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Seasonal Affective Disorder

Seasonal Affective Disorder, or SAD, is a depression that normally occurs in winter months, in response to changes in the natural day/night cycle. Artificial light therapy is an effective treatment.


Seasonal affective disorder (also called SAD) is a type of depression that follows the seasons. The most common type of SAD is called winter depression. It usually begins in late fall or early winter and normal mood returns in summer. A less common type of SAD, known as summer depression, usually begins in the late spring or early summer. SAD may be related to changes in the amount of daylight you get.Seasonal affective disorder is estimated to affect 10 million Americans. Another 10 percent to 20 percent may have mild SAD. SAD is more common in women than in men. Illness typically begins around age 20. Some people experience symptoms severe enough to affect quality of life, and 6 percent require hospitalization. Many people with SAD report at least one close relative with a psychiatric disorder, most frequently a severe depressive disorder (55 percent) or alcohol abuse (34 percent). Although some children and teenagers get SAD, it usually doesn't start in people younger than age 20. Yet when it does the syndrome is first suspected by parents and teachers. Risk decreases with age. SAD is more common the farther north you live.

Symptoms                                                                                                                                            *Not everyone with SAD has the same symptoms, but common symptoms of winter depression include the following:
  • Feelings of hopelessness and sadness
  • Thoughts of suicide
  • Hypersomnia or a tendency to oversleep
  • A change in appetite, especially a craving for sweet or starchy foods
  • Weight gain
  • A heavy feeling in the arms or legs
  • A drop in energy level
  • Decreased physical activity
  • Fatigue
  • Difficulty concentrating
  • Irritability
  • Increased sensitivity to social rejection
  • Avoidance of social situations

Symptoms of the summer SAD are:
  • Poor appetite
  • Weight loss
  • Insomnia
  • Agitation and anxiety

Either type of SAD may also include some of the symptoms that are present in other kinds of depression, such as feelings of guilt, a loss of interest or pleasure in activities previously enjoyed, ongoing feelings of hopelessness or helplessness, or physical problems such as headaches and stomachaches.Symptoms of SAD tend to reoccur at about the same time every year. The changes in mood are not necessarily related to obvious seasonal stressors (like being regularly unemployed during the winter). Usually depression is mild or moderate. However, some people experience severe symptoms and 6 percent of SAD patients need hospitalization at some time in their lives.Seasonal Affective Disorder can be misdiagnosed as hypothyroidyism, hypoglycemia, or a viral infection such as mononucleosis.

The cause for SAD is unknown. One theory is that it is related to the amount of melatonin in the body, a hormone secreted by the pineal gland. The body is exposed to its secretions for a shorter period of time during summer because light suppresses it production. The long nights of winter extends the amount of time melatonin is released into the body, thus increasing symptoms. It is not clear how melatonin produces the symptoms reported. One possible explanation is that melatonin causes a drop in body temperature and lower body temperature is associated with sleep. This could indicate that it is related to the sleep-wake cycle and related to the hypersomnia and fatigue reported.  

Because winter depression is probably caused by a reaction to a lack of sunlight, broad-band light therapy is frequently used. This therapy requires a light box or a light visor worn on the head like a cap. The individual either sits in front of the light box or wears light visor for a certain length of time each day. Generally, light therapy takes between 30 and 60 minutes each day throughout the fall and winter. The amount of time required varies with each individual. When light therapy is sufficient to reduce symptoms and to increase energy level, the individual continues to use it until enough daylight is available, typically in the springtime. Stopping light therapy too soon can result in a return of symptoms.When used properly, light therapy seems to have very few side effects. Side effects include eyestrain, headache, fatigue, irritability and inability to sleep (when light therapy is used too late in the day). People with manic depressive disorders, skin that is sensitive to light, or medical conditions that make their eyes vulnerable to light damage may not be good candidates for light therapy.When light therapy does not improve symptoms within a few days, then medication and, or, behavioral therapies should be introduced. In some cases, light therapy can be used in combination with anyone or all of these therapies.Self-Care
  • Monitor your mood and energy level
  • Take advantage of available sunlight
  • Plan pleasurable activities for the winter season
  • Plan physical activities
  • Approach the winter season with a positive attitude
  • When symptoms develop seek help sooner rather than later

*From Psychology Today

When the Argument Never Stops: 4 Ways Couples Counseling Can Help
Do you feel like you and your partner are always arguing? Do one or both of you avoid difficult conversations, fearing that it could escalate? Every relationship has its ups and downs, but for some couples, additional help might be required. That’s where couples counseling can help.
Meeting with a counselor who specializes in helping couples can provide an emotionally safe place to express feelings. The therapist can act as a referee, making sure that tensions don’t get blown up into conflicts, while allowing each person the opportunity to talk. Having someone else create the structure for the conversation takes some of the pressure off  you and your partner, helping to prevent things from spiraling out of control.
Another advantage of attending couples counseling is that it makes it harder for either of you to avoid talking about difficult subjects. When we are having interactions with our partners, we may just try to avoid talking about the tough topics as a way of preventing a larger argument. In some cases, we may even avoid the house altogether, for fear that we will start arguing.  Although this may keep things calm in the short run, the unsaid feelings and emotions can build, becoming a bigger problem and spilling over later on down the line.
Couples therapy can be a place where partners learn new communication skills they can apply outside of the therapist’s office. Improved skills include:
Your therapist can provide “homework assignments” that you and your spouse can practice outside of session, and then report back when you all meet again. During the session you can debrief with your therapist about what happened and strategize on how to improve for next time.
Couples counseling isn’t all about focusing on the problems that you both have. As Susan Krauss Whitbourne, Ph.D. says in Psychology Today, a couples therapist can also highlight the strengths of your relationship and what you are doing well.  For example:
Taking a strengths-based approach can help you to find greater appreciation for your partner, build on what you are doing well, and use this momentum in other areas of your relationship.

Divorce isn’t failure; living in unhappiness is failure

I’ve often heard people in conflicted and unhappy marriages claim that they are staying together for the sake of the children. Their implied message is that their children will be better off being raised in an intact family, spared from the negative effect of divorce. This position really requires deeper consideration.
As with many commonly held beliefs we owe it to ourselves to really examine them to determine if they’re valid. Often, they don’t really hold up under scrutiny. This may well be the case here. Several questions come to mind: Are we really staying together for the sake of the children, or are we fearful of coming to terms with our own lives (and in that case using the children as a scapegoat)? Second, is divorce necessarily harmful to children? Last, what are the effects of remaining in an intact family in which the parents are either conflicted or simply loveless? Let’s take a look at these questions.

Are we avoiding our larger fears?

Countless times in my practice, I’ve had adult clients comment that they wished their parents had not waited until they were out of the house to divorce. To do so makes a mockery of the institution of marriage. Waiting for the children to go off to college and then divorcing may make the kids feel guilty that their parents sacrificed their own happiness for them. We owe our children much more than the physicality of an intact family. We owe them our truth.
Not infrequently, people are simply afraid to move on with their lives and take their own responsibility for happiness. Financial concerns or the fear of being alone often motivate such paralysis, hidden beneath the mask of staying together for the children. At other times, it’s easier to blame your partner for your discontent than to come out of your sense of victimhood. Unloving or conflicted marriages often follow a lineage as they are passed down from generation to generation. And so the cycle continues. Is this what we really wish for our children? It is much more challenging to come to terms with our own circumstances and face our fears than it is to hide behind them as we stay together “for the kids.”

Divorce isn’t failure; living in unhappiness is failure

becoming more commonplace and is certainly a goal. Either way, for the sake of the children, we should either commit to making our marriages the best they can be. And if we can’t succeed in that endeavor, we should demonstrate lovingly to our kids that we all deserve happiness, even at the cost of divorcing.
Having the courage to truly live our lives for the sake of our children should be our ethic. But it needs to be more than lip service. For the sake of our children, we need to make our marriages the priority in our lives. This is the legacy that we owe them. Our marriages should be a vessel through which we model that positive value, not an imprisonment that we justify because of our children. To be the best parents we can be, we must be the best people we can be. This is what we owe our children.
Five Steps to Repair Your Marriage or Relationship

Did you know that boredom plays an important role in declining marital satisfaction? Yes, that’s what research by Irene Tsapelas and others found and that being bored now can actually predict dissatisfaction nine years later. It’s not just conflict that you need to pay attention to but levels of engagement. What are you doing stay close?
Bring it back by spending time sharing. Ask each other questions that go past the mundane such as “ If a crystal ball could tell you the truth about yourself, your life, the future or anything else, what would you want to know?” (This question is drawn from the study, as is the next one.) Done right, this doesn’t have to be a parlor game; for example, given the choice of anyone in the world, name the person you would invite to dinner.

“The same old tattoo” is what a certain someone in my life used to say dismissively, with his arms folded across his chest, whenever I brought anything up that was bothering me. This interaction actually has a name—“demand/withdrawal”—and a nasty reputation for being the most effective relationship killer around and a reliable predictor of divorce. If this is a pattern in your marriage—and both husbands and wives can play either role, although it’s more common for women to be in the “demand” situation and men in the “withdraw” position—you need to recognize it and work at doing what you can to stop it. Obviously, this has to happen in a moment of calm, not agitation.
First, stop the spiral before it starts. Be proactive. Since these are repetitive fights, they often have predictable triggers— it could be a disagreement over how to handle one of your kids, your in-laws’ pending visit, or money being tight—so talk about it calmly first. If you see the signs of a brewing fight—a shift in tone or body language—stop and take a break. Yes, it’s a time-out for grown-ups, so each partner can collect his or her thoughts. Take as much time as you need to cool off and then continue the discussion. Second, work on expressing yourself in ways that won’t lead to escalation. Substitute words that are less inflammatory—“distress” for “anger,” for example—and make sure you’re not making it a personal attack. As Roloff and Reznik explain, beginning with “You really made me angry and you need to change” will only put your spouse into a defensive or withdrawal stance; instead, phrase it as an invitation to talk,” I am bothered by your actions; can you explain to me why you did that?” Finally, each of you has to get a bead on your own negative emotions, and figure out how both to regain your own self-control and help your partner regain his or hers.  It takes two to tango and to escalate and de-escalate interaction.
3.  Rediscover touch
When you reach for your partner, what does your touch convey? Does your spouse touch you or don’t you touch at all? Ask yourself honestly and discuss it.
4. Acknowledge your differences
In his book, Why Marriages Succeed or Fail, John Gottman suggests that strong couples find “the glory” in their marriages. According to his research, these couples derive strength and meaning from the rocky times they survived and the hardships and doubts they worked through. Telling these stories in detail, Gottman notes, serves to bolster thei faith in each other and their union.
5. Increase commitment

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