The Dead of Winter Can Leave You Feeling Depressed 
More than 300 million people worldwide suffer from depression, according to the World Health Organization. Twice as many women than men have depression, and all ages are affected.
Depression is especially important to recognize in pregnant or postpartum women, patients who are elderly or have cancer and in children and teenagers, as it can often be overlooked and can lead to devastating consequences.
At its worst, depression can lead to suicide, with more than 800,000 people dying of suicide every year. Notably, people who have gone through unemployment, loss of a loved one, a divorce or separation or even suffered a heart attack can become depressed. Depression also runs in families, so it’s important to know your family history of mental illness.
When patients with depression go to their doctors’ offices, two-thirds will present with symptoms such as a headache, backache or another type of pain, rather than admit they have depression. Often, it takes a direct question, such as “are you depressed?” for it to be recognized.
Common symptoms of depression
The following symptoms are typically present for at least two weeks, and depending on the number of symptoms, one can classify depression as mild, moderate or severe:

1. Feelings of worthlessness, guilt or failure. People interpret minor setbacks in their life as personal failures.
2. Becoming more withdrawn, or not caring to participate in activities that once caused joy.
3. Depression causes loss of energy in routine activities. Sometimes people with depression report feeling exhausted before the day even begins.  Losing that “get up and go” is commonly found in depression.
4. Crying spells, or becoming teary-eyed are easily recognized signs of depression.
5. Eating too much or binge eating, or conversely not having an appetite, can all be signs of depression. While there is no absolute number in weight gain or loss that defines depression, losing or gaining an average of 5 percent of one’s body weight per month is concerning.
6. Sleep is often affected in depression, both in sleeping too much or not being able to fall asleep or stay asleep. This is frequently one of the earliest signs of depression. Depressed persons can feel fatigued despite getting a full night’s sleep.
7. Depressed people often experience a loss of concentration or become easily distracted.

Many times, people won’t admit they’re depressed because they don’t think of depression as a “real” disease, or they might feel as though their doctor will just prescribe antidepressants or refer them to a psychiatrist to have their “head checked.”
The more we understand and talk about depression, the earlier we can recognize it in our friends, families and loved ones. And for someone who’s suffering from this very real and debilitating disease, talking with a doctor can be the first step toward recovery.
Treatment for depression
Treatment depends on the severity of the symptoms. It can range from simple recognition of the disease to medications and, sometimes, admission to a hospital for intensive treatment. Many patients with depression benefit from counseling and behavioral therapy. Regardless, neither counseling nor medications work instantly. It can take up to two weeks to begin to see the beneficial effects of medicine and up to four weeks to see the beneficial effects of counseling.
People with depression have a lower quality of life and a higher risk of suicide than those without depression. Additionally, depressed patients affect the quality of life of those who live and work with them. Recognizing the symptoms of depression and identifying ways to manage and alleviate it can have a profoundly positive impact for the patient and his or her loved ones.
This post is based on one of a series of articles produced by U.S. News & World Report in association with the medical experts at Cleveland Clinic.

​Most people experience a slump in January and February after the frenetic end-of-year and new year festivities.  Some of this is merely fatigue but the Winter Blues can leave you feeling, sad, irritable, unmotivated.  If these feelings intensify and lead to sleep problems, changes in appetite or weight, depression, you may be experiencing Seasonal Affective Disorder (SAD).
If your symptoms are in the milder category of Winter Blues there are several things you can do to help yourself feel better.​

• Since the 1980's light therapy has offered an effective remedy to boost energy.  There are even full-spectrum light visors so you don't have to remain in place to get your dose.  You do need to follow guidelines about when during the day and how long the exposure. There's lots of information on-line to inform you how to use light therapy.
• Cognitive Behavior Therapy (CBT) can teach you coping skills for the short-term seasonal occurrences.  Once you learn the skills you can use them daily throughout the year for your general well-being.  
• Of course, exercise is an effective mood-enhancer.
• Meditation can promote relaxation and mindfulness and enhance cognitive skills.  Future blog posts will present activities to promote mindfulness, stress reduction and relaxation techniques.
• If your symptoms persist for days and light, CBT, exercise and meditation are not effective it may be time to consult a physician or mental health counselor to discuss other interventions.

This brief article from the Mayo Clinic provides more information and this article from The New York Times is also useful.  
​A report from Cornell University found that natural light in an office significantly improves health, wellness and productivity in workers.

​Just about everybody goes through stressful times at work. Projects pile up, you stay late and take work home with you and the flow of emails doesn’t slow down. When this becomes the norm, it’s time to re-evaluate your work-life balance and make some healthy changes to avoid job burnout.
How do you know when it’s time to examine how your job fits into your life? 

• You’re staying up too late or having trouble staying asleep. You’re sitting all day and not exercising. You’re getting most of your food from a vending machine or drive-thru window or not eating at all. You have a nagging pain or health concern but don’t feel like you have time to go to the doctor.
• You’ve started noticing signs of anxiety or depression.  You are feeling angry or irritable. You may experience dread, restlessness, hopelessness, panic attacks, mood swings, and maybe even thoughts of suicide.
• Your work no longer feels meaningful. You don’t feel connected to your colleagues or clients. You’re just going through the motions.  You just don't care anymore.
• You feel incompetent.  No matter what you do, it feels like it’s never enough. You’re always behind and the quality of your work may suffer. You worry constantly about your job performance. You fear (but maybe also secretly fantasize about) being fired.
• There are no clear boundaries between work and home.  You’re working longer and longer hours. You can’t take time off without getting calls, texts and emails from work. You feel like you have to be available around the clock.
• You’re lonely.  Although you may have people around all the time and you’re constantly connected electronically, you no longer have the time or energy for meaningful interactions with family or friends. Your relationships begin to suffer. ​

If any of this sounds familiar, don’t despair. There are ways out of this.  Psychologist Amy Sullivan, Psy.D., offers the following tips for taking control and getting things back in balance.

• Disconnect when you’re at home. “Put down the phone,” Dr. Sullivan says. “We don’t need to be available 24/7.” Constantly checking and responding to texts and emails raises stress levels, makes it difficult to connect with family members and negatively affects your sleep.
• Be more efficient at work. Focus on one task at a time and keep working on it until it’s complete. Don’t try to multitask. Close your email and turn off your phone when possible to minimize distractions. “If we’re efficient we finish our work, and then we’re able to go home and spend time with our family,” Dr. Sullivan says.

• Prioritize self-care. Make a decision to set aside time for exercise. Choose and plan for nutritious meals and quality time with friends and family. Make those things non-negotiable in your schedule.

• Get professional help. If the stress is really getting to you and impacting your mental health, don’t hesitate to talk to a therapist. Many employers offer employee assistance programs that can connect you with a mental health professional who has experience helping people manage their stress.

Although hard work is prized in our culture, you don’t have to let your job take over your life. It’s OK, and necessary, to take care of yourself first.
Become a Time Realist as this article from The NY Times says.
​Here's some information from the Cleveland Clinic about the illusion of multitasking.

Now that Fall is here it’s time to revise or create an outdoor exercise routine.  The list of the benefits of regular aerobic and strength-training exercise is too long to post here.  However, relief of depression is an important one.
Depression is a common disorder that is associated with compromised quality of life, increased health care costs, and greater risk for a variety of medical conditions, particularly coronary heart disease. 
Here are some tips to help you get started and maintain the benefits of regular exercise. 
To use that famous NIKE slogan, “Just Do It.”

1. Choose an activity that you enjoy and stick with it.  The number of activities to choose from can boggle the mind.  Just because you “don’t feel like it” is not a reason not to exercise. Tell yourself the truth that you’ll feel better afterwards.  
2. Invest in a good pair of exercise sneakers.  Consult with an expert.  It’s an investment that you won’t regret!  Don't let sore feet provide an excuse to skip your workout.
3. Timing is everything.  Exercise at a time of day that is most convenient.  Do not exercise on a full or empty stomach or just before you go to bed.  People with depression often suffer from insomnia, and night time exercise can leave you feeling energized when you want to sleep.  If possible, exercise during daylight hours to also benefit from sunlight.
4. Watch out for barriers to exercise.  Anticipate them and develop strategies to make exercise as easy and simple as possible.  Brainstorm potential solutions to bad weather, work commitments, fatigue, and any other lame excuse your demons will present.
5. Get a buddy.  Some people who exercise with a partner enjoy it more and are more likely to stick with it.  Also, the additional social support may provide motivation and have other beneficial effects.
6. Think positively. Praise your successes. Keep a record, get a tracking device.  View lapses in your exercise program as learning opportunities and don’t get discouraged if you miss a session.  Succumbing to excuses for one day is not a tragedy but get out there the next day.
7. Enjoy the moment. Take a minute when you are finished with an exercise session to appreciate how you feel in your body, mind and spirit.  A sense of accomplishment can follow you throughout the day.

Exercise appears to be an effective treatment for depression, improving depressive symptoms to a comparable extent as pharmacology and psychotherapy.  Observational studies suggest that active people are less likely to be depressed.  Even modest levels of exercise are associated with improvements in depression.  While the optimal “dose” of exercise is unknown, clearly any exercise is better than no exercise.  "Just Do It." and sustain it.
Here is a recent article from Slate which provides information on the anti-depressant effects of regular exercise.   Exercise and Happiness from The NY Times provides more information.
​

​​May is Mental Health Awareness Month and it's time to talk about confronting the stigma around therapy.  Many people would benefit from therapy but won't choose it because they feel ashamed and weak when confronted with emotional difficulties.  There is no shame in seeking professional help for emotional difficulties anymore than there is to visit a medical doctor for your physical health.
Physical and Mental Health are entwined.  Ignoring either can lead to greater difficulties.  Early intervention is the key to dealing with both physical and mental problems.
Men are particularly at risk from not talking about emotional issues.  Men can perceive themselves as weak and inferior for feeling anxious, depressed, angry, overwhelmed and other uncomfortable emotions.  Stuffing feelings down or ignoring them can be dangerous to functioning in relationships, can interfere with concentration at work, contribute to fatigue, irritability.
​Here are some excerpts from an article by Sean Evans, "Not Talking About Mental Health is Literally Killing Men",  May 2, 2018.


"Your mental health is inseparable from your physical health. Not a revolutionary concept, but what is astounding is the stigmatization that still surrounds men who dare to talk about their emotional struggles.
Men who are vocal about any kind of mental issues can be dismissed as weak.  As inferior.  As flawed, broken guys who are more likely to be ostracized for their honesty, instead of rewarded for their bravery.  Instead of affording a fellow man compassion, we mock, belittle, and turn a blind eye. We freely spit the phrase, 'Man up', as though your gender alone should suffice to guide you through your darkest times.
Or worse the response can be 'Well, that sucks', then change the subject because talking about feelings is just too real.
What’s real is the fact that 9 percent of men experience depression.  That’s more than 6 million men.  More than 3 million men struggle with anxiety, daily.  Of the 3.5 million people diagnosed as schizophrenic by the age of 30, more than 90 percent are men.  An estimated 10 million men in the U.S. will suffer from an eating disorder in their lifetime.  One in five men will develop and alcohol dependency over a lifetime.  Male suicide is rising at such an alarming rate that it’s been classified as a 'silent epidemic.'  It’s the seventh leading cause of death for males.  That’s a staggering statistic. 
It’s okay to feel depressed.  It’s okay to feel overwhelmed.  It’s okay to be sad.  It’s okay to be anxious. It’s okay to be scared. It’s okay to not have everything figured out, to feel a wave of uncertainty come crashing over you and not know which way is up, or when your next gulp of air will come. These are perfectly normal feelings that every man experiences.  And it’s okay to talk about it.  What’s not okay is suffering in silence."  You can read the full article here.
Freud called therapy the Talking Cure.  It's time to talk!
Here are some misconceptions about therapy which may block someone from seeking help.

​Good Mental Health is no different than good physical health.  In fact, good mental health contributes to better physical health.
​Seeing a physician isn't embarrassing if we have the flu, a high fever, or other serious health problems.  No one will criticize you for seeking medical help for a physical health problem and, indeed, most people would fault you if you didn't seek medical help.
Yet we often find that mental health issues bring a very different reaction.  People sometimes see mental illness not as a health issue, but as a character flaw, a serious defect, something that marks a person as weak, unstable, perhaps even violent or dangerous.
Such reactions have serious consequences for millions of Americans who could be healthier and happier if they were receiving the mental health help readily available.  But many don't seek such help out of fear of being "labeled" with a mental illness, feeling family and friends won't understand, or that it could lead to discrimination at work or school.
Too many people who could use help instead see their condition as a sign of personal weakness. They may mistakenly believe that they should be able to control whatever is wrong without outside help.
Please, work to correct this misinformation and encourage people to seek needed treatment.  For example, researchers estimate that one in eight U.S. adolescents is suffering from depression.  Each day an estimated 3,000 young people in grades 9 to 12 attempt suicide, yet only 30% of young people facing mental health issues ever receive any type of treatment or intervention. This lack of treatment helps lead to more than 4,600 suicides by young people each year. The statistics are even scarier among senior citizens and our military veterans.
What you can do:

• Speak up.  Tell people if you have had treatment and how valuable it was just as you would share that an MD treated you for blood pressure, cholesterol, digestive problems, heart conditions, etc.
• Ask your schools to teach a module on emotional intelligence at all grade levels each year.  This could empower students to be assertive, learn empathy, and decrease incidents of bullying.
• If you see a relative or friend in distress don't shy away, instead, suggest psychotherapy as an option and share your own experiences.
• Do some research and study in improving communication, parenting techniques, conflict resolution and bring these skills into your family and work situations.
• Consider scheduling a weekly Family Meeting where all members can feel safe to discuss issues and generate solutions to influence family dynamics toward more cohesion, trust and contentment.  Even infants and toddlers attend!

It's vital for people to recognize that mental health issues are not a reason for shame, but rather a condition that requires treatment by a professional. Anxiety, depression, panic attacks, eating disorders, social phobias and similar problems are not a sign of personal weakness.  They are simply conditions that, when treated successfully, can result in a happier, healthier and more productive life.
If you or someone you know is suffering from a mental health issue, don't give in to the stigma, but rather take action for better health.  Talk to a friend or family members about what's bothering you and look into assistance from a mental health professional.  Seeking mental health help is not a weakness; it's as logical and right as seeing a doctor for the flu.
Adapted from American Counseling Association’s Counseling Corner Blog.
​Here are some misconceptions about Couples' Therapy.

It doesn't always have to be a teen vs. parent fight.  Parents and teenagers are always going to disagree about some things. It's simply the nature of the beast.
You, as the parent, are the half of the relationship with experience, who knows the limits, who wants to protect your child and who hopes to help guide him or her in positive ways.
Your teenager is the half of the relationship who is not only dealing with physical and emotional changes, peer pressure, and the normal developmental growth of desiring more independence, but who has to also put up with all the rules, "those totally unfair rules", that you, the parent tend, to impose.
Yes, some conflict between parent and teen is inevitable, but there are things you can do to minimize the disagreements.

• Start by remembering that you are the adult. Stay in control. Your teen may be trying to act grown-up, but often realizes deep down that protection and guidance are needed. Children want to be reassured that their parents are still in control, helping to guide the teen's life and development.
• Most importantly, learn to listen! It’s easy to be the busy adult, ignoring or misunderstanding your child. Instead, remember your own teen years and try to understand what your child is feeling and trying to communicate.  Really listening to your child, understanding and respecting what is being expressed without being judgmental, can help strengthen and improve overall communication.
• You also want to set limits, but limits with options. Your teens may argue, but they also understand that there are always limits to what is allowed. Instead of being a dictator, offer options whenever possible that keep things within limits but do allow your teen some freedoms. Choices are important to a growing teen, even if sometimes the wrong choice might be made.
• You also want to build a relationship with your teen, not one where you are your teen's best friend, but rather one as an adult who can be depended upon and trusted. Get to know your child, his or her friends, interests and feelings. Let your child know that as an adult you have your own feelings, values and rights.

As teens move toward adulthood there will always be some conflicts and disagreements. But by respecting your child's growing maturity and independence, and showing you're aware of those changes, you can help build a more positive relationship for both of you.
​Adapted from American Counseling Association’s Counseling Corner Blog.
​Here's some interesting insight into the adolescent brain from The New York Times and more about depression and anxiety in adolescents.