Thursday, December 31, 2009

Live 2010 Like You Want To

By Bill Callahan, M.D. 

It’s that time again.  Big balls dropping, toasts given, resolutions given and many broken.  We are on the eve of a New Year. I look at a resolution for change, whether on January 1 or on any anniversary, as a battle between the healthy part of me that is for change and courage, and the destructive part of me that wallows in ruts and familiar patterns.

A careful review of our behavior over the past year allows us to see the thoughts, actions, and fear that causes us to retreat into familiar patterns with known results.  We can predict, if we are honest with ourselves, how we talk ourselves out of change, and perhaps berate ourselves after we get disappointed.  This hopeless pattern does not need to continue.

I find when I set out for my three mile run in the dark at the end of the day, that there is a point just before a mile where my mind and body scream out with every reason to give it up (just for today they tell me) with all kinds of legitimate reasons to postpone, and yet when I make myself persevere there is a powerful euphoria related to the genuine side of me winning over the part that wants to quit and postpone.  We all have the chance to strengthen our healthy side and weaken the self destructive parts of us.

A few ideas that I use to keep resolutions for change, at New Year’s or any anniversary that matters to me:

1.      1. Do set goals.  The focus of our minds makes a huge difference.  Take a look at the movie What the Bleep Do We Know to get a glimpse into the untapped potential of the human mind and spirit.

2.      2.  Catalogue the ways you talk yourself out of change, postpone and procrastinate so that you know the enemy parts of yourself and their maneuvers.  Every time you stop one of them it’s another win for you.

3.     3. Pat yourself on the back for successes, but don’t reward yourself by undoing your gain (spending money if you are reigning that in, eating excessively when you wish to lose weight).  Speak honestly to yourself when you have given in to your destructive side but without berating yourself.

4.     4. Learn to talk in terms of what you want and will do.  Remove the words should, need, have to, can and can’t from your vocabulary.  This language reinforces obligation, which can cause a  knee-jerk stubbornness, and the helpless part of our character.  These parts are not our friends.

5.     5. Remember, when waging war for your independence, there will be many battles.  You simply need to win more than you lose, and you can do that.

Monday, December 28, 2009

New Routines for the New Year

by R. Scott Benson, M.D.

A reader asked what to do before you get to the doctor asking about medication for a child’s school behavior problems. I thought it appropriate to answer that question and take advantage of the tradition of setting New Year’s resolutions.

In general, the answer is increased structure, not punishment. Set routines that head off trouble before it starts. Families can improve structure with a behavior plan. You will get the best success if you focus on one problem area to address and promote a positive behavior that would prevent the problem. And it will take 2, 3, even 4 weeks to see consistent change.

Let me give an example. I asked a second grader “What time do you get up in the morning?” He gave his mother a puzzled look, hoping she would answer the question. But I pressed a little, “Tell me about getting up in the morning.” Now we get the interesting part. “Well, my mother wakes me up, but I can stay in bed. She calls me a couple of times before she sends my dad in. Then I get up.”

Many families do this kind of complicated dance every school morning. Of course, it adds to the parents’ frustration when the same sleepy-head child bounds out of bed early Saturday if cartoon time is scheduled.

One family faced with this fight every morning decided to send Dad first. And they kept score with punch tickets which could be traded for a treat (a special late movie on Friday, a lunch out with Dad on Saturday). And they practiced their lines, “Good morning, this will be a great day.” Or something similar.

Has you family found a different solution to this problem? What are the other conflicts that repeat every day in your house?

Friday, December 25, 2009

Healthy Eating

by Felicia K. Wong, M.D.

In my previous blog post, I brought up the importance of exercise as an effective treatment for depression. Today, I’d like to focus on another aspect of lifestyle that you can control to improve how you feel about yourself:

Healthy Eating.

Psychiatric medications and mental illness can pose a double threat to maintaining healthy weight. A common challenge faced by people with mental illness is weight gain. Some psychiatric medications can stimulate appetite and lead to overeating. Others cause sedation, decreasing your energy expenditure and calories burned. Mood disorders have been shown to create carbohydrate cravings because carbs increase serotonin, a chemical that makes us feel better. Eating too many carb-rich foods can lead to repetitive episodes of weight gain or failure to succeed on weight loss regimens.

For people with mental illness, proper nutrition is extremely important to overall health. Weight gain is not only detrimental to emotional health, as it can lead to poor self-esteem and worsening depression - it can also be physically dangerous, increasing the risk for many medical problems including diabetes, heart disease, osteoarthritis, hypertension and gallbladder disease.

Here are some basic tips to jumpstart a healthier diet and promote weight loss:

1. Read the food label.

2. Pay attention to portion size.

3. Eat slowly to give the stomach time to signal the brain when it's full.

4. Eat more frequent small meals and snacks to lower insulin levels, reducing the production of body fat.

5. Differentiate between stomach and psychological hunger. Try not to soothe your negative feelings with food.

6. Reduce fast food intake.

7. Minimize soft drinks with sugar and other high calorie beverages.
8. Eat more fruits, whole grain, vegetables, lean meat, fish, and poultry.

9. Prepare food by broiling or baking more often instead of frying.

10. Keep food/activity diaries.

Start the New Year out with a resolution to eat healthier and lose weight!

Tuesday, December 22, 2009

Am I Alone?

by Gariane Phillips Gunter, M.D.

Am I Alone? by Megan Hance

I get a funny feeling, it comes from deep inside.

I get all mad and angry, wanting to go and hide.

My doctor calls it depression, my dad says it's just me.

But the thoughts and feelings, no one will ever be able to see.

Some say I'm psycho, some say I'm just weird.

It's like I'm a different person, and the old me just disappeared.

I get really edgy, I want to commit suicide real bad.

Then I get a headache, followed by feeling sad.

I wish I could get help, I wish it would go away.

Maybe if I keep praying real hard, it will some day.

I came across this poem and think that the author does a beautiful job of describing the stigma often experienced by those with mental illnesses. The holiday season can be a particularly difficult time as symptoms of depression and anxiety may flare, and feelings of hopelessness creep in.

If you feel yourself slipping away, please contact your doctor or a friend and get help right away. Receive the gift of treatment that everyone deserves. I wish you all a safe and Merry Christmas.

Friday, December 18, 2009

Thanksgiving – the true spirit of this holiday season.

By Roberto Blanco, M.D.

I love Thanksgiving. It is my favorite holiday of the year. Each year my family gets together to catch up, share quality time and make plans for the future. Leading up to the holiday season this year, however, I had been feeling less than excited about the holidays. Having become accustomed to my daily routine, I found myself searching for a way to escape that monotonous, empty feeling.

So, this year, in celebration of Thanksgiving, I began a list of gratitude: 100 things for which I am thankful. This is not a list of wants or obligations that we create for ourselves - a Christmas wish list, a list of New Year’s Resolutions, or a ‘Bucket List’ (a list of things to do or see before you die). It is a celebration of that with which you have already been blessed. On my list included things like having my health, living in a country with tremendous opportunity, and being able to spend time with family.

Nobody’s family, financial, or personal situations are perfect. For evidence of this, just look at the personal lives of celebrities. And so it’s not surprising that many people can get down during the holiday season because it often reminds us of what we don’t have or didn’t accomplish. This often leads to feelings of emptiness or longing that set the stage for self-destructive situations.

Many individuals take what they have been blessed with for granted and don’t truly appreciate what they have until it’s gone. If you have ever lost something dear to you, you understand this adage all too well. This year, let’s try not to make the same mistake. This year, let’s focus on what we have rather than what we don’t.

Wednesday, December 16, 2009

Too busy to relax?

By Gina Newsome Duncan, M.D.

For most of us, stress is a part of everyday life—at home, at work, during our commute. Even going on vacation can be stressful. Stress not only has a psychological effect. It also has a physiological effect. That is, it affects us physically, leading to direct changes in our heart rate and blood pressure, and over time, our risk for certain illnesses such as heart attacks and strokes.

Stress also plays a significant role in anxiety, depression and other mental illnesses. This is detailed in the book The Relaxation Response, by Dr. Herbert Benson, a Harvard physician and expert in Mind/Body medicine.

Relaxation, the antidote to stress, can often seem like a luxury. How many of us picture a hot bubble bath complete with scented candles and soothing music, or a long walk on a sun-soaked beach as the perfect way to relax? The problem is that most of us don’t have time to do these things on a regular basis. When you’re in the midst of a crisis, or have a deadline looming at work, it’s not always possible to take an extended break.

The good news is that there are steps we can take psychologically to improve how we feel physically. With practice, you can learn how to relax anywhere and in any situation.

Some of the most common relaxation techniques are:
1. Deep breathing
2. Progressive muscle tension and relaxation
3. Guided Imagery/Visualization
4. Mindfulness

If you have a moment, try this simple exercise right now:

Sit in a comfortable position, either reclining slightly or laying down.
Take a deep breath in while slowly counting “one-thousand-one, one-thousand-two”. Then exhale, while counting “one-thousand-one, one-thousand-two, one-thousand-three, one-thousand-four”. Repeat this for several minutes.

Next, while maintaining a slow, regular pace of breathing, move on to progressive muscle tension and relaxation. This means tensing and relaxing the different muscle groups of your body one at a time. For example, start with your feet, curling your toes under… holding…and then relaxing. Then move on to your legs, stomach, etc, until you have worked your way up to your head.

How did that feel? Don’t worry if you couldn’t relax right away. It takes practice!

Most major bookstores and entertainment stores carry relaxation CDs that incorporate the breathing and muscle relaxation techniques described above. Combined with guided imagery and soothing music, these CDs can be a great way to learn the relaxation response if you don’t feel confident doing it on your own. A quick Google search can also pull up many websites with different types of relaxation exercises, suggestions, and even video.

The best thing is that this can take as little as 5 minutes and can be done anywhere—at your desk or while parked in your car—anytime you need to recharge.

Taking time to relax is not a luxury, it’s a necessity!

Tuesday, December 8, 2009

Holiday Anxiety

By Jeffrey Borenstein, M.D.

As we begin the holiday season, people have hopes and perhaps expectations of an ideal holiday. Time with family and friends, time off from work or school, plans to travel – but the preparation and anticipation is often stressful. While some people may experience feelings of sadness this time of year, often people experience anxiety.

Family gatherings – both large and small may bring up memories and emotions which have been on the back burner but which now result in a higher level of emotions. The holiday season is also a busy time, juggling usual work/school/household activities with holiday preparations. With time off from work and school, our usual routines are interrupted, which is an additional stressor. All this can result in feelings of anxiety. What should you do?

Most importantly – step back and realize what emotions you are feeling. If you are experiencing heightened anxiety, there are steps you can take. I was interviewed for a New York Times article that may be helpful: “Easing Anxiety in All It’s Forms.”

Excessive drinking during the holidays is also a problem for many people. Some use alcohol to help with their stress and anxiety, and those with alcohol problems are particularly vulnerable. Instead of helping, drinking can do the opposite and make you feel worse.

To help you cope during the holidays, make sure you get adequate sleep, make sure you exercise (and walking counts), and share your feelings with friends or family. If you begin to feel overwhelmed and have difficulty functioning, you should seek professional assistance. Most importantly – realize that you are not alone. Many people experience holiday anxiety. Accept support from family, friends, and if need be professionals.

Wednesday, December 2, 2009

What do the holidays mean to you? It’s how you frame the question.

R. Scott Benson, M.D.

Thanksgiving seems to be the one time a year we can get a national focus on family and sharing with others. And before we finish that pumpkin pie everyone seems to start working on the next holiday which comes in different names in different cultures, but typically involves gifts. In the Santa tradition the focus is on what will he bring me.

But then we realize that is not the real meaning of the holidays.

A tool from cognitive therapy might help at this point, reframing. Reframing involves recognizing distorted thinking and focusing on other thoughts that reflect the reality that we want.

Let’s try an example. Typically we ask children “what do you want?” and later we ask “what did you get?” And these are the questions that define the meaning of the holiday season for them.

I don’t think that is the meaning we intended. So we can try a different approach. And it takes a lot of practice. In working with children or in my community I try to start the conversation with “What have you been thinking about doing for your mother during the holidays?” Or “What do you think your brother would like this year?”

And after the presents have been opened I ask, “Who really liked the present you gave?” And always in this era of instance messaging and Tweeting it never hurts to ask “Have you started on your thank you notes yet?”

Well? Have you?

Monday, November 30, 2009

Exercise - An effective treatment for mild to moderate depression

By Felicia K. Wong

We’ve all heard it before - “Exercise is good for you”. As holiday eating can lead to unwanted pounds, “Getting more exercise” will be a common New Year’s resolution. However, did you know that exercise has the potential to do wonders for your mental health?

Studies have found that regular exercise can be just as important as medication and therapy for the treatment of mild to moderate depression.

Exercise causes the body to release endorphins, natural chemicals that can reduce your perception of pain. Endorphins can trigger positive feelings and improve your mood quickly.

Regular exercise has been shown to relieve the symptoms of depression by:

- reducing stress

- increasing your energy level

- improving your sleep

- improving your physical fitness, which can improve your self esteem

- providing a distraction from anxiety and feelings of depression

- increasing your sense of mastery and control over your life

It can be difficult to motivate yourself to start moving when you’re feeling down. The goal is to exercise at least 20-30 minutes, three times a week to reap the maximum benefits of exercise for depression. But even a few minutes a day can help boost your mood! Here are some tips to help you get started:

Keep it simple! Set simple and realistic goals. You can start by getting outside and walking around the block. Increase the duration of exercise a little bit each day.

Choose an activity that you enjoy. Walking, biking, yoga – find something that appeals to you.

Keep it interesting. Vary the exercise so you don’t get bored.

Keep it cheap. Unless you plan to use them regularly, avoid buying a health club memberships or expensive equipment. Go outside, get active and enjoy the fresh air!

Make it social. Find friends to exercise with - talking to people will keep it fun and help you stay motivated.

Stick with it! If you exercise regularly, it will become part of your lifestyle and help reduce your depression.

Seeing your doctor is an important step in dealing with depression, and you should discuss treatment options including medication and therapy. However, exercise can be an important additional tool that can provide you with immediate and long-term relief from depression.

Thursday, November 26, 2009

This one is for my mother

During my year as Mrs. United States and daily as a psychiatrist I am fighting to eliminate the negative stigma of mental illness. The presence of mental illness has been very real to me since I was a child. After many years or suffering without a clear cause, my mother was diagnosed with Bipolar disorder when I was in elementary school. Frequent hospitalizations, medication adjustments, ECT were part of a typical day in our household. Nevertheless, my mom is my mom, not “crazy”, “psycho” or a “freak”.

As an adult and now as a psychiatrist, the presence of stigma toward those suffering from a mental illness has become very evident to me. I believe that the source of much of this misperception is from a lack of understanding not a lack of compassion. Many people still do not know that mental illnesses are true biological illness similar to diabetes or hypertension.

They don’t understand that they are brain diseases, not character flaws. Having a mental illness does not mean that you are stupid, lazy, worthless or incompetent. You don’t develop a mental illness because you did something wrong or because you are a “bad” person. It is not your fault.

For you that are struggling with a mental illness, or have a family member who is, you are likely all too familiar with the devastating effects of stigma in your own life. Let us all work together to teach the truth about mental illnesses, as education is our most powerful weapon in the fight against stigma.

……………Be The Change You Hope To See In This World


Tuesday, November 24, 2009

Might limiting our exposure to TV make us happier?

By Roberto Blanco, M.D.

Do you ever find yourself feeling hopeless during the evening news? According to a recently published study by University of Maryland Sociologists Robinson and Martin, it appears that it is not just the evening news that is contributing to our unhappiness.

The study, conducted over the last 30 years, showed that self-reported unhappiness was closely linked to the amount of time spent watching TV. The people who reported to be the happiest spent more time reading and socializing instead of sitting in front of the TV.

These results suggest that even when we can “escape” the news to lighter programming, we are still receiving negative messages: that we are not attractive enough, that we should own more things, or that we should have the unattainable lives that are being portrayed. The programs are often entertaining, but the benefits are short-lived. And in the long run, they may be doing more harm than good. The results of the University of Maryland study indicate that limiting our exposure to TV may help us live happier lives.

In the hopes of making you and your family happier, here are a few things you can do to limit TV watching:

Limit the number of hours per night that you spend in front of the television. Pick alternative activities such as reading or exercising to do after work.

Limit the number of hours that your children can spend in front of the television. Set a timer and be consistent. Encourage exercise and outdoor play as much as completing homework , chores and other responsibilities.

Plan family time or an outing for your family that does not involve the TV. Go for a walk, to a park, or to the local public library.

Be an active TV watcher. Pick out the programs you want to watch during the week in advance and stick to your choices. Pick TV programs that are educational, positive, or contribute in some way to your experience of the world. Purchase a recorder for TV programs that you would like to watch and make TV fit your schedule and not the other way around.

Carefully monitor the shows your young children are watching. Studies show that the younger children are, the more they will be affected by scary or violent programming.

If all else fails, get rid of the cable box or Satellite dish. At a cost of $60 per month, getting rid of cable or the dish can save us over $700 per year. This will not only improve your mental health, but your financial health as well.


Friday, November 20, 2009

Does “The Most Wonderful Time of the Year” leave you with the blues? Thoughts on how to make this holiday season less stressful and more enjoyable.

By Gina Newsome Duncan, M.D. 
The holiday season can, indeed, be a wonderful and exciting time of year, but for some, it can also be stressful and overwhelming. Many of us tend to overextend ourselves during the holidays, both with our time and our finances. This can take a huge toll, leaving some of us physically exhausted and financially spent come January.

With the current economy, some people may feel pressured to make up for the cutbacks they’ve had to make in recent months by spending above their means. Others may be more realistic about what they can afford, but worry that they won’t be able to have a good holiday on a budget. We tend to think of the holiday season as a time for family, however, bringing everyone together can also be stressful if there are unresolved tensions within the family.

If you’re worried about being able to afford gifts this holiday season, talk with your loved ones about the real meaning of the holidays for your family. Do things that are consistent with your religious and cultural traditions.

The season may be bittersweet for some adults. If reminded of losses such as the loss of a loved one, find a way to incorporate old traditions and honor your loved ones during this season.

Here are some tips to help you cope with the holiday blues:

Don’t focus on having the “perfect” holiday. Focus instead on having an enjoyable holiday, and that includes time for relaxation.

Examine and then lower expectations—both those that you have of yourself and those that others have of you. Do you expect that you have to create the perfect holiday and give the perfect gift? Do you expect others to give you the perfect gift? Do you expect your children or relatives to be on their best behavior at all times? If so, you will likely be disappointed. Things are rarely (if ever!) perfect. Having this mindset will make it more likely that you will run yourself ragged and end the season feeling exhausted and inadequate.

Avoid overspending, as this will only cause increased post-holiday stress when you get your bank statement. Where possible, consider giving homemade gifts. Baked goods make delicious presents and are a lot less expensive than individual store-bought gifts. They also allow you to give something of yourself in a tangible way.

Do something nice for yourself. Take a break from your shopping and make time for a bubble bath or a nice walk.

Don’t be afraid to say no. Setting limits can be difficult. But overextending yourself can leave you feeling underappreciated and resentful. It’s hard to have the “holiday spirit” when you feel that way!

If worried about not having enough, try giving to the less fortunate. This can often produce a change in our perspective.

Shop online if the mall is too stressful.

For some, the holiday season itself is always enjoyable, but the months that follow can be difficult. The winter season in some areas of the country may not end until late March or early April. Some find that their moods go down predictably during this time of year. Read Dr. Felicia K. Wong’s recent post on Seasonal Affective Disorder for tips on coping with this common form of depression.

Wednesday, November 18, 2009

Knowledge is Power

When it comes to mental health, knowledge is power. As host of the Healthy Minds public television series, my goal is to provide people with information about psychiatric conditions and treatment. I interview experts who provide cutting edge information and more importantly, I speak with people who have sought treatment for a mental health issue.

One of the most moving interviews was with Jennifer Crane, a veteran who served in Afghanistan. She spoke about her experiences with post-traumatic stress disorder (PTSD) and how treatment is helping her recover. She has received treatment through the Give an Hour program, which is sponsored by the American Psychiatric Foundation.

The combination of medical and scientific information with the real life experiences of individuals and their families provides our audience with new knowledge and insights about mental health. I hope the show will open up conversations in families and inspire people to seek help. In addition to PTSD, topics include autism, chemical dependency, depression, bipolar disorder, eating disorders and suicide prevention.

As we plan for future episodes of Healthy Minds, I would very much appreciate your comments, ideas and questions. And, remember, when it comes to mental health, knowledge is power.

Monday, November 16, 2009

Maintaining Health in Stressful Jobs

By Bill Callahan, M.D.

I have been asked frequently in the past 10 days how psychiatrists deal with their own reactions to what they hear every day and what its impact is on them.

When I became a psychiatrist after five years as a flight surgeon in the military, I was struck by how much of the four years it takes after medical school to become a psychiatrist was spent on making sure that we dealt with our emotions, knew our own warning signs for stress, and would set limits on a reasonable work load. We are also trained to know when to ask for a consultation with a colleague, or to get additional training for ourselves. Our educational requirements are life-long and part of our commitment to do our best for you.

A big part of my role is to be the “personal trainer for emotions.” At the end of each day, after spending eight hours immersed in the emotions and struggles of other people, I spend some time experiencing the different emotions that work caused in me. That will mean being able to cry to relieve sadness that is created, feeling the full impact of anger, as well as the affection I feel for the people I work with. This process lowers anxiety and stress and prevents a toxic buildup of emotion every day.

In future posts I will talk about how to feel healthy anger, since I find this is the most misunderstood emotion, and the fear of feeling it is a major source of stress for many.

I already had the fundamentals of a healthy life from my military flight surgeon experiences. Daily exercise for at least 45 minutes, combining aerobic and weight training, sleeping from 7 to 9 hours a day, moderate alcohol use and avoiding it all together when under increased stress or emotional strain, and making sure I took time to have fun with family and friends are things we can all do as well.

Please leave your own tips for what you do to relieve stress in the comment section.

Thursday, November 12, 2009

Eight Questions Parents Should Ask About Psychiatric Medications

By R. Scott Benson, M.D.

As a child and adolescent psychiatrist I talk to many parents about treatment options for their children. Whether it be talk therapy or medication, any recommendation for treatment should be based on a thoughtful evaluation.

If medication is recommended, parents find the following questions help in navigating this process. This dialogue with your child's doctor is a first step in forming a team effort for your child's treatment.

  1. How will the medication help my child? How long before I see improvement?
  2. What are the side effects which commonly occur with this medication?
  3. Is this medication addictive? Can it be abused?
  4. Are there any tests which need to be done before my child begins taking the medication? Will any tests need to be done while my child is taking the medication?
  5. How will my child's response to medication be monitored? How often?
  6. Are there any other medications or foods to avoid?
  7. How long will my child need to take this medication?
  8. What do I do if a problem develops (e.g. if my child becomes ill, doses are missed, or side effects develop)?

Thursday, November 5, 2009

Are Gray Skies and Short Days Making You S.A.D.? 10 ways to help you manage your symptoms of Seasonal Affective Disorder

Autumn in the North is a magical time of year. The colorful leaves fall with the mercury. The air is cool, crisp, and clean. But for many people, there is a certain reluctance that comes with packing away the summer whites and taking out the winter woolens. Summer has come and gone. Winter is on its way.

Seasonal Affective Disorder (SAD) is a common affliction for those who live in northern climates. SAD symptoms mirror those of clinical depression. However, SAD follows a seasonal pattern, whereas general depression is not affected by the calendar. SAD sufferers may feel depressed, irritable, and tired. They may find it more difficult to concentrate or pay attention. They may want to stay in bed longer and eat more. In severe cases, SAD can lead to problems including suicidal thoughts or behavior, social withdrawal, relationship difficulties, school or work problems, and substance abuse.

Seasonal mood variations are related mostly to daylight, not temperature. For this reason, SAD is common even in places with mild winters such as the Pacific Northwest. Long periods of overcast weather can also exacerbate SAD. Warning signs of SAD usually appear in late fall and end in the spring.

One way to prevent Seasonal Affective Disorder is to live in a warm, southern, climate. But what about those of us who live in the north? Following these suggestions can help alleviate some of the symptoms of SAD:

1. Go outside and walk briskly for thirty minutes during your lunch break, when sunlight is at its peak.

2. If you can’t exercise outdoors, try exercising next to a window.

3. Get more natural sunlight by doing outdoor chores (raking the leaves, shoveling the snow).

4. Keep your windows and blinds open in the home and office.

5. Sit near a window, preferably in sunlight, whenever possible.

6. Join a support group with other SAD sufferers. Join a walking or activity group!

7. Try phototherapy. You can replace the light bulbs in your home with brighter full (broad) spectrum light bulbs. While more expensive then regular light bulbs, these provide light more similar to natural sunlight.

8. Maintain your schedule. Try to keep a regular pattern of sleep. It may be helpful to have a bedside light on timer to turn on half an hour before you wake to help you wake at a regular time even when it is dark outside.

9. Keep things in perspective. Remember that spring is only about 6 months away and that these sad feelings are only temporary and will go away.

10. If you can, go south for vacation!

If none of these strategies improve your depressive symptoms, consider consulting your primary care physician or mental health professional. SAD is a form of depression and can be readily treated with medications or psychotherapy when other self-help methods aren't effective.

Are Depression Symptoms the Same Across Cultures?

By Gabriella CorĂ¡ , M.D., MBA

Although, as psychiatrists, we make a diagnosis of depression given a specific set of signs and symptoms, the way in which depression manifests may be different across cultures.

In addition to stigma, many Latinos struggle with acculturation issues, lack of insurance coverage and difficulty communicating with healthcare professionals who are not culturally proficient.

Barriers to care also affect African American communities. The diversity of the Latino, African American as well as the Asian communities is often minimized. Many believe that because someone has the same skin color or speaks the same language they have a similar set of needs. In fact, Spanish-speaking African Americans need tailored interventions to address Latino as well as African American cultural needs in order to effectively treat depression or other mental health disorders.

What to do?

1. Learn about depression: look for good sources of information.

2. Seek for help: Tell your doctor you or your loved one may be experiencing depression. If you don’t have a doctor, go to a community mental health clinic and let staff know you need help.

3. Become familiar with cultural differences in the diagnosis and treatment of depression: ask your doctor if his/her office has culturally-competent or culturally-proficient staff to help you. Cultural proficiency goes beyond speaking the language.

4. Be open to staff: Although the doctor’s office may not have culturally-competent staff, healthcare professionals may be very familiar with working across cultures. The “I can only be treated by someone who looks or talks like me” is a myth. Although this may help in the beginning, we know caring and empathic staff will be able to help you beyond gender, color, ethnicity or language.