 Primary treatments for SAD include: antidepressants, light therapy and psychotherapy. Many times a combination of these treatments are used.. Light Therapy Light Therapy is the use of full spectrum light during the fall and winter months. These lights are readily available without a prescription. They can be purchased online for under $50 and can you may be able to use a Health Savings Account with a prescription from your provider.
Light therapy is a nonpharmacological approach that has been studied and shown to have positive effect. Three key elements for effectiveness in Light Therapy Light therapy is most effective when you have the proper combination of light intensity, duration and timing.
In addition, we encourage patients to incorporate all of the following adjunctive interventions throughout their entire course of acute (and maintenance) treatment: ●Sleep hygiene • Sleep only as much as you need to feel rested and then get out of bed • Keep a regular schedule • Do not try to sleep unless you feel sleepy • Exercise regularly, preferably at least 4 to 5 hours before bedtime • Avoid caffeinated beverages after lunch • Avoid alcohol near bedtime: no “night cap” • Avoid smoking, especially in the evening • Do not go to bed hungry • Make the bedroom environment conducive to sleep • Avoid prolonged used of light-emitting screens before bedtime • Deal with your worries before bedtime ●Daily walks outside, even on cloudy days ●Aerobic exercise ●Enhanced indoor lighting with regular lamps and fixtures Patients with winter depression who receive bright light therapy usually respond within one to four weeks of starting treatment.
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 NAC (N-acetylcysteine) has shown efficacy in clinical trials as a treatment for Skin Picking and Hair Pulling Disorder. NAC is readily available over the counter. While results are very preliminary, case reports have demonstrated mostly positive results and a lack of significant side effects.
Braun TL, Patel V, DeBord LC, Rosen T. A review of N-acetylcysteine in the treatment of grooming disorders. Int J Dermatol. 2019;58(4):502-510. doi:10.1111/ijd.14371  Attention Deficit Disorder is a real thing, many adults have it to some degree. The old thinking was that this was a disorder in childhood and teenage years that they would grow out of. We know better now. Many times Adults are diagnosed at a time that they take their children to a provider to be diagnosed. We know that there is a strong genetic component for ADD/ADHD.
Treatment varies with each individual, approximately 20% of individuals will respond to non stimulant medication: Straterra, Wellbutrin and Guanfacine. Most other patients respond to stimulants: adderall, ritalin, vyvanse, concerta or others. Attention is not the only problem, we know that this disorder is pervasive and causes problems in every area of an individual's life. Emotional dysregulation is an often overlooked phenomena with ADD. ED is characterised by problems with temper control ( feelings of irritability and frequesnt outburst of short duration), emotional over reactivity (diminished ability to handle typical life stresses, resulting in frequent feelings of being hassled and overwhelmed) and mood swings (short and unpredictable shifts from normal mood to depression or mild excitement) A complete diagnostic exam can help distinguish this from other disorders that share some of the same characteristics. Adults with ADHD are more likely to be less educated, have poorer work performance and increased likelihood of dismissal from work or frequent job changes. They often have difficulties in maintaining long-term social relationships, and higher divorce rates, frequent and serious car accidents and criminality  Often experienced and under diagnosed, Premenstrual syndrome (PMS) has a wide variety of signs and symptoms, including mood swings, tender breasts, food cravings, fatigue, irritability and depression. It's estimated that as many as 3 of every 4 menstruating women have experienced some form of premenstrual syndrome.
Recent research has shown that Serotoinin levels appear to vary during the menstrual cycle under the influence of estrogen and progesterone. SSRIs such as zoloft, lexapro, prozac and others may increase the amount of serotonin available for neurotransmissions. Some health care providers have been increasing by a small dose, the SSRI that a woman takes the week before their menstral period and a week after their menstral period with significant improvement in PMS symptoms. I have used this in my practice for several months and women have reported significant improvement in their symptoms. Of course, every patient is different and this should only be done under the direction of your provider. If you are suffering with symptoms of PMS, talk to your provider. 
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AuthorMaryann Ryan,NPP is a psychiatric nurse practitioner working in her private practice in Warwick NY. Knowledge is Power and we look to provide information that is accurate and timely for those with mental health issues and their families. Archives
October 2020
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