Articles 3 | Menlo Park Psychiatry & Sleep Medicine

Seasonal Affective Disorder and the Risk of Addiction

By Laura Baker:

Seasonal affective disorder (SAD) is a form of depression that occurs only during certain times of the year. Most people will experience SAD during the winter due to lack of sunlight and the consequential lack of vitamin D, though spring and summer SAD also can occur. As with most mental illnesses, SAD creates an increased risk for addiction which can, in turn, worsen the symptoms. If you struggle with SAD or seasonal substance abuse, there are a few things you should know.

Self-Medication is a Concern for Those with Depression

Too many people with depression go untreated for their condition. Depression can become a very serious health concern and lead to suicidal thoughts and difficulty maintaining daily life. When a person goes untreated or undiagnosed, he may turn to detrimental forms of self-medication.

Self-medication refers to the act of abusing substances in place of proper treatment for a condition. With the stigma attached to mental health care, it is all too common for those with mental illnesses to self-medicate. As a result, people with SAD may develop a habit of seasonally self-medicating through the winter months rather than seeking the help of a professional. If you are experiencing the symptoms of SAD, it is important that you speak to your doctor about a diagnosis and treatment plan.

Addiction Can Occur as a Result of Self-Medication

When a person turns to self-medication, he opens himself up to the possibility of developing an addiction. The habit of turning to a substance when depression strikes creates the perfect circumstances for a dependency to develop. With time, the brain will learn that when the symptoms of depression or SAD arise, it should expect substance abuse. The individual will begin to crave the substance whenever he feels depressed, even if the self-medication no longer seems to relieve his symptoms.

Unfortunately, addiction makes mental illnesses such as seasonal affective disorder worse. The result is a vicious cycle in which an untreated individual notices his symptoms growing worse and increases his substance abuse, thereby solidifying his addiction and worsening his symptoms even further. In order to fully recover from an addiction due to self-medication, it is critical that the person with the mental illness gets treatment. Without proper treatment for the illness, the individual will likelyreturn to self-medicating.

Proper Treatment Can Prevent or Eliminate Addiction

The best way to prevent and manage an addiction in those with depression or SAD is to get professional help. Without proper treatment, it is all too easy for a depressed person to turn to what he knows: substances. However, if he learns to manage his symptoms, the perceived need to self-medicate will decrease.

If the person in question has already cultivated an addiction, it certainly can be treated while effectively managing the symptoms of seasonal affective disorder. Dual diagnosis treatment programs are a great option for those who struggle with self-medication because they not only tackle the addiction but also focus on treating the cause of depression. If you struggle with self-medication or realize you may have an addiction, it is important that you seek help as soon as possible. The longer the addiction is allowed to continue, the more your depression will progress.

When you have a form of depression like seasonal affective disorder, it can be difficult to identify the pattern of self-medication. However, like any form of depression, it is important that you speak with your doctor about a treatment plan. Treatment for SAD is reasonably simple and could potentially save you from the process of addiction recovery. If you believe you have SAD, do not wait. Speak with a professional now and get the help you need before you also are seeking help for an addiction due to self-medication to treat your disorder.

For additional information, see: https://www.nestmaven.com/sleep/seasonal-affective-disorder/

Less Stressful Holiday Hosting

The holiday season is upon us. Along with the season, come many friends, family, trips, and social gatherings. The holidays can certainly be a spirited, nostalgic time that many look forward to.

But the holidays can also be trying times for many people, especially those who deal with overwhelming stress and anxiety during this time of year. That tension can manifest itself in the form of depression, weight gain, isolation, and so much more. The following are some ideas on how to lessen stress when you’re hosting a holiday party.

Stress Management

In order to keep yourself in good spirits this holiday season, try to maintain some perspective. When planning for a big event, you don’t need to change your routine that drastically.

Plan things out before: Dictate to yourself where your event will happen, what you will need, and how long you should prepare. Too many things done last minute is an unnecessary stressor for you and your family. Also, include a budget so you don’t overspend.
Take time for yourself: No matter what, remember to take a breather every so often. Look around and reflect on the goodness happening around you.
Get your sleep: Sleep is also very important during the holidays. No job should be so big and no event should be so significant that you should miss any sleep.

Hosting a Big Party

Should you find yourself hosting a big event, keep in mind it should still be fun. There are many sources such as HGTV that can help you during the entire process of planning, preparing, and executing a stellar party at your home. Plan to include the basics into your party, such as easy decorations. Wreaths, tinsel, table runners, and candles are good options. Festive background music is a great addition to a party. In addition to any food and drinks you serve, you’ll want to include some holiday snacks. There are tons of recipes available that taste delicious and can be done together with the family.

Pinterest can also be an excellent resource for ideas involving holiday parties. There are many aesthetically pleasing do-it-yourself options such as placemats and center pieces that can make your party a talking point for the entire holiday season.

Preparing the Feast

Getting a large amount of food for many people can be a daunting task, regardless of what season it may be. Different people have different tastes, and it can be a headache trying to figure out who might want what. Still, there’s no need to worry too much. When faced with preparing a big meal, keep these things in mind:

Cook for the collective: Try to stick to typical holiday fare that most people enjoy. These options will likely be crowd-pleasers.
Include other options: Understand who will be in attendance. Research any special diets or restrictions guests may have. Including a vegan option is always a good backup.
Prepare enough food: Always make sure you have enough food for your guests. If needed, have backup dishes ready and prepared if you see signs you might run low.
Invite others to bring sweets: Having others bring their favorite dessert dishes cuts down on your work. It can also be a fun way for everyone to introduce their own sweet options.

Regardless of whether you are hosting a dinner party or just attending one of many this holiday season, remember to just be happy. Take many moments to simply breath and reflect upon the joy this season brings. Through your own happiness, you will be better fit to promote the happiness of others.

By Jennifer Scott

L-Methylfolate For Depression

In an ongoing search to find increasingly effective treatments for depression, nutritional supplements often come up as a relatively benign, and possibly effective option. One supplement that has received significant attention is folic acid – readily available over the counter, and Deplin (L-methylfolate). Folic acid is converted to L-methylfolate, which is believed to play a key role in the synthesis of the neurotransmitters serotonin, dopamine and norepinephrine – targets of most anti-depressant treatments. Unlike folic acid, L-methylfolate is able to cross the blood brain barrier and play its role in neurotransmitter synthesis. Some people are believed to be poor converters of folic acid to L-methylfolate, for which reason PamLab markets the metabolite, L-methylfolate (Deplin) – a much more expensive alternative to the folic acid supplements available in most pharmacies.

Most studies thus far have found a small but significant relationship between low folic acid levels and depression ( (Gilbody S et al., J Epidemiol Community Health 2007;61:631-637)) The data supporting the efficacy of L-methylfolate has been more impressive. 0.5mg per day of folic acid (not Deplin) in combination with fluoxetine, beat placebo by 38% vs 18%, but only 10 weeks after treatment. (Coppen A and Bailey J, J Affect Disord 2000; 60:121-130). Other studies have yielded mixed results – in 2012 – an analysis of 15mg Deplin added to an SSRI for treatment resistant depression, yielded no improvement in the first trial, and a marked improvement in the second ( American Journal of Psychiatry. 169(12), 1267-74.)

Bottom Line: Folic acid supplementation is a relatively benign augmenting strategy for treatment resistant depression, and certainly worth a try, ideally with the inexpensive, readily available supplements first. Up to 10 weeks may be required to notice its effect. Recommended doses of Deplin are 7.5 to 15mg daily, while the recommended dose of folic acid is 0.4mg, or 400 micrograms per day – the latter is far less expensive, and certainly worth a try before Deplin.

Menlo Park Psychiatry has been working with patients for Depression over the years and the insight and experience collected has made us known as one of the best sources in the area for treatment. For more information on how we can help with Depression, contact us at: www.siliconpsych.com

Weight Loss And Happiness – Serotonin And The Carbohydrate Connection

The bread rolls at restaurants may actually help you eat less… Serotonin is an essential neurotransmitter – and acted upon by many commonly known anti-depressants which boost its levels. It has a myriad of effects- ranging from creating a feeling of satiety, sleep, mood, anxiety, pain, blood pressure, and sense of overall calm. The highest number of serotonin receptors are actually found in our gut.Tryptophan is one of 22 essential amino acids and is the essential precursor to the formation of serotonin.

Studies now show that having a moderate dose of (low fiber) carbohydrates, can have mood elevating effects, and actually reduce our sense of hunger and food consumption. The reason lies in the “plasma tryptophan ratio” – which affects which amino acids get through the blood brain barrier. Eat a protein rich meal – and all the amino acids equally compete to cross into the brain (so less tryptophan, and less serotonin). Eat a carbohydrate rich meal, and the insulin drives a lot of amino acids into muscles – leaving less competition for tryptophan to cross into the brain (so more tryptophan and more serotonin). The proof? Work by Judith Wurtman has demonstrated that people served a carbohydrate rich pre-meal drink “became less hungry and were able to control their calorie intake” and this effect was not achieved with a protein rich drink (less transported serotonin). Additional studies have found impaired tryptophan transport in fibromyalgia, as well as a tendency to over-eat carbohydrates in patients with depression and during periods of anxiety – which may be a form of self medication by enhancing serotonin levels.

THE RECIPE: For weight loss and happiness from the book: “The Serotonin Power Diet” by Dr. Wurtman

1. Have your carb snack on an empty stomach so there is no competition from other amino acids
2. Snack on 25-35 grams of carbohydrate- with low fiber to speed up absorption
3. Protein content should be less than 4 grams, less than 3 grams of fat. Pretzels, chips, or crackers are a great option
4. Wait 20-40 minutes to feel the effect – don’t keep eating!
5. Aim for more protein in the morning and more carbs with dinner, to reduce snacking, and enhance sleep.

A Concise Review Of Behavioral Approaches To Insomnia

From the American Academy of Sleep Medicine. Below is the current recommendations for behavioral treatment of insomnia.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2576317/

Common Cognitive and Behavioral Therapies for Chronic Insomnia

Stimulus control (Standard) is designed to extinguish the negative association between the bed and undesirable outcomes such as wakefulness, frustration, and worry. These negative states are frequently conditioned in response to efforts to sleep as a result of prolonged periods of time in bed awake. The objectives of stimulus control therapy are for the patient to form a positive and clear association between the bed and sleep and to establish a stable sleep-wake schedule.

Instructions: Go to bed only when sleepy; maintain a regular schedule; avoid naps; use the bed only for sleep; if unable to fall asleep (or back to sleep) within 20 minutes, remove yourself from bed—engage in relaxing activity until drowsy then return to bed—repeat this as necessary. Patients should be advised to leave the bed after they have perceived not to sleep within approximately 20 minutes, rather than actual clock-watching which should be avoided.

Relaxation training (Standard) such as progressive muscle relaxation, guided imagery, or abdominal breathing, is designed to lower somatic and cognitive arousal states which interfere with sleep. Relaxation training can be useful in patients displaying elevated levels of arousal and is often utilized with CBT.

Instructions: Progressive muscle relaxation training involves methodical tensing and relaxing different muscle groups throughout the body. Specific techniques are widely available in written and audio form.

Cognitive Behavioral Therapy for Insomnia or CBT-I (Standard) is a combination of cognitive therapy coupled with behavioral treatments (e.g., stimulus control, sleep restriction) with or without relaxation therapy. Cognitive therapy seeks to change the patient’s overvalued beliefs and unrealistic expectations about sleep. Cognitive therapy uses a psychotherapeutic method to reconstruct cognitive pathways with positive and appropriate concepts about sleep and its effects. Common cognitive distortions that are identified and addressed in the course of treatment include: “I can’t sleep without medication,” “I have a chemical imbalance,” “If I can’t sleep I should stay in bed and rest,” “My life will be ruined if I can’t sleep.”

Multicomponent therapy [without cognitive therapy] (Guideline) utilizes various combinations of behavioral (stimulus control, relaxation, sleep restriction) therapies, and sleep hygiene education. Many therapists use some form of multimodal approach in treating chronic insomnia.

Sleep restriction (Guideline) initially limits the time in bed to the total sleep time, as derived from baseline sleep logs. This approach is intended to improve sleep continuity by using sleep restriction to enhance sleep drive. As sleep drive increases and the window of opportunity for sleep remains restricted with daytime napping prohibited, sleep becomes more consolidated. When sleep continuity substantially improves, time in bed is gradually increased, to provide sufficient sleep time for the patient to feel rested during the day, while preserving the newly acquired sleep consolidation. In addition, the approach is consistent with stimulus control goals in that it minimizes the amount of time spent in bed awake helping to restore the association between bed and sleeping.

Instructions (Note, when using sleep restriction, patients should be monitored for and cautioned about possible sleepiness):

Maintain a sleep log and determine the mean total sleep time (TST) for the baseline period (e.g., 1–2 weeks)
Set bedtime and wake-up times to approximate the mean TST to achieve a >85% sleep efficiency (TST/TIB × 100%) over 7 days; the goal is for the total time in bed (TIB) (not <5 hours) to approximate the TST.
Make weekly adjustments: 1) for sleep efficiency (TST/TIB × 100%) >85% to 90% over 7 days, TIB can be increased by 15–20 minutes; 2) for SE <80%, TIB can be further decreased by 15–20 minutes.
Repeat TIB adjustment every 7 days.

Paradoxical intention (Guideline) is a specific cognitive therapy in which the patient is trained to confront the fear of staying awake and its potential effects. The objective is to eliminate a patient’s anxiety about sleep performance.

Biofeedback therapy (Guideline) trains the patient to control some physiologic variable through visual or auditory feedback. The objective is to reduce somatic arousal.

Sleep hygiene therapy (No recommendation) involves teaching patients about healthy lifestyle practices that improve sleep. It should be used in conjunction with stimulus control, relaxation training, sleep restriction or cognitive therapy.

Instructions include, but are not limited to, keeping a regular schedule, having a healthy diet and regular daytime exercise, having a quiet sleep environment, and avoiding napping, caffeine, other stimulants, nicotine, alcohol, excessive fluids, or stimulating activities before bedtime.