Mar 04

SAD? Or just blue?

PeaceWinter2By Dr. Micaela Wexler

Are you feeling the post-holiday let down? After all the parties are over and the guests have left, many people feel anxiety, disappointment and depression. That is normal.

However, if you are feeling depressed, tired, weak, achy or ANGRY, you might be SAD
The “winter blues” might be something more: you might have SAD – Seasonal Affective Disorder. This is a type of depression that occurs every year during the winter months. It’s not just the “winter blues,” which is a feeling of mild disappointment and irritation most people get as they cope with the challenges of winter.

How do you know if you’re SAD and not just blue?
WexlerPsychiatryDepressedGirl
People with SAD feel the following:
- worthless, guilty, tense
- fatigue
- down and depressed
- arms and legs feel heavy, achy
- increased headaches
- irritable
- worried, increased checking behavior
- indecisive
- increased urination, heart palpitations, stomach aches
- difficulty focusing
- suspicious, paranoid, think co-workers don’t like them
- increased difficulty starting the day
- increased insomnia

These symptoms go on for at least two weeks at a time and can recur. They start in late fall and fade away in early spring.

It isn’t in your head. Well, actually, it is: it is caused by your hypothalamus, a part of your brain, secreting more melatonin when your eyes are exposed to less sunshine. So, if you’re having insomnia, don’t take melatonin. When light hits are eyes, melatonin starts to go down.

There is also a decrease in serotonin caused by a decrease in physical activity. An additional contributing factor is the disruption of your circadian rhythms by the change in weather, shorter days and change in routine. Many people first notice these symptoms following the time change.

SadWomanWexlerPsychiatryWomen are at higher risk, as are people with a family history of depression. Living far from the equator doesn’t help.

There are some dangerous symptoms you should not ignore:
- feeling suicidal, or feeling that life just doesn’t matter – get help right away
- irritability leading to behavior that is out of character: yelling at co-workers, engaging in physical fights or road rage
- social isolation that is out of character – missing the company holiday party even though you are known as a social person, for example

Why you shouldn’t ignore it:

- Decreased focus can lead to problems with work, increased debt, child neglect
- SAD can become major depression
- suspicious thoughts can cause irreparable harm: premature termination of a job or relationship. Many people file for divorce during these months.
- your immune system can become depressed

Treatment is easy and effective
micaelaWexlerOCH
- Increase physical activity – increases serotonin levels
- Watch your diet: beware of giving in to carb craving; eat more nuts and fruits – maybe this is why fruitcake is a traditional fruit at this time of year
- Eat more walnuts – have been shown to help make you less SAD
- Make home brighter
- Bundle up and step outside – nothing makes your home feel warmer than stepping in from the cold
- Light box therapy
LightphoriaWexlerPsychiatry
Does light therapy work?

Yes. it is supported by at least two meta-analyses. It also works for non-seasonal depression. Most companies will your refund money in 30 days if symptoms don’t decrease.

What type of light works?

Bright sunshine in the morning works best – not available in the winter time
10,000 lux for 30 minutes
5,000 lux for 60 minutes

Light boxes – what to look for:

- beware of blue light – not proven to be effective, may cause macular degeneration
- light must shine in your face
- 10,000 lux – 30 minutes
- research shows the bigger the better, less lux requires longer exposure

Look at lux distance
- 22 inches: normal distance from computer when working
- 28 inches: distance from computer when you lean back in the chair

Dawn stimulators:
- require longer exposure
- effective – eyes more sensitive in the morning
- help reset sleep-wake cycle
- convenient – can use in bedroom

And, I can’t stress this enough, if you feel suicidal, please call 911 or go to the emergency room.

Early diagnosis beneficial in AD
WexlerPsychLogo
Appointment information for Dr. Micaela Wexler: wexlerpsych.com

Nov 27

Genital warts: what to tell your teenager

By Dr. Micaela Wexler
One wouldn’t expect a child psychiatrist to be writing about this, but it turns out a common source of severe anxiety for teenagers is discovery of a sexually transmitted infection. Genital warts is one such infection, which is poorly understood by teenagers. Once they have it, they hear just two things: 1) it’s forever; 2) it’s transmittable. In most cases, no one has ever sat down and had an in depth discussion with them about genital warts.

First, parents always want to know: HOW do you talk to your teenager about GENITAL WARTS?

Here’s a way I know of that has worked for parents. This is the phrase that you can use for just about anything:
“This may not ever happen to you, but I was reading an article about it, and I want you to be prepared if it does happen to you, or if it happens to anyone you know.”

Practice saying that to yourself, and then practice saying that phrase to your teenager. Start by using it for a topic that isn’t so sensitive, like, how to avoid being pick-pocketed. You can then segue to topics about health, like, how to treat a urinary tract infection, how to avoid constipation, all the way to talking about sex.

Once you’ve used it a few times on these less sensitive subjects, don’t waste your currency. Dive in and use it before it “expires.” You can say, “now that we’re on the topic of things I’ve read about, what do you know about genital warts?”

Here’s the skinny on genital warts.

Genital warts are warts that are located near or in the genital areas. In a female, that means on or near the vulva (the outside genital area), vagina, cervix, or anus. In a male, that means near or on the penis, scrotum, or anus. They look like bumps or growths. They can be flat or raised, single or many, small or large. They tend to be whitish or flesh colored. They do not cause pain. They do not drain or ooze.

Genital warts are caused by a type of virus, the Human Papilloma Virus (HPV). There are 100’s of types of HPV warts, and they infect multiple parts of the body. Some types of HPV cause plantar warts, which appear on the bottom of one’s foot. Other types infect the genital area, and a smaller subset of those can cause cancer.

Typically, a wart will show up between three weeks to six months after exposure. Sometimes warts can take even longer, up to years, to appear; the virus can live in the body for a very long time without causing any symptoms. This makes it difficult to know who gave you HPV.

Because warts are caused by a virus, they need to INCUBATE in order to cause a visual wart. In simple terms, what this means is that the virus needs to take over the cell’s genetic machinery, and then change those cells to become cells that look like warts. This takes time; it doesn’t happen in just a few days. And, while the virus is going through all the steps of creating a wart, our body’s immune system is fighting the virus at each step. So, if a person is healthy with a good immune system and living a stress free life, the body could potentially fight off HPV enough to keep a wart from appearing.
To better understand this, think about chicken pox, which is also caused by a virus which causes skin eruptions. The chicken pox virus is much stronger than the HPV virus: no matter how healthy and stress free you are, you’re going to get skin eruptions after being exposed (unless you have been vaccinated). Chicken pox requires at least 10 days to incubate and cause skin eruptions, ie, it takes at least that long after exposure to get the chicken pox rash.

How contagious are warts?

HPV transmission can be complicated. If you have a wart, or a lesion, then you are very contagious. For women, this can be a problem, because they could potentially have an eruption on a part of the body they can not see, like the vaginal canal, and not even know they have HPV. The male sexual partner could then get the virus on his penis, and then give that virus to another female, and SHE could get HPV. All of this could happen without anyone knowing anyone has HPV. This complicated transmission is a strong case for using condoms. However, condoms are not 100 per cent protective, because a male could have a virus on his scrotum and transmit it to a woman’s vulva.

How dangerous are genital warts?

Some types of HPV can cause cancer. In women, they can cause anal or cervical cancer. In men, they can cause penile cancer. For this reason, they should not be ignored. Because of the complicated transmission described above, ALL women are advised to get annual pap smears. (Pap is short for papilloma.) Men should examine their genital area on a regular basis, including the penis, the scrotum and the anal regions. If they see or feel a lesion, they should have it looked at by a doctor. Some physicians provide “anal pap smears” for people who have engaged in receptive anal sex.

How can genital warts be prevented?

The only 100 per cent way to prevent genital warts is to abstain from all sexual activity. For many people, especially married people, this is highly impractical. There are ways to reduce the risk of genital warts: 1) use condoms; 2) get the Gardisil vaccine; 3) know your sexual partner well enough to examine the genital area; 4) get annual pap smears; 4) let your partner know you have “tested positive in the past for HPV.”

The last one is important. Many teenagers will neglect to tell their partners out of fear that they will be ostracized, or accused of intentionally spreading STDs. However, saying “I have tested positive for HPV” is clinically no different than saying “I have genital warts,” but much easier to get out of your month. If teenagers are informed with the knowledge in this article, they can at least have the proper “ammo” to disclose this important information.

Click here for more information on genital warts.

Nov 14

Is your depression keeping you from losing weight?

By Dr. Micaela Wexler
If you are having trouble losing weight, it could be due to depression. As a family psychiatrist, this link is very obvious to me, but not to my patients. Studies show that depression and obesity are linked to each other. A meta analysis study published in JAMA in March 2010 shows a that depression can lead to obesity and obesity can lead to depression. (1) A study of Dutch teenagers, published in Obesity in March 2010, showed a clear association between weight status and suicidal behavior in obese adolescents. (2) The same link was found in a later study done on Korean teenagers. (3)
Depression causes physical changes which affect interest, sleep, appetite, sexual drive, and thought processes. Some types of depression cause people to eat and sleep more than normal. If you are having trouble finding the willpower to exercise it might be due to decreased motivation, which might be due to depression.

Are you finding it hard to lose weight even though you are exercising and sticking to your diet? This could also be due to depression because depression makes the body’s metabolism change. When a person is depressed chemical changes take place that make it harder to lose weight. Some of these changes can cause weight gain and fatigue.

Depression can also cause a change in eating patterns. The chemical imbalances caused by depression make it harder for people to connect hunger with food intake, which is why some depressed people eat even when they are not hungry. Or, they are hungry even after eating.

It is easy to blame your weight on lack of willpower. But, if you are having trouble losing weight, it is important to make sure you are not depressed. Besides causing weight gain, untreated depression can cause more serious problems like diabetes, heart disease, and suicide. And, studies show that treating depression leads to weight loss.

Do you feel sad or hopeless? Are you having trouble sleeping? Have you lost interest in things like hobbies or TV shows or fun activities? Do you have trouble motivating yourself to do things? Are you short-tempered? Do you have negative thoughts about yourself? All of these are signs that you might be depressed.

If you’re having any of these signs, go see a therapist or a doctor or call your local mental health center. Start treating your depression so it doesn’t keep you from losing weight.

1) Overweight, Obesity, and Depression
A Systematic Review and Meta-analysis of Longitudinal Studies FREE
Floriana S. Luppino, MD; Leonore M. de Wit, MS; Paul F. Bouvy, MD, PhD; Theo Stijnen, PhD; Pim Cuijpers, PhD; Brenda W. J. H. Penninx, PhD; Frans G. Zitman, MD, PhD

2) Weight status, psychological health, suicidal thoughts, and suicide attempts in Dutch adolescents: results from the 2003 E-MOVO project.
van Wijnen LG, Boluijt PR, Hoeven-Mulder HB, Bemelmans WJ, Wendel-Vos GC.

3) The relationship of weight-related attitudes with suicidal behaviors in Korean adolescents. Kim JS, Lee K. Department of Family Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea.

4) Pagoto S, Schneider KL, Whited MC, et al. Randomized controlled trial of behavioral treatment for comorbid obesity and depression in women: the Be Active Trial. Int J Obes (Lond). 2013 Mar 5. [Epub ahead of print]

Sep 10

“Suicide prevention starts with you.”

By Dr. Micaela Wexler
Whenever I say this to people, they think I mean for them to help prevent suicide in other people. They immediately think about their families, friends, co-workers, children, spouses. In most cases, they are eager for tips on how to join in the fight to stop suicide.

“I mean YOU, specifically. Suicide prevention starts with YOU.”

Suicide is something that can happen to anyone. While we all need to help each other in preventing this tragedy, you can’t prevent someone else from committing suicide unless you prevent yourself from committing suicide.

“Well, that’s easy,” people tell me, “I don’t believe in suicide. Suicide is a selfish act; I would never do that to my loved ones.”

It turns out that people who commit suicide were once just like you: they didn’t believe in suicide. Like you, they had children, parents and friends. They loved them very much and did not want to hurt them. Just like you, they had religious beliefs that once gave them strength and comfort. They had goals and dreams and plans. They had crushes. They had love affairs. They had marriages.

So, to prevent suicide, you have to start by examining yourself.

Do you find yourself doing things you never did before like yelling at the grocery checkout person? Are you snapping at your husband? Does your best friend suddenly make you fly into a rage? Are you drinking more than you ever did? Are you in a financial crisis you feel you have no way out of?

Do you find yourself being careless about your safety: being less careful about locking doors at night; not slowing down for yellow lights; driving recklessly on the freeway?

Many people have these thoughts. That doesn’t mean you should ignore their seriousness. Letting thoughts like these pile up can put you on the road to developing a serious depressive episode. That is the most common reason for suicide.

If you are having these thoughts, then you are not taking care of yourself. You are not taking time to enjoy life. You are losing sight of your dreams and goals. Maybe you are not spending enough time with friends who appreciate you. Maybe you are working too much, at the expense of socializing and exercising.

You can do things immediately if any of these situations pertain to you. Right now, take a deep breath and think of something positive you will do for yourself TODAY. It can be something simple like taking a walk, calling a good friend, making plans to go watch a movie, buying yourself a new song, playing a computer game.

Look at your schedule and see what items are on it that make you feel good. How can you add more? You may not be able to get out of your financial crisis, but you can probably find someone to talk to, either about your problem, or something completely unrelated, to take your mind off your crisis.

If you are having the thoughts I’ve mentioned, this is a sign you need to find time to reflect on what is good about you and your life; you need to make it a DAILY practice; you need to refocus on your hopes and dreams. You need to reach out to loved ones, clergy, maybe a therapist, or the employee assistance program.

There are some thoughts that will require much more than than what you can do alone. There are thoughts that are a sign of something serious that needs immediate professional attention.

Do you feel you have no purpose in life? Do you feel completely hopeless? Do you ever find yourself having thoughts about what it would be like to be dead? Do you find yourself thinking that people would be better off without you in their lives? Do you find yourself going beyond simply not slowing down for yellow lights, and actually running red lights? Do find yourself wondering what it would be like to go toppling off the overpass? Do you notice you are preoccupied with the after life?

These are all thoughts that are a sign of serious suicide risk. Do not ignore this. There are several options for immediate help, from calling 911 and talking to the police, to calling 1-800-273-TALK or 1-800-SUICIDE (1-800-273-8255, 1-800-784-3433) or going to the emergency room. Either one of these options will lead to a trained professional who can help determine the type of help you need immediately.

Nine out of ten people who commit suicide had a diagnosable mental disorder. But, only THREE out of 10 people who die by suicide received mental health care in the year prior to their suicide.

So, start preventing suicide by taking a look at yourself. Because, trust me, we need you around.