Over-powering anxiety, depression, suicidality, angry meltdowns, insomnia, feeling hyper or wired, loss of judgment, concentration or motivation all must be treated. Medication relief from debilitating feelings, thoughts or actions can be miraculous. But patients are more than diagnoses and symptoms. They truly suffer and most often seek deeper healing that enables them to feel whole and live meaningful lives.

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More competitive and structured curriculum and extracurricular activities may underemphasize more complete development of empathy, cooperation, compassion, negotiation and overall social maturity. Parents can easily feel caught in the middle, knowing how hard children are being pushed, but fearing that children who don’t do it all will not be successful.

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Shining the light of knowledge, insight and compassion significantly reduces the risk for completed suicide. Though none of us has the power to prevent suicide, family, partners, friends, religious or spiritual resources, other therapists, crisis hotlines or even psychiatric hospitalization can all be joined together as a safety net for suicidal patients. Both psychopharmacology and the treatment of underlying substance abuse are critical resources in strengthening this safety net.

Suicidality is commonly a symptom of mood disorder. Using mood stabilizing medications like lithium, Depakote, Serouquel or Lamictal, often in combination with antidepressants, can save patients lives. Psychopharmacology must always be supplemented by individual, family and/or marital psychotherapy, cognitive therapy and psychoeducation that includes a therapeutic suicide plan.

Buddhism also characterizes desire as the enemy of a peaceful mind. Once again, insight gained through detached meditative observation can free us from the suffering of a life full of insatiable and omnipotent cravings. Buddhism transcends Freudʼs individual psychological freedom by teaching us to empty our mind of our karmic unconscious. We then sense our connection to universal source energy which creates, destroys and gives birth to all.

Thus all healing derives from the seeming paradox of both accepting and relinquishing the objects of our greatest desires. This singular painful truth is as humbling as it is liberating. Patient and healer are united through a luminous compassion as we strive to discover ways we may honor each other.

I wish I knew of an easier way.
For a bit of inspiration, I gratefully share with you what a dear friend shared with me:

Enjoy even a few minutes of quiet. Notice that we have all been so stuck in survival mode that we are fixated in our anxieties. There is a correlation between anxiety and performance. A little anxiety enhances performance. With more stress, performance then deteriorates. Ratchet up anxiety even more, and our evolutionary limbic brain kicks into the flight or fight mode. As this stress becomes ever more chronic we can easily become trapped in the circuitry of our subcortical brain. Prolonged severe stress
eventually erodes our sense of self which may begin to feel absent, lost or broken. This is post-traumatic stress disorder marked by dissociation from many of our most important feelings. We know that now more than ever, we need to act decisively with courage, creativity and clarity. Yet we feel numb, paralyzed by our fears. How can we stop feeling so stuck? We become more alive when we reclaim the time and space to feel our fears outside of survival mode. Fearʼs alchemy is transformed by light. Despite the anxieties of our collective despair, we can successfully struggle towards an insight and wisdom that knows that our identity is so much greater than the sum of our fears.

The majority of people in CNY have some degree of seasonal affective disorder (SAD) that can be marked by decreased energy and motivation, mild irritability or moodiness and feeling the blues more often. From the end of September until the winter solstice we lose about about two and a half hours of daylight, not getting home from work until dark both before and after the holiday season. Being in the snow belt with our lake-effect clouds makes us among the least sunny locations in the U.S. Typically patients who are already prone to depression get more depressed in winter.

We can decrease SAD by spending more time outside, home or health club exercise (try a day pass swim and sauna), structuring indoor time with hobbies like reading or yoga and healthy eating. Using a light therapy box that supplies 10,0000 lumens of full or blue spectrum light, angled at 45 degrees at a distance of about 3 feet for 20 minutes to start the morning, diminishes symptoms of SAD. A good example of a light box is the small six inch square LED programmable and rechargeable Philips Go-Lite 2 at about $150.00 on Amazon. Some medical insurance will cover this cost with a doctorʼs prescription.

If you experience full-blown depression marked by loss of pleasure, sadness, apathy, sleep disturbance, increased drug or alcohol use, and even suicidal feelings, then winter depression or mood disorder (cycling from summer highs to winter lows) should be evaluated by a psychiatrist.

Just a reminder to the potential optimist in us: after December 21st our days begin getting longer, until by mid-March with daylight savings time, weʼll gain more than an hour and a half of daylight. For some, the natural rhythm of the seasonʼs with winterʼs slowed and inward focus can be experienced as renewing us for the joy of spring.

Patients usually present with depression, often accompanied by ʻmeltdownsʼ. Frequently mood disorders are mixed and also include periods of feeling ʻwiredʼ or hyper with bursts of increased energy, racing thoughts, rapid speech and less need for sleep. Most people with mood disorder also experience high levels of anxiety sometimes marked by panic attacks, insomnia and obsessions (constant worrying about impending catastrophe) or compulsions (repeated ritualistic behaviors). Patients may act reckless and self-destructive. They can become so pessimistic and worn down that they become suicidal or at least fantasize about killing themselves. Drug and alcohol use is widespread.

I often start treatment with mood stabilizing medication. This is accompanied by individual, family, or couples therapy, education and continued assessment. If you have suffered from depression but failed to get better, or even became manic with anti-depressant treatment, you probably have an underlying mood disorder. If you became ʻwiredʼ on stimulant treatment for ADD or ADHD, chances are you may have a mood disorder. If the only way you can relax is using alcohol or drugs, you are a candidate for having mood disorder. If you are starting to feel like mood disorders must unfortunately be very common, youʼre right.

Typical symptoms include inability to sustain concentration, being easily distracted, and misplacing personal objects like our keys, wallet or purse. Students report they are unable to both take good notes and carefully listen to lectures at the same time. What often makes people believe they canʼt possibly have AD(H)D is that when they are reallyinterested in something, they can be highly focused. But as in all psychiatric conditions, we only sometimes are symptomatic. Another confusing factor for patients is that ADHD usually co-occurs if patients have an underlying mood disorder. When this happens, treatment with a stimulant causes a worsening of symptoms, particularly increased anger or even mania. For these patients, initiating treatment with a mood stabilizer like lithium or depakote than allows stimulant medications to work.

Hyperactivity makes us feel like we sometimes have a motor driving us. We may feel ʻwiredʼ and easily get irritated. Kids often have ʻmeltdownsʼ. Rapid pressured speech and talking out of turn are common. We start 10 projects, but donʼt finish one. Itʼs hard to relax and feel calm. We sometimes act impulsively and then wonder why in the world we did something so dumb!

Treatment for either ADD or ADHD utilizes once daily stimulant medications like Adderall-XR, Concerta or Vyvanse. Sometimes non-stimulants like Strattera or Intuniv are effective. I often see both children and adults completely start turning their lives around after just a single dose of a stimulant. It is counter-intuitive and paradoxical that amphetamines calm patients, but I see amazing transformation when I treat ADHD. Patients then report that ʻthe weight of the world is off my shoulders. Why didnʼt I do this
years ago. That is why early treatment in very young children is so effective.

Psychopharmacological treatment of anxiety centers on serotonin (SSRI antidepressants similar to Prozac). However, SSRI drugs take a few weeks to work and may initially even increase anxiety. Therefore, conjointly prescribing valium type drugs like Klonopin or Xanax, which can later be tapered, can immediately stop panic attacks.

Psychotherapy that uses support and education like dialectical behavior therapy and insight oriented therapy are the most effective ways to both supplement and potentially replace medication. Anxiety symptoms, as terrifying as they are, are defenses against facing repressed or minimized real life traumas and stresses that lie hidden behind our symptoms. Whenever we summon enough courage to shine the light of understanding and acceptance on the roots of our anxieties, they lessen. The key to the psychotherapy of anxiety lies in the recognition that anxiety is ʻjustʼ a feeling. Our identity and lives are inherently more stable and far richer than any passing feeling, no matter how powerful those feelings are.