: BS: Depression and impulse control
From: Richard Bridge
Date: 23 Apr 12 - 06:42 PM

I am seeking hard information, not speculation, about the consequences of depression in relation to impulse control. Not for me, but in relation to someone I know. And not the classic impulse control disorders (eg pyromania and kleptomania etc) but a lesser tendency to impulsive-ish behaviour that would be hard to justify rationally - poor choices particularly related to expenditure priority.

The subject also displays behaviour associated with depression for example excessive drinking (possibly true alcoholism) and smoking loss of libido and body dysmorphia.

Subject: RE: BS: Depression and impulse control
From: GUEST,Ed
Date: 23 Apr 12 - 08:17 PM

Now, here's an idea. Why not consult a professional in the field rather than a bunch of ageing folkies?

Subject: RE: BS: Depression and impulse control
From: Rapparee
Date: 23 Apr 12 - 08:29 PM

Is this person suffering from Post Traumatic Stress Disorder? Or do you know?

Subject: RE: BS: Depression and impulse control
From: GUEST
Date: 23 Apr 12 - 09:48 PM

Mr. Bridge is a UK solicitor...(aka lawyer...aka legal beagle...aka ambulence chaser)

Post at your own vigilance.

Remember to sign your Guest name, gargoyle
mod

Subject: RE: BS: Depression and impulse control
From: Rapparee
Date: 23 Apr 12 - 10:46 PM

So's my wife -- in the States.

Subject: RE: BS: Depression and impulse control
From: Richard Bridge
Date: 24 Apr 12 - 03:37 AM

No PTSD in the classic sense - unless you include the consequences of 25 years in fear of the bailiffs.

And the reason for enquiring here, Ed, is to get some sort of balance not the selling of unwanted clinical services - and here is free.

This is not with my day job hat on!

Subject: RE: BS: Depression and impulse control
From: Jack Campin
Date: 24 Apr 12 - 06:36 AM

Back when it was more often prescribed, L-tryptophan was found to be useful both for impulse control and depression.

It wasn't useful enough for depression, considering its risks and expense, to remain a first-line or even second-line treatment, but it does suggest that something affecting serotonin levels might help for both. (I have never had any serious impulse control problems, but have had severe depression and was on L-tryptophan for a while - such impulse control issues as I did have were helped by it).

L-tryptophan makes your shit stink of cheese, costs a bomb to the NHS, and can destroy your pancreas if you don't take enough pyridoxine. As an antidepressant medication (combined with SSRIs) it's now considered the last stop before ECT.

I would think that second-generation antidepressants (SSRIs, venlafaxine, trazodone) would be worth trying first.

Subject: RE: BS: Depression and impulse control
From: Rapparee
Date: 24 Apr 12 - 10:37 AM

If this person is over 65, be aware that the US Veterans Administration strongly advises against a dosage of more than 20mg per day for citalopram (Celexa) because it apparently can cause heart problems for "older people" in higher dosage. Other SSRIs might be preferable.

But the most important thing would be to get to the underlying cause of the depression. Therapy is, in my opinion, definitely indicated (if the person will cooperate with that or anything else).

Could this be a case of slow suicide?

Subject: RE: BS: Depression and impulse control
From: Richard Bridge
Date: 24 Apr 12 - 01:05 PM

Yes could be. Person is mid 50s and in the UK. Unhelpful doctor. I think many depressions could be cured by winning the lottery... new motorbike to help resist temptation to drink (new driving licence, last one lost to drink...)

Ho hum.

Subject: RE: BS: Depression and impulse control
From: GUEST,Stim
Date: 24 Apr 12 - 01:22 PM

It'll require some quality professional help to sort out whether your friend is suffering from depression, chronic alcoholism, or something else.

Some might tell you to leave this to the professionals, but in practical terms, they see people for only a short time, so your observations are going to be better than theirs--their conclusions as to cause will be better than yours, when it comes to how to deal with the problem, it will be completely up for grabs.

First, you have to figure out whether these impulse spending issues are a new problem or an old one.

Some people with depression and bipolar disorder tend to use spending binges as a kind of self-stimulation, we eve jokingly call it "shopping therapy". This if often a habit that becomes part of a lifestyle.

On the other hand, people who suffer brain injuries of one type or another often have problems making appropriate spending choices, when they once were good at it. It also can come with dementia of the various types, and after years of alcohol abuse.

This stuff isn't easy to deal with, and the solutions, if there are any, tend to be imposed--sooner or later, people run out of money and fall into debt, family members, friends, etc end up taking away credit cards, check books. take over financial responsibilities.

There are financial advisors, therapists, and even 12-step groups for people who are trying to reign in bad spending habits, and rehabilitation hospitals have programs to help people relearn budgeting and management skills, but the spender has to be committed to making a change.

You have my sympathy and best wishes--it is difficult to stand by and watch a friend or relative harm themselves in this way, and it can be both emotionally and financially expensive to intervene.

Subject: RE: BS: Depression and impulse control
From: GUEST,Stim
Date: 24 Apr 12 - 01:27 PM

And, sadly, a large cash windfall, whether a lottery, an inheritance, or other, can be spent surprisingly quickly.

Subject: RE: BS: Depression and impulse control
From: jeffp
Date: 24 Apr 12 - 04:45 PM

And to add to the fun, if the problem is really bipolar disorder, antidepressants will just make things worse, as they will spin the patient into a stratospheric mania. Lithium is good for bipolar disorder, but it has its disadvantages.

Subject: RE: BS: Depression and impulse control
From: Richard Bridge
Date: 24 Apr 12 - 05:13 PM

Thanks, chaps. I don't think it's bipolar disorder, I have a number of friends who are bipolar and I don't see the upphase in this person. Alcoholism is very much in the frame - and is often associated with depression - but to my mind the depression is the first stage here and the alcoholism the consequence.

Can anyone point me to any literature (comprehensible to the reasonably intelligent layman) on depression and impulse control?

Subject: RE: BS: Depression and impulse control
From: Jack Campin
Date: 24 Apr 12 - 05:19 PM

Does this seem to fit?

Compulsive Shopping

Subject: RE: BS: Depression and impulse control
From: JohnInKansas
Date: 24 Apr 12 - 06:39 PM

As stated, the question is how does depression affect impulse control.

My impression is that the way psychiatry classifies and describes mental variations, you quite probably need to be looking for a particular "illness" (defined by a cohort of symptoms) for which depression and inadequate (or inappropriate) impulse control are coexisting symptoms. There may be any number of possibilities in which both appear but in each of which the two may relate differently. Both depression or inappropriate impulse control seem to be more often considered "facets of somethings" rather than as indicators of a particular deviance. Depression, in particular, appears much more frequently as a factor in another syndrome than as the pure(?) "clinical depression" that's an actual diagnosis.

Sometimes it's "how you think of it" more than "what you think of it" that gets most directly to what you want to know.

John

Subject: RE: BS: Depression and impulse control
From: GUEST,Stim
Date: 24 Apr 12 - 08:53 PM

First, John in Kansas, you've got it turned around-depression is not often considered a facet of something else, it is often considered an underlying cause of other issues. As to alcohol and depression, there is a strong connection, but which causes the other, or whether both are caused by something else is still up in the air. There seems to be a strong connection between alcoholism and impulsive behavior, which, given that alcoholism is an impulsive behavior, is kind kind of obvious.

The classic OC stuff, like pyromania and kleptomania, and the ever popular nymphomania have been studied for years(though not necessarily successfully treated), but the everyday sort of impulsive behaviors, like hoarding and binge spending, compulsive cleaning, and such things have only been looked at recently, and often the experts are people who have to deal with them, rather than researchers. Blogs and web forums will probably yield more useful info than anything else.

I cut and paste this, from the article above, as evidence of how far the field has to go:

"In 2001, Koran was involved in one of the biggest studies on compulsive shopping. Preliminary findings from Koran's research indicated some compulsive shoppers generated large credit-card debts." Duh...

Subject: RE: BS: Depression and impulse control
From: Jack the Sailor
Date: 25 Apr 12 - 12:30 AM

http://www.bipolarcentral.com/otherillnesses/icd.php

Subject: RE: BS: Depression and impulse control
From: Janie
Date: 25 Apr 12 - 12:30 AM

There is no such thing as diagnosis by the numbers. Psychiatric diagnoses are normative, descriptive diagnoses. Commorbidity is common. Diagnosis requires individual evaluation and comparison of reported and/or observable changes in function, personality, behavior, coping mechanisms and skills between periods of possible depression and periods when one is not depressed.

Speaking very generally, chronic problems with impulse control are not diagnostically significant when evaluating for clinical depression. People who are depressed may experience increased impulsiveness in terms of emotion regulation, or may experience increased inhibition, anhedonia, and lack of spontaneity when clinically depressed. Any correlation between impulsivity and depression must be weighed in terms of the individual and their baseline level of functioning.

Subject: RE: BS: Depression and impulse control
From: Richard Bridge
Date: 25 Apr 12 - 02:46 AM

Thank you Janie, that makes a lot of sense.

Subject: RE: BS: Depression and impulse control
From: freda underhill
Date: 25 Apr 12 - 08:58 AM

Here's something on impulse control.

Subject: RE: BS: Depression and impulse control
From: Rapparee
Date: 25 Apr 12 - 09:19 AM

Professional help IS needed. Trust me one this.

Subject: RE: BS: Depression and impulse control
From: GUEST,Stim
Date: 25 Apr 12 - 10:38 AM

"Speaking very generally, chronic problems with impulse control are not diagnostically significant when evaluating for clinical depression."

Here's the problem, and I say this with no intent to be disrespectful to you Janie, but for friends, family and Richard Bridge, the chronic impulse control problems are significant, and for them, that it the primary focus, not evaluating clinical depression.

The fact of the matter is treating the depression may not bring the impulse spending under control at all("Hey, with my depression gone, I feel like going out and shopping!").

Richard is just trying to figure out how his friend's bouts of depression affect the impulse issues, and how that will play out over time.

Subject: RE: BS: Depression and impulse control
From: Richard Bridge
Date: 25 Apr 12 - 10:42 AM

I know the person affected is clinically depressed. I'm trying to figure out how best to alleviate the poor economic choices (accompanied by rationalisation) that appear to me to be linked to ineffective impulse control.

Subject: RE: BS: Depression and impulse control
From: GUEST,Stim
Date: 25 Apr 12 - 12:17 PM

Don't know how things are handled in the UK, Richard, but here there are rehabilitation services and specialists(such as occupational therapists) who provide training/retraining in "life skills", money management being one.

The caveat is that the person has to co-operate, otherwise, there is not much that can be done, short of breaking up credit cards, taking away the check book, and taking on all financial responsibilities yourself.

Subject: RE: BS: Depression and impulse control
From: Richard Bridge
Date: 25 Apr 12 - 12:21 PM

Definitely not going there thanks Stim! There already are no credit cards and no cheque book. And there is also a total breakdown in trust with the GP which would be the gateway to medical intervention, and many forms of therapy are no longer free in the UK - there are even prescription charges for the liquid cosh and it would probably make impulse control worse anyway.

Subject: RE: BS: Depression and impulse control
From: Jack Campin
Date: 25 Apr 12 - 12:56 PM

Describing antidepressants as a "liquid cosh" is not a very constructive attitude. There are a lot of options that work in different ways, and there's a very good chance that some of them will help.

CBT might be another option, almost certainly available on the NHS if you take it seriously and ask.

Subject: RE: BS: Depression and impulse control
From: Richard Bridge
Date: 25 Apr 12 - 01:00 PM

Ah, I knew 2 meanings for that TLA (three letter acronym) and cognitive behavioural therapy was NOT one of them!   

Seriously Jack - are you saying that they will help the depression or the poor economic behaviour? As I mention above (I think) I know a number of people with bipolar disorder and I have never seen any medicaments assist their economic behaviour.

Subject: RE: BS: Depression and impulse control
From: GUEST,Eliza
Date: 25 Apr 12 - 01:10 PM

Richard, if the GP is not helpful, would it be possible to change doctors? We did this some time ago and are glad we did. It's so important to have a GP one can trust and in whom one has confidence. There's no need to see the 'old' doctor, you just go to the new one and ask to be accepted on their list. No questions are normally asked.
Just a suggestion.

Subject: RE: BS: Depression and impulse control
From: Jack Campin
Date: 25 Apr 12 - 01:26 PM

are you saying that they will help the depression or the poor economic behaviour?

Yes to both. As I said in my first post, I had first-hand experience of that with a medication intended to affect serotonergic receptors. My problem probably wasn't as serious as your friend's seems to be, but as that Australian article pointed out, I wasn't the only one where it tied in to the same physiology.

I wasn't suggesting bipolar disorder was in any way involved, or that medications designed for it would be any use at all.

Subject: RE: BS: Depression and impulse control
From: GUEST,Stim
Date: 25 Apr 12 - 02:19 PM

Eliza is right--if there is a trust issue with the GP, or any other issue that is a barrier to getting the referrals and treatment that are necessary, you need to move to someone else. A good GP will help you to find a treatment program that specializes in addressing the issues your friend has--and that would be ALL of the issues.

From what you say, your friend needs detox, psychiatric treatment for the depression, psychological therapy for the body dysmorphia, and life skills assistance for the financial problems, and a support group. Sounds like a lot, but it all will be part of the package in a specialized treatment program.

I were in your position, I'd google OCD treatment programs, maybe using alcoholism, body dysmorphia, and compulsive spending, as keywords, till you find programs that's close and looks good. Then I'd make contact and explain your situation and let them tell you what they can do to help.

Subject: RE: BS: Depression and impulse control
From: Richard Bridge
Date: 25 Apr 12 - 03:21 PM

OCD. I never thought of that approach.

Subject: RE: BS: Depression and impulse control
From: Jack Campin
Date: 25 Apr 12 - 07:40 PM

OCD is probably overdiagnosed. The standard treatments for it are pretty horrific - massive doses of antidepressants with the accompanying massive side effects, and if that fails, brain surgery. No talking cure or behavioural treatment does anything.

You really don't want to self-diagnose with it.

If depression seems on the face of it to be the central problem, treat that first. Treatments for depression are reasonably effective and their side effects are usually not too hard to live with.

Subject: RE: BS: Depression and impulse control
From: Janie
Date: 26 Apr 12 - 12:08 AM

What Rapparee said.

Mudcat is not the place to get effective diagnostic opinions or impressions or recommendations regarding specific treatments, whether those of us posting are professional clinicians, people with treatment histories, or family members and friends who have or are dealing with loved ones whose behaviors and choices are problematic.

Posts from UK mudcatters with experiences navigating your health care system that address access to services or changes in providers might be helpful to the extent that access to services or access to an appropriate provider is an issue.

There are no magic bullets, and no easy or "one-size-fits-all" answers for issues related to human behavior.

Subject: RE: BS: Depression and impulse control
From: GUEST,Eliza
Date: 26 Apr 12 - 05:14 AM

Just to add Richard, that your friend is lucky to have your care and concern.

Subject: RE: BS: Depression and impulse control
From: Richard Bridge
Date: 26 Apr 12 - 06:56 AM

Or my nagging!

Subject: RE: BS: Depression and impulse control
From: GUEST,Manuel
Date: 26 Apr 12 - 09:07 AM

Eliza has once again displayed her precious gift of being able to catch what is right there under our noses but yet not noted (if at all seen). She makes this cafe such a cozier place.