Now that it is December, and the shortest days of the year are quickly upon us, Seasonal Affective Disorder, or SAD, can be a common encounter. “Bright Ideas for Winter Blues” is a fairly good review article on the state of current thinking regarding SAD, and its treatments. It gives a solid overview of the issues involved with light therapy and the kinds that actually work. It refers the reader to www.cet.org (Center for Environmental Therapy) and has a questionnaire to determine what time of day the light therapy would maximize your wakefulness depending on your own individual circadian rhythm and when your brain probably secretes melatonin.

I actually went to the site and took the test to see when would be ideal for me— 6:15 am, and I am hardly a morning person! It would have to be way better than coffee, at that time of the morning! And maybe the idea is if it can get you to wake at that time of the day, you can do anything! But the article does mention that in addition to lights, antidepressants, natural sunlight, and exercise can often help as well. They throw in Vitamin D, which seems to be this decade’s cause of all the world’s problems, but they admit there is really no good data to support it as a treatment for SAD. CBT or Cognitive Behavioral Therapy is mentioned as treatment for maladaptive thought patterns that come about due to the depression, and actually helped a fair number of people. It was better at preventing a recurrence the following winter than anything else, which I was very surprised about. I left out the other treatments that really provide little benefit, from my point of view, but you can read the article to see what they come up with.

I still feel there is nothing better than a week on a sunny beach in the Caribbean during midwinter, if you can get away, or a ski trip with blue sky and sun reflecting on the bright white snow, providing you can get out of bed and have the energy to travel!

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So in trying to join the new millennium, I decided to give this blog a go many months ago. Alas, my schedule did not allow for much time to consider this enterprise other than saying, “Sure! How hard could it be?” Fast forward almost a year later and well, here it is. This is meant simply to be a place to put observations about life and work in the psychiatric field, mixed in with comments about interesting articles I have stumbled on. It’s a way to laugh at life, and not take oneself so seriously. And, it’s food for thought. Mine and/or yours. I am sure it will evolve, as everything seems to do.

I get most of my medical information these days from The Wall Street Journal. A lot of interesting and relevant sort of stuff. Tuesday, November 17, 2009, Personal Journal had 2 “opposite end of the spectrum” entries. The first, “When Mr. Clean Meets Ms. Messy” is a laugh, sobering though it is, about the nature of relationships, and the passive-aggressive stances some people get into when centered around clutter and cleanliness. Talk about being unable to change a person! Not to mention the feeling of helplessness about a partner that is mis-matched on the other end of the messiness spectrum. Although it may give additional work to my colleagues, it seems more to be a ticking time bomb. It is hard to imagine living like that.

The other, “A Key to Unlocking Memories” is more scientific in nature about the effects of music on memory. Listening to oldies, sing-alongs with old standards that everyone seems to know often, can help a person’s memory, even Alzheimer’s patients that have trouble remembering their spouses. Think back to the craze of Mozart music before taking tests, and you may remember (if you recently listened to music) that IQ scores are raised as well test performances. The Institute for Music and Neurologic Function is trying to get playlists for Alzheimer’s patients identified so relatives can download them onto ipods and play them for “therapy”. Music also has a tremendous effect on mood and has been claimed to “soothe the savage beast”. Take my job away? I dunno. We all can point to certain songs that evoke powerful memories or strong feelings. It’s something to think about—this complicated and engmatic brain of ours. No wonder so many people sing in the shower, or in the car!

So, either a family member or a doctor (or perhaps even yourself) has indicated you should see a psychiatrist to get psychotherapy or an evaluation for medication. It seems like a fate worse than death, or the last stop on a slow train bound to nowhere. Actually, it is neither, but what should you expect?

A psychiatric consultation is a primarily a conversation between you and the psychiatrist to figure out what might be wrong and to come up with a “treatment plan” to correct the problem. Since establishing the correct diagnosis will lead to the proper treatment, the conversation begins with what is presently wrong — Why do you come to the psychiatrist’s office today when you could be anywhere else on the earth? And, what complaints do you have?

Other pertinent information will be asked about, including: family history, prior psychiatric history (if any), and if you have ever been tried on any kinds of psychiatric medications before. A review of comprehensive psychiatric symptoms will occur next, to fill in details about common psychiatric disorders like panic, insomnia, anxiety or depression and to get a sense of your present level of functioning. Questions will also be asked to get some information about what kind of person you are, and about your interests and background. Often, the above takes close to an hour to complete.

All the information is used to reach a tentative diagnosis and then used to discuss the initial components of treatment: psychotherapy and/or medication . Occasionally, blood work may be obtained to rule out other overlapping medical problems such as low thyroid, or anemia.

It may not be reasonable to expect a person to have to decide their course of action at the conclusion of the first session if they are uncertain, want to do research, want to discuss it with family members or need time for further consideration. The decision regarding treatment can be discussed then, or at our next appointnent. Pros, cons, benefits and side effects of medication treatment under consideration are reviewed.

Medication therapy is also compared to the obvious choice of doing nothing. If medication treatment is begun, a follow up appointment is scheduled approximately 2 weeks after the initial appointment to assess the early benefits of the medication prescribed and to make whatever adjustments are necessary. It is never assumed that anyone, by the mere fact of walking into a psychiatrist’s office, will have to take medication, never mind for the for the rest of their life. The length of time needed for medication treatment is determined by a number of factors, particularly, how long have the symptoms been present?

When the agreed upon length of time on medications has passed, and the original complaints are resolved, the medication will be tapered and discontinued to see if meds are no longer needed to keep the symptoms treated. Your condition and symptoms will be closely monitored and followed regardless of the diagnosis or treatment pursued. Each person’s treatment is individualized a reasonable amount of time between appointments to allow for adequate practice of certain psychotherapeutic techniques or enough time for a medication to begin to work.

Office visits are scheduled for different lengths of time, to allow for adequate observation, communication, assessment, exchange and decision making. During that time, no question, concern or problem is ever too minor or unimportant to be discussed as treatment. Treatment is an active collaboration and evolving decision making process between two persons.

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