As the days get darker, colder, and shorter, it is a common phenomenon to experience the winter blues, or its more severe form, Seasonal Affective Disorder (SAD). What exactly does it mean to feel the winter blues or experience SAD? Symptoms of the winter blues can include the following: 

• Gloomy or sad mood
• Lack of energy, feeling fatigued
• Decrease in desire to be social

Whereas symptoms of SAD are more severe and can include:

• Depressed mood for most of the day, nearly every day
• Persistent fatigue and lethargy
• Problems with sleeping
• Social withdrawal or isolation
• Feelings of pessimism or hopelessness
• Loss of interest and pleasure in activities you typically enjoy
• Difficulty concentrating
• Thoughts of death or suicide

The winter blues are typically experienced when the seasons change toward fall and winter months and can persist through the winter season. SAD often has a similar presentation, with a winter-onset pattern most common. Those living in areas farther from the equator with a more drastic loss of daytime sun may be more prone to seasonal shifts in mood. Individuals who struggle with SAD may have decreased serotonin activity (mood regulator) and increased melatonin production (sleep initiator) due to changes in light exposure, resulting in the above symptoms (Melrose, 2015). Studies have shown that increasing daily full-spectrum light exposure can aid in quality sleep and maintenance of circadian rhythms (Figueiro et al., 2017), fighting jet-lag (Bunney et al., 2005), and of course, treating SAD (American Psychiatric Association, 2000) as well as even non-seasonal depression (Even et al., 2008). 
​​

Thankfully, there is a tool to use at home to help stave off or manage the effects of the winter blues or SAD: full-spectrum light therapy. This treatment has been found to be highly effective and with minimal side effects, and it is affordable and easy to use. You can purchase a full-spectrum light box for personal use online for under $30-$100, depending on the model and technological features. The light is most effective at a level of 10,000 lux bright-white fluorescence (with harmful UV rays filtered out), which is significantly brighter than typical lighting. Light exposure should take place first thing in the morning, within an hour of  waking up, and for 20-60 minutes per day during the months of the year when daylight is diminished. The light should be close to the face (16-24 inches away), but the user need not stare directly into it for the effect. Light therapy should be completed every day, even on weekends, and at a consistent time for optimal effects. It often can take some time of regular use to feel the effects of it, so it requires a consistent routine. Light therapy can become a foundation for a morning self-care practice of taking some time for yourself in the mornings before getting started with your day. You can have it by you as you have breakfast, check the news, knit, catch up on emails, or however else you like to start your day - just be sure to use it within an hour of waking up to not interrupt your sleep schedule. I am not affiliated with any brands or marketing, but I can personally attest to Verilux for quality light therapy products. 

Light therapy should be used with caution with certain medications or mental health diagnoses - always check with your medical providers and read manufacturer guidelines before starting any type of treatment. Some people may benefit more fully by using light therapy in conjunction with other treatments for SAD or depression, so it is important to explore all options for the care you need. 

To read more about light therapy, check out this overview from the Mayo Clinic. 

Have you considered, or have you tried light therapy yourself? Share your experience below. ​

It's been a wild ride these last few months as the threat and then reality of the COVID-19 pandemic has hit full force. Here in Pennsylvania, we were notified only yesterday about a state-wide shut down of all non-essential businesses, which many others have been facing for far longer and with even more restrictions. As the situation unfolds, we are each faced with some hard choices to make as our worlds shrink smaller and smaller. Taking a proactive and intentional approach to social distancing and quarantine will be instrumental in finding peace and comfort in an uncomfortable situation. Following are some strategies to keep in mind to practice good self-care and promote emotional well-being during this challenging time:

• Routine is key: Maintaining some sort of a routine is essential to prevent the days from becoming too monotonous and causing a depressive spiral. What that routine looks like depends greatly on your situation. Some ideas, though, include maintaining an exercise schedule at home (some exercise companies are offering free at-home programming during this time, such as Peloton), getting changed out of your pajamas each morning, keeping up with daily hygiene, maintaining a consistent sleep/wake cycle, limiting time on screens, engaging in tasks such as cleaning, paperwork, organizing, work responsibilities, and being planful with hobbies and leisure activities.
• Take media breaks: Staying glued to social media and news is tempting when there are infinite question marks about what is happening, how it happened, and what will happen next. Our brains crave answers and understanding, and right now this situation is wrought with unknowns. However, filling our open time with an endless flow of news, posts, and tweets offers perhaps 5% useful information, with inaccurate data, panic-stricken posts, and other unhelpful or minimizing material making up the remainder. One idea to set boundaries is to schedule in media time, such as checking for updates only when you're having a meal, or a few designated times during your day. Keeping the very beginning and very end of your days free from its influence would be another great boundary to set to allow your mind to start and finish each day in a calmer state.  
• Learn something new (or revisit something old): This is a great opportunity to pursue that hobby you've always wanted to try, whether it's crafting, learning a musical instrument, trying a new game or puzzle, cooking/baking, writing, reading, or art. These types of activities are physiologically soothing to combat anxiety - an added bonus. You may also have been wishing for more time to get back to a hobby or pursuit you've lapsed in; now is a great time to dust it off and get back to it. 
• Connect with nature: While it is still permissible, getting outdoors and into nature is a perfect way to get some fresh air, exercise, and feel more present while following social distancing protocol. 
• Stay in touch: Social distancing doesn't mean social isolation. Familiarize yourself with video chat options to stay connected with friends and family. Schedule conversations with friends while watching the same show or movie, organize times for online gaming sessions, stay active in messaging and texting, and even get back to old-school letter writing, especially with some older family members. 
• Learn about options for maintaining mental health treatment: Many providers (myself included) are transitioning to online-only therapy sessions during this time. It may feel overwhelming, uncomfortable, or awkward to switch from face-to-face to video therapy, but generally after the first few minutes that wears off. Your provider can answer questions and guide you through the process of accessing your sessions. We are all sitting with some level of stress and discomfort - try to avoid letting those concerns about the telehealth transition stand in the way of accessing care for your mental health. 
• Be vigilant + calm: ​The Yerkes-Dodson Law has much to teach us about the role of stress as a helpful force - in the right amount. Too little stress can result in lackadaisical decision making and not adhering to important protocol and policy. Too much stress can result in panic, causing intense anxiety, fear, and rash behavior. That middle ground is where stress helps protect us, guides us, and supports us through challenging situations. I like the motto "be vigilant and calm" for our current state - vigilant to take the necessary precautions set forth by the CDC and governing bodies, and maintaining a calm, present, and rational mind throughout. 

I hope these guidelines spark some ideas for cultivating purpose, comfort, and maybe some joy  during these challenging times. If you have ideas of your own I would love to hear them! Share below in the comments.  

A few months back, I received an email from Lehigh (my PhD program and where I currently work as an adjunct professor) asking if I would be interested in teaching an eight-day course on group counseling for master's students in Kuwait. I paused and took account of my reactions to this question. Isn't it dangerous there? Would I feel uncomfortable as a foreign woman in the Middle East, alone? How would I connect with students from such a different culture, and within a society that has very different views on mental health? My stomach was performing anxious somersaults  imagining this experience. However, I also noted a familial tingle of excitement - a different part of me was reawakening - the part of me that loves a challenge, embraces having my comfort zone stretched, and thirsts for experiencing something new and different, especially related to culture and travel. After a week of pondering, I made the decision to go. 

I am currently on my fifth day here in Kuwait. I am curled up on a couch in the lobby of my hotel, sunlight and warmth streaming in from the big windows overlooking the city. I am feeling utterly fulfilled and refreshed as a professor of these brilliant, brave, and complex students. I am also feeling enriched and enamored with this country, the beauty of Kuwait City, and the vibrancy of the culture around me.

I felt some culture shock when I first arrived here. Kuwait does not have a big focus on tourism - and it shows. The airport had minimal signage for people new to Kuwait. The public transportation system is also limited and difficult to grasp if you don't speak Arabic. There is no hop-on-hop-off bus or tourism offices to plan your visit. Thankfully, I had some help with a meet and greet service at the airport to help me get my visa sorted and to transport me to my hotel. Lehigh also made sure I had contacts both at home and here in Kuwait to make sure things ran smoothly. Upon arrival, I was immediately struck by how urban it is here - the city is packed with tall apartment buildings, endless high-end shopping malls, busy roadways, and enough honking to rival NYC. The buildings are varying shades of sandy beiges and browns, bedecked with the visages of the Emir, smiling and waving. While the city is, in theory, walkable, it is not always pedestrian friendly, and crossing streets can be an extreme sport. 

On my second day, I got to meet two of my students who offered to take me out for coffee and dinner, and to show me around the city. While sipping on an iced matcha latte, I could already feel the warmth and generosity of the social climate. My students answered all of my questions about Kuwaiti culture, expressed curiosity about how it felt for me being here, and gave me great pointers on everything from how to cross streets without having my life flash before my eyes, to where to find top-notch knock-off perfumes at the Mubarakiya Souk (Arabic market).

My class includes nine students who represent as vast an array of cultural, religious, and lingual backgrounds as Kuwait City overall. Some hold very traditional and deeply held religious beliefs; others embrace more liberal and modern attitudes. Mental health here is in its infancy - there is deeply held stigma about mental illness and treatment for mental health problems. And yet, my students are defying stigma and opening themselves to learning about a topic that is not widely embraced within their culture. That takes courage. 

A significant aspect of our course is having an hour long experiential group that takes place during each class meeting. Students rotate being group leaders, and student members are themselves - no role playing or acting. I led the first group, but since that initial meeting I have been a group member as well. As each meeting has occurred, I have been able to see my students learn how to let go of their anxiety about the unknowns of what will happen in group, embrace the beauty of organic conversation and connection, and dig deep to share parts of themselves that they tend to keep hidden. Due to their diverse identities, this means something different for each student - however each one has taken courageous steps to find and embrace those common threads that hold us all together. These common threads are woven through sharing laughter, speaking in our home languages and explaining cultural sayings, discussing cultural values that shape our experiences and perspectives, and holding together shared emotions of anxiety, sadness, isolation, joy, empowerment, and connection that reflect a universal language. We are creating a tapestry as a group that is intricately textured, patterned, and infinitely colorful. 

I am already mourning the impending end of this teaching experience as it is already halfway to completion. However, I remain excited about where this journey will continue to go, and what other common threads will emerge along the way. 

Until this past Sunday, it had been years since we took my stepdaughter bowling. The last time we bowled, I remember wondering how her tiny eight-year-old fingers would ever be able to lift that six-pound ball. Somehow, she hoisted the ball, dangling it haphazardly from her little arm, and staggered to the line, her whole body off balance. She would swing the heavy ball with the shortest of arcs, and it would drop almost straight down in front of her with an ear-splitting clatter. Then, we'd wait. About 35 years later, the ball would finish its achingly slow commute, zig-zagging from bumper to bumper and finally, finally, hitting a pin so gently that it would pretty much bounce off it. To her delight, she'd knock over at least a few pins every. single. time. She'd spin around with unbridled glee, jumping up and down. As the proud parents we are, we'd join her in her excitement, providing endless high fives and verbal affirmations of her bowling prowess.  

Fast forward to present day, and we had a less-unbridled, ultra-cool 13-year old joining us for bowling this time. While excited for the family activity, she was more measured in her outward display. On the way to the ally, we warned her that this would be her first time bowling without bumpers. After a moment of pensive reflection, she simply said, "Okay, that's fine." My husband and I glanced at one another and then readied ourselves for the game. I marveled when she chose a 10-pound ball and lifted it with ease. She started off our first set. We gave her the usual pointers about keeping her wrist straight, taking her time, trying not to drop the ball straight down on the ally. She seemed determined and confident.

The first bowl was a disaster. Her wrist twisted, resulting in the ball careening sharply into the gutter. Next bowl, an exact replica of the first, except into the gutter on the other side. Three rounds in and she had accumulated a total of six gutterballs and zero points. My husband and I started to waver. Was she not ready for regular bowling? Should we ask to switch to a bumper lane? It was so hard to watch her keep trying, and keep failing.

Time for the fourth set. Miraculously, the ball stayed straight, and she knocked over several pins. We were all over the moon! She jumped up and down, a replica of her eight-year-old self, despite being such a cool teenager. As the day wore on, she got better and better scores, doubling her tally between the first and second games. She was proud, confident, and quickly reclaimed her former bowling prowess. 

So, what if we had moved to a bumper lane? Sure, she would've had much better bowling scores (and my husband and I would have, also, if we're being honest...). But she would not have learned. She would not have been challenged to focus on her skills - her wrist stability, knowing how to slow her pace, lining her feet up properly with the pins. She would not have realized that she can learn, grow, and see her abilities bloom right before her eyes through her own hard work. In short, she wouldn't have had an opportunity to believe in herself. 

Bowling without bumpers gives us a perfect metaphor for why we should find ways to embrace the adversity we face. Just as our kid didn't grow in her skills and confidence without first failing and struggling, we don't grow and learn without facing some hardship ourselves. If we were to have everything we want without working, or struggling, or failing first to get there, we wouldn't value the things we have or the skills we demonstrate. As parents, it is easy to want to clear out obstacles that impede our children, or rescue them when they fail. It hurts to see your kids suffer. But when we clear out hurdles in their path, they never have a chance to strengthen their own muscles and realize that they CAN do it. It might not be pretty, and they might throw a few gutterballs, but they will eventually succeed. And that knowledge is priceless. 

Unbelievably, the holiday season has returned again. It feels like just yesterday was back-to-school season, and here we are, up to our necks in turkey and mashed potatoes, shivering in the blustery cold weather. This time of year tends to be a mixed bag for many. It can bring joy, hope, and optimism through delicious meals, time spent with family, beautiful decor, and anticipation for happy memories. It can also bring an increase in stress, however, due to immense pressures of preparing food, hosting guests, traveling, navigating crowded roads and stores, spending money, and engaging with family who may not be your ideal companions. For others, it can be a time of profound loneliness and grief due to family estrangement or conflict, coping with the loss of a family member, or battling seasonal mood symptoms. For many, it can be a whirlwind mix of all of the above. Let's go over a few quick tips to help navigate this assortment of emotions and make the most of the holiday season.

1. Be Present: The busyness and pressure of this time of year can make us feel pulled in many different directions. It often feels like there is always something to do, someone to see, a gift to buy, a meal to prepare, a terrible driver to shout at. Before we know it, it's the new year and the holiday season passed by in a blink. Carving out mental space to be fully present with family, friends, pets, food, and any other joys this time of years can bring is incredibly important. Notice when you have been succumbing to pressure and stress, not being fully attentive with those around you. Practice putting aside the to-do lists, racing thoughts, perfectionism, and high expectations to just be. Practice a guided meditation in the mornings to set the tone for your day. Yoga or mindful walking can also help you remain centered. At the end of the day, the joy, connection, and fun memories  will be remembered and cherished - not the pesky little details.
2. Set Boundaries: Those with not-so-perfect family relationships (aka, ummm, everyone?), this one is for you. I encourage you to feel empowered to set boundaries with those in your life, especially people who cause you distress or create toxic environments. Spending time with people who are not good to be around simply because "that's what we do every year" does not translate to an obligation on your end. Think about your needs and how you can ensure that you will take care of yourself. You might consider limiting the time you spend with the family that day. Or, if things become uncomfortable, come up with exit strategies to get space - help out in the kitchen, go outside for a breather, or play with the dog/cat/hamster for a while. If holiday gatherings are always unpleasant, maybe it's time to make yourself a new tradition! Look around for shelters, soup kitchens, or nursing homes to volunteer for the day. Call up a friend and tag along to their family dinner. Whatever the solution, you have the right to set limits and boundaries to take care of yourself. 
3. Get Support: For some, the holiday season can bring about some difficult emotions due to grief and hardship. Living in isolation or estrangement from family can cause deep loneliness. The holidays can also make grief - even from years ago - feel fresh again. If you are in this camp, it is important to reach out for support. Stay in touch with friends or family that are encouraging and empathetic listeners. Let people know when you are having an especially difficult time - even a brief interaction can lighten the burden of sadness. Look into securing a therapist to support you. Keep up with self-care routines and coping skills. Take a hot bath, a brisk walk, or read a good book. You may even consider getting away for a while - a day trip or even a vacation might be enough to shake up your typical holiday routine and the struggle that comes with it. Remember that you are worthy and loved, even if it feels far away sometimes. 

​What helps you get through the holiday season in one piece? Share your thoughts in the comments. Wishing you a joyful and mindful season!

Anxiety can be exhausting, grueling, and overwhelming. It consumes copious amounts of physical energy and mental space. Many clients describe their racing thoughts as a track running constantly in their minds at 100 miles per hour, taking up valuable room that could be used for more productive things. In Part 1, we discussed what anxiety is and the value of insight. In Part 2, we reviewed the negative effects of finding ways to avoid anxiety triggers, which only serves to make anxiety worse in the long-run. However, avoidance is only one of many less-than-helpful ways of coping with anxiety. The discomfort of anxiety offers tempting invitations to find quick fixes for relief. Those facing physical exhaustion from anxiety-induced sleep issues or fatigue may grab a few extra cups of coffee or a Red Bull to get through the day. Some who always feel keyed up or tense may look to alcohol or other drugs to take the edge off. Still others turn to what they can control and rely on - food, shopping, social media - to provide distraction or comfort. Let's break down some of these quick-fix anxiety responses that may not be so helpful for long-term symptom reduction:

• Caffeine: Taking in caffeine actually amps up your anxiety. Caffeine can mimic the physical and mental response of fight-or-flight, adding fuel to the fire of anxiety. If you are feeling anxious, it's smart to avoid caffeine. Look for herbal teas instead, or something that is more soothing and hydrating to help you feel more level.  
• Alcohol: While safe, moderate consumption of alcohol is not inherently problematic even for those with anxiety, it can become a slippery slope when it is taken to directly combat anxiety. Just as avoiding triggers reinforces anxiety, taking alcohol or other drugs reinforces the pattern of needing a substance to manage anxiety. Over time, that pattern solidifies with repeated use, causing risk for developing substance use problems, risky situations, or the development of other mental health issues. 
• Control: At its core, anxiety is often linked with trying to control things we can't. Humans are designed to dislike uncertainty, unknowns, and unfinished business. This dislike breeds anxiety when we want to know all of the answers - what is going to happen, what people will think, how to keep bad things from happening, etc. In actuality, we can never have control over the many variables in our lives. You'd think we'd be better at tolerating ambiguity with how ambiguous our lives are! Unfortunately, that's not the case. It is common to look for things we can control when we feel out of control, including food/eating, compulsive shopping/gambling/OCD behaviors, trying to answer all of the "what ifs" running through our minds, etc. Rather than indulge your mind's control-freak side, practice instead sitting with uncertainty. Try mindfulness practices, including meditation, walking meditation, deep breathing, guided relaxation, yoga, etc. Over time, mindfulness practices fine-tune the brain to reduce neural responsiveness to perceived threats, thereby reducing anxiety. 

Something to try: A saying I use often with clients is to strive to find your comfort within life's discomfort. We have no way to ensure life will be smooth and easy; in fact, it tends to be just the opposite - but that's what makes our lives meaningful. We are tasked with finding ways to cultivate a sense of peace even when our lives feel far from peaceful. When you are feeling anxious, practice closing your eyes, taking some measured breaths, and mentally stepping back so you can appraise your situation from a different perspective. Try to hold in your mind the realities of whatever discomfort is causing your distress, but also hold your grit - your inner strength and resilience - and remind yourself that you can lean into the discomfort with grace and persevere. Breathe through the discomfort and notice how even in the midst of our tumultuous worlds, we can still hold peace within. 

I hope you enjoyed this three-part series on anxiety! Are there other topics you'd like to learn more about? Share them below or reach out.  

By far the most common anxiety mistake I see people making is giving into it. As I reviewed in Part 1, anxiety often boils down to a misapplied fight-or-flight response to a threat that isn't truly life-or-death. It is a good thing that we have fight-or-flight, as it keeps us from harm through readying our minds and bodies for action or escape. However, sometimes that response can get linked up with things we face in life that are not actually threatening enough to warrant such a strong neurobiological response (e.g., meeting new people, public speaking, spiders, unknowns, compulsive behaviors, being imperfect, etc.), resulting in a state of anxiety.  When we are in an anxious state, our minds and bodies are basically screaming at us to get ourselves OUT of that situation through trying to find things to control (hello, perfectionism!), numb the anxious feeling (hey there, comfort food), or avoid the threat altogether. This post focuses on the danger of avoiding the anxious trigger.

What happens when we listen to our screaming brain and simply avoid the trigger? Avoidance often gives us immediate relief from anxiety, but it does us no favors in terms of making our anxiety better. In fact, it seems to make it worse. By giving in and avoiding the trigger, we reinforce our brains, telling ourselves that yes, this threat I am facing truly is life-or-death, and we give our fight-or-flight response a pat on the head (brain?) for a job well done. The next time we face the same trigger, our brains will respond as actively, if not even more so, as the first time we faced it because we reinforced the fear by giving in.  

So what should we do instead? Face the fear directly. Anxiety lives on a bell curve (see below) - it builds up with those initial signs (the red zone) and continues to grow in intensity (the orange). Often, we look for ways to cut those anxious feelings before it crests - we become afraid of our own anxiety - through avoidance, numbing, or control. However, if we can muster our inner strength to sit in the discomfort of anxiety, it will subside. The acute anxiety state does not last forever, and the more that we face the threat, breathe, and ride the wave, the less intense our response will get every time we face our fear.  

Ignorance is definitely not bliss when it comes to understanding what your mind and body are doing when you feel anxious. I think about anxiety (vs. appropriate fear) as an incredibly valuable neural response that is being either overblown or misapplied. In other words, the sensations that accompany an anxious state (accelerated breathing and heart rate, sweaty palms, muscle tension, decreased or increased appetite, racing thoughts, adrenaline rush) are highly useful when we are faced with actual threats to our safety or well-being. These bodily and cognitive changes represent our fight-or-flight response that readies us for survival in threatening situations. Our bodies are poised for action with activated muscles and quick respiration and heart rate, and our thoughts are running on high speed to alert us to our surroundings and possible ways to escape. Think about how adaptive this response is, especially remembering what life was like for the original humans fending off vicious predators and fighting for the survival of our species.

However, anxiety happens when that fight-or-flight response is misapplied to situations that aren't actually threatening to our safety, or at least not threatening enough to truly need that type of response. This is where having insight into what is happening mentally and physically can give you some leverage with anxiety - it gives answers to what you are feeling, it fights "anxiety about anxiety" (e.g., thinking you may pass out or die due to how your body feels in a state of fight-or-flight), and it opens up the possibility for challenging your anxious thoughts and practicing physical relaxation training to regain a sense of calm. Truly, knowledge is power when it comes to managing anxiety. 

Something to practice: If you are feeling anxious or even just stressed out, try to pause for a minute and notice what is going on in your body and mind:

• Where is your body holding tension? Your jaw? Shoulders? Neck?
• Check in with your breathing - is it rapid and shallow or smooth and deep?
• How quickly is your mind jumping from thought to thought?

Notice these sensations and place them in context of fight-or-flight. Remind yourself that your body and mind are simply following through with a hardwired response to perceived threat. Now, try to identify what that threat seems to be. Is it truly a threat to your safety? Or, is it something that maybe just makes you feel uncomfortable, thrown off, stressed, or vulnerable that doesn't need you in full-blown survival mode? Finally, see if you can slow down your breathing. Take your tongue off the roof of your mouth and relax your jaw. Bring your shoulders out of your ears. Remind yourself that this saber tooth tiger your mind is picturing is not a real threat, but rather something you are more than well-equipped to handle as an advanced, modern human. Repeat this mental and physical exercise as needed to start to teach your brain a new and more appropriate way or responding to your anxiety triggers. 

Keep an eye out for Part 2, which will discuss how giving in to our fears exacerbates anxiety. What strategies do you use to manage stress and anxiety? Share your go-to coping methods in the comments below.

We hear the word "depressed" thrown around frequently these days, applied to many situations that may or may not relate to true depression. We also hear terms like "clinically depressed," "major depression," or simply "depression" when describing mood diagnoses. This post will break down how to differentiate between situational sadness, typical mood fluctuations, and the mood disorder known as Major Depressive Disorder. 

It is a normal and expected part of life to have ups and downs in mood. To feel sad when disappointed by someone, to be burdened by grief after a major loss, to feel frustrated and angry at a boss, to feel defeated when getting a low grade on an exam; these are typical human reactions to life's many stressors. As Buddha said, life is suffering. So, we can expect those fluctuations within our days and weeks. 

However, a persistent low mood can reflect something beyond situational sadness. This is the point at which we look at the possibility of a Major Depressive Disorder (MDD), which is how depression is currently diagnosed. To be diagnosed with MDD, you must meet at least five of the following criteria:

• Depressed or irritable mood most of the time
• Loss or decrease in pleasure for most activities, including ones that used to give joy
• Significant change in weight or appetite
• Sleep disturbance (too much/too little)
• Feeling either restless or slowed down in moving
• Energy depletion - feeling tired, fatigued
• Feeling worthless or excessive guilt
• Struggling with thinking clearly, making decisions, focusing, concentrating
• Having thoughts of death or suicide
  
  

Now that we've covered primary symptoms, let's look at the key differences between situational sadness and MDD:

• Cause: Typical fluctuations with low mood are situational; that is, you feel sad/down/angry about something. MDD often feels like low mood with no real cause or trigger. 
• Pervasiveness: MDD symptoms must persist continuously for at least two weeks to qualify for the diagnosis, whereas situational sadness comes and goes with gaps of normal or positive mood in between. 
• Energy: Although not true for everyone, many clients who struggle with MDD describe their depression more as a sapping of energy than feeling sad or weepy. It can feel as though all of your vitality has drained from your body and mind, the world has lost its color, and you are running on a gas tank on E. Situational sadness can also be tiring, but typically the sad feeling dominates over feeling depleted. 
• Impairment: For most struggling with situational sadness, maintaining key areas of functioning generally is not a major issue. Keeping up with work, household responsibilities, and important relationships are not compromised in a significant way. However, those with MDD often experience impairment in their functioning to different degrees. It can look like withdrawing or avoiding contact with family and friends, taking excess days off from work, being unable to get out of bed to take care of responsibilities, or falling behind in school.

If you or someone you know seems to be struggling with MDD, it is important to seek help. Untreated MDD can spiral into more severe symptoms, greater impairment in functioning, and increased risk of suicide. Psychotherapy is great resource to manage symptoms depression. Others utilize medication, which is most effective when combined with psychotherapy. There are also exciting new treatments on the rise, including Repetitive Transcranial Magnetic Stimulation (rTMS) and physician-administered psychoactive drugs, such as Ketamine, that are being implemented for treatment-resistant cases of MDD. 

Here's to a brighter future and better treatment for MDD. Thanks for reading!