Feeling Blue? It could be Seasonal Affective Disorder...

Seasonal affective disorder (SAD) is one of the few ailments that is on a clock: It usually begins in October, and people who suffer from it usually feel the full effects in January and February. We also know that it’s more common for people living in places that get less sunlight during the winter and it’s more common in women than men, according to psychologists and researchers.

Traditionally, SAD is treated with antidepressant medication or light therapy, but there has been recent piloting towards a new approach using cognitive behavioral therapy (CBT), looking at the effects of CBT method on reducing negative thought patterns for people with SAD, using the Socratic method to interrupt negative thought patterns and make way for more mood-neutral thoughts, while simultaneously focusing on behavior and helping people to make slight shifts in their habits.

Here are a few questions to consider.

Q

What is seasonal affective disorder?

A

Seasonal affective disorder is a type of clinical depression that commonly occurs in the fall and winter months and typically resolves in the spring and summer. While it can take any seasonal pattern, the fall/winter type is overwhelmingly the most common. The only thing that makes it different from garden-variety depression is the seasonal pattern that it follows.

Because of their similarities, SAD is often misdiagnosed as depression. It sometimes takes a few years for people who have this pattern to recognize that it’s a pattern, and that it’s tied to the seasons.

Q

What are the most common symptoms?

A

Because we’re diagnosing depression when diagnosing SAD, we look for at least five of the nine diagnostic symptoms of depression. We’re diagnosing a depression that follows a seasonal pattern, meaning we’re looking for depressive symptoms that are present much of the day, almost every day, for at least two weeks. The hallmark symptoms of depression are:

  1. Feeling consistently down for most of the day or nearly every day.

  2. A loss of interest in the things that would have otherwise been enjoyable, such as social activities that previously would have brought a sense of enjoyment or pleasure.

  3. Feeling overwhelmingly tired or experiencing low energy.

  4. Inability to hold attention and focus or experiencing difficulty in concentrating.

  5. Feeling worthless or hopeless.

  6. Issues with sleep. Either too little or too much. In winter depression, we tend to see hypersomnia or sleeping too much. In most cases, the individual sleeps for at least an extra hour a day compared to the spring or summer. Some patients may sleep ten to even fourteen hours a day and are still tired. It’s not restorative sleep that we’re seeing. A minority of patients, on the other hand, experience insomnia.

  7. Changes in appetite or weight. This could be either wanting to eat a lot more or a lot less than usual. In winter depression, it’s usually wanting to eat more, and it’s usually carbohydrate-rich foods. Either sugars, starches, or both. With this, we typically see weight gain with an increased appetite or weight loss with a decreased appetite.

  8. Agitation often accompanied by feelings of guilt and shame.

  9. In extreme cases, thoughts of death or suicide.

Individuals can be diagnosed with SAD when they’re experiencing five of these symptoms, which need to include the first and/or second symptom.

These are not momentary symptoms; rather, they are pervasive for at least a couple of weeks. On average, it’s estimated to be five months of the year in a major depressive episode. It’s a lot of time to spend in depression, in terms of the cumulative toll that it could take on a person’s life.

Q

Whom does it affect most?


A

Similar to depression, there is a pronounced gender difference for those affected by SAD. Depression in general is two times more common in women than in men, and data suggests seasonal depression is even more common in women than in men. When we look at its prevalence, we’re looking at a single snapshot in time. And we’ve found that most cases occur in young adults, typically in their twenties to thirties. We’re not entirely sure why it occurs in this age range, though, since these studies don’t follow people over time. One theory is that SAD becomes less prevalent as people age, because they learn how to cope with it or possibly move to places that don’t have winters that are as harsh.

Q

How does SAD differ from depression? For individuals who have been previously diagnosed with depression, does that put them at an increased risk of developing SAD?

A

It’s estimated that up to 10 to 20 percent of recurrent depression cases follow a seasonal pattern. This is generally the course of depression, in which a depressive episode tends to return over time, with periods of time without depression between the episodes.

For SAD patients, there are unfortunately very few studies that have tried to look at the long-term trajectory of the disorder. So we don’t have a coherent idea of its outlook. We’ve tried contacting people we knew who had SAD in the past to learn about their experience and see where they’re at today, and we’ve found mixed long-term courses. A lot of them continue to experience SAD episodes every winter. Others become more subclinical, where they used to have full-threshold SAD, and now they may just have the winter blues. Some develop a completely nonseasonal course where they still have depressive episodes but it’s not tied to the seasons. And others fully remit, where they don’t have depression, seasonal or otherwise, moving forward.

In terms of how SAD differs from depression, there is a strong correlation of SAD with latitude in the United States. The farther you are from the equator, the more cases you’ll find. It is estimated that 9 percent of those people who live in Alaska suffer from SAD, compared with 1 percent of those who live in Florida. For most people—at least in the northern United States—SAD slowly begins in October. People often report an increase in their symptoms after the end of daylight saving time and experience their symptoms in full effect in January and February. It is in these two months that we find the largest proportion of SAD patients in a full major depressive episode.

Another strong link is photo period, or length of daylight. Photo period is the strongest predictor of when symptoms start in any given year for someone who has seasonal affective disorder, as well as how severe the symptoms are on a given day. The number of hours from dawn to dusk determines your photo period. We believe that photo period is what explains the onset of this disorder and can determine how bad symptoms may be on any particular day.

Q

What is the traditional approach to treating SAD?

A

Light therapy was the first line of treatment developed specifically for SAD patients. It was developed at the National Institute of Mental Health under Norman Rosenthal. He was a psychiatrist who moved from South Africa to Bethesda, Maryland, to work at the National Institute of Mental Health, and he experienced SAD symptoms. He was interested in learning more about it, and seeing if others experienced similar symptoms. He put an ad in The Washington Post, asking whether anyone experienced depression in the fall and the winter, and the lab phone rang constantly for weeks at a time. They had a huge response from people who thought they had the symptoms. They brought them they seemed to follow. From this, they developed light therapy as a form of treatment.

With light therapy, the goal is to give people a very bright dose of light, first thing in the morning, to simulate an early dawn. In theory, we’re trying to jump-start a sluggish biological clock, so that circadian rhythms go back to a normal phase as if they’re in the summer, when these people are feeling good. The devices tested in clinical trials are 10,000 LUX, which is the same intensity of light from the sky at sunrise. We block out the UV rays since they’re not necessary for an antidepressant response. We’ve found that prescribing patients to sit in front of 10,000 LUX for at least thirty minutes a day is what it takes for the treatment to be effective in people who have SAD. That said, similar to finding the right antidepressant, it can be a bit of a trial-and-error process. We try to find that sweet spot of exactly how many minutes a day and at what time or times of the day it’s most effective for the patient. The optimal benefit from light therapy must be determined on an individual basis so we can balance any side effects they may experience in response to the light.

The same drugs that are effective in treating nonseasonal depression—particularly SSRIs like fluoxetine/Prozac—have been tested for SAD with a good outcome in placebo-controlled studies. There is one drug that’s FDA-approved specifically to prevent SAD, which is Wellbutrin Extended Release. There was a large multisite study—with the GlaxoSmithKlein drug—completed a few years ago with over 1,000 SAD patients. The study compared putting people on the Wellbutrin Extended Release versus a placebo, and the participants started the treatment early in the fall when they weren’t yet having their symptoms, and the study followed them into the winter. The researchers found fewer relapses on the drug than with the placebo, which led to the FDA approval of the medication. Either bright-light therapy or antidepressant medication are typically used in treating SAD.

Q

How can cognitive behavioral therapy be used to treat SAD?

A

There is an extensive body of research demonstrating that CBT is an effective talk therapy for people with depression. There have also been a lot of clinical trials showing that it worked as well as antidepressant medications for improving depression. Additionally, when you follow people over time, after they’re treated to remission using CBT versus treated to remission using antidepressant medications, there are fewer relapses and recurrences among those treated with CBT than those treated with antidepressant medication.

Q

Recommendations?

A

Resist the urge to self-diagnose and self-treat. Seek evaluation from a qualified person who can figure out once and for all if it’s SAD or if it might be something else, including a depression that’s not following a seasonal course. And know that there are treatment options out there that are effective, including light therapy, antidepressant medications, and cognitive behavioral therapy. So there are reasons to be optimistic that one of these interventions will be helpful in terms of improving your experience.



This article is for informational purposes only, even if and to the extent that it features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. View the full article here: https://goop.com/wellness/how-to-treat-seasonal-affective-disorder/


If you live in the Los Angeles/Westlake Village area and are interested in therapy, I invite you to contact me via email at: tanyasamuelianmft@yahoo.com . I provide a complimentary consultation. Contact me now to see if we might be a good fit to work together! Or book your appointment here!

Why You Need To Know Your Partner's Love Language

Knowing a partner’s love language just might save a relationship. The idea behind this psychology is that every individual has a different way that they give and receive love. Dr. Gary Chapman, #1 New York Times Bestseller, The Five Love Languages: How to Express Heartfelt Commitment to Your Mate, argues that these ways can be divided up into 5 simple categories:

  1. Acts of Service

    If your #1 Love Language is “Acts of Service,” you feel most loved and appreciated when your partner thinks about what they can do to ease the responsibilities that are weighing on you. Hearing “let me help you with that” or “I already took care of it” is most exciting to you. Laziness, failure to perform their share of chores, or being unthoughtful with how they can help you are all easy ways for you to feel unappreciated and unloved.

  2. Word of Affirmation

    If your #1 Love Language is “Words of Affirmation,” actions do not speak louder than words. Unsolicited compliments make you feel secure and happy in your relationship. Hearing “I love you” on a regular basis is important to you, and helps you to believe you are loved. Hearing the reasons behind why they love you is icing on the happy-relationship cake. Insults are not easily forgotten and not hearing enough words of affirmation will make you feel unloved.

  3. Quality Time

    Having your partner’s undivided attention is the time when you feel most appreciated. Distractions during quality time or postponing dates can make you feel like you aren’t important to your partner. Scheduling the time to be together is crucial to the success of your relationship.

  4. Receiving Gifts

    If this is your #1 language, don’t question your character. It actually has more to do with the thought behind the gift than the gift itself. You appreciate the thoughtfulness behind gift giving (whether it’s a grand birthday present or bringing home your favorite magazine from a trip to the drugstore). All gifts, whether small and daily or big and grand, remind you how much you matter to your partner and how much thoughtfulness and effort they think you’re worth. Missed birthdays or thoughtless gifts are your relationship nightmare because it makes you feel like your partner doesn’t care about you.

  5. Physical Touch

    This isn’t just about intimacy — holding hands, hugging, or pats on the back make you feel loved and cared for. Physical closeness is directly related to emotional closeness for you, and neglect can be destructive to the relationship. A hug can lift your mood or take away your insecurities.

So why is knowing your partner’s love language so crucial to the success of your relationship?

It will help you and your partner feel more appreciated.

If you’re an “Acts of Service” person dating a “Words of Affirmation” person, your partner might shower you with compliments and “I love you”s every day, but you would spend the relationship not feeling truly appreciated because they never offer to run errands or do the dishes. Understanding your partner’s love language will help you discern how they show their love, so that you do feel loved and appreciated, knowing the way in which they give their love is different than yours.

It will allow you to communicate your needs more.

Understanding that they do other things out of love, and that they just have a different love language, will help you to communicate, “it makes me feel appreciated when you clean the kitchen,” or “I feel loved when you hold my hand.”

It will show you and your partner what you both should do without being asked.

Knowing your partner is a “Physical Touch” person will make you more thoughtful about holding their hand in public or hugging them when they’re down, and you will be able to understand the meaning and importance behind these little acts that, for you, would otherwise be insignificant. Your partner will be more conscious about what they can do to show you how much they appreciate and love you. When you and your partner both know how the other gives appreciation and wants to receive appreciation, it makes for more thoughtful decisions and efforts that make you and your partner both feel loved and valued.

If you live in the Los Angeles/Westlake Village area and are interested in therapy, I invite you to contact me via email at: tanyasamuelianmft@yahoo.com . I provide a complimentary consultation. Contact me now to see if we might be a good fit to work together! Or book your appointment now!

Unpacking Emotional Baggage

When dealing with emotional baggage, you are constantly struggling under the weight of baggage, bad filters, and triggers. In any situation, nothing that is said is evaluated objectively. Everything is going through a filter that distorts the original message. It stops being about the content of the message, and instead becomes about our perceptions of the sender, and more importantly, about us. We have let ourselves get to the point where we're not really hearing anymore, we're just judging. If you've reached this point with someone, it's time to unpack your baggage.

Here are a few things that contribute to the problem and understanding them is important tp changing the situation:

  • Your brain processes most information using primitive filters looking only for the most basic information about threats that should be attended to.

  • Attention errors make it likely that you'll pay more attention and give weight to information that confirms your original point of view.

  • You don’t get to hear the intent of people’s messages; you only to get hear how their words come out and to feel how the message impacts you. The disconnect between intent and impact is at the heart of many strained relationships.

Start with a Positive Assumption

The next time you react to something someone else says, turn the situation on its head. Start with a positive assumption, rather than a negative one. Instead of assuming that a person is attacking you, start by assuming they are adding value.

  • Instead of having your normal reaction to what is said, really think about it. Repeat what they said in your head before responding. Think about the words, without reading between the lines or thinking about the back story. Hear the words coming out of someone else’s mouth—how do you interpret them now?

  • Pay attention to the positive, rather than the negative components of the message. Did the person start with a compliment and then share some constructive feedback? Focus on the compliment for a moment. Let it soak in.

  • Think about the possible positive intentions they might have had. How might the person have been trying to help? What were they trying to get at? What value are their comments adding?

If you start with a negative assumption, you waste all the value that others could be providing.  A positive assumption is the only thing that gives you a chance.

If you live in the Los Angeles/Westlake Village area and are interested in understanding your emotional baggage and unpacking them, I invite you to contact me via email at: tanyasamuelianmft@yahoo.com . I provide a complimentary consultation. Contact me now to see if we might be a good fit to work together! Or book your appointment now!

Forgiveness

What does forgiveness mean to you? What does it mean to forgive someone? What does it mean to forgive yourself? It sounds like it would be an easy question to answer, but I challenge you to pause and really think about the last time you forgave someone, or even yourself. Many times, it’s easier to forgive someone else before you can forgive yourself. Here are a few key things to remember when forgiving yourself:

  • admit the wrong: take ownership of what you did. You have to deal with it, face what you did, and how the situation was created by what you did. We are all human and you’re going to make mistakes.

  • prepare to restart and try again: continuing to punish yourself for the past only blocks you from your own happiness in the present. You are allowed to grow and become a better person. Make amends with others and yourself, keep what you have learned, and let go of the rest.

  • a restart is not an undo: although forgiving yourself is important, you have to remember that others may continue to hold on because you cannot control how anyone else thinks or feels, and forgiveness is not permission to do it again. You can’t force someone else’s forgiveness, and just because you apologize doesn’t mean that the person who was affected will accept it; however, that does not mean have to continue to punish yourself for whatever happened.

In order to grow as people, we have to learn from our mistakes and our past. We have to forgive ourselves even when others might not. Forgiveness is an important and necessary part of building a loving and trusting relationship with yourself.

What are some ways that you forgive yourself? Share in the comments below!

If you are finding yourself struggling with forgiveness and live in the Los Angeles/Westlake Village area and are interested in individual or couples therapy, I invite you to contact me via email at: tanyasamuelianmft@yahoo.com . I happily provide a complimentary consultation. Contact me now to see if we might be a good fit to work together!

Preparing for a Good Week Ahead

Happy Sunday! There are a few tricks to setting yourself up to have a really good week ahead. How you spend your Sunday has a big impact on you feel the rest of the week. Having a Sunday ritual helps to create the positive environment and mindset you want to have in order to be prepared for a really great week ahead. Here are some tips:

  • meal prep: taking some time out of your day to meal prep will allow you to get all of your meals ready for you to just grab and eat during the week. Not only will it save you time and stress, but it also makes it so much easier to eat healthy since you don’t have to think about it.

  • clean up your space: the way your space looks makes a huge impact on the way you feel. If your home is messy, you feel like your life is a mess, too. Kick off the week right by spending a little time on Sunday tidying up.

  • enjoy some self care: taking time for yourself on Sunday will boost your mood, relieve stress, and will make you feel overall happier so that you can dive into the new week with a good mindset.

  • set your intentions: setting an intention for the week ahead is so powerful. It’s not so much about goal setting or what you want to check off your to do list; it’s more about deciding how you want to feel in advance. 

  • plan out your week: this one is especially important if you know you have a busy week up ahead. Instead of just letting your to-do list roam around in your mind, get it all down on paper and map out when you’ll get what done. This will instantly relieve some stress which allows you to focus on just the tasks that need to get done for the day — instead of feeling overwhelmed by everything that needs to get done that week.

What are some of your Sunday rituals? Share in the comments below!

If you live in the Los Angeles/Westlake Village area and are interested in individual or couples therapy I invite you to contact me via email at: tanyasamuelianmft@yahoo.com . I happily provide a complimentary consultation. Contact me now to see if we might be a good fit to work together!