The SAD time of year

It’s that time of year, when the days get shorter and the amount of sunlight we are exposed to decreases dramatically. In some individuals who are predisposed to Seasonal Affective Disorder (SAD) this corresponds to an increase in depressive symptoms. While the cause of this disorder is not fully understood, many believe that changes in our neurochemicals may be responsible: specifically changes in Melatonin levels. Melatonin is a chemical that is produced during the hours of darkness; it is involved with regulation of sleep, temperature, and release of other hormones. It is thought that individuals with SAD produce an excess of Melatonin that leads to depressive symptoms.

Symptoms of SAD can sometimes mimic hibernation: tendency to sleep more, eat more (especially cravings for high carbohydrate items), weight gain, irritability, fatigue, social withdrawal and isolation (in addition to other signs of depression: sadness, hopelessness, anxiety, loss of interest and pleasure, and difficulty concentrating and focusing. SAD is more than the “winter blues” and requires a full diagnosis of Major Depression with the seasonal specifier for timing.

If you suspect that you might have SAD or Seasonal Depression, please see your doctor for full evaluation and discussion of treatment options. Many treatments are available and may include Light Therapy, medications, and psychotherapy. Light Therapy (with a specialized lamps using 10,000 Lux bulbs) should be initiated in early November and continued on a daily basis, for 30 minutes daily, until March or otherwise instructed by your healthcare professional. It’s not too late to address the cycle of moodiness and loss of motivation that may occur this time each year.

Should Christians Take Antidepressant Medications?

The decision to seek treatment for any condition can be a difficult one.  The decision to seek treatment for depression and anxiety can be made significantly more difficult by current social stigmas and also by one’s interpretation of religious beliefs.  This question represents so many other questions that can become barriers to treatment: If I seek treatment, does it mean I don’t have enough faith in God’s healing power?  If I seek treatment, does it mean that there is something really wrong with me?  If I seek treatment and someone finds out, will they judge me in a negative manor?  I have lost count of how many believers have delayed or avoided treatment for these very reasons; not to mention how many stop treatment prematurely so they can “get back to thinking that there’s nothing wrong” with themselves.  These same people generally would not hesitate to seek treatment for high blood pressure or diabetes.

 

My response is this: Our bodies are temples that we are entrusted with caring for.  We are an incredible collection of cells, nerves, chemicals, and more that are continually changing in response to biologic, psychological, and social factors.  Sometimes our chemistry can become unbalanced necessitating the use of antidepressant medication to correct states of depression and anxiety when they cause dysfunction in our lives.  Depression and anxiety are not punishment; they are real medical conditions that can respond to specific treatments.  To not take the steps needed to maintain our bodies would be far more wrong and damaging; sometimes this might mean taking medications in addition to doing therapy and other activities.  Have faith that the God of the Universe is not limited in His capacity to heal: that healing may very well be accomplished through any variety of treatment modalities including medications. Find a physician, who understands your beliefs and listens to you, but don’t avoid or delay getting the help you need.

Book Review: Find Your Stongest Life: What the Happiest and Most Successful Women Do Differently by Marcus Buckingham

Despite unprecedented opportunities in all spheres of daily living, women are becoming increasingly unhappy, less satisfied, and less fulfilled in their lives. Somehow on the path to “having it all” women got lost. By believing that the only way to “have it all” was to be perfectly balanced and accomplished in all areas: wife, mother, career, civic, and social—women have experienced feelings of failure, self-doubt, and shame. In his book, Find Your Strongest Life, Mr. Buckingham provides a different model for “having it all” (defined as “drawing enough strength from life to feel fulfilled, loved, successful, and in control) then provides a set of different “Strength” based tactics to accomplish this.

Find Your Strongest Life reads and feels like being at a motivational seminar, complete with Power-point style recaps at the end of each chapter. He utilizes an online strength assessment to help determine “the role you were born to play.” Overall, the book is very accessible, addresses numerous real-life situations faced by today’s women, and provides workable solutions and suggestions for all. The shift in focus from “Balance” to “Fullness” by focusing on “capturing moments” that bring strength feels both intuitive and empowering. This book will be beneficial for all women who are stuck in the search for “elusive perfection” amid the bounty of choices available to us.

Donald Miller: Million Miles Tour

Book Review: A Million Miles In A Thousand Years by Donald Miller

So…what’s your story? I love stories–always have.  I may not always remember names, but I rarely forget a story. A Million Miles is one story I am certain not to forget.  I became acquainted with Mr. Miller earlier this year through his bestseller, Blue Like Jazz (2003)– an excellent work in itself: especially cathartic for those who might be recovering from negative religious experiences. A Million Miles is the powerful story that arose as Mr. Miller was approached about turning Blue Like Jazz into a movie.  Mr. Miller has an exceptionally engaging and easy style of writing that complements and lends credence to this insightful memoir.

A Million Miles is the story about “Story”: what makes a good story; the transformational power of stories; and most of all, about our ownership and responsibility for our own story.  In many ways, Mr. Miller’s story is not unlike the stories my patients share with me on a daily basis: the quest for love, meaning, adventure, forgiveness, and purpose; these elements making up some of the pillars of most good stories.  As Mr. Miller faces his own conflicts and demons, he inspires the reader to take a chance and live “a better story”.  Mr. Miller shares so much of himself in his writing that a sense of familiarity and intimacy is conveyed:  he feels like a trusted friend that you want to succeed.  His narration is both humorous and poignant. A Million Miles balances being instructive and encouraging, avoiding being dogmatic or “preachy”,  while demonstrating that significant life-changes are both possible and worthwhile.

As a psychiatrist, I am blessed to get to hear individuals’ stories on a daily basis: to reflect back these stories (as a type of whiteboard) and help my patients make course corrections as desired.  I have already begun recommending A Million Miles to many of my patients as well as to my friends.  I find it to be a most entertaining guide to assist anyone in “speaking a better story”.  I share Mr. Miller’s basic precept: all human life is meaningful and the best path finding meaning is by doing.  I am grateful to have read this wonderful book.  I recommend A Million Miles highly and without reservation.

Book Review: Love & Respect by Dr. Emerson Eggerichs

All you need is love? Not according to Dr. Eggerich:  Love & Respect, based on Ephesians 5:33 and culminating from Dr. Eggerich’s vast experience in pastoral and marital counseling, focuses on the transformational power of unconditional love and unconditional respect in marriage. Although it is certainly not the most entertaining or captivating book, Dr. Eggerich does successfully capture one of the primary sources of conflict in a majority of marriages: unmet needs.  Dr. Eggerichs postulates that women have an innate need for love and that men have an innate need, not for love, but for respect.  He explains that the failure to have this essential need met results in a cycle of reacting and withholding the other from one’s spouse, dubbed the “Crazy Cycle”.  While this may seem an overly simplistic distillation, it does have merit.  In a highly unscientific poll, I queried my patients over the past week that were experiencing challenges in their marriage: 100% agreed, not only that “love & respect” were an issue, but also that the converse had the potential for restoration.  Dr. Eggerich presents his thesis in the first section, accompanied by many relevant and supportive Biblical quotations.  He follows in the subsequent sections with suggestions for creating an “Energizing Cycle” including specifics on how to express your love/respect in a way that the other spouse can receive; then concludes with the “Rewarded Cycle” and several appendices with practical exercises.  While Eggerich tends to be redundant in his writing style, his message is both valid and useful in application.  I recommend this book for couples that are experiencing difficulties in their relationship or those who want to take their relationship to a higher level through improved communication and greater understanding.

Book Reviews forthcoming….

One of the most frequent requests I receive from patient is for book recommendations.  I have not been as much of a “reader” as I would like in the past few years; but have decided to remedy that.  I have agreed to review a few books from Thomas Nelson Publishers: specifically those applicable to mental health and relationships.  First up:  Love & Respect by Dr. Emerson Eggerichs followed by the latest from Max Lucado: Fearless.  The first review should be available within the next few weeks.  I am open to suggestions for future titles as I have found some of my favorite books at the recommendation of my wonderful patients.

Adam: A Movie Review

I had the pleasure of attending a screening of the film Adam on August 18^th, 2009.  This film, written and directed by Max Mayer, tells the story of an awkward and unusual relationship between two neighbors: Adam Raki, who has Asperger’s Syndrome, and Beth Buchwald, who aspires to write children’s books.  Adam is one of three new films being released featuring individuals with this complex and mysterious disorder considered to be an Autism Spectrum Disorder.

The film opens with what could easily be considered every parent of a child with disabling condition’s worst nightmare: the funeral of his parent and caretaker.  Thus, my initial reaction came not as a psychiatrist, but rather as the parent of a child on the autism spectrum:  “I cannot die—who will look after my child?”  This reaction is understandable  given the film’s remarkable job of depicting the reality of day-to-day living with this difficult condition: the need for routine and structure, problems adapting to change, communication challenges arising from rigidity of language, as well as other problems interacting with the “neurotypical” world—including the benefits of having a trusted advocate and interpreter to facilitate these interactions.

Hugh Dancy does a wonderful job portraying Adam Raki: complete with his fixation on astronomy, awkward social interactions, and tender gestures.  He depicts many of the physical attributes common to those with Asperger’s syndrome, including lack of appropriate eye contact as well as other automatisms, with absolute accuracy.  Dancy is able to capture not only these differences, but also the courage, subtle tenderness, and humanity that enables the audience to not only accept him, but to hope for him as well.  The neighbor Beth, beautifully acted by Rose Byrne, is portrayed as incredibly kind, patient, and understanding—yet seems too idealistic to be believed at times.

The story is insightful, engaging, and entertaining; it has the potential to bring awareness of this condition to audiences that hopefully may lead to a greater understanding of, compassion for, and acceptance of individuals with this disorder.  Adam captures the hope and possibilities for those who are affected by this condition in a very accessible, balanced, and believable manner.  While Adam unfortunately does not seem destined for blockbuster status, it is easy to see why it won the Alfred P. Sloane award at the 2009 Sundance Film Festival.  I highly recommend this movie to those with an interest in Autism Spectrum disorders as well as to those just looking for a tender, romantic movie.

To Tweet or Not to Tweet…?

It seems that everyone is a-twitter about Twitter. This social networking site has exploded in recent months leading many to ask the questions: “What is it?” and more importantly, “Why Twitter?” I created an account to experience the phenomenon for myself. Twitter appeals to me on several levels: from the tech/gadget geek side as well as from a psychological perspective—”tapping into the stream of human consciousness”. Fellow psychiatrist Dinah Miller, of ShrinkRap fame, did a similar experiment herself: after one week of Tweeting she posted: “My week is almost up. I still don’t get this. Who is rilescat and why does he have a dead panda on his desk?” There is certainly no shortage of characters in Twitterland. I was impressed with the amount of wit and wisdom being shared in 140 characters. The requisite brevity forcing some to re-discover the art of editing: making every word count. I also observed some incredibly empathetic and compassionate exchanges: including one mother’s life-changing foray into the world of childhood leukemia. Twitter has been described as “a cocktail party” and Facebook as “a dinner party” given the degree of intimacy with ones friends and followers; this seems to be quite accurate. Twitter seems to function best in niches: thus promoted by the use of “Hashtags”.

 

To “get it”–to understand WHY, it is necessary to look at the motivation of each individual. Twitter asks the question: “What are you doing right now?” Differences in motivation lead to diverse responses to this simple question and a variety of Twitter experiences: some individuals are looking for entertainment, some for connection, some for information, and others for self-promotion. The potential for all exist in abundance on Twitter.

 

Many basic emotional needs of individuals can potentially be met through social networking: feeling validated, belonging, being heard… and with minimal risk of emotional trauma and physical effort (as one can happily tweet away in ones pajamas). While this connection for such individuals who may have limited access to other interaction can have certain positive aspects; (ie, a mom who stays home with her children); one must also consider the potential negative consequences of such virtual relationships as well. When needs are met in this superficial way… is the individual kept from developing deeper, albeit more complicated relationships in the world beyond the internet?

 

The potential for constant connectedness leading to the loss of being fully present in one’s “real” life is another concern. When I first began looking for people to follow, I searched for Jon Kabat-Zinn (author & founder of Mindfulness Based Stress Reduction): figuring that he would disseminate some incredibly wise tweets. He’s not on Twitter; the closest I could find was a remark about Twitter being the antithesis of mindfulness. No less concerning is the diversion of time and energy from other “real world” relationships. It is not unheard of for people to spend upwards of 5 hours daily checking their Facebook, MySpace, and Twitter accounts.

 

Perhaps the first question to answer before “What are you doing?” is “What am I doing here?”; consider if the virtual world is the best place to accomplish your goals. As for myself, I remain undecided. While I am absolute junkie for wit and humor, I have found the pace of information to be excessive at times. As with most things in life, it will come down to finding the right Balance… and the determination of how long to stay at the “party.”

Hope… for the economy & in depression

I had the pleasure of watching Dave Ramsey’s Town Hall for Hope last night. I like Dave Ramsey’s approach to money and I often recommend his “Financial Peace” program to my patients who are struggling with financial difficulties. I appreciate his take on the family’s budget as being just that: the outline of the family’s priorities as determined by the entire family together. His focus on personal responsibility resonates with me as well. I thought his presentation was uplifting and encouraging as he reiterated his common sense financial fundamentals to allay the “spirit of fear” that has come over most of America. If you missed it, I would encourage you to check out his website: www.townhallforhope.com .

Mr. Ramsey concluded his presentation with three action steps to combat “fear, panic, and hysteria.” They are: “take action, don’t participate in loser talk, and be giving”. I was struck by the need to apply these same principles in all areas of our life where we experience hopelessness: concern about a down-turned economy, dealing with difficult life situations, and most certainly, dealing with depression. Hopelessness can be one of the most challenging aspects of depression due to its invasive and destructive nature.

Let’s look at each step of the action plan as it pertains to mental health:

Take Action: “Get up, take action, get moving.” My treatment plans almost always include a recommendation for exercise. This type of “action” gets people off the couch and “out of their heads” at least for the moment. The mood enhancing effects of exercise have been well documented: improving levels of mood-enhancing neurotransmitters in the brain, boosting endorphins, releasing muscle tension, reducing stress –hormone cortisol levels, as well as improving sleep, confidence, and potentially reducing isolation. Exercise and music therapy remain some of the best non-pharmacologic steps individuals can take to improve their mental and physical health.

Don’t Participate in Loser Talk: This is one of the basic principles of Cognitive Behavioral Therapy. Specifically, don’t stay stuck in negative thinking. There really is power in positive thinking. Seek to identify and correct any distortions of thought that might be keeping you mired in negativity. Hopelessness is associated with many such “loser thoughts” that lead to poor self-esteem and creating a self-fulfilling negative spiral of thoughts and beliefs. Surround your self with optimistic and encouraging people and avoid those besieged with the “Spirit of Eeyore”.

Be Giving: Of all the recommendations I make to patients, giving can have the most profound effects on peoples’ lives. Giving is empowering. It improves self-esteem, imparts a sense of connectedness, and can foster an optimistic attitude. Altruism is one of the surest ways to restore hope as well as restoring an individual’s sense of purpose and meaning. Being a part of a cause larger than oneself and the feeling of making a difference in others’ lives are crucial for mental well-being. Giving, especially gifts of time and service, can grant a person perspective thus enabling him to look beyond his problems for a little while.

So no matter what obstacles or challenges you might be facing in your life, I join with Dave Ramsey in encouraging you to choose HOPE now.