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SEASONAL AFFECTIVE DISORDER (SAD) AND TREATMENT


SEASONAL AFFECTIVE DISORDER (SAD) AND TREATMENT

Seasonal affective disorder (SAD) is a type of depression that's related to changes in seasons — SAD begins and ends at about the same times every year. If you're like most people with SAD, your symptoms start in the fall and continue into the winter months, sapping your energy and making you feel moody. Less often, SAD causes depression in the spring or early summer.

Treatment for SAD may include light therapy (phototherapy), psychotherapy and medications.

Don't brush off that yearly feeling as simply a case of the "winter blues" or a seasonal funk that you have to tough out on your own. Take steps to keep your mood and motivation steady throughout the year.

SYMPTOMS

In most cases, seasonal affective disorder symptoms appear during late fall or early winter and go away during the sunnier days of spring and summer. However, some people with the opposite pattern have symptoms that begin in spring or summer. In either case, symptoms may start out mild and become more severe as the season progresses.

Major depression

Seasonal affective disorder is a subtype of major depression that comes and goes based on seasons. So symptoms of major depression may be part of SAD, such as:

*Feeling depressed most of the day, nearly every day

*Feeling hopeless or worthless

*Having low energy

*Losing interest in activities you once enjoyed

*Having problems with sleeping

*Experiencing changes in your appetite or weight

*Feeling sluggish or agitated

*Having difficulty concentrating

*Having frequent thoughts of death or suicide

Fall and winter SAD

Symptoms specific to winter-onset SAD, sometimes called winter depression, may include:

*Irritability

*Tiredness or low energy

*Problems getting along with other people

*Hypersensitivity to rejection

*Heavy, "leaden" feeling in the arms or legs

*Oversleeping

*Appetite changes, especially a craving for foods high in carbohydrates

*Weight gain

Spring and summer SAD

Symptoms specific to summer-onset seasonal affective disorder, sometimes called summer depression, may include:

*Depression

*Trouble sleeping (insomnia)

*Weight loss

*Poor appetite

*Agitation or anxiety

Seasonal changes in bipolar disorder

In some people with bipolar disorder, spring and summer can bring on symptoms of mania or a less intense form of mania (hypomania), and fall and winter can be a time of depression.

When to see a doctor?

It's normal to have some days when you feel down. But if you feel down for days at a time and you can't get motivated to do activities you normally enjoy, see your doctor. This is especially important if your sleep patterns and appetite have changed or if you feel hopeless, think about suicide, or turn to alcohol for comfort or relaxation.

CAUSES

The specific cause of seasonal affective disorder remains unknown. Some factors that may come into play include:

*Your biological clock (circadian rhythm). The reduced level of sunlight in fall and winter may cause winter-onset SAD. This decrease in sunlight may disrupt your body's internal clock and lead to feelings of depression.

*Serotonin levels. A drop in serotonin, a brain chemical (neurotransmitter) that affects mood, might play a role in SAD. Reduced sunlight can cause a drop in serotonin that may trigger depression.

*Melatonin levels. The change in season can disrupt the balance of the body's level of melatonin, which plays a role in sleep patterns and mood.

RISK FACTORS

Factors that may increase your risk of seasonal affective disorder include:

*Being female. SAD is diagnosed more often in women than in men, but men may have more-severe symptoms.

*Age. Young people have a higher risk of winter SAD, and winter SAD is less likely to occur in older adults.

*Family history. People with SAD may be more likely to have blood relatives with SAD or another form of depression.

*Having clinical depression or bipolar disorder. Symptoms of depression may worsen seasonally if you have one of these conditions.

*Living far from the equator. SAD appears to be more common among people who live far north or south of the equator. This may be due to decreased sunlight during the winter and longer days during the summer months.

COMPLICATIONS

Take signs and symptoms of seasonal affective disorder seriously. As with other types of depression, SAD can get worse and lead to problems if it's not treated. These can include:

*Suicidal thoughts or behavior

*Social withdrawal

*School or work problems

*Substance abuse

Treatment can help prevent complications, especially if SAD is diagnosed and treated before symptoms get bad.

PREPARING FOR YOUR APPOINTMENT

You're likely to start by seeing your family doctor or primary care provider. Or you may start by seeing a mental health provider such as a psychiatrist or psychologist.

TESTS AND DIAGNOSIS

To help diagnose seasonal affective disorder, your doctor or mental health provider may do a thorough evaluation, which generally includes:

*Physical exam. Your doctor may do a physical exam and ask in-depth questions about your health. In some cases, depression may be linked to an underlying physical health problem.

*Lab tests. For example, your doctor may do a blood test called a complete blood count (CBC) or test your thyroid to make sure it's functioning properly.

*Psychological evaluation. To check for signs of depression, your doctor or mental health provider asks about your symptoms, thoughts, feelings and behavior patterns. Your doctor may have you fill out a questionnaire to help answer these questions.

Seasonal affective disorder is considered a subtype of major depression or bipolar disorder. Even with a thorough evaluation, it can sometimes be difficult for your doctor or mental health provider to diagnose SAD because other types of depression or other mental health conditions can cause similar symptoms.

Many mental health professionals use the criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, to diagnose mental conditions. This manual is also used by insurance companies to reimburse for treatment.

The DSM-5 criteria for diagnosing depression with a seasonal pattern includes having these experiences for at least the last two years:

*Depression that begins during a specific season every year

*Depression that ends during a specific season every year

*No episodes of depression during the season in which you experience a normal mood

*Many more seasons of depression than seasons without depression over the lifetime of your illness

TREATMENT

Treatment for seasonal affective disorder may include light therapy, medications and psychotherapy. If you have bipolar disorder, tell your doctor — this is critical to know when prescribing light therapy or an antidepressant. Both treatments can potentially trigger a manic episode.

Light therapy

In light therapy, also called phototherapy, you sit a few feet from a special light therapy box so that you're exposed to bright light. Light therapy mimics natural outdoor light and appears to cause a change in brain chemicals linked to mood.

Light therapy is one of the first line treatments for fall-onset SAD. It generally starts working in a few days to two weeks and causes few side effects. Research on light therapy is limited, but it appears to be effective for most people in relieving SAD symptoms.

Medications

Some people with SAD benefit from antidepressant treatment, especially if symptoms are severe.

Your doctor may recommend starting treatment with an antidepressant before your symptoms typically begin each year. He or she may also recommend that you continue to take the antidepressant beyond the time your symptoms normally go away.

Keep in mind that it may take several weeks to notice full benefits from an antidepressant. In addition, you may have to try different medications before you find one that works well for you and has the fewest side effects.

Psychotherapy

Psychotherapy, also called talk therapy, is another option to treat SAD. Psychotherapy can help you:

*Identify and change negative thoughts and behaviors that may be making you feel worse 

*Learn healthy ways to cope with SAD

*Learn how to manage stress

LIFESTYLE AND HOME REMEDIES

There's no known way to prevent the development of seasonal affective disorder. However, if you take steps early on to manage symptoms, you may be able to prevent them from getting worse over time.

Some people find it helpful to begin treatment before symptoms would normally start in the fall or winter, and then continue treatment past the time symptoms would normally go away. Other people need continuous treatment to prevent symptoms from returning.

If you can get control of your symptoms before they get worse, you may be able to head off serious changes in mood, appetite and energy levels.

ALTERNATIVE MEDICINE

Some people are interested in trying alternative medicine (a nonconventional approach instead of conventional medicine) or complementary medicine (a nonconventional approach used along with conventional medicine).

Certain herbal remedies, supplements or mind-body techniques are sometimes used to try to relieve depression symptoms, though it's not clear how effective these treatments are for seasonal affective disorder.

Keep in mind, alternative treatments alone may not be enough to relieve your symptoms. Some alternative treatments may not be safe if you have other health conditions or take certain medications.

Supplements

Some people choose to take a supplement to treat depression.

Keep in mind that nutritional and dietary products aren't monitored by the FDA. You can't always be certain of what you're getting and if it's safe. 

Also, because some herbal and dietary supplements can interfere with prescription medications or cause dangerous interactions, talk to your health care provider before taking any supplements.

Mind-body therapies that may help relieve depression symptoms include:

*Acupuncture

*Yoga

*Meditation

*Guided imagery

*Massage therapy

COPING AND SUPPORT

These steps can help you manage seasonal affective disorder:

*Stick to your treatment plan. Take medications as directed and attend therapy appointments as scheduled.

*Take care of yourself. Get enough rest and take time to relax. Participate in an exercise program or engage in another form of regular physical activity. Make healthy choices for meals and snacks. Don't turn to alcohol or illegal drugs for relief.

*Practice stress management. Learn techniques to manage your stress better. Unmanaged stress can lead to depression, overeating, or other unhealthy thoughts and behaviors.

*Socialize. When you're feeling down, it can be hard to be social. Make an effort to connect with people you enjoy being around. They can offer support, a shoulder to cry on or a joke to give you a little boost.

*Take a trip. If possible, take winter vacations in sunny, warm locations if you have winter SAD or to cooler locations if you have summer SAD.


TREATMENT

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