Seasonal Affective Disorder

Seasonal affective disorder (SAD), also known as winter depression or winter blues, is a mood disorder in which people who have normal mental health throughout most of the year, experience depressive symptoms in the winter or, less frequently, in the summer,spring or autumn, repeatedly, year after year. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), SAD is not a unique mood disorder, but is "a specifier of major depression". Once regarded skeptically by the experts, seasonal affective disorder is now well established. Epidemiological studies estimate that its prevalence in the adult population of the US ranges from 1.4 percent (Florida) to 9.7 percent (New Hampshire). Social Worker Continuing Education
The US National Library of Medicine notes that "some people experience a serious mood change when the seasons change. They may sleep too much, have little energy, and may also feel depressed. Though symptoms can be severe, they usually clear up."[4] The condition in the summer is often referred to as reverse seasonal affective disorder, and can also include heightened anxiety.

SAD was first formally described and named in 1984 by Norman E. Rosenthal and colleagues at the National Institute of Mental Health.

There are many different treatments for classic (winter-based) seasonal affective disorder, including light therapy with sunlight or bright lights, antidepressant medication, cognitive-behavioral therapy, ionized-air administration,and carefully timed supplementation of the hormone melatonin.

Symptoms

Symptoms of SAD may consist of difficulty waking up in the morning, morning sickness, tendency to oversleep as well as to overeat, and especially a craving for carbohydrates, which leads to weight gain. Other symptoms include a lack of energy, difficulty concentrating on completing tasks, and withdrawal from friends, family, and social activities. All of this leads to the depression, pessimistic feelings of hopelessness, and lack of pleasure which characterize a person suffering from this disorder.

Diagnostic criteria

According to the American Psychiatric Association DSM-IV criteria, Seasonal Affective Disorder is not regarded as a separate disorder. It is called a "course specifier" and may be applied as an added description to the pattern of major depressive episodes in patients with major depressive disorder or patients with bipolar disorder. The "Seasonal Pattern Specifier" must meet four criteria: depressive episodes at a particular time of the year; remissions or mania/hypomania at a characteristic time of year; these patterns must have lasted two years with no nonseasonal major depressive episodes during that same period; and these seasonal depressive episodes outnumber other depressive episodes throughout the patient's lifetime. The Mayo Clinic describes three types of SAD, each with its own set of symptoms. In the popular culture, sometimes the term "seasonal affective disorder" is applied inaccurately to the normal shift to lower energy levels in winter, leading people to believe they have a physical problem that should be addressed with various therapies or drugs.

Physiology

Seasonal mood variations are believed to be related to light. An argument for this view is the effectiveness of bright-light therapy. SAD is measurably present at latitudes in the Arctic region, such as Finland (64º 00´N) where the rate of SAD is 9.5%. Cloud cover may contribute to the negative effects of SAD.

The symptoms of SAD mimic those of dysthymia or even major depressive disorder. There is also potential risk of suicide in some patients experiencing SAD. One study reports 6-35% of sufferers required hospitalization during one period of illness. At times, patients may not feel depressed, but rather lack energy to perform everyday activities.

Various proximate causes have been proposed. One possibility is that SAD is related to a lack of serotonin, and serotonin polymorphisms could play a role in SAD, although this has been disputed. Mice incapable of turning serotonin into N-acetylserotonin (by Serotonin N-acetyltransferase) appear to express "depression-like" behavior, and antidepressants such as fluoxetine increase the amount of the enzyme Serotonin N-acetyltransferase, resulting in an antidepressant-like effect. Another theory is that the cause may be related to melatonin which is produced in dim light and darkness by the pineal gland, since there are direct connections, via the retinohypothalamic tract and the suprachiasmatic nucleus, between the retina and the pineal gland.

Subsyndromal Seasonal Affective Disorder is a milder form of SAD experienced by an estimated 14.3% (vs. 6.1% SAD) of the U.S. population. The blue feeling experienced by both SAD and SSAD sufferers can usually be dampened or extinguished by exercise and increased outdoor activity, particularly on sunny days, resulting in increased solar exposure. Connections between human mood, as well as energy levels, and the seasons are well documented, even in healthy individuals. Mutation of a gene expressing melanopsin has been implicated in the risk of having Seasonal Affective Disorder.

Take Your Holiday Spirit into the New Year by Linda Davis

The holiday season is a time of great generosity as people reflect on the previous year, think about why they are thankful, and look for ways to support those in need. It is important to remember that homelessness organizations need your help year-round. When you feel like donating your time or money this holiday season, consider waiting until another time next year. If you are a provider, don’t be afraid to ask volunteers and donors to extend their generosity into the New Year. Here are some ideas. Content:

Consider throwing a holiday party at a local homeless service agency in January, February or March, rather than in November or December. The holidays are often a time of abundance for these programs. Many special meals, donations and services are provided by an army of volunteers that are eagerly anticipated, and soon disappear after December.

If you are considering volunteering during the holiday season, why not put it off until later in the winter, or even in the spring or summer? The months after the holidays can be especially trying for people who are homeless and your volunteer efforts would be a true gift.

At any time of year, join forces with colleagues from work, civic groups or spiritual communities. You could create and serve meals, develop care packages, or raise money to help a family with first and last month’s rent and a security deposit.

Not sure what to do and when to do it? Contact your local homeless service provider network. Decide which program you want to support and contact them to determine what they need, and when it would be most helpful.

Here are some links to help you do your holiday homework:

Continuum of Care Contacts (organized by state/region):
http://hudhre.info

United Way:
www.211.org

VolunteerMatch
www.volunteermatch.org

Idealist
www.idealist.org

Volunteers are essential to many homeless service agencies. Whether you are new to an organization or a seasoned pro, these tips will help you to make the most of your time as a volunteer. If your organization counts on volunteers, share these tips with the team – and add your own! Social Worker Continuing Education
1. Dress comfortably.
You will probably be on your feet so make sure that your shoes and clothes can go the distance.

2. Show up on time and ready to work.
Chances are your program relies on volunteers, so be punctual and let someone know when you will be late or absent.

3. Let your supervisor know when you arrive.
Even if you are a regular volunteer, check in at the beginning of your shift to find out where you can pitch in.

4. Don’t be afraid to ask questions.
Staff appreciate the gift of your time and want you to feel comfortable. Asking questions helps to clarify expectations for everyone.

5. Know where and when to have conversations with consumers and staff.
Many programs have rules about loitering in certain areas and prefer that volunteers finish their assigned tasks before spending time talking with consumers and team members.

6. Be open-minded.
As a volunteer, you may be asked to assist with a variety of tasks, depending on the changing needs of your agency. Don’t be afraid to step outside of your comfort zone and try something new.

7. Know your boundaries.
Burnout is an issue for direct service providers and volunteers. Be a sensitive listener, but understand the limitations of your role. Volunteers are not expected to do the work of case managers or clinicians.

8. Have a sense of humor.
Working in homeless services brings many challenges and rewards. When you are faced with a tough situation, a little humor goes a long way.

9. Don’t be afraid to make suggestions.
You bring a different perspective that can be very valuable.

10. Remember that your contribution matters.

Winter Wellness Planner

Developed by CSP-NJ Institute for Wellness 2
and Recovery Initiatives – John Garafano, BS, CPRP, CFT , Jay Yudof, MS, CPRP & Peggy Swarbrick, PhD, OT,CPRP -December 2010

Winter Memories

Many of us may have good memories of winter/holiday gatherings, and/or outdoor winter recreation. Some people face challenges including isolation, limited ability to exercise, memories of losses, overeating, and overspending. This wellness planner is designed to help you plan ahead so you can maintain a sense of wellness during the winter season.

Describe a positive winter memory.
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What do you see as the benefits of the winter season?
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Holidays

The holiday season, (the holidays) is an annual festive period. Various studies have shown that the winter holiday season can have some impacts on health (social, emotional, physical etc).

What do you like to do during the Holiday Season?
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How do you celebrate the Holiday season?
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Winter Challenges

Winter is the coldest season of the year in temperate climate, between autumn and spring. At the winter solstice, the days are shortest and the nights are longest, with days lengthening as the season progresses after the solstice.
Challenges during the holidays Many holidays occur during the winter months when people are already more susceptible to the common cold, flu, and depressed mood Holidays usually involve the obligation of spending money on gifts or food Alcohol is typically served during holiday functions which can be a trigger for some Holiday travel can be a major source of contention and stress. Dealing with traffic and the short-tempers of other travelers can also be quite challenging Social anxiety may be heightened when we are invited to parties with large gatherings of people.

General Stressors and Triggers

Physical
o Diet and nutrition, physical activity, sleep, Emotional
o Losses may impact harder during winter time Social
o Too much stimuli or may not have a support network so sense of loneliness becomes overwhelming
o Drinking can be a trigger for some people Financial
o Spending can become out of control Spiritual
o Sense of purpose and meaning can be impacted Occupational
o Work routines are altered which can impact rhythm and – over or under productive

What triggers do you face during the holidays?
(Examples include large groups of people, overspending, and alcohol at parties)
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List supporters and how you can connect with them during the holidays?
Supporter Methods to Connect
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Diet and Nutrition Eat several small meals so that you are not starving when it comes time to eat a holiday feast. Drink water before your meal so that you get full faster. Watch portions. Aim to eat mostly vegetables and fruit on your plate and opt out of breads and biscuits. Opt for water instead of soda, alcoholic beverages, or caffeinated drinks. Be aware that many of us get less fresh fruit and vegetables during winter months – look for healthy ways to replace these vital nutrients.
Physical Activity and Environment: Walk around a mall with friends Join an exercise class or fitness group in the community Clean your living area Enjoy outdoor winter activities Exercise extra care to prevent slips and other winter injuries, and make sure that kids and elders do the same Health Care Practice good prevention for colds and flu such as frequent hand washing If you follow self-management for a chronic health condition, don’t let holiday events, meals. Travel, etc. let you get derailed
Family, Friends, and Supporters: Consider who in your support network is a positive supporter and who might be unhealthy for you Decide on how much socialization time you need in order to feel well Make holiday get-togethers a positive opportunity to renew acquaintances with family and friends you may not see or speak with very often Make attempts to “give back” whenever possible

Finances: Plan ahead in terms of spending and know your limits Consider ways to give gifts other than spending money

Rest/Relaxation: Know your limits and plan ahead for proper balance of sleep, relaxation, and activity. Try to get enough sleep/rest each night, and avoid oversleeping during the winter months

Spiritual: Attend spiritual gatherings and celebrate in the holiday season Find ways to express gratitude each day

Expressive Art: Art can be a great way to express yourself during the holidays Consider attending a museum or holiday light show Attend a play with a holiday theme Think about combining friends/family and expressive arts – do a project or go to a show with some of the kids (young and old) in your life. MFT Continuing Education
When considering our holiday/winter wellness, it is a good idea to think of the self-care practices that we need in order to feel well and maintain/improve our overall health status. Activities like exercise, spiritual connection, social contact, and reading can all be tools that help us to stay well during the winter season. List your top five strategies for staying well this season:

Wellness Strategy How often I will do it When I will start
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Coping with Grief During the Holidays

For many people who have experienced a loss, holidays can be a very difficult time. "If only I can get through the holidays" is often a continued refrain during this season. In the roller coaster of grief, holidays are, for many people, a low point.

According to the Hospice Foundation of America, there are many reasons why the holidays can be so difficult. Kenneth Doka says the holidays are full of memories. We often pause to reflect on all the holiday experiences we've had, both good and bad. We remember all the people who have been part of our lives.

Second, holidays are not only times for past memories, but for fantasies of the present and future, as well. As we shop, we may see things that would be perfect gifts for the person who has died. We envision how that person would be so delighted when the gift is opened.

Third, holidays are stressful. There are so many things to do and so much to accomplish. In a time when one is already experiencing low energy, this can be overwhelming.

Finally, we can feel out of sorts with the season. Everyone seems so happy and cheerful; it is easy to feel alone. Recognizing that the holidays can be painful often helps ease that sense of isolation. We can acknowledge that this is a normal reaction to grief.

There are strategies to make holidays easier. They won't take your grief away, but they may help.

1. Be kind to yourself. Only do as much as you can comfortably manage. Honor your own feeling and needs.

2. Express your feelings. According to Judy Tatelbaum, the surest road through grief is to feel it, not deny it. When you are hurting, the best advice is cry if you need to cry.

3. Ask for what you need. If you want privacy or companionship or a shoulder to cry on, say so. Other people don't know how you feel unless you tell them. Helping you can be satisfying for someone else.

4. Don't overwhelm or over commit yourself. Give yourself a reprieve. Take time for yourself and take care of yourself. Take it slow and easy.
MFT Continuing Education

Coping with the Holidays After the Death of a Loved One or when you Are a Victim/Crime Survivor

You Can Make It Through the Holidays
Many among us have struggled with the cloud of sadness that may surround the holidays when a friend or family has experienced a tragedy such as a sudden violent death or a serious physical or emotional injury. The onslaught of holiday cheer may seem too much to bear. Holidays may give rise to new or returning bouts of depression, panic attacks, and other forms of anxiety for those whose lives have been affected. Victims of crime, family members, friends, and work colleagues may re-experience life-changing traumas through flashbacks, nightmares, and overwhelming sadness. Some have trouble sleeping, while others don't want to get out of bed. Tears may come easily, often when least expected. Old ailments, including headaches, gastrointestinal problems, and other aches and pains may return.

Many victims and families, however, have found that holidays can be manageable if they take charge of the season, rather than letting it take charge of them.

Families who have made this difficult journey offer some suggestions to help those who may be just starting down this path.

Change Traditions

Trying to make this holiday seem like holidays of the past can intensify the difference. Gather the family together early and decide which traditions to keep and which to let go. Change holiday plans to accommodate the needs and wishes of those who are hurting the most. Pay particular attention to the physical needs of someone who has acquired a disability as a result of victimization.

Create a Special Tribute

Some families light a special candle and place it on a holiday table to honor the memory of a loved one who has died. Others keep a chair empty and place a flower or other memorial on the seat. Some write treasured remembrances and place them on a special plate or in a bowl for those who wish to read them. Families of a surviving victim may want to honor that person by openly expressing gratitude for his or her presence.

Consider Carefully Where to Spend the Holidays

Many people think going away will make the holidays easier. This may be helpful if you are traveling to a place where you will feel loved and nurtured. However, if travel is arranged as a means of trying to avoid the holiday atmosphere, remember that American holidays are celebrated throughout this country and in many parts of the world. It is impossible to escape holiday reminders.

Accept grieving friends and family members as they are; don't try to tell them how they should feel or state that you "understand" how they feel. Focus on giving unconditional support.

Balance Solitude With Sociability

Rest and solitude can help renew strength. Friends and family, however, can be a wonderful source of support. If you are invited to holiday outings, make an effort to go. Attend concerts or other cultural events that lift your spirits. You may surprise yourself by enjoying special outings, even if you feel like crying later.

Relive Fond Memories

Attempting to go through the holidays pretending that nothing has happened can be a heavy and unrealistic burden. Think about holiday seasons you have enjoyed in the past and identify memories you want to hold in your heart forever. No one can take those away from you. Celebrate them and be grateful. If feelings of sadness pop up at inappropriate times, such as at work or in a public gathering, try thinking about what you have, rather than what you have lost. Focus on the blessing of the memories in your heart.

Set Aside Some "Letting Go" Time

Schedule time to be alone and release sad and lonely, pent-up feelings. You may want to cry or write about your thoughts and feelings. If someone has died, you may choose to write a letter to say "goodbye," "I love you," or "I'm sorry." Even though it may feel strange, allow your loved one to write back to you through your pen. You may be surprised at what you write. By setting aside special times to allow painful feelings to surface, it becomes easier to postpone expressing them in public.

Counter the Conspiracy of Silence

Family members may consciously or unconsciously conspire to avoid mentioning the tragedy in your family. This is usually a well-intentioned but misguided attempt to protect your feelings. If this seems to be happening, take the initiative and talk to your family about the importance of talking openly about what has happened and sharing your feelings of loss or sadness. Encourage them to tell stories about your loved one and to look for opportunities to refer to him or her by name.
LPC Continuing Education
Notice the Positive

Some people conclude that facing the holidays is simply "awful." But deciding prematurely that "everything about life is awful" is too strong a generalization from a personal tragedy. Although you may have difficult times during the holidays, you also may experience joy. Accept the love and care of others. Reach out to someone else who is suffering. Give yourself permission to feel sad and to experience joy.

Consider shopping online as an alternative to the frenzy of mall shopping-but don't try to "buy" your way out of sad feelings.


Find a Creative Outlet

If you have difficulty talking about your feelings, look for a creative way to express yourself. Write a poem or story that you can share with others. Buy watercolors or oils and put your feelings on paper or canvas, even if only splashes of color. Contribute to a favorite charity or organization in your loved one's memory-either financially or by volunteering to help. Buy gifts for less fortunate children, a hospital, or a nursing home.

Remember the Children

Listen to them. Celebrate them. Cherish them.

Children may have deep feelings that can be overlooked if you spend all your time focusing on yourself. Putting up holiday decorations can be a draining emotional experience, but these symbols are very significant to children. A friend or relative likely will be happy to help decorate or purchase and wrap gifts.


Protect Your Health

Physical and emotional stress changes the chemical balance in your system and can make you ill. Eat healthy food and avoid over-indulging in sweets. Drink plenty of water, even if you don't feel thirsty. Avoid alcohol, which can be a depressant. Take a multivitamin. Get 7 to 8 hours of sleep each night. Talk with your doctor about an antidepressant or anti-anxiety medication if you think it will help. If you are unsure how a medication will affect you, talk to your doctor about your concerns.


The most valuable help usually comes from someone who shares a common experience or understands something about what you're going through.


Call Upon Available Resources

People of faith are encouraged to observe services and rituals offered by their church, synagogue, mosque, temple, or other faith community. Many "veterans of faith" offer serenity, a quiet presence, and healing wisdom. You may want to look for a support group of persons who have suffered similar experiences. The Mental Health America has affiliates around the Nation that keep lists of such local groups. If a group does not exist in your area, you can establish your own short-term group to focus on getting through the holidays. Spend as much time as possible with the people you love the most.

Most important, remember that you can't change the past, but you can take charge of the present and shape the future.

Family Health: Holiday Health and Safety Tips

The holidays are a time to celebrate, give thanks, and reflect. They are also a time to pay special attention to your health. Give the gift of health and safety to yourself and others by following these holiday tips.

Wash your hands often.
Keeping hands clean is one of the most important steps you can take to avoid getting sick and spreading germs to others. Wash your hands with soap and clean running water for at least 20 seconds. If soap and clean water are not available, use an alcohol-based product.

Clean Hands Save Lives


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Stay warm.
Cold temperatures can cause serious health problems, especially in infants and older adults. Stay dry, and dress warmly in several layers of loose-fitting, tightly woven clothing.


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Manage stress.
The holidays don’t need to take a toll on your health. Keep a check on over-commitment and over-spending. Balance work, home, and play. Get support from family and friends. Keep a relaxed and positive outlook.


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Travel safely.
Whether you're traveling across town or around the world, help ensure your trip is safe. Don’t drink and drive, and don’t let someone else drink and drive. Wear a seat belt every time you drive or ride in a motor vehicle. Always buckle your child in the car using a child safety seat, booster seat, or seat belt according to his/her height, weight, and age.

Available through the CDC:
Extreme Cold: A Prevention Guide to Promote Your Personal Health and Safety

Impaired Driving

Keep Kids Safe on the Road

Stay Safe and Healthy in Winter Weather

Traumatic Brain Injury

Travelers’ Health


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Be smoke-free.
Avoid smoking and breathing other people's smoke. If you smoke, quit today! Call 1-800-QUIT-NOW or talk to your health care provider for help.


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Get check-ups and vaccinations.
Exams and screenings can help find problems before they start. They can also help find problems early, when the chances for treatment and cure are better. Vaccinations help prevent diseases and save lives. Schedule a visit with your health care provider for a yearly exam. Ask what vaccinations and tests you should get based on your age, lifestyle, travel plans, medical history, and family health history.

Available through the CDC:
Things to Do Before Your Next Check-Up

Family Health History Resources and Tools

Get Smart: Know When Antibiotics Work

Vaccines and Immunizations

Safety of 2010-2011 Flu Vaccines

Women: Stay Healthy at Any Age (AHRQ)

Men: Stay Healthy at Any Age (AHRQ)


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Watch the kids.
Children are at high risk for injuries that can lead to death or disability. Keep a watchful eye on your kids when they’re eating and playing. Keep potentially dangerous toys, food, drinks, household items, choking hazards (like coins and hard candy), and other objects out of kids' reach. Learn how to provide early treatment for children who are choking. Make sure toys are used properly.

Injuries among Children and Adolescents
Toy Safety Tips (CPSC)

Counselor Continuing Education
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Prevent injuries.
Injuries can occur anywhere and some often occur around the holidays. Use step stools instead of furniture when hanging decorations. Leave the fireworks to the professionals. Wear a bicycle helmet to help prevent head injuries.

Most residential fires occur during the winter months. Keep candles away from children, pets, walkways, trees, and curtains. Never leave fireplaces, stoves, or candles unattended. Don't use generators, grills, or other gasoline- or charcoal-burning devices inside your home or garage. Install a smoke detector and carbon monoxide detector in your home. Test them once a month, and replace batteries twice a year.

Bicycle Related Injuries

Carbon Monoxide (CO) Poisoning Prevention

Fall-Related Injuries during the Holiday Season- United States, 2000-2003

General Injury Related Information

Fire Deaths and Injuries: Prevention Tips

Fireworks-Related Injuries


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Handle and prepare food safely.
As you prepare holiday meals, keep you and your family safe from food-related illness. Wash hands and surfaces often. Avoid cross-contamination by keeping raw meat, poultry, seafood, and eggs (including their juices) away from ready-to-eat foods and eating surfaces. Cook foods to the proper temperature. Refrigerate promptly. Do not leave perishable foods out for more than two hours.

It's Turkey Time: Safely Prepare Your Holiday Meal

Seasonal Food Safety: Fact Sheets (USDA)


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Eat healthy, and be active.
With balance and moderation, you can enjoy the holidays the healthy way. Choose fresh fruit as a festive and sweet substitute for candy. Select just one or two of your favorites from the host of tempting foods. Find fun ways to stay active, such as dancing to your favorite holiday music. Be active for at least 2½ hours a week. Help kids and teens be active for at least 1 hour a day.

Alcohol: Frequently Asked Questions

Get Smart Entertaining

Healthy Weight

Be Physically Active in the New Year

Managing Diabetes During the Holidays

Physical Activity for Everyone


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Protect pets from rabies.
Pets are also considered family members by many. Keep them healthy. There are several things you can do to protect your pet from rabies. First, visit your veterinarian with your pet on a regular basis and keep rabies vaccinations up-to-date for all cats, ferrets, and dogs.

Searching for a Leader in the World of Online CEUs

The internet has been a viable source for finding all kinds of "stuff". It can also be a great source for finding the right CEU provider. The problem lies in sifting through the number of search results generated by whatever search engine being used. Just because a website ranks high in the search engine results, doesn't necessarily mean it is the best option. Companies are constantly battling for rankings. So, here are some things to ask when drudging through the options found on the search engine results pages.

First, "Are they approved in my state for my license?" There are so many choices in the field of online continuing education; however, many are not approved across the United States. Some specialize in a few states that may be key for them. Others just haven't done the work to achieve approval in every state. Even if the provider is approved in your state, they may not be for your particular license. It is always crucial to read the fine print of each provider and make sure they provide an easy to view table with this information.

Second, "Do they offer all the courses I need to renew my license?" Great question to ask. Look thoroughly through their course listing and make sure they have the courses to fulfill the requirements of your particular license. Something else to consider is not only do they have the core courses you need but do they have enough of a selection outside of the core courses to meet your needs in the future as well.

Third, "Can I even find what I am looking for?" How many times have you pulled up a website from a search result and spent way too much time searching for what you were interested in only to end up backing out of that site and returning to the search results list? Sometimes this may be because the site was irrelevant, however, most of the time it was probably because the website was so poorly designed that it made it way too difficult to find anything. Make sure everything is straightforward and easy to find. No wasting time, which is critical in today's busy, fast-paced world.

Fourth, "Are their rates affordable and reasonable?" This is the brass tacks of the matter. What is the cost? It has been said "You get what you pay for." For the most part this is correct. That is why it is a good rule of thumb to never pay the highest amount and at the same time never pay the lowest amount. The highest amount is usually overpriced. The lowest amount is usually stripped of any value and may cost more in the long run in both time and money. Choosing a price more in the middle is usually the best bet.

Aspira works in the fields of online CEUs for MFT continuing education, online CEUs for Social Workers, online CEUs for Counselor continuing education, and online CEUs for Addiction Counselors

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