Target Zero: Redefining the Clinical Definition of Success

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The first priority in treating a mood disorder is ensuring that the person is out of immediate crisis. But should this be the end goal? Too often researchers, providers, family members, and peers consider a stable mood as a measurement of a successful outcome.

On April 1, the Depression and Bipolar Support Alliance (DBSA) kicked off a month-long program challenging the mental health community to raise expectations from fewer symptoms to zero symptoms. “Target Zero to Thrive” is a campaign to insist on new standards for research and treatment that raise the bar from stability to lives of wellness.

Twenty-one million people in the U.S. live with mood disorders, and persisting symptoms increase the likelihood of:

  • relapse
  • functional impairment that increases the challenges of work, family, and day-to-day living
  • life-threatening co-occurring conditions such as heart disease, diabetes, hypertension
  • death by suicide

According to Allen Doederlein, president of DBSA, “Living with a mood disorder can damage hope and lower expectations so a person may not expect or think they deserve a full life. We as peers, clinicians, researchers, and family need to help them expect and achieve more.”

Dr. John Greden, Executive Director of the University of Michigan Comprehensive Depression Center, wrote in a March 11, 2014 CFYM post that “We need policies that move away from short-term research grants and that support a change in approach in how we measure outcomes.”

In that same post, Greden further noted, “We treat mental health issues in an episodic way, even though we know that mood disorders are going to be with a patient for a lifetime and recur even with the best therapy.”

What is the flip-side of raised expectations? Certainly, not shame or guilt because one is experiencing residual symptoms. Rather, it is a call to the research and medical communities that we expect and demand more. Target Zero to Thrive points out how the system has failed people living with the mood disorders when they are not being given the opportunity to achieve zero symptoms—not the other way around.

Doederlein reiterates this point when he says “Believe me, I know—I know—that thriving can seem so elusive, even impossible at times. But we can’t get there if it’s not even part of the conversation.”

There are many ways to get involved in the campaign

  • Spread the word and sign the petition
  • Post a selfie with the Target Zero logo on Facebook or Instagram
  • Request and wear a Target Zero pin
  • Nominate a professional who you believe embraces the ideas of the campaign

Your Turn

  • What should the research and medical community be doing to support people living with mood disorders to obtain a life lived with zero symptoms?
  • How do you support your friends or family members in attaining optimal health?

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16 comments
careforyourmind
careforyourmind moderator

Thank you for sharing your family's story Lauren. We too at CFYM hope that those living with mood disorders can see Target Zero achieved in their lifetimes. Continuing to advocate our government and the research and medical community to support and embrace research in innovative and breakthrough treatments will be required by all of us.  But it is possible if we are all pulling together.

LaurenPatriciaSul
LaurenPatriciaSul

I have lived with bi-polar disorder my whole life, though I was not diagnosed until well into my late 20's. My husband has done the same, with similar experiences with late diagnosis. We have both struggled with mis-diagnosis, meds that don't work at all, or only work a little, or make us feel so detached we'd rather suffer with our bi-polar symptoms than take them. I still haven't found the right med or combo of meds to even stabilize myself. My husband goes without any medication at all because he made too much money to qualify for state insurance and he would have needed a third job to even try to pay for the insurance offered by his employers.  He has lost both jobs because of sick days due to bi-polar symptoms.  He is back on state insurance and seeking mental health care.  He has made an appointment with a med provider for the soonest available date, which is in August. Today is June 21.  He is looking for another job and agonizing over the fact that he may lose his coverage if he finds one. It has happened to both of us in the past.  I have , within the past two years, been diagnosed as SMI (Seriously mentally ill) bi-polar so, thankfully, I no longer have to worry about being covered for med appointments or meds, my SMI diagnosis qualifies me for those services at an SMI facility.  We have a son. He is currently 8 years old. He was finally diagnosed as Bi-polar with extreme ADHD at the age of 5.  I say finally, because we noticed signs and symptoms of mental illness around the age of 3.  I also say finally because it took him getting expelled from kindergarten to get anyone to listen to us. He has been lucky.  The first medications he tried have worked wonders for him. He thanks us for his meds.  We have had to fight to keep my son covered for his medications when my husband is working.  When my son does not have his medication he gets frustrated easily and becomes violent. I worry about him everyday.  I have no real hope for more than relative stabilization for myself or my husband, but I pray everyday that my son will have brighter prospects than ours.  I do not want my son to become me.  We work hard everyday to make sure he knows he is a good kid even if he sometimes makes bad choices.  I truly hope "Target Zero to Thrive" succeeds in my sons lifetime. I hope my son will be able to thrive, instead of just surviving like we do.  Thank you.

crazyprofessional
crazyprofessional

When we talk about "zero" symptoms, it makes a huge difference whether we are talking about "zero" BP symptoms but accept significant side effects. If I am free of BP symptoms but have, as a side effect, lost so much small motor accuracy that I can no longer type fast enough to work as a senior administrator, the meds have disabled me, not freed me. If I am free of BP symptoms but have lost so much word-finding ability that I use a search engine as a brain extension to locate information I used to know, such as "the name of the fabric that has an all-over pattern of flowers," then I have become a much slower, much junior writer. The meds have disabled me, not freed me. And when US culture has accelerated to the point where 2 sick days a year is the norm instead of the 5-6 that people with depression take -- and that were average for the workforce as a whole at the beginning of my career -- then perhaps the culture is defining people as having a problem when the culture itself is having the problem.

Perhaps many of us 'thrive' better when we manage our lives instead of being managed by medication. I know I was more successful in every way before the doctor in my new city -- who knew he was so much smarter than all my previous docs -- refused to just let me have antidepressants when the depression was too bad to bear. Thanks to him, I had my first full-blown mania (four months into a course of unopposed antidepressants) and entered a course of drug experimentation that took seven years to stabilize me on a cocktail of five meds (including, in the process, generating my one and only hospitalization, thanks to the suicidality that a black box warns is a "side" effect of one antidepressant that the subsequent good doctor tried). And, ironically, I'm neither symptom free nor -- as noted -- free of side effects at this point. I just have less severe symptoms than the first smart doctor created.

Am I thriving? Oddly, that is the word I chose as my "one word resolution" for this year. I'm in a good church. I continue my freelance business while thinking seriously about the most likely to succeed career transition, since it looks like this is a transitional time. My husband and I now shelter two "refugees" from a desperately chaotic and collapsing MH group home. We may find ourselves transitioning into a career of caring outside the system for people that system "reform" cannot properly care for when the goal is "independent" living. "Zero" symptoms and "thriving" may not be the same thing. Toleration, community, and love may be the best picture of "thriving" for people who are not able to meet the accelerating norms of an increasingly demanding and fragmented culture.

StephenBonin
StephenBonin

Evandaniel, I agree with your last sentence. Thank you for writing. Stephen

evandaniel
evandaniel

Having lived with bipolar II for over 15 years, and having tried many treatments, some helpful, some less so, I believe that the quest for "a life lived with zero symptoms" is unrealistic for me.  For me, as an individual with bipolar II, symptoms involve mood swings from depression to hypomania, with my primary symptoms of depression being persistent sadness, lack of motivation, lethargy, and oversleeping and my primary symptoms of hypomania being racing thoughts, flight of ideas, agitation, and irritability.  At this point in my life, I believe I have found the best combination of treatments for me, and they work very well.  Nevertheless, the symptoms I listed above do recur, and I believe that is the nature of my illness.  That said, however, I certainly am thriving, even with recurring symptoms.  After spending 6 years in and out of hospitals after I was first diagnosed at age 18, I returned to school, initially taking one class a semester, gradually building back up to full time, until I graduated with my master's degree in 2012.  I now have a highly rewarding career in occupational therapy.  I work 32 hours a week, which is just right for me.  I have been married for almost 7 years to the love of my life, and we maintain a healthy relationship and a beautiful home with our 2 cats.  

I spent years searching for treatments that would give me zero symptoms, meanwhile putting the rest of my life on hold.  It was only after I gave up that (to me) unrealistic expectation of zero symptoms and resumed active engagement in meaningful activities, even with some symptoms, that I began to feel like I was in recovery.  I may be misunderstanding the meaning of Target Zero to Thrive, but I worry that this campaign makes it sound like people with mental health conditions are not thriving unless we have "zero symptoms."  I contend that, with the right individualized balance of occupations (i.e., meaningful daily activities, including self-care, household, social, work/education, play/leisure, and rest/sleep), we can and do thrive even when we sometimes also have symptoms.

afish
afish

First and foremost, those physicians treating patients like myself with a long history of mental illness and then being dx with bi-polar in my early 40's along with being a professionally trained clinical social worker, must be trained in how to do therapy, clinical interventions; psychopharmacology if needed and alternate approaches for our tx.  The majority of psych docs do not have the same training as I have.  And regular docs, i.e., internists' pediatrians, primary care docs are not really trained to write out the psych cocktail drugs and don't have experience needed to treat patients with mental illness.  Psychiatry is an art not a science - there is no cure for mental illness nor substance abuse - only getting one self back into control and the positive relationship with one's therapist, no matter their mental health backgroud.  If some folks feel religion is helpful for them, that is good and I certaintly would not judge the use of religion as pts. regain their control and understand the necessary tools we need to know when we know we are headed into a crisis situtation and need to get back into treatment.  I learned from my psych doc in Seattle that too much therapy escalates mood swings, and he was right on.  I also learned from a psych doc in D.C. that SSRI's are not the appropriate meds for bi-polar patients.  cognitive behavioral tx is the right mix with meds if pts. need them.  I also believe in alternative tx for mental illness, diet, nutrition and excersize once we have gotten ourselves under control and out of crisis stage.  


The continued use of labeling us pts. is the only way mental health professionals can be billed and the new DSM-V adds/deletes new and/or older dx in order to give credibility for the dx and payments if any insurance companies/Medicare/Medicaid are accepted by these folks.  I suspect the majority of mental health professionals, especially psych docs have never taken any of the meds they prescribed for us and although they can site the side effects of these drugs, really lack an understanding of the side effects, but probably feel helpless as they don't know what else to do.  Therapy has to be a 2-way street and when patients tell their psych docs and others that these meds are making us worse, not better and the doc continues not to listen, it is time to find someone else.   being able to listen when a pt. tells their psych doc how these meds are affecting us physically and emotionally is a major key to getting back into remission.  and knowing when we are out of remission, knowing how to handle it is essentail.


Finally acceptance of my bi-polar dx along with PTSD, and you can be sure it took me a long time to accept my illness, like in the past 12+ years or so and i'm older now and having a really good therapist teaching me coping skills, etc. has helped.  However, for me and I speak for me only, having a dx of bi-polar is terrible and I know I will live with this for as long as I live.  Support groups - sure,. but one cannot continue to obsess about their mental

health dx and stop thinking of themselves as a victum.  I am not a victum, but i know as a professionally trained clinical social worker and a patient that what is "normal" for others who don't have a severe mental illness is not the same for me.  Getting away from contiually thinking about myself and getting involved with other stuff when I get the much needed rest, eat right, exercise, laugh and do whatever, will hopefully maintain me for a while longer.  This ain't going away and anyone who says it is, is in denial.  I do not believe there will ever be a life with out "zero symptoms", but knowing how to act when these symptoms start creeping up will maintain some quality of life for all pts. dealing with mental illness.

StephenBonin
StephenBonin

Thank you for this opportunity to probe our brains about the treatment we have received thus far, focusing on a failure or more, and asking ourselves what the research and medical community can do better.

My first thought is that the community can be proactive about the gravy pace of improvement. I will share three examples of bad memories in  my treatment history, which goes back to 1986. 


1. In February, 1986, my Mom drove while my Dad held a tight clutch around me in the back seat. My very pregnant wife of almost nine months sat next to my mother. I was having a nervous breakdown and was psychotic. my parents had called ahead to the psychiatric hospital. When I arrived on the wing, I cussed at a female staff, for which I was put in the padded room the first night. Put on heavy medication, I was there a total of four weeks, for whichI gained a lot of weight and needed glasses.

I cussed at my wife when she came to visit. She became upset, cussed back at me, then left. I said a vulgar message to the psychiatrist upon entering his office the first time. Also, I spoke a vulgar message to a young male in rotation who met with privately to interview me. I remember thinking that I was under bright lights and that I was not in total control of what I was saying.

All that and more--after symptoms that had begun more than six years ago, with me refusing my Mom's suggestion that I see a psychologist. . .

All that, and I was released with a shrug of the psychiatrist's shoulders and, "Situational Depression?"

My Dad paid $45,000 for that. Finally, 27 years later,I accepted that I had been sexually traumatized as a young person, felt severe guilt, did not want to be with a psychologist for fear of a label, wanted a marriage to take care of the traumatic memories.

HOW COULD THE SUPPORT HAVE BEEN BETTER? The medical team could have done the math and deduced that something horrific was buried deep within me. They could have interviewed my parents to learn that growing up, we (parents and four sons born within 4 1/2 years) did not talk with each other about feelings, and thoughts.

2.  HOW COULD THE SUPPORT HAVE BEEN BETTER 2004 - 2006, when I did sessions with "One of the best psychiatrists in Dallas?" I felt frustrated with my psychiatrist of the local clinic. My Mom--God bless her for trying--asked a highly credible, local general practitioner, who told her he had referred a substantial number of folks to this "best".

Well let me tell you: those three years, he--performing the function of a psychologist AND psych,--would take notes the entire sessions each time. HE NEVER, NEVER, NEVER started a  session by saying, "Mr. Bonin, I've been looking at the notes of last time, and have been reflecting that we need to start with. . ."

You've already read that I came into full acceptance of my trauma only in 2013, seven years after I left him. For many years, I did not have the capacity to assert my feelings and thoughts to, well, anyone.

3. I did need to join a second support group, which has a directly Christian (I say it this way because I am convinced of DBSA's Christian values), 12-step recovery program, from 2007 - 2013. So, taking my example here, and remembering a DBSA Conference speaker, some of us need to participate in several support groups--for a while, or for a long time.

Thank you.

Stephen

player 09
player 09

The medical community and research departments of treatment centers should be doing for people with mood disorders by 1). Using alternatives methods and exploring results that occur  when symptoms are rising to the top. Stop the use of over medicating or prescribing another drug but use more of the persons describing what brings thiese episiodes on and how they can reduce triggers by simply exploring themselves. 2). Peer supporting , and 3). Focusing on the preventions treatment alternactives that do work with knowledgeable instructors that can reach out or by contacted for a solution.


I support my peers and family and strangers and community with knowledge and good listening skills. Reaching optimal health takes time and real decicated effort from people that really what to be healthier and live longer. Everything takes time and I also suggest getting to their doctors for physicals and check ups yearly. 

Phyllis D. CPS.

kimgallen
kimgallen

Though I am aware that in todays unstable health environment medical doctors face significant caseloads, I feel that medical doctors must take the time to hold a discourse with patients to consider all contextual variables and avoid doing just what is "efficient", or doing what is "typically" or commonly done for patients, such as just using medications or just using certain medications in certain combinations. Also, doctors should promote the concepts of health and wellness rather than promoting mood disorders as a disability. There are many consumer-friendly strategies that may be used to empower the patient, including self-help and psycho-educational approaches and targeted, early interventions involving the client, family and other potential resources, when needed. 




afish
afish

@evandaniel

very good comments and i certainly liked what you had to say and glad you liked my comments.  Indeed, if this campaign for "target zero to thrive" is what DBSA is looking for then I agree that they are not being realistic nor understanding of our disease.  don't know who is forming their strategy of on-going mental health treatment, but whomever it is needs therapy!!!!

thanks again for your comments and for your response to mine!!

afish

StephenBonin
StephenBonin

@afish

Thank you for sharing, afish. It seems you've been in treatment 12+ years. I have been in treatment 28 sand feel comfortable "aspiring to the thriving."

I believe length of time dealing with the symptoms factors into one's ability to accept the concept of "Thriving." Thank you. Stephen

StephenBonin
StephenBonin

@player 09 I feel comforted reading your point, "Stop the use of over medicating" Thank you, Phyllis D.!  Also, referring to your second paragraph, I also own my strength of having "good listening skills." Finally, because I regularly talk with people about body, mind, spirit, and emotions all needing to be maintained, I feel enthusiastic about the suggestion you give that people see their doctors for physicals and check ups yearly.

Thank you for sharing!

crazyprofessional
crazyprofessional

@kimgallen  Where I live, most support groups are for disabled "consumers." That is to say, not even the pt-led groups promote health and wellness as an expectation. The idea that I held a FT job has seemed remarkable (in rooms with up to 30 people), where the discussion has focused on how to get SSDI, needs for individuals to go inpatient, and to "take all the time off you need" (which is the best Rx I know for losing a job). I now attend a Meetup started by a BPII "patient" where we deal w/ issues like divorcing spouses stigmatizing us due to illness, should we be open at job and to whom, repairing relational wreckage, etc. I wish it was typical for support groups to assume that people with BP had "ordinary" lives, but I haven't seen it.

StephenBonin
StephenBonin

@kimgallen Kim, I feel some relaxation, having just released my examples, that you and I have both experienced the same pitiful  dynamics with washed-out doctors. We advocates-in-training are so blessed to learn, and relearn that this is a new, totally, positively revolutionary time in mental health treatment. The doctors have a lot of collaborators for the enactment of optimal treatment. Specifically, through DBSA we know about the importance of sunshine, exercise, good nutrition, laughter, therapeutic and cognitive benefits of the arts, doing edifying reading, forming healthy friendships, and on and on.

Have a good weekend!

afish
afish

@StephenBonin @afish

stephen:  did respond to your question about how long I've been in tx.  need to sorta clarify that I have been in and out of tx since my late 20's and am now 72 yrs. young!!!!!  i do "thrive" whatever that means when i'm back into control and believe how one thrives and deals with their mental illness is when we are feeling well and doing what we like to do.  I have always learned something from the various therapists I have seen thruout the years as I have moved around to various cities throughout my life both as a clinical social worker, and as a patient.

kimgallen
kimgallen

@crazyprofessional @kimgallen  Thanks for writing this. Gives me a lot of motivation, as I have thought of starting a group that is centered around health and wellness. I know what you mean about many groups that are focused on other elements. Thank you for sharing.