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The Anxiety and Stress Management blog has now been retired. You can still find Dr. Farrell at the WebMD Anxiety & Panic Disorders Exchange. And you can visit the Anxiety & Panic Disorders Health Center for more information about these conditions.
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Posted on 1 March 2010 | 12:03 pm
SAD: The Demon Beast of Winter
SAD often affects groups who live above certain latitudes. So, it would seem, people often referred to as 'snow birds' know what they're doing when they head south for the winter. It may not be just the cold they're escaping, it may be depression. The shift that takes place in our biological clocks happens in response to the light that hits our eyes and affects our internal settings.
A small structure in our brains, the pineal gland, produces a substance which can be both problematic and helpful. The substance is melatonin and it has been linked to both SAD and sleep. During the winter months, the decreased exposure to sunlight may stimulate the production of this hormone.
How do you know you have SAD and what can you do about it? First, let's look at the usual symptoms we see with this winter variety of the disorder. Yes, there's a summer disorder, too, for some people.
SAD Symptoms
- January to February is the prime time of year in most Northern climes and we see:
- Changes in sleeping and eating habits
- Persistent sad, anxious or "empty" mood
- Loss of pleasure in activities once enjoyed
- Depression subsides in the spring and summer months.
- Symptoms have occurred in the past two years, with no non-seasonal depression episodes
- Seasonal episodes substantially outnumber non-seasonal depression episodes
- The individual craves sugary or starchy foods probably because this increases the availability of serotonin which fights depression
As a result of the dietary changes seen, there is weight gain and that further increases depression by lowering self-esteem and intensifying feelings of helplessness. Your clothes don't fit, you can't buy new ones and you feel self-conscious. Double whammy there.
Steps You Can Take
- Light box or visor treatments
- Dawn simulation devices for morning awakening
- Antidepressant medications
- Outdoor or even indoor exercise such as walking for as little as 15 minutes a day
Our thinking about how to treat SAD has changed since 1984 when Dr. Norman Rosenthal first described the disorder. Light boxes aren't seen as necessary because we've discovered that light, from any source, may be beneficial. The most interesting results have come from just plain old exercise several times a week and it can be indoors or outdoors. Walking is one of the exercises that has been found to be both useful and to involve no cost. Leave the car a few blocks away from where you've going shopping or at the edge of the parking lot, walk to the stores, take a walk around your neighborhood or in front of the TV. You can probably, if you have a high-tech home, use TV exercise programs such as the virtual tennis, yoga and other programs. This way, you avoid the cold weather and still get your anti-depression exercise fix. In the office, get up and walk things over to your colleagues, walk to the water cooler a few times a day and walk up and down stairs.
You do have resources and you can overcome this disorder, so get walking.
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Posted on 17 November 2008 | 12:30 pm
Alcohol, Stress and the Holidays
Alcohol has its many advocates in the literature of the past several centuries and it has all those witty phrases we've come across. The phrases include, "A day without wine is like a day without the sun," and "In vino veritas" (In wine there is truth). George Bernard Shaw is reported to have said, "Alcohol is the anesthesia by which we endure the operation of life" and Benjamin Franklin is quoted as saying, "Beer is living proof that God loves us and wants us to be happy." History tells us that Franklin along with many of the other Founding Fathers, was a great consumer of things alcoholic. Water, after all, was not considered fit to drink, so alcohol filled the bill for daily fluids.
The holidays are around the corner, the economy seems to be headed for a long recovery period and alcohol may play an increasing role in the lives of people in the months to come. Not just a drink for celebration, alcohol, as many of us know, is a powerful non-prescription drug that can lift someone's mood, temporarily, help with anxiety and may be beneficial to our health. All of this should be taken with a grain of salt, as the saying goes.
Red wine has come into the medical literature as something that can help with a variety of physical disorders or illnesses and, working in nursing homes, I have heard physicians prescribe a "drink" at dinner for some residents. Yes, prescribe. It has to be written into the orders or it can't be dispensed by the nursing staff. Some residents have their own liquor stored in the nursing station cabinets. I knew of one patient who had champagne for special occasions in her room. She had a terminal illness and champagne was seen as the least of her problems.
Alcohol, unfortunately, also has the ability to cause serious disinhibition with serious, sometimes fatal consequences. We've seen the stories about initiations where a bottle of alcohol has to be consumed at one sitting, or in one elongated gulp-session. In these instances, alcohol acts as a fatal poison for the breathing center of the brain. For others, alcohol facilitates actions which result in not a calming effect, but a rage reaction and not Franklin's "proof." Statistics on suicide related to the current economic gloom won't be available for another two years and one wonders what the stats on alcohol consumption will show and if there might be a relationship.
Yes, alcohol has its place in life as we've seen from its use in many ceremonies, family gatherings and holiday parties. It can serve as a mild aid to the socially sensitive, but its potential for harm has to be considered, too. The researchers who've seen some alcoholic beverages as beneficial are always cautious to say that it has to be used reasonably and, as any drug, with an eye to abuse. What is your limit on alcoholic drinks? You should know what it is and keep yourself within a safe limit. That's not me preaching, it's just good sense.
The National Center for Health Statistics (2007) found that 33% of current drinkers had five or more drinks per day in the past year; in 2005 there were 21,634 deaths related to alcohol excluding accidents and homicides. Alcohol deaths were 3.2 times more likely to occur in males as females. One of the major problems with alcohol, in addition to these grim statistics, is that anxiety is related to alcohol abstinence. So, if you drink to help handle your anxiety, trying to cut down on your drinking will result in more anxiety which, in turn, leads you right back to drinking again.
What the National Institute on Alcohol Abuse & Alcoholism Suggests
First, you have to be honest with yourself and answer a few questions:
- Do you drink alone when you feel angry or sad?
- Does your drinking ever make you late for work?
- Does your drinking worry your family?
- Do you ever drink after telling yourself you won't?
- Do you ever forget what you did while you were drinking?
- Do you get headaches or have a hang-over after you have been drinking?
One "yes" response can indicate you have a drinking problem and you may need professional help to stop. If you do agree that you need help, you can begin helping yourself right now. Steps that are suggested include:
- Write down your reasons for cutting down or stopping drinking.
- Set a drinking goal. Not a bad idea whether or not you have a problem with alcohol.
- Write your drinking goal on a piece of paper and keep it where you can see it.
- Keep a daily diary of your drinks that includes the number of drinks, what they were and where you did your drinking.
- Take a break from alcohol and make at least one or two days a week alcohol-free days.
- Stay active and get involved in something that doesn't include alcohol.
- Seek out support from family, friends or groups.
- Remember the places, people and times of great temptation for you. Plan ahead when you are going to social or business events so you can avoid drinking or going over your limit.
- Don't drink when you are upset or angry.
- Do not give up. It takes time, like anything else, to reach a goal and along the way there are going to be things that will make you want to toss in the towel.
Remember, there are always going to be "reasons" to drink that don't include special occasions or ceremonies and you don't want to take the bait. One of the most unfunny and, potentially disabling remarks I've ever heard is, "Well, it's 5 o'clock somewhere, so we can begin drinking now." Not funny.
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Posted on 12 November 2008 | 6:19 pm
