We have put together this set of ‘Frequently Asked Questions’ to assist students seeking information about the Black Dog Institute, or about depression and Bipolar Disorder. Many of the answers to questions in school projects can be found on our website, underneath the common questions, or Q&A about the Institute.
If you can't find the answer to your question, feel free to contact us and we will see what we can do to help you.
The Black Dog Institute has a distinguished Board chaired by Mr Peter Joseph OAM. Its Executive Director is Professor Gordon Parker, an internationally-recognised leader in the field of mood disorders. Mr Michael Eyers, a Board Member, is also Chairman of the Black Dog Foundation (the fundraising component of the organisation.) Find out more about the Board members.
The Institute's mission is to advance the understanding, diagnosis and management of mood disorders by continuously raising clinical, research, education and training standards. In so doing, the Institute aims to improve the lives of those affected - and in turn - the lives of their families and friends.
As at June 2007, approximately eighty staff are employed at the Black Dog Institute – either on a full-time, part-time or contract basis. The staff comprises a dedicated, expert and highly-regarded team of psychiatrists, psychologists, research staff, project officers and administrative staff.
There are currently no volunteer positions at the Black Dog Institute. However, if you would like to express an interest, we are happy to keep your details on file and notify you of any upcoming opportunities. Send an email to: blackdog@unsw.edu.au.
See our Yearly Reports.
Being a NSW-Government funded body, the Black Dog Institute’s primary focus is on providing services to people in NSW. For practical reasons, some of our activities are limited to people who can visit our premises in Randwick (in the Eastern suburbs of Sydney). If you would like someone from the Institute to come and give a talk at your community event, please phone Deana Bayoud on 02 9382 8368 or email d.bayoud@unsw.edu.au For a comprehensive database of nationwide services, we recommend the following website: depressioNet.
We have a Depression Clinic to provide free clinical assessments and comprehensive second-opinion services for those suffering treatment resistant depression or Bipolar Disorder. These are dependent upon a referral from a GP or psychiatrist. (The Institute does not take over the management of patients.) We also have a Consumer & Community Resource Centre open to the general public, to assist in accessing mental health information, services and support groups. We provide education and training to mental health professionals (GPs, psychologists, school counsellors, nurses and psychiatrists) to help them recognise, understand and manage mood disorders in their clients. Finally, we undertake research into the clinical nature of depression, Bipolar Disorder and other related areas.
Common questions about Bipolar Disorder are listed in the Bipolar Disorder section of our website.
Common questions about depression are listed in the depression section of our website.
This can sometimes be a complex issue. There is no doubt that a number of people receiving a diagnosis of schizophrenia actually turn out to have Bipolar Disorder. This is due to several factors - firstly, that those with schizophrenia and those with Bipolar Disorder can have psychotic episodes and there are no psychotic symptoms that are absolutely specific to one diagnosis. For such reasons, health clincians will sometimes use the diagnostic term ‘schizo-affective disorder’, essentially reflecting a lack of certainty as to whether the patient has one particular disorder or the other, but sometimes to represent the reality that a patient may have features expected for each of the conditions, but occurring together. In young people particularly, an early onset psychosis may show many features of schizophrenia and it is only over time that the more characteristic mood swings of Bipolar Disorder become evident.
Family history can sometimes assist but there is no absolute principle whereby a family history of one condition will always predict its presence in other family members, so that it is only of marginal assistance at best. The way such complexities are best approached is to ensure that the individual receives a sophisticated clinical assessment by a psychiatrist and, if there is any doubt, for a diagnostic review to be repeated over time.
Although the clinical experience of depression or Bipolar Disorder is the same for both men and women, generally speaking, men are less likely to seek professional help for their symptoms. Cultural expectations of masculinity can contribute to men’s unwillingness to acknowledge problems and admit needing help. In general, men have fewer social support networks then women, and are also less inclined to talk about their feelings. Thus, it is more likely socio-cultural factors, rather than biological factors, that result in a higher rate of women experiencing depression. Many men can refuse to seek treatment and their mood disorder may go undiagnosed as a result, which can lead to an increase in angry, self-destructive or self-medicating behaviour. Being able to recognise that depression and Bipolar Disorder are health issues, in the same way diabetes or asthma, is a key part in the decision to seek professional help. One person in five experience depression in their lifetime, and as such, it is a common health issue dealt with by GP’s. With the right treatment and management people with mood disorders can achieve stability and live successful lives. Find out more...
The impact of depression or Bipolar Disorder is not limited to the consumer. There is often a great burden of care placed on family and friends (especially parents and partners). Relationships can suffer due to the strain of illness, and many carers can develop depression themselves due to increased worry, feelings of guilt, lack of intimacy, social isolation and the heavy responsibility they feel in supporting a loved one to wellness. In some cases, chronic illness can also reduce a person’s capacity to work, which can lead to problems related to reduced family income. The physical side-effects of mood disorders can also impact sleeping patterns, irritability, moodiness, sexual desire and function which can contribute to interpersonal stress within the family unit.
There are also problems arising from reckless behaviour during the manic episode of Bipolar Disorder. For example, mania can induce people to spend excessively. This can create real financial trouble for families that can impact the household. Mania can also lead to an increase in socially and sexually inappropriate behaviour, which can have negative consequences on relationships.
One of the best ways that family and friends can help a person with depression or Bipolar Disorder is to get a better understanding of the illness. There are many valuable sources of information available on our website. It is also important for carers to recognise their need for support, and to seek help from support groups and carer services when necessary.
One in five children and adolescents are affected by mental health problems and disorders. Those aged 18-24 have the highest prevalence of mental disorders of any age group. Depression in this age group should be taken seriously. Youth suicide is the third most common cause of death in this age group. However, it can be hard to distinguish adolescent turmoil from depressive illness, especially as the young person is also forging new roles within the family and struggling with independence, and academic and career decisions. Both biological and developmental factors contribute to depression in adolescence.
Browse these websites:
We do not treat young children at our Clinics, as this is an area that requires specialist skills and expertise. If parents suspect a mood disorder, the first step is to either take them to a General Practitioner or to the local Community Health Centre. The General Practitioner will either conduct an assessment or refer the adolescent to a child and adolescent psychiatrist or mental health worker. They may then be referred o a Child & Adolescent Mental Health team for management.
Sometimes an adolescent may not want to seek help. In this case it's best for family and friends to explain their concern and perhaps also provide them with some information to read about depression. There are also some excellent websites designed for young people, as well as online and telephone counselling services. It's important for them to know that depression is a common problem and that there are people who can help.
Bipolar Disorder can commence in childhood, but onset is commoner in the teens or early 20s. Some people develop their first episode in mid-to-late adulthood. Many people go for years before it is accurately diagnosed or treated. Finding out when the 'highs' first commenced helps in determining the possibility of a Bipolar Disorder.
Bipolar Disorder can occur (rarely) in childhood and this makes identification somewhat more difficult. However, people with true Bipolar Disorder often identify a period of change, most commonly in adolescence or early adulthood. Bipolar Disorder can sometimes be misdiagnosed as ADHD (Attention Deficit Hyperactivity Disorder) in children. The identification of a clear onset period goes some way towards distinguishing Bipolar Disorder from certain personality states and other conditions.
The presence of a positive family history also increases the probability of Bipolar Disorder. Bipolar Disorder is frequently inherited, with genetic factors accounting for approximately 80% of the cause of the condition. If one parent has Bipolar Disorder, there is a 10 per cent chance that his or her child will develop the illness. If both parents have Bipolar Disorder the likelihood of their child developing the illness rises to 40 per cent. However, just because one family member has the illness, it is not necessarily the case that other family members will also develop the illness. Other factors also come into play. Some overseas experts suggest that the pattern in childhood is very similar to the pattern in adulthood, but others believe that the features tend to be more restricted to ones such as intermittent over-excitement and poor sleep, rather than many of the features reported by adults (eg: over-spending, increased libido).
Parents who are concerned about their child’s behaviour should seek an assessment with their GP first, and then consider a referral to a specialist working in child & adolescent mental health.
Drug treatment for mania and depression during pregnancy is an extremely important issue in terms of the health of the baby. The general principles are that, if a woman is on antidepressant and mood stabilising medication, consultation with an expert should be undertaken and drug-free conception attempted. In the first three months of pregnancy, certain medications should be avoided, but this is not always achievable. In such circumstances, the mother, her partner and her doctor need to work together to address the cost-benefit issues.
Pregnancy and breast feeding for women with Bipolar Disorder
Special care needs to be taken for women planning to become pregnant. It is no longer the accepted opinion that women with Bipolar Disorder 'should not' become pregnant nor that all medications need to be ceased. The issues are complex and it is highly recommended that advice from an experienced psychiatrist, ideally involved in women's mental health, is sought. The postnatal period is a period of maximum risk for a woman with Bipolar Disorder, especially if she ceased the mood stabiliser prior to becoming pregnant. It is therefore vital that medication of some type is used to 'cover' this high-risk period. Valproate and carbamazepine have been considered to be compatible with breastfeeding by the American Academy of Paediatrics despite passing through into breast milk and having some effects on the infant.
It is highly recommended that specialist advice be sought at this time. Women with Bipolar Disorder have a very high chance of a significant mood disturbance both during pregnancy and in the postnatal period - most commonly in the first four weeks. (Most will have a depressive episode, a significant proportion will have highs, and 10% will have mixed highs and lows.)
1. Ernst C, Goldberg JF. 'The reproductive safety profile of mood stabilizers, atypical antipsychotics and braid spectrum psychotropics', J Clin Psychiatry 2002; 63 (suppl 4);42-55
2. Llewellyn A, Stowe ZN, Strader JR Jr. 'The use of lithium and management of women with bipolar disorder during pregnancy and lactation', J Clin Psychiatry 1998; 59 (suppl 6):57-64
If you are taking medication for treatment of depression it is important that you consult your GP before you cease your medication. Your doctor can then review your health and advise if it is appropriate for your to discontinue your medication prior to conception. Your doctor will also be able to advise you how to do this and how long to wait before you try to conceive. There is a risk for some women that their symptoms will re-occur after ceasing medication which is why medical review is indicated.
For a relatively small group of women their hormonal state appears to influence their mood state. So these women may notice they feel "low" or "anxious" before their periods but not necessarily at other times. Also some women notice mood swings when prescribed certain brands of the contraceptive pill and if you have this tendency it is advisable to discuss this with your doctor so that they can select a brand that is less likely to have this effect. Following childbirth all women go through periods of hormonal shifts but not all women experience mood swings at this time. It is thought that only a small group of women are sensitive and react adversely to the hormone shifts associated with pregnancy and childbirth and that the majority of women who experience mood swings at these times are reacting to stresses that are not primarily hormonal.
The Institute does not recommend any particular treatment or drug therapy, but recognises that there are a range of alternative treatments and therapies that can be helpful adjuncts to medication, particularly for people with the more common form of depression (non-melancholic depression.) Alternative treatments for depression have been well-documented by the Centre for Mental Health Research at the ANU. Those that have been found to have scientifically proven benefits for depression include:
See our Fact Sheet: 'Treatments for Depression'
Help for Depression: What Works and What Doesn’t by Anthony F Jorm, Helen Christensen, Kathleen M Griffiths and Bryan Rodgers.
Order the booklet from the CMHR website, or download the research paper from the Medical Journal of Australia website.
Find out more information on stress management, exercise, diet and relaxation.
What does TMS stand for?
Transcranial Magnetic Stimulation
What is TMS used for?
Medical researchers are investigating TMS as a treatment for depression, schizophrenia and other psychiatric disorders, as a potential alternative or adjunct to medication and electroconvulsive therapy. Worldwide, studies have reported that TMS reduced depression, auditory hallucinations, obsessions and compulsions in some sufferers. However, the use of TMS to treat psychiatric disorders is still mainly in the research phase, with promising results so far. The Black Dog Institute, located at the Prince of Wales Hospital at Randwick in Sydney, has been a leading centre in research into the benefits and applications of TMS for over eight years. The Institute is now looking to expand their research in this field and is seeking people to participate in trials of TMS as a treatment for depression in adolescents (15-18 years of age) and schizophrenia.
How does TMS work?
Strong magnetic fields are used to stimulate the surface of the brain. Research has shown that parts of the brain appear to be underactive in disorders such as depression and schizophrenia. TMS is given by placing an electromagnetic coil on the head to produce stimulating pulses in the brain cortex. The stimulation is non-invasive and is given while the person is fully awake and alert.
How long does the TMS treatment take to work?
Evidence from trials of TMS suggests that several weeks of daily treatments are more effective than single sessions. Our research trials currently give TMS for 4 to 6 weeks (on weekdays).
How long do the benefits last?
As with other currently available treatments, a course of TMS can be helpful in lifting a sufferer out of their current episode of illness. However, no treatment to date has been found to ‘cure’ psychiatric illness, i.e. prevent future episodes.
Are there any side-effects?
Research to date has found TMS to be quite safe with minimal side-effects, although some people say they feel uncomfortable at the time of stimulation and about a third suffer from mild headaches following a treatment session.
Where can I find out more information?
For information on the adolescent depression and schizophrenia TMS studies:
Ph: (02) 9382 3720
Email: TMSandDCS@unsw.edu.au
What is Mild Brain Stimulation used for?
Mild brain stimulation is a potential treatment for depression, offered as an alternative to antidepressants and ECT. Researchers believe that mild brain stimulation may have an antidepressant effect when applied over the frontal areas of the brain.
How does Mild Brain Stimulation work?
The beneficial effects of mild brain stimulation on mood were reported in the 1960’s and 70’s but it was not developed further as a treatment. The Black Dog Institute is now looking to examine the antidepressant effect of mild brain stimulation. A weak current is used to stimulate a part of the brain that is believed to be underactive in people suffering with depression. The stimulation is a short, continuous stimulation (for 10 minutes) delivered through 2 pads placed against the forehead. The stimulation is painless and given while the person is awake.
How long does mild brain stimulation take to work?
Similar to TMS, it is believed that a number of daily sessions are more effective than single sessions. The stimulation period will be 10 minutes once a day for 10 consecutive weekdays.
Are there any side-effects?
The stimulation is delivered with little or no sensation for the patient, and is therefore painless. Some people may feel a slight itching sensation below one or both of the electrodes.
What is the cost to be involved in the TMS and mild brain stimulation research trials?
Treatment will be provided free of charge and all subjects details are kept confidential.
Where can I find out more information?
For information on the mild brain stimulation study:
Ph: (02) 9382 3720
Email: TMSandDCS@unsw.edu.au
The Black Dog Institute gratefully accepts donations though its fund-raising and friend-raising arm of the Black Dog Foundation. Find out more...
A list of the Institute Fact Sheets - including self-assessment tests for depression & Bipolar Disorder – are available to download from our website. Feel free to print off and distribute these as you wish. If you experience any trouble downloading these files, please contact us, and we will send you out some hard copies.
Also available on our website are:
You might also consider contacting the following organisations:
The Black Dog Institute cannot offer advice about medication. If you have any queries or concerns regarding your medication, we recommend that you ask your GP or psychiatrist. Alternatively, you can also browse these websites for general information on medications:
For statistics, reports and publications on the impact of mental illness, we suggest you browse the following websites:
Publications & Reports
'Twelve-month prevalence and disability of DSM-IV bipolar disorder in an Australian general population survey' by P.B. Mitchell, T. Slade and G. Andrews, (Psychological Medicine, 2004, 34: 777-785). Provided with permission Cambridge University Press [PDF, 112KB]
The Department of Health & Ageing have many publications related to mental health on their website. A selection of topics are listed below:
Page last updated: 8-Sep-2008
Depression and Bipolar Disorder Information Australia - Black Dog Institute.
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