Schopick Psychiatry

Binge Eating Disorder is a condition that is only recently gaining attention and awareness. Formally recognized as a medical condition in 2013, it is the most common eating disorder among U.S. adults, affecting an estimated 2.8 million Americans. It affects both women and men, although more women are afflicted. While the disorder relates to overeating, it can occur in people of normal weight.

What is binge eating disorder (B.E.D)?

Most of us overeat from time to time, whether during the holidays or at a celebration, but this is typically a rare occurrence. We may experience some indigestion, but otherwise are none the worse for wear. People suffering from binge eating disorder regularly eat more food than most people would in a similar time period under similar circumstances. Binge eaters feel that their eating is out of control during a binge; they either cannot keep from eating, or once they start eating, they cannot stop. Binge eaters also:

• Eat extremely fast
• Eat beyond feeling full
• Eat large amounts of food even when not hungry
• Eat alone to hide how much they are eating
• Feel terrible after they binge, and are upset by the fact that they have binges

Those with the disorder typically binge on at least a weekly basis and have been doing so for at least three months. Those with B.E.D do not counteract their excessive eating by purging, vomiting or overexercising as do people suffering from anorexia or bulimia. Only a healthcare professional can diagnose binge eating disorder.

What causes binge eating disorder?

The exact causes are unknown, but certain theories indicate that those with B.E.D. may have differences in their brain chemistry. These anomalies interfere with their ability to regulate food intake, and may increase their desire for a particular food. Some evidence suggests that B.E.D. may run in families, and genetic influences may be at work. Stress can also trigger B.E.D., as well as undergoing a trauma, such as a terrible accident or natural disaster.

What are the dangers of binge eating disorder?

Beyond the potential harm to one’s health, B.E.D. can also lead to depression, anxiety, low self-worth, and other mental health issues. B.E.D also makes it difficult for people to function in social roles and can impact families, personal relationships, and work.

Can binge eating disorder be treated?

Yes. The first step is to get a proper diagnosis and begin working with your health care provider and a mental health care provider. B.E.D can be treated in several ways, and often a combination of therapies is used.

• Cognitive Behavioral Therapy involves working with a mental health professional to learn how to regulate eating habits. It will help teach self-monitoring, goal setting, and work on reducing negative self-perception.
• Interpersonal Therapy may help when the binge eating is motivated by an underlying social problem.
• Dialectical Behavior Therapy may assist those who are bingeing to cope with a traumatic experience.
• Medication has also proven successful. The U.S. Federal Drug Administration has just approved Vyvanese, a stimulant used in the treatment of ADHD, for treatment of those with B.E.D.
• Other medications used in treatment include antidepressants, which work on the depression/anxiety aspects of the disorder, and also can influence the chemical imbalance in the brain.

At some point, those with B.E.D may also work with a nutritionist to help develop healthy eating guidelines, and if overweight, a program for healthy weight loss. However, it is advised that the binge aspects and mental health aspects of the disorder be brought under control prior to embarking on any diet plan.

Binge eating disorder can affect people from all walks of life and income levels. It is not something to be ashamed of; it is a medical condition that can be treated. If you feel you suffer from B.E.D, talk to your healthcare provider. Help is available.

About Dr. David Schopick:

Dr. David Schopick is a psychiatrist in private practice in Portsmouth, NH. He is Board Certified by the American Board of Psychiatry and Neurology in adult, adolescent and child psychiatry and has been serving patients in the Greater Seacoast area and beyond for more than 22 years.

For more information, call (603) 431-5411 or visit www.schopickpsychiatry.com

by Dr. David Schopick

When we think of sleep disorder, we tend to think of insomnia, but there are other sleep disorders that can affect a person’s ability to work, attend school, or live a normal life.

What is a Circadian Rhythm Disorder?
Your circadian rhythm is your body’s “internal clock,” which signals when you should sleep and when you should wake, as well as other body processes. Normally, this clock runs on a 24-hour cycle which echoes the earth’s pattern of night and day. We sleep at night; we are awake during the day. However, sometimes our circadian rhythm becomes disrupted, making it difficult for people to sleep during the night or be fully awake and functioning during the day.

What can cause these disruptions?
Some common causes are going on shift work, pregnancy, time zone changes, medications, and changes in routine.

Some common Circadian Rhythm Disorders are:

Jet Lag or Rapid Time Zone Change Syndrome: This includes excessive sleepiness and lack of daytime alertness in people who travel across time zones.

Shift Work Sleep Disorder: This sleep disorder impacts those who frequently have to rotate work shifts or often work at night. They may have trouble adjusting to sleeping during the day and working at night, and this can lead to insomnia.

Delayed Sleep Phase Syndrome (DSPS): This disorder affects the timing of sleep. People with DSPS tend to fall asleep very late at night and have difficulty waking in time for work, school, or other appointments.

Advanced Sleep Phase Syndrome (ASPD): With this disorder, a person goes to sleep earlier and wakes earlier than desired.

Non 24-Hour Sleep Wake Disorder: With this disorder, a person has a normal sleep pattern, but they live in a 25-hour day. Over time, their sleep cycle is affected by inconsistent insomnia that occurs at different times each night. They may fall asleep at a later time and wake up later, or fall asleep earlier and then wake up earlier.

How are sleep disorders treated?
Treatment options vary depending on the type of sleep disorder involved. One of the first steps is ruling out side effects from any medications, as well as any underlying medical conditions. Having the patient keep a sleep diary for one or two weeks is also important. Often, a combination of behavior therapy, light therapy, and possibly medication is involved in providing successful treatment.

Behavior Therapy:
This usually involves having the patient maintain regular sleep/wake times and avoid naps. This will help “train” the body to the proper sleep time. Engaging in regular exercise is also key as it will encourage physical tiredness. Patients are also advised to avoid caffeine, nicotine, and other stimulants, as well as any intense exercise within several hours of bedtime.

Those suffering from Delayed Sleep Phase Syndrome should minimize exposure to light during the evening and at night by reducing illumination in their home, and avoiding the bright screens of televisions and computers. For those suffering from Advanced Sleep Phase Syndrome, the situation is the reverse, with light exposure needing to be increased in the evenings. Typically, patients are advised to keep lights on indoors for a longer period, or to spend more time outside in the longer daylight months.

Medication:
Medications such as melatonin, drugs that promote wakefulness, or short-term sleep aids may also be used to adjust and maintain the short-term sleep cycle in order to shift it toward the desired schedule. (DR. SCHOPICK: I would ask you to add in here what medications you might prescribe.) Melatonin is available over-the-counter, and is a hormone that is found naturally in the body. It promotes sleep and can help with short-term sleep issues.

Chronotherapy:
Chronotherapy is a behavioral technique in which the doctor works with the patient to gradually and systematically adjust bedtime until the patient is on the desired schedule. This can take several weeks to achieve.

Bright Light Therapy:
Sleep therapists use bright light therapy to help reset a body’s circadian clock. The patient is exposed to a high intensity light (10,000 lux) and the amount of exposure may vary from an hour to longer.

Summary:
We often joke about not getting enough sleep, but for those suffering from true sleep disorders, this is no laughing matter. A good rest, and being able to sleep and wake on a regular schedule are keys to our being able to function successfully in the world. Lack of sleep, or lack of a regular sleep pattern, can lead to depression, substance abuse, and other mental health issues. If you are suffering from a sleep disorder, do not self-treat. Consult with your physician. Treatment is available.

Years ago, we called it teasing. Kids were encouraged to become stronger by tolerating the teasing, if not learning to give it back. Educators as well as parents often dismissed their children’s concerns. Sometimes, it was easier to “normalize” it like a rite of passage or a learning process.

The term “bullying” was reserved for the groups of high-testosterone boys who physically picked on and humiliated the weaker, smaller kids.

Over the past 10-15 years, “teasing” has appropriately come to be recognized as bullying. One may view bullying as child abuse by other children. If we ask ourselves if the behavior in question would be considered abuse if committed by a parent or other adult, then it is bullying.

Bullying takes many forms. In boys, it tends to involve overt aggression, either physical or verbal. In girls, it more commonly involves exclusion from peer groups. Name-calling is common. These are often hard-hitting words, which can be sexualized in nature or content. Cyber bullying is a major stressor for kids because they can instantly be ridiculed in front of their entire school. The humiliation from today’s methods of bullying can be horrific.

Your child may not initially confide in you that they are being bullied. Many children feel ashamed, thinking the fault is somehow theirs. If you notice your child repeatedly suffering from headaches, stomach aches, or not wanting to attend school or activities, bullying may be the reason.

Additional consequences of bullying can include symptoms of depression, anxiety, and panic attacks appearing in the child being bullied. Shame, guilt and suicidal thoughts (and sometimes actual attempts or completions), and intentional self-injury can also result. Emotional distancing from parents and friends is common because of the sense of shame and humiliation. A child being bullied may often beg parents not to complain to others about the bullying for fear they will be further ostracized.

How to Support Your Child

First, acknowledge your child’s pain–this is important. It is important to communicate that you will help them – they are not alone any longer. Be prepared to listen to your child’s frustration and fears. Second, talk to their teachers, school guidance counselors and principal about the situation to make sure they are aware (see additional school comments further down)
–in a large school, especially, these kind of actions can go unnoticed. The bullies may also be adept at perpetrating their actions when no one is around. A consult with the school can be done via phone to alleviate your child’s fears about repercussions. Involving the appropriate authorities is a necessary step. The school authorities are responsible for setting limits on the bullies, not your child. Collaboration with the school is essential. It is for the authorities to speak with students and their parents to stop the harassment.
If, however, your child is suffering from the symptoms noted previously–depression, panic attacks, suicidal thoughts etc.–then it may be wise to seek psychiatric help.

When I see kids for evaluations, I ask whether there is a history of their being bullied. Kids today are well aware of the term and the meaning. Schools are generally doing a good job educating kids on the need to not bully their peers and establishing criteria such as a “zero tolerance” policy, but obviously, incidents still occur.

I have found that it is important for children to share their stories, and very important for these stories to be heard by the parents– and the psychiatrist, if they are seeing one. It is important for children to have their pain acknowledged and to understand that the bullying is wrong, damaging, undeserved, and related to their current problems (depression, panic attacks, suicidal thoughts, self-injury etc.).

If a child is suffering from being bullied, psychotherapy can be very helpful. I strongly encourage trauma-oriented therapy because trauma is exactly what your child is experiencing. Your child needs to get well as quickly as possible so they can resume their social development and education under the best possible circumstances.

Psychopharmacology can be helpful in some cases. It is always important for the psychiatrist to inform parents and patients of the possible benefits (and risks) of medications. If the child is depressed, anxious or experiencing panic attacks, an anti-depressant trial can often be helpful in controlling such symptoms and improving resilience. Sometimes, other psychiatric diagnoses are uncovered during the evaluation which may not be the primary reason the family sought the evaluation, but these may contribute to the overall picture. Issues such as ADHD, learning disabilities, or impaired social skills may coexist. Treatment for these issues can help alleviate the overall sense of suffering by the child, and reduce some of the reasons for being victimized.

Talk to Your School

Many states have passed strict laws regulating how school officials must respond to bullying. In New Hampshire, any school employee aware of bullying is obligated to inform the principal. The principal is the lead person with the ultimate official responsibility for investigating and putting a stop to the bullying. I encourage parents to use this resource on behalf of their child’s safety. Be aware though, that sometimes what you will hear back is that your child is the instigator, or that your child dishes it out to the same level as the others, or that no teacher has seen the bullying.Possible reasons for this response can include that your child may be exaggerating or fabricating the bullying. More common, though, is the likelihood that the bullies are clever enough to not act out this behavior within sight of the authority figures, and are able to do it in such a way that the only behavior observed is your child’s reaction. In this case, your best course is persistence with school authorities, and to continue thoroughly documenting the bullying incidents. You may also want to talk to other parents to see if their children are being bullied. If so, speaking to school authorities as a group may be a more successful force for change.

What If Your Child Is the Bully?

The professional consensus is that those who bully have significant emotional problems themselves. They may be acting out what they experience or see at home or in their community. These are often children with poor self-esteem, low self-worth, and chronic insecurities. Their lack of empathy or compassion for those they hurt often reflects underlying antisocial attitudes. The bullies need limits set by the authorities, as well as professional treatment. The families may need the involvement of social services if abuse or neglect is suspected. Such referrals are generally done by the school or mental health professionals.

In summary, bullying is a multi-dimensional process that is very harmful to the emotional and educational development of children. It can leave kids ashamed and with low self-esteem. Reaching out to schools for help is essential. Professional treatment can often be helpful to more quickly restore kids to an overall sense of well-being and resilience.

Bullying is an issue in our society like never before, with many pages devoted to the ongoing problem in schools, the added issue of cyberbullying, and the devastating affect it is having on a generation of children. Most parents worry about their child becoming a victim, but for every victim there is a perpetrator, so the other question to ask is how do I prevent my child from becoming a bully?

There is no simple “one size fits all’ answer, but there are steps that can be taken to help ensure that your child does not adopt bullying as a behavior. Many of the keys to thwarting this behavior rest with the parents and others who will help raise the child. It is essential that parents step in if inappropriate actions are demonstrated, not only to instruct that this is not acceptable, but to also show the child what is appropriate. Good behavior should then be rewarded with praise and encouragement.

Children start forming behavior patterns in terms of how they interact with others as young as two years old. They also start dealing with feelings of aggression about this time–which is normal–and it is at this point that they start needing help in channeling those feelings. Who has not seen children tussling over a toy or one child snatching a desired object from another? Most of us have, and most children will act this way at some point in time. The key is to make sure it does not become a habit. If a child thinks that taking items by force gets them what they want with no consequence, then this is the road they will choose. As the child gets bigger and stronger behavior that started as simple toy snatching can become more aggressive and troublesome.

In redirecting the behavior, it is important not to yell and scream and also snatch the toy away but rather speak firmly and calmly to the child, indicating that this behavior is wrong and restoring the toy to the child who had it first. The offending child needs to then be shown how to ask to play with the toy. Such redirecting will likely need to be repeated a number of times before it fully takes hold and parents will need to pay attention during playtime. During this period, any time the child is observed asking or indulging in a sharing of toys, he or she should be praised so they understand what is good behavior, not just what is bad.

Hitting may also be common among young children. In the beginning, they do not understand the consequences and are just releasing aggression and watching to see what the response is. Again, it is important to “nip this in the bud,” by firmly indicating that hitting is not acceptable. It may also be useful to try to ascertain what the child thought would be accomplished by hitting. Was it an issue of sharing? Did the other child hit first? Or was the child just out of sorts and taking out anger or frustration? Isolated incidents of hitting are typical, and while they need to be addressed, need not be cause for undue concern. But, if a pattern starts to develop, with a child using hitting as a way to get what he or she wants, then parents must be diligent about correcting this behavior and possibly getting expert advice on determining the source of the aggression and how to modify the behavior.

Teaching by Example

Children learn from their parents so it is critical that children see parents exhibiting good behavior when it comes to handling their anger or making requests. If children see parents acting in a bullying fashion, with one ridiculing or intimidating the other, or with hitting involved, then they will copy this pattern. The same holds true in terms of their parents’ interaction with others. If children see parents acting politely, fairly, and calmly even when someone else is angry, they will learn that there are better ways to deal with situations than through threats or yelling.

What If Your Child Is Already a Bully?

The professional consensus is that those who bully have significant emotional problems themselves. They may be acting out what they experience or see at home or in their community. These are often children with poor self-esteem, low self-worth, and chronic insecurities. Their lack of empathy or compassion for those they hurt often reflects underlying antisocial attitudes.

Families need to look inward to see how conditions and behaviors in the home may be influencing their child’s actions and self-perception. Professional help may be needed to help address the family dynamic and help the child improve their behavior. (If there is abuse or neglect within the home, social services may need to be involved.)

Bullies also need to have limits set by those in authority, so it will be essential to work closely with the child’s school or with other adults who may oversee activities the child is involved in.

Bullies need not be bullies for life. With proper counseling and encouragement, children can alter their behavior and enter a happy, fulfilling role in society.

by Dr. David Schopick

Chances are, there are people reading this article who have suffered from abuse. The abuse may have been physical, emotional, or a combination thereof. It may be buried in their past or they may still be victims. Either way, it is affecting their lives.

If you have been abused, or are suffering from abuse, know this: healing can take place. It will take work and it requires trust, which can be a very difficult thing to achieve once you have been abused. Abuse has a way of interfering with a person’s ability to trust, but learning to trust again is one of the first steps on the road to recovery.

Finding a therapist or counselor who is experienced in dealing with abuse is key. Once you have found a therapist, it may take time for you to feel comfortable enough to share your experiences, but a good therapist will guide you in a way that helps you make progress.

Abandoning Secrets

Why is therapy important? Abuse is built around secrets. Don’t tell what’s happening to you. Don’t tell who is doing it. Don’t let on that anything is wrong. If keeping secrets is the hallmark of a dysfunctional or abusive home, then sharing secrets, opening all the locked doors, letting all the monsters out of the darkness, is the hallmark of psychotherapy.

There are many ways to think about psychotherapy and the process of recovery. Therapists, researchers and people in treatment have many different theories about how the healing actually takes place. I believe that sharing our secret monsters is a key way that therapy helps to generate healing. Talking about the monsters takes away their power and has a therapeutic effect. In fact, I use the word “monster” deliberately as I encourage my patients to see their abuse as a monster on their shoulder, always there, always controlling them. Our job as therapists is to help patients identify the monsters then banish them once and for all. Monsters like dark, secret places so we get rid of them by bringing them into the open, into the light.

Secrets are a way that your inner self keeps you weighed down with all those huge monsters that you have lived with for so long. Secrets are like monster blackmail. Every time you recall the abuse your inner monster punishes you. It urges you not to tell anyone about what has happened: “If people ever find out, they’ll hate you!” says the monster. “They will see you as damaged!” Secrets foster feelings of fear, anger, loneliness and suspicion.

For you to be well again, the secrets must come out. The reality is the shame and guilt are not yours; they do not belong to you. They belong to the abuser.

During psychotherapy, all the secrets and secret monsters can come out, be closely examined, and healed. This is where you sort out the shame, guilt and terror that may have plagued you since the abuse.

Uncovering Feelings & Emotions

Therapy is a safe place where you can experience emotion. This may sound simplistic, but it is true. Many abuse victims say they have never felt safe anywhere because of what happened to them. For abuse victims, the therapist’s office is a place where they can feel safe, maybe for the first time in their lives.

Experiencing emotion is essential to restructuring your view of yourself. In our culture, emotional release is generally viewed as a sign of weakness. However, in therapy we learn that releasing anger, rage, grief, pain, loss and fear, as well as joy and pleasure, are necessary steps toward self-knowledge and growth.

In therapy, you become the master instead of the monster being the master. By releasing the monster inside, you can look at it, describe it, name it and finally move beyond it.

The goal of therapy is to learn new ways to relate to yourself and to others. An important step in this goal is learning to communicate your needs, feelings, wishes and fears more effectively. In therapy, anger is not acted out, but is instead expressed, understood and worked through. The goal is to bring everything, all the monsters, feelings and experiences into the light. Hiding your feelings during treatment will only undermine your therapy. Hiding your feelings is like keeping secrets; it may be something you learned to do as you were growing up, but just like secrets, it can poison a relationship.

Building a new life means building a new foundation of trust and communication. It means taking the monster off of your shoulder, putting it on the table between you and your therapist, and saying “What have we got here?” And that’s when the healing begins.

The next article will focus on techniques for coping with the pain and flashbacks caused by abuse, including ways to de-stress and relax.

In addition to more than 25 years of experience in private practice, Dr. David Schopick is also the author of “Safe at Last: A Handbook for Recovery from Abuse” which highlights the use of “monster therapy.

by Dr. David Schopick

Those who have experienced abuse often see themselves as victims, and indeed they have been victims of horrible experiences. However, in order for healing to take place, it is important for those who have suffered abuse to take back control of their lives. They need to see themselves as survivors, as people who have overcome, and who will go on to become strong, healthy, and capable of living fulfilling lives.

Overcoming Guilt

People who have suffered sexual abuse, whether as a child, teen or adult, often partially blame themselves for the abuse. They may see themselves as flawed, guilty or even dirty. If they at times accepted the abuse or even initiated sexual contact in order to avoid further punishment, then the burden they place on themselves is even greater. What they need to realize, and what therapy can help them understand, is this: You are examples of the very bravest human beings. Rising up from despair and dealing with painful memories and disclosure are true acts of courage. You may not have been able to refuse the act of abuse when it occurred but you are now able to refuse to accept the guilt, shame and responsibility for what happened.

Transitioning from victim to survivor is an important part of the healing process. That said, recovery does not happen overnight. You must be patient with yourself. Expect setbacks when they come and forgive yourself for not being perfect. Your courage and hard work will be rewarded with a better understanding of yourself and increased self-respect and self-love.

Ways to Cope

In the first article, we talked about monster therapy and how, in my experience, people often found it helpful to see their abuse as a monster that must be brought into the light, examined and then vanquished. Monster therapy is all about learning to identify ways to heal on your own.

Some who have experienced abuse want to confront the perpetrator, seeking an apology or some sort of redress. Believing that an apology or a confrontation is key to being healed is a mistake. The apology or confrontation puts the power back in the perpetrator’s hands. No apology may be forthcoming; the abuser may try to put part of the blame on the victim; the abuser may be dead, moved away or otherwise unavailable. Thus it is important to not allow the abuser to have any more control over your life. The time when he or she controlled you is past, and now you take control. True healing cannot be achieved at the whim of someone else. True healing comes from within. YOU are in control of your thoughts and feelings, and coming to realize this will put you on the road to achieving inner strength and self-respect.

This does not mean you cannot express outrage and pain over what was done to you. In fact, it is essential that you do so. But the way to express this is to yourself, through therapy, and not necessarily to your abuser. Take back your own power. Focus on what you can change–which is yourself and your inner world–and not on what you can’t which is the abuser and the past. Once you can do this, you can move on without the extreme anger, powerlessness, guilt and shame that may have crippled you in the past.

Some who have experienced abuse find it therapeutic to write a letter to the abuser, even though that letter is not sent. Others create journals or express their feelings through art. Some draw the abuser or pictures epitomizing their suffering. Others may move on from this and draw pictures of how they see their future–giving themselves a goal to strive for.

All of these methods can be very therapeutic in helping people cope with abuse and move forward into better lives.

De-Stress and Relax

We all need to manage stress, but survivors have a special challenge. It can be difficult to overcome bad memories and truly relax. I usually recommend that my patients learn therapeutic breathing techniques, meditation, mindfulness or self-hypnosis. These therapies can be very useful in helping people on their quest to find serenity and wholeness. I call them “monster antidotes” to be used when the pain and terror of the past seem overwhelming.

The essence of life is breath so when you are able to master your breathing, the more you are apt to feel that you control your own body–not the abuser. Controlled breathing is a wonderful way to relax your body and it is easy to learn. Open your mouth slightly, this will relax your jaw, and help your whole body to relax. Breathe slowly in through your nose, then out through your nose. Inhale. Exhale. Slowly. As you repeat this for several minutes, your blood pressure will lower and levels of carbon dioxide in the blood will lower as well. Slow, steady breathing is the opposite of your body’s response to panic, so as you breathe in this way your body will become calm.

Meditation can begin with controlled breathing but works best if you can spend 15 to 30 minutes by yourself. Once your breathing is calmed, begin repeating a positive thought or word over and over until nothing exists but the word and your breathing. This should be a word that evokes feelings of calm such as “serenity” or “peace.” Gradually, your body will relax.

Your therapist can teach you effective self-hypnosis techniques that can also be useful in reducing stress.

Remember, you are brave, you are courageous, you are a survivor. And now you are on your way to learning a new healthy way to live.

In addition to more than 25 years of experience in private practice, Dr. David Schopick is also the author of “Safe at Last: A Handbook for Recovery from Abuse” which highlights the use of “monster therapy.

by Dr. David Schopick

According to the American Pain Foundation, about 32 million people in the United States report pain lasting longer than one year. Anywhere from one quarter to one half of patients suffering from pain issues told their doctors that they felt depressed. This is especially true of those whose chronic pain incapacitates them.

Can chronic pain cause depression?

Yes, pain and depression can go hand in hand. When you are in pain, it is normal to feel irritable, anxious or agitated. Usually, as a patient’s pain subsides, these symptoms go away. But if the pain never goes away, the heightened stress response can cause depression, and the problems associated with it. Constant pain can wear people down over time.

People suffering from chronic pain may also experience chronic anxiety, confused thinking, fatigue, irritability, sleep disturbances and weight gain.

Sometimes patients get caught in a vicious cycle in which pain worsens symptoms of depression, and depression aggravates feelings of pain. Many times, the pain that they are feeling is also the pain of losing the life they used to lead. If the pain is causing a person to be disabled, then financial woes, loss of physical ability, loss of self-respect, and possible limited social interaction can worsen feelings of sadness, isolation, and fear for the future.

Why do so many patients suffering from chronic pain have untreated depression?

The short answer is because it often goes undiagnosed. Patients in chronic pain frequently focus on their pain symptoms when seeing their doctors, and omit the fact that they are losing sleep, have loss of appetite, loss of energy, or other symptoms of depression. Reporting these issues to your doctor is key because depression can make pain worse. In fact, those suffering from both chronic pain and depression frequently have more intense pain, feel less in control of their lives, and are more apt to cope with the pain by self-medicating through drug abuse or alcohol abuse.

How is depression associated with chronic pain treated?

Sometimes, both causes may need to be treated separately in order to achieve real success. A pain management clinic can help with issues of chronic pain, while a psychiatrist can address depression. However, there are some treatments that can assist with both issues.

• Antidepressant medications may relieve both pain and depression because they affect the same chemical pathways in the brain.

• Psychological counseling can also help patients get to the root causes of their depression and learn coping techniques. Cognitive therapy can also help patients learn how to use the power of their mind to combat chronic pain.

• Stress-reduction efforts, such as exercise, meditation, yoga, journaling and other activities may help. Exercise is very important. The better fitness level you can maintain, the less likely you are to suffer injury or from other physical difficulties. Exercise also releases endorphins, the “feel good” hormone. Gentle, regular physical activity helps chronic pain; your physician can help you devise an appropriate plan.

Treatment for chronic pain and depression may be most successful when a combination of methods is used, which address both the physical and mental aspects.

Anyone suffering from chronic pain should not hesitate to report any symptoms of depression to their doctor. The sooner the depression is treated, the better they will feel–both physically and mentally.

We all experience stress as we go through life, and sometimes our levels are extra high. The kids are late getting ready for school; the car is making a troublesome noise; we have a big deadline at work–as things pile up, our anxiety grows. But for most of us, as problems get resolved, our feelings calm down.

However, there are those for whom feeling anxious is a regular state-of-mind. If you have those types of feelings day after day, you may have generalized anxiety disorder. Professional help can bring this disorder under control.

Symptoms

Symptoms can vary, but typically they include:

• Constant worrying about issues large and small
• Restlessness and feeling on edge
• Feeling tired
• Difficulty concentrating or having your mind “go blank”
• Irritability
• Muscle tension or muscle aches
• Trembling, feeling twitchy or being easily startled
• Trouble sleeping
• Sweating, nausea or diarrhea
• Shortness of breath or rapid heartbeat

People with generalized anxiety disorder may also feel anxious for no obvious reason. They may needlessly fret about their safety or the safety of their family, or feel a sense of impending disaster.

Children and adolescents can also experience this disorder, and may worry excessively about the following:

• Performing well in school, sports or activities
• Being on time
• Catastrophic events, such as natural disasters or wars
• Fitting in with peers

This worry may manifest itself with children / teens in the following ways:

• Being a perfectionist
• Lacking confidence
• Redoing tasks that were not perfect the first tim
• Constantly striving for approval
• Requiring a lot of reassurance about performance

When to Seek Treatment

See a doctor if you feel that your anxiety is beginning to interfere with your work, relationships, and other aspects of your life. You should also get help if you are feeling depressed, drinking excessively, doing drugs, or have other mental health issues as well as anxiety. If you have suicidal thoughts or behaviors, then seek emergency help immediately.

What Causes Generalized Anxiety Disorder?

The cause for this disorder is not fully understood. Here is what we know: Naturally-occurring brain chemicals (neurotransmitters) such as serotonin, dopamine, and norepinephrine seem to be involved and be “out of balance.” Some physical health conditions, such as gastroesophageal reflux disease, heart disease, hypothyroidism or hyperthyroidism, and menopause, can increase the likelihood of developing this disorder. People who have experienced childhood trauma, a chronic illness (such as cancer), chronic stress or a significant stressful incident, and women, are at greater risk of experiencing generalized anxiety disorder. The disorder may run in families and is also worsened by abuse of alcohol, nicotine or drugs. Some personality types are are also more prone to developing this condition.

It is important to get help because generalized anxiety disorder does not just cause constant worry, it can lead to other debilitating physical and mental conditions, such as depression, substance abuse, insomnia, digestive or bowel problems, headaches, and teeth grinding.

How is Generalized Anxiety Disorder Treated?

The main treatments for the disorder are medication and psychotherapy, or a combination of the two.

Among the medications typically prescribed are these:

• Antidepressants: These medications affect the activity of the neurotransmitters believed to influence anxiety disorders. Antidepressants frequently prescribed include Paxil, Zoloft, Celexa, Lexapro, and Prozac.

• Buspirone: This is an anti-anxiety medication which may be prescribed on an ongoing basis.

• Benzodiazepines: In some circumstances, a doctor may prescribe a sedative from this family of medications for short-term relief of anti-anxiety symptoms. Common examples include Ativan, Klonopin, and Xanax. These medications can be habit-forming, and can have side effects, so they are used only in certain circumstances and for short duration.

Psychotherapy, or talk therapy, can help you figure out the underlying stresses and concerns that are triggering the chronic anxiety. Such therapy can help you develop coping strategies and make behavioral changes that will aid you in dealing with future stress.

Other Helpful Tips

• Get regular exercise: Exercise is a powerful stress reducer; it can improve your mood and help keep you physically healthy as well.

• Eat a healthy diet. Avoid fatty, sugary and processed foods; be sure to include foods that are rich in Omega-3 fatty acids and B vitamins.

• Avoid alcohol and other sedatives–these can worsen anxiety.

• Try relaxation techniques such as breathing exercises, visualization, meditation and yoga. All are helpful at easing anxiety.

• Get enough quality sleep. A good night’s rest makes it easier for you to cope with life’s curve balls and can also help keep physical ailments at bay.

• Join an anxiety support group. Sharing your story with others who understand what you are going through can be beneficial.

• Interact with friends and loved ones, and enjoy activities.

• Socializing can help reduce anxiety; isolation can make it worse

• Take practical steps toward reducing stress. If you worry about finances, work out a budget to follow. If you worry about your health, talk with your doctor about a fitness plan.

• Look at ways to break the cycle when worries start–go for a walk, call a friend to get together; seek comfort in spiritual support.

Generalized anxiety disorder is treatable. With the right approach, you can learn to relax and restore a sense of balance to your life.

No one likes to see summer end, but for some people, the shortening of daylight and increase in stormy weather triggers a form of depression, otherwise known as Seasonal Affective Disorder.

What is seasonal affective disorder (SAD)?
Seasonal affective disorder is also known as winter depression, winter blues or seasonal depression. It is a mood disorder in which people who have normal mental health throughout most of the year experience symptoms of depression as fall and winter approach. (A spring/summer version can also occur, but this is rare.)

What triggers SAD?
It is believed that less daylight during the fall and winter can cause depression in some people. Other factors contributing to SAD may include genetics, age and chemical imbalance. Neurochemicals help regulate our mood and ability to function. Melatonin is a hormone that our brains produce during the hours of darkness. It helps regulate sleep, body temperature and the release of hormones. As with any hormone, the amount produced is important. People with SAD produce too much melatonin. This excess throws off their internal body clock leading to symptoms of depression. If you have had episodes of depression that clearly have an onset in fall or winter followed by remission of symptoms in the spring or summer, you may have SAD.

What are symptoms of SAD?

Symptoms include:

• Depressed mood
• Irritability
• Hopelessness
• Anxiety
• Loss of energy
• Social withdrawal
• Oversleeping (feeling like you want to hibernate)
• Loss of interest in activities you normally enjoy
• Appetite changes, especially a craving for foods high in carbohydrates such as pastas, rice, bread and cereal
• Weight gain
• Difficulty concentrating and processing information

How is SAD treated?
There are a number of options. Medications or light therapy (phototherapy) are usually the first step.

Light Therapy
Light therapy literally involves using exposure to light as a way of sending new signals to the brain and lifting depression. The type of light used, the patient’s distance from the light, and the amount of time spent in front of the light, are very specific. The light should be of adequate intensity, 10,000 lux (lux is a measurement of light intensity) is usually recommended. At 10,000 lux, the amount of time required in front of the light is 30 minutes per day. If the light is 5,000 lux, then the amount of time will be 60 minutes per day. The person undergoing treatment needs to have their eyes open so that the light reaches the retina in the back of the eye. The patient does not need to look directly at the light, and can read, do crosswords, knit, etc. while undergoing treatment. Patients usually sit about 12 to 18 inches away from the light. The light does not emit damaging UV rays, but some people have complained of eye strain or headaches. Light therapy is typically done in the morning, as it can cause insomnia if done too late in the day. If you struggle with bipolar, hypomanic or manic episodes, these can be triggered by light therapy, so light therapy should be used with extreme caution in these cases.

You can purchase a phototherapy light without a prescription, but speak with your provider first to discuss the best type to buy and how it should be used. Some insurance companies may cover some of the cost.

Patients with milder forms of SAD have experienced light therapy by simply increasing their exposure to sunlight–sitting by a window, spending more time outside, for example.

Medication
Antidepressants have proven effective in treating SAD. Sometimes these are used in combination with light therapy. Increasing Vitamin D levels has also had some success. Your doctor can advise after a thorough review of your symptoms.

Other Treatments

Behavioral changes and finding the right social support can also be effective. People experiencing SAD have benefited from:

• Counseling to help them identify signs of depression and ways to cope with negative thoughts
• Stress management
• Joining weight control/nutrition groups for adjustments to their diets that will enhance energy levels
• Counseling to help them improve their social skills and networking and thus increase their interaction with others
• Finding wintertime activities that they enjoy
• Education on sleep management.
• If the coming of winter makes you feel blue, do not suffer in silence. Make an appointment with a mental health provider and get the treatment you need to make every season of the year one to enjoy.

Know the Signs

How do you know if you or a loved one is being affected by depression?
The classic symptoms include a persistently sad mood, irritability, an inability to enjoy activities that are usually a source of pleasure, fatigue, lack of energy, poor sleep (or increased sleep), guilt, excessive worrying, and a decline in what doctors call cognitive functioning– meaning memory, concentration, decision-making, and thinking clearly. A decline in sex drive, appetite, and interest in social interaction can also occur. Sometimes thoughts of suicide are also present, and this is obviously of significant concern.

If you, or a loved one, have a combination of these symptoms, a psychiatric evaluation is recommended.

What Happens During a Psychiatric Evaluation?

A psychiatric evaluation consists of a thorough review of a person’s history. The psychiatrist will ask about the current episode of depression and when those feelings began, as well as explore possible past episodes. Further areas of exploration include past psychiatric history, family psychiatric history, substance abuse history, trauma history, medical history, social history, and educational history (particularly important with children and adolescents). Stress factors that may be contributing to the depression are reviewed. Symptoms need to be clearly defined so they can be targeted and treated. We make sure to clearly identify the target areas so we can measure improvement.

Types of Treatment

Treatment for depression can take several forms. A number of types of psychotherapy can be used. Psychotherapy is a way of healing a mental disorder by psychological rather then medical means. I will provide referrals for psychotherapy if it is indicated and the patient does not presently have a therapist. As a psychiatrist (who is a medical doctor and can prescribe medications), I feel it is extremely important for anyone suffering from depression to become aware of the medication options that may be useful for treatment. I discuss these options thoroughly with my patients, including their pros and cons, along with the option for psychotherapy. This way, patients, or their family members, can make informed decisions as to what course of treatment may work best. Sometimes the choice is medication, sometimes therapy, and sometimes a combination is used.

by Dr. David Schopick

Chronic illness affects millions of Americans nationwide, and many of those victimized by illness are also suffering from depression. A chronic illness is considered to be one that either lasts for a very long time, or cannot be cured. Those that cannot be cured can often be successfully managed with medications, other treatments, or lifestyle changes, but the concern over possible flare-ups, illness progression, possible limitations, and what the future holds can affect mood. Some examples of chronic illnesses are: diabetes, heart disease, arthritis, kidney disease, HIV/AIDS, lupus, and multiple sclerosis.

It is estimated that one-third of those suffering from chronic illness also suffer from depression. Side effects from medication, and the illness itself, may also be contributing factors.

Do certain illnesses trigger depression more than others?

First, let me state that any illness can be associated with depression, but the risk of depression gets higher when the illness is chronic, and higher still if the illness is severe. The risk is especially high in someone who already has a history of depression. People suffering from chronic pain or having had a heart attack have the highest risk of depression, followed by those suffering from multiple sclerosis, Parkinson’s disease, cancer and diabetes.

What are the symptoms of depression?

Family members may miss symptoms of depression because they assume it is normal for someone with an ongoing illness to feel sad. Sometimes the patient may not be aware that some of what is being experienced is depression. Medications can hide symptoms, as can the illness itself.

Typical signs of depression are listed below. If you, or someone you love, has a chronic illness and exhibits most of these symptoms, consult a mental health provider.

• Loss of appetite
• Insomnia
• Overwhelming fatigue
• Loss of interest in sex
• Taking no pleasure in life
• Feelings of shame, guilt or inadequacy
• Severe mood swings
• Difficulty bonding with loved ones
• Withdrawal from friends, family and social contact
• Thoughts of harming yourself or others

How does depression affect illness?

Depression can keep patients from getting the most out of life, despite their illness. It can become self-perpetuating as the depression causes more limitations, which in turn fosters more depression. Depression can also place a patient’s health at further risk as it can cause them to forget to take medications, miss doctor appointments, skip treatments, and stop pursuing a healthy lifestyle.

Heart disease is a good example of the association between depression and greater health risks. Heart disease patients have a greater likelihood of depression than otherwise healthy people. Depression can be closely linked with angina and heart attacks; it can increase your risk for heart disease, or make heart disease symptoms worse.

By contrast, once depression is treated, many patients find their overall medical condition improves, their quality of life is better, and they are more likely to maintain a long-term treatment plan.

How is depression treated?

• Talk to your doctor. If you feel that some of your current medications are causing depression, see if there are other medications or treatments available. If chronic pain is part of your illness, ask your doctor about pain management options.

• Learn as much as you can about your condition. This knowledge will help you get the best treatments possible and restore some sense of control.

• Antidepressant medications can help improve mood, and if the illness also causes chronic pain, they may assist in this regard as well. Antidepressants affect the same chemical pathways in the brain as pain receptors.

• Psychological counseling can also help patients get to the root causes of their depression and learn coping techniques. Cognitive therapy can also help patients learn how to use the power of their mind to combat chronic pain.

• Stress-reduction efforts, such as exercise, meditation, yoga, journaling and other activities may help. Exercise, as allowed by the illness, is very important. The better fitness level you can maintain, the less likely you are to suffer injury or from other physical difficulties. Exercise also releases endorphins, the “feel good” hormone. Gentle, regular physical activity helps chronic pain; your physician can help you devise an appropriate plan.

• Maintain a support team. Reach out to family and friends and try not to become isolated. Maintain as many of your social interests as possible. You will stay connected and feel better about yourself. Your doctor can also recommend support groups for others with your illness.

Remember, more than 80 percent of people with depression can be treated successfully with medication, psychotherapy, or a combination of both. Help is available, so talk to your doctor.