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Interviewer: Ten percent of people living in Utah are at a higher risk for seasonal affective disorder. We're talking today with Dr. Jason Hunziker. First of all, why are we, living in Utah, at a higher risk?

Dr. Hunziker: There are a lot of theories as to why people who live in the northern latitudes are at higher risk of this type of depression. One of those theories is the fact that there just is not as much daylight in the north as there is closer to the Equator. So the further we get away from the Equator, the shorter the days become, the darker it becomes, and so people get more depressed.

Interviewer: And so, then it's true that sunlight actually makes you happy.

Dr. Hunziker: That's correct. People who live closer to the Equator have less chance of this type of depression.

Interviewer: Are there other risks then, being in Utah, besides not enough sun?

Dr. Hunziker: There are, and people who are at risk that live in Utah are people who are young, they're a lot more at risk. Women tend to be at a higher risk than men, at an almost ten times more likely to get this type of depression than men.

The other thing that occurs in Utah, that doesn't occur in other places, is our inversion. So time away from the sun, even on a bright day, we don't get that because the inversion's there to block the sun. People who live around tall buildings that block the sun tend to get more depressed. If your job is indoors, in the basement with no windows, during the winter you're really at risk.

Interviewer: And especially since we have Daylight Savings here in America, you get out of work at 5:00 and it's already dark.

Dr. Hunziker: That's right.

Interviewer: And so you don't really ever . . .

Dr. Hunziker: That's right.

Interviewer: And then you wake up at, you know, 6:00, 7:00 and it's still dark, and so you never really see the sun.

Dr. Hunziker: That's correct, and it can't just be the light in your office that makes the difference, it has to be the same wavelength as the sun to make a difference, which is why people use light boxes because that does help with most people who have this type of seasonal disorder.

Interviewer: So knowing that people in Utah are at higher risk for depression, tell me from a doctor's perspective exactly how dangerous that is.

Dr. Hunziker: Yeah. So depression can be extremely dangerous, and suicides rates, particularly in Utah, are quite high. And if depression of any type goes unchecked, it can lead to people thinking about ending their life, which is extremely important. So any time you're experiencing a depressed mood, it should be evaluated, at least by your primary care doctor to see if something else needs to be done.

Interviewer: So with depression being so serious, does it often get confused for somebody just being moody, then, because people get moody and they get upset, but when does that become depression? When does it become dangerous?

Dr. Hunziker: The way you can tell is if this lasts every day for at least two weeks, where you're feeling so terrible that you don't want to get out of bed, where you feel like you have to sleep all of the time. You have absolutely no energy, or interest, or desire to do anything with anyone. You notice that you're eating a ton, particularly carbohydrates. With this population that gets seasonal affective disorder, carbohydrates tend to be the big thing that they do. And then, of course, if you start having any thoughts about hurting yourself at any time, that's when it really needs to be addressed.

So in summary, I think that for those of us living in Utah, we are at higher risk, so we need to pay attention to those signs of depression. Particularly women, particularly young people, particularly people who work in environments where they're not around sunlight need to pay attention to this. If you notice that you're having any changes in your mood, please seek help.

updated: December 16, 2022
originally published: December 16, 2015

Interviewer: You have somebody in your life who is entering the alcohol recovery process or is in recovery and you want to be supportive but some of the things you say might actually be harmful.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Interviewer: We're talking with Dr. Jason Hunziker, psychiatrist at the University of Utah. Dr. Hunziker, people who are recovering from alcohol addiction, it's a really hard process and they need all the support they can get.

Dr. Hunziker: The choice to go into recovery is a big deal for everyone who does it. It's a very difficult process and it does take a lot of support not only internally but from people in the environment and from systems that help people enter the recovery process. We do have to be careful however what we say to people as they are getting ready to enter that process and as they are in that process so that we can motivate them to stay sober and make this big change in their life.

Some of the things I recommend that we don't say are things like, "Hey you can have just one, and it's not going to hurt anything." That clearly is not going to be helpful to somebody who is telling you that their life has been destroyed by alcohol. That's sets you up for failure in your process and in your program and so that's something that should be avoided.

Interviewer: So what are some other things that people say sometimes that you think are supportive but really aren't?

Dr. Hunziker: Somebody is in the program and you think you're being supportive by visiting them and then you say, "You know I'm glad you're doing this right now. It's a good time for you to do this but one day you're going to be able to drink again."

Interviewer: Really? They say that?

Dr. Hunziker: Yes, and again that is not something that is helpful at all to maintain the sobriety that they're looking for. When you stop, you still have the addiction. You just choose now not to use. And I use the word choose pretty lightly because if it was that easy to quit, everybody would just quit. So they make the decision to everyday get up in the morning and realize that they're not going to use and then go through that day not using even though they still have some cravings, they still have some desires and they still fight that impulse to go get some alcohol.

Interviewer: Okay, what are some other things that people might say?

Dr. Hunziker: Other things people say when they don't realize you don't realize you're an alcoholic at all they'll say, "Wait a minute. I see you go to work every day. You have a job. You're still making money. How can you be an alcoholic?" They think that just because you can function that you're not an alcoholic. But that still does not mean that this does not interfere with other aspects of your life.

Some people will say when you've been in the process for a long time and you've been going to your recovery meetings and you haven't had a drink they'll say, "Aren't you done yet? I mean, you've been doing this for years, shouldn't you be cured already?" There's no cure. I mean the cure is to not drink and the only way to not drink is to get positive support and to be actively making sure that doesn't happen.

Interviewer: Okay, any other things that people might say they think are supportive to a recovering alcoholic but might not really be that supportive?

Dr. Hunziker: Well I think sometimes people want to down play or minimize the alcoholism in the other person's life and so they will say things like, "Well I eat food every day, that doesn't make me addict so how could you be an addict?"

Interviewer: Because those two things are so comparable.

Dr. Hunziker: Exactly, exactly. So clearly our words are very important when somebody has made the decision to go into recovery and we need to choose those words carefully. We don't shy away from having conversations but I don't think we want to interfere and actively seek out information about the alcoholism. If somebody wants to give it to us, great. Let's listen, let's be supportive but if you start asking a lot questions people feel like you're being intrusive and then when you're intrusive it sets them up for failure.

Interviewer: So what are the words and the conversations that you can say to recovering or you should be saying to a recovering alcoholic?

Dr. Hunziker: It's not so much what you say all the time but some of the things that you do. Be available so if they call you in the middle of the night you don't say, "Oh, you're just drunk again" or " Oh, here it goes again." You're supportive, you're available, and you're encouraging them to use you as a support system so they don't go drink. Other things, you stay positive. Keep giving them encouragement all the time because it is a difficult process.

I mean you could imagine if you had to give up something you really enjoyed doing even if you didn't really think it was causing you that much problems. So you want to make sure that you're positive and they get encouraged by you so they will continue to fight the addiction.

Interviewer: So say you know someone who is thinking, who is considering the recovery process, what can you say to them to kind of motivate them to enter it?

Dr. Hunziker: You know I think normally what you want to do is have them think about how this helps them or doesn't help them. If you can say to them, "Okay, let's make a list of how alcohol helps you in your life, and then let's make a list of how alcohol hurts your."

Interviewer: Doesn't help you in your life.

Dr. Hunziker: Exactly, exactly.

Interviewer: Pros and cons.

Dr. Hunziker: And then people can look at that and then you can provide motivation based on the positive feature say, "Look what you can... You want these, you want that, you want this. The only way to get that is to be sober and if you can be sober, good things are going to come."

Interviewer: So any final thoughts that you have about recovering alcoholics, what you should and shouldn't be saying?

Dr. Hunziker: The only thought I have is that if somebody comes to you and says, "I'm contemplating stopping my drug use or my alcohol use." Please refer them to somebody who has a knowledge of recovery, has a knowledge of treatment, their primary care doctor, Alcoholics Anonymous, Al-Anon, somewhere that they can get that process moved from contemplation to full active recovery.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: March 12, 2019
originally published: November 5, 2014

Interviewer: Hollywood has been banking on fascinating taboos in their shows and movies and this is why psychiatric illness have been such a major theme. But what do you really know about them? That's next on The Scope.

Announcer: Medical news and research from University of Utah Physicians and Specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: We're talking today with Dr. Jason Hunziker, psychiatrist at the University of Utah about Hollywood and psychiatric illnesses, in movies and TV shows. One that pops into my head is the film Sybil, which was actually a real case taken from a book that was actually based on a real life patient.

Dr. Hunziker: Yes, dissociative identity disorder or at that time known as multiple personality disorder.

Interviewer: Like Sybil had.

Dr. Hunziker: Exactly. It is one of the more common psychiatric illnesses used in movies because so much is not known about that illness. But it also plays on all of our kind of fantasies and fascinations, and our interest about what the brain can do and how fragile it really can be.

Interviewer: So what exactly is Hollywood's definition of dissociative identity disorder?

Dr. Hunziker: The way films look at it is a way that I think it was described early on, which is somebody who has suffered from a very bad trauma, usually some type of sexual trauma, when they were young, that may or may not have been repeated over and over again, that somehow fractures their brain.

Interviewer: What does fracture your brain mean?

Dr. Hunziker: What that means is that the brain is so powerful that it does what it can to protect the human body against some outside source that's so overwhelming that it feels like you might die literally from that exposure. So the brain then separates itself and allows you to protect it by sending your consciousness level off somewhere else while your body just kind of remains there in person dealing with that trauma.

Interviewer: So it's kind of like you have multiple views.

Dr. Hunziker: Exactly, and that's where this came from. While you're gone somebody else is interacting with the people around, and so the thought was that people would form these different personalities to deal with different stressors in their life. And so Hollywood, of course, jumped all over that. What a great story, you have all these different people living inside you and when you go to the grocery store you can be Jill, and when you go to the carwash you're Bobbie, and when you're at home with your Mom you're a three-year-old girl who's scared. So Hollywood loves that stuff. But that's not the reality of what this illness really is.

Interviewer: Reality then; what have you seen in your studies and patients' cases?

Dr. Hunziker: There is so much controversy, even in the mental health industry about dissociative identity disorder. There are those that swear by almost the Hollywood version of what this looks like. And then there are others who say people clearly use dissociation to help protect themselves, and that's kind of where I fall in line. I think that people use that mechanism to get out of a stressful situation, and they then have a different personality style that interacts with you during those moments that they are real self is not present.
So when patients that I've seen, and that's generally what I've seen, is that when they get under stress they fall back onto disassociation to protect themselves, and they literally are not the same person. I talk to them, and they don't respond as quickly. They respond differently. But they are not Bobbie or Johnny, or Cindy; they don't have a name to it. It's just a part of their personality that remains to get the job done while the other part is protected and away from the stress.

Interviewer: This sounds to me, and correct me if I'm wrong, but kind of like a PTSD.

Dr. Hunziker: Exactly like PTSD. I think we see that a lot more now and I think dissociation is becoming more prominent because of our soldiers who are coming home and they struggle with flashbacks and paranoia, and depression and anger. All of these things, and when they get into a experience that's similar to what they experienced in the Middle East, they shut down and disappear, and they try to alleviate the stress by letting their brain wander somewhere else.

Interviewer: But it's not exactly like having multiple personalities, and that's what the illness was called back then.

Dr. Hunziker: That's correct. And again, it's hard, because there are two different camps on this, and there will be arguments that there are distinct personalities, and those distinct personalities need to all be reintegrated into one person, so the person can be whole again. But that's just not been my experience clinically when I have somebody who has that diagnosis or come to me with that diagnosis. That's not what I have seen.

Interviewer: When someone comes to you and they tell you, I have multiple personalities, as you mentioned before that some of your patients come and they tell you that they have multiple personalities, are they aware then that they have multiple personalities?

Dr. Hunziker: Again, that's where the controversy is, too. If they really are not present with the other personalities, it's hard to know why they know that they have multiple people and who they are and what their names are and what they are doing.

Interviewer: Right.

Dr. Hunziker: But they will, and I do have patients who tell me they have multiple personalities, and they'll have four or five or ten, and they have names for all of them. And some patients have been through the reintegration process and so they feel like it's mainly under control and all their personalities are meshed together. Others say they're still struggling with that. But the importance is when they tell me that, what I understand is they are extremely distressed, and whatever that stress is is causing their brain to not function in a way that's healthy for them. And so we focus more on that, and not so much on each individual personality.

Interviewer: Because you really don't know how many personalities they might have.

Dr. Hunziker: That's correct, and it's easier to say, we want to keep you, the real you, here with us dealing with everyday life, and we don't want you to keep using that crutch or that defense mechanism of dissociation to leave and then not deal with the issue that we really need to deal with.

Interviewer: How do you develop something like this? It's so fascinating, and like you said, controversial in so many areas of film and life?

Dr. Hunziker: It's hard to know how this really develops and we do see patterns in people who have dissociation as a major feature of their illness. And that pattern generally is the trauma. Some type of extreme trauma where you think your life is being threatened will then promote this type of defense.

Interviewer: It's almost like you're protecting yourself.

Dr. Hunziker: Yes, from experiencing what's going on, because it's too overwhelming. Because when you're young, we use these types of defense mechanisms all the time. I mean, we all use dissociation...

Interviewer: We play house or doctor.

Dr. Hunziker: Exactly, and we disappear into, and you'll hear your mom say, well you used to disappear into this different world. Well you did, and that works for us when we're kids. But when we're adults disappearing doesn't work as well. But when you get a trauma, particularly at that age, you get stuck and then that defense mechanism can become the prominent defense mechanism that you use later in life when it doesn't work anymore to disappear and go to your...

Interviewer: Happy place.

Dr. Hunziker: Your happy place, exactly. And instead you are not present with the people around you and then when you interact with them it's different, it's odd.

Interviewer: Any final thoughts on this?

Dr. Hunziker: Again, I'm glad that Hollywood brings awareness to mental illness, but I think we have to remember that Hollywood tends to over generalize and/or overly extreme put mental illness in the forefront that some of the symptoms that they describe are not accurate. But if you do have family members that struggle from zoning out or not being present all the time, or forgetful and don't remember doing certain things, that's probably time to get them into the doctor and be evaluated to make sure that dissociation is not something that they are experiencing.

Dr. Miller: We're your daily dose of science, conversation, medicine. This is The Scope; University of Utah Health Sciences Radio.

Interviewer: People with eating disorders experience severe disturbance in their eating patterns. It's important to remember that eating disorders are mental illnesses and the physical effects are the symptoms. That's coming up next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Three percent of Americans suffer from binge eating disorder. We're talking with Dr. Jason Hunziker, a psychiatrist at the University of Utah. Dr. Hunziker, what mental conditions can cause an eating disorder?

Dr. Jason Hunziker: There are lots of mental illnesses that are associated with eating disruption or eating disorder for different reasons. An example would be somebody with schizophrenia gets very paranoid often, so they won't eat their food because they're afraid it's been poisoned. We have other people who are so anxious about allergies in food that they just won't eat, so they have a specific phobia about certain foods. Some recent studies have shown that people with bipolar disorder and/or depression also struggle with eating disorder of a different type in which they binge eat.

Interviewer: First of all, what is binge eating?

Dr. Jason Hunziker: Binge eating is when you're going along fine and you eat normal foods, then you have an episode in which you just can't get enough food. You binge on whatever's in front of you. Most often it's not stuff that's good for you.

Interviewer: Always.

Dr. Jason Hunziker: You eat lots of it. Then, you eat to the point that you almost feel like you're going to burst. That leads to some people then going in and purging and getting rid of the food that they just ate.

Interviewer: So, it's different than, say, on a Saturday night I'm in front of a movie and I'm eating everything that's in my kitchen. That's different. It's those people that do that but then feel guilty, and then they throw up afterwards. Is that correct?

Dr. Jason Hunziker: That's correct. Usually, with binge eating there is a number of times you need to participate in that event before it even gets classified as a binge eating disorder. That has to be several times a week or month. Then, you qualify for a binge eating disorder.

Interviewer: What exactly causes someone mentally to think okay, I need to throw up? Because when I eat too much and I'm full I just wait for the food to settle down.

Dr. Jason Hunziker: Not everybody does throw up when they have the binge eating. What they'll do, though, is they use that food as some way to help comfort them for whatever's going on in their life. Often, as I said, it is associated with depression. When people are sad and they're down they...

Interviewer: They eat.

Dr. Jason Hunziker: ...feel like eating. And, the same with bipolar disorder - when you're sad and you're down, you eat. That somehow gives them some comfort, while at the same time it induces shame, and guilt, and other aspects of well, now I'm gaining weight, and now I'm not thin. It's a vicious cycle for them.

Interviewer: We obviously know that we classify binge eating as an eating disorder which is a mental illness. What other physical health conditions can it cause?

Dr. Jason Hunziker: It depends on how long this goes. Clearly, binge eating is going to increase your weight. As your weight increases we know that affects all aspects of your body including your lungs, and your heart, and then the cardiovascular system and other physiologic effects that it can bring on. Type-2 diabetes in this country now is really expanding because of the obesity problem, and this would be another way to contribute to that problem.

Interviewer: That's interesting. There are all these sorts of more severe diseases that can come from just binge eating.

Dr. Jason Hunziker: That's correct.

Interviewer: Obviously, you know that's going to happen. You want to treat it. Is it something that you physically and emotionally are maybe aware of, or do you need somebody to tell you I think there's a problem you need to go see a specialist?

Dr. Jason Hunziker: I think that some people are aware and some aren't. I think if it's associated with your mood disorder that would be a time to get into your doctor and get on some medication for your depression, which often will help take care of those binge eating episodes. Sometimes the medication itself will help take care of that compulsion or drive to eat which some people just have. They just feel compelled to do it and they can't feel good unless they do it. Then, they feel bad after they do it. It's a really vicious cycle. The medicine often will help with that.
There are good therapies that can help with eating disorder as well. It's really important to understand the underlying cause, and if it's caused by another illness to make sure that you treat that illness so that you can then treat the binge eating.

Interviewer: Any final thoughts on binge eating?

Dr. Jason Hunziker: I think that the important thing to do is for the patients and/or their families to recognize that the binge eating is a disruption to them, and that they get into talk to their doctor as soon as possible about what could be done to help them...

Interviewer: Because it can be treated.

Dr. Jason Hunziker: ...because it can be treated.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope. University of Utah Health Sciences Radio.

Interviewer: A happy lifestyles goes a long way. What are some of the steps you can take to promote and protect your mental health? That's coming up next on The Scope.

Announcer: Medical news and research from University Utah Physicians and Specialists you can use for happier, healthier life. You're listening to The Scope.

Interviewer: We're talking with Dr. Jason Hunziker from the University of Utah. Dr. Hunziker, first of all what is mental health and why should I even be paying attention to it?

Dr. Hunziker: Mental health and mental well being is something that I think we all take for granted and think it's just going to happen, but it really doesn't. I think mental health and mental well being is how you feel about yourself every day and how you look at the world and how you feel the world looks at you. So it's always important to address that every day, to do certain things to kind of help yourself continue to enjoy the life that you have and attain those goals that you've set for yourself.

Interviewer: What things can affect my mood and my emotion, because I'm just going to wake up and think it's going to be a good day and I'm going to be happy and things don't go well and you get upset? Ultimately what affects your mood?

Dr. Hunziker: Well pretty much everything affects your mood. Unfortunately in our environment and in our society today we have created things that we had hoped would help our lives be easier and better and move along quicker, but at the same time what we're finding out is that it causes a lot of disconnect between people. We don't talk as much as we used to talk because we don't have to. Instead of calling on the phone anymore to talk with somebody we just send them a text message, or instead of writing a nice letter to somebody we just send them a quick email. And those things, that disconnection from people is one way that we see the destruction of people's well being and good outlook.

Interviewer: So connectivity with the people around you is definitely one of them. How about my diet; does that affect anything?

Dr. Hunziker: Clearly your diet is really important.

Interviewer: Not just my physical state, but also my mental state as well.

Dr. Hunziker: Definitely. If you're eating unhealthy, which we tend to do, again I'm going to go back to the society and how we're moving so quickly. We don't take the time to eat breakfast, because, oh we'll just swing by McDonalds...

Interviewer: Or just grab a banana.

Dr. Hunziker: ...and get a McMuffin or something. And then the next meal is fast food as well, and pretty soon what we've done is we've added all these empty calories that aren't available for your body to use. And then we end up hurting ourselves in the long run.

Interviewer: Is it as easy just to say, eat a good diet, or are there certain foods that I should be looking for and say, okay, this is going to help my brain be happy.

Dr. Hunziker: I think that the way that they have set up the calories and the nutrition that they think is good for us in this country I think is a fairly good way to look at that. If we're eating carbohydrates and fats and protein with every meal, I think we're going to be okay.

Interviewer: A good balance.

Dr. Hunziker: But we need to have a good balance, and that's our problem, because I would rather have three donuts in the morning than a good sensible breakfast.

Interviewer: But you can't do that though.

Dr. Hunziker: No we can't; otherwise that changes a whole bunch of things in your life. Along with the good diet I think though is an exercise program as well. And what I mean by that is I don't think you need to be at the gym three or four times a week. But I think what you need to do is make sure you're getting physical activity of some type every day.
Most of our jobs anymore seem to be sitting down. We don't spend a lot of time moving around from one place to the next because we have everything we need right in front of us. So parking a long way away from the door to your office and walking in is helpful. Trying to take the stairs when you can is helpful. Some people wear pedometers on their belt and they shoot for 10,000 steps a day to make sure that they're getting some type of exercise.

Interviewer: People always say it's good to talk about your feelings. How good is it to talk about my feelings?

Dr. Hunziker: I think it's really good to talk about your feelings.

Interviewer: But who do you talk about them with?

Dr. Hunziker: Well I think that's up to you. I think you want to find somebody who you trust and who you feel like will listen to your feelings and then help you deal with those issues. If that can be your significant other that's even better, because opening up communication between partners is another way to enhance your well being. But if that's not going to be helpful, there are therapists out there that are there for you to help you discuss those things that you need help with so that you can keep your mental health elevated. You don't have to wait to be severely depressed or severely anxious or to have marital problems or financial problems to go see a therapist.

Interviewer: So in talking to you I just realized I have a terrible mental health wellbeing. I don't eat a good diet, and I don't communicate with people very well. I don't keep in touch. I don't do all these things that you should be doing to keep a well balanced mental health. What are some tips to improve this?

Dr. Hunziker: Focus on the one thing that you think might be impairing you the most, and then make a change in that first. Start by eating breakfast every morning and maybe set something out the night before so it's already to go. Maybe take a healthy meal with you to work so that you don't end up just running and grabbing something.

Interviewer: Keep something on your stomach.

Dr. Hunziker: Exactly, or just not eating at all. And then make that change first and then move on to your next thing that you want to do to help you feel better.

Interviewer: What are the three things that you think are most essential to a healthy mental well being?

Dr. Hunziker: That's a great question. I don't know if there are just three things, but I would say that the things we have talked about; I think if you want to stay healthy we have to take care of your physical body, your mind, and make sure that everything is working together. A healthy diet is going to go a long way to improve your mental health as well as your physical health. And that's going to help you get where you need to be. Exercise always is a way to increase the way you feel about yourself, and those around you, and that helps you improve. Getting excellent sleep is very important, because if you don't have good sleep you are not going to function.

Interviewer: What is a good amount of sleep, because I feel like it's different for everybody. I'm getting like two hours of sleep a night, and that's not good I'm assuming.

Dr. Hunziker: No, we have medications for that if you need something. Yes, two hours of sleep is not healthy. There are going to be problems if you continue to function on two hours of sleep. I think you're right; there are some variations in what people do need for sleep, but for the most part it is recommended that a good healthy eight hours of sleep a night is a way to keep yourself moving forward and being healthy. You should try to do things on a schedule so that you go to bed at the same time and get up at the same time and have a nice routine that you go through so that you can then promote a more healthy well being.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope. The University of Utah Health Sciences Radio.

Interviewer: Sixty-six percent of Americans say they occasionally drink, and that number is increasing. Are we drinking too much, too little, just the right amount? How does this all affect your mental health? That's coming up next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: We're here with Dr. Jason Hunziker, psychiatrist at the University of Utah Hospital. Dr. Hunziker, the first question is mental health and alcohol addiction. Is there a connection between the two?

Dr. Jason Hunziker: Clearly. There's clearly a connection. Unfortunately, it's a complex connection, and there are several different theories on how this happens. Is it the alcohol changing neurotransmitters in you brain that causes the mental health? Were you already depressed and anxious, so you started drinking as a way to fix your anxiety and your depression? Did the alcohol and the depression start at the same time? Is it mixed that way? It's really hard to know in most people which came first and what the connection is, but we do know that mixing the two is not healthy for you.

Interviewer: What do you mean by mixing the two?

Dr. Jason Hunziker: If you're depressed, you're already putting yourself in a position, particularly if you're not getting treatment, that you have a hard time taking care of yourself. Getting out of bed is a struggle, trying to get to work, and if you have kids, taking care of your children, it's very difficult.
Then, you throw alcohol on top of that which is in and of itself a central nervous system depressant. The alcohol actually makes you more depressed. It makes it harder for you to function. You lose time at work. You have marital problems, relationship issues with your children. It can lead to more trouble taking care of yourself and lead to childhood abuse and neglect.

Interviewer: It's almost like the chicken and the egg thing. You don't really know if it's a mental thing first or if it's an addiction first, right?

Dr. Jason Hunziker: That's correct. It's really hard to know for a lot of people, and when we evaluate people who come in with alcohol and mood disorder we have to take some time to figure out were they already depressed first or did the alcohol come first and that's what caused the depression.

Interviewer: Is that important in the treatment, to know which one came first?

Dr. Jason Hunziker: It's definitely important in the way we diagnose the illness. Often, we don't diagnose depression or anxiety if we feel like the alcohol was the direct cause of that. Often, what we see is people have been depressed unknowingly for a long time and then picked up the alcohol as a way to kind of medicate that, and it didn't work.

Interviewer: I mentioned earlier that we both talked about how alcohol has become such a normal part in American society, American life. It's like a part of your day. Is that normal? Is that healthy? What's going on there?

Dr. Jason Hunziker: Again, healthy, probably not...

Interviewer: Not even the red wine?

Dr. Jason Hunziker: There is some evidence that red wine can be healthy if you drink it in the five ounce or less per night and that's all you have. The problem with most people is...

Interviewer: That's not all they have.

Dr. Jason Hunziker: ...that's not all they have. In fact, a study that came out recently from the CDC shows that 38 million Americans say they drink too much.

Interviewer: Really, they admit that?

Dr. Jason Hunziker: They admit it, and these are people who aren't considered alcohol dependent.

Interviewer: How do you treat that? Can you treat it, or is it classified as a mental illness at that point?

Dr. Jason Hunziker: It is, and in the new DSM-V it's called the substance use disorder.

Interviewer: Okay.

Dr. Jason Hunziker: Yes, there is treatment for it. First and foremost, you need to make sure if you've been drinking too much that you talk to your medical doctor. Alcohol detoxification can be tricky and at times deadly and needs to be monitored closely just to get you through that initial phase of getting the alcohol out of your body.
The detox part, believe it or not, is the easy part to this process. Staying off of alcohol is when it becomes very difficult, because if you go back and drink one drink it is never enough for you and you will start drinking again and again and again. Then, it leads to all those problems that brought you in in the first place.
We do have treatment. There are inpatient programs where you can go stay for 30 to 90 days, learn all about addiction, learn what to watch for, make sure that you stay sober. There's AA, which is free meetings all over the town. Every hour somewhere there's a meeting with great support system to help you stay sober. There's intensive outpatient programs that are available for people to go to which are four days a week at night time when most people are drinking, so it keeps people from using alcohol.
The reason alcohol is so important is that it doesn't just affect your life.

Interviewer: Right.

Dr. Jason Hunziker: It can affect everyone around you. When you're addicted to alcohol often you do drink by yourself, because you don't want people to see how much you're drinking. You'll start drinking at work. You'll drink in your car. You'll drink while you go grocery shopping. You'll drink Listerine and mouthwash and Nyquil just to get the alcohol out of it?

Interviewer: Really? Oh, so it's...

Dr. Jason Hunziker: It leads to all kinds of medical complications.

Interviewer: What are some of those medical complications that you just mentioned?

Dr. Jason Hunziker: Some of the medical complications can be liver failure.

Interviewer: Of course.

Dr. Jason Hunziker: Alcohol can also lead to hypertension. It can lead to problems with respiratory drive and respiration. Then, of course, the family issues that come from alcohol can be devastating. You're causing yourself issues, the depression, the anxiety. That can bleed over as anger and frustration to your significant other and your children, which then gets perpetrated later again in life by your kids.

Interviewer: Any final thoughts?

Dr. Jason Hunziker: I think that if you or someone you know or love or care about you think has an alcohol problem, please approach them about that. Tell them why you're concerned and what the concern is. Get them to their doctor where they can get some more resources. There are plenty of things online that you can pull up and say hey, this is where I can go get treatment.
If nothing else, go to an AA meeting. They're everywhere all the time. Everybody has an hour that they can go sit. Even if you're intoxicated, go sit in the meeting and hear what these people say about sobriety and how they can help you get sober so you can improve your life and the life of everyone around you.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.

Dr. Jason Hunziker: Today we're going to talk about the long-term consequences of child abuse and neglect.
I'm Jason Hunziker from the University of Utah Department of Psychiatry and this is what's coming up next on The Scope.

Announcer: Medical news and research from University Utah physicians and specialists you can use for happier, healthier life. You're listening to The Scope.

Dr. Jason Hunziker: Information from the Child Welfare Gateway and the U.S. Department of Health and Human Services suggests that in the physical year of 2011 over 650,000 children were the victims of abuse and neglect. Those injuries that those children suffer can take many different forms, including physical, behavioral, societal, and psychological and have consequences that ripple through their families for generations to come.
It is often difficult at times to separate out which of the physical, behavioral, societal, or psychological injuries are responsible for the signs and symptoms that we see in our children as they are growing up and turn into adults.
An example of this would be let's say a child gets brain injury and ends up causing significant psychological issues such as depression, emotional problems, and cognitive problems. Those emotional problems or cognitive problems can then go on to lead to poor decision making and risk taking behavior that we wouldn't normally see. And those then can lead on to more societal problems such as long-term disability or crime.
There are several different factors that can lead to these consequences from abuse and neglect that we can possibly see and a few of those include age and developmental status when the abuse occurred. So if the abuse occurs younger we could see different problems than if it occurs at an older age.
The types of abuse or mistreatment; physical abuse leaves different long-term scars than sexual abuse would. The frequency, the duration or severity of the abuse; if it happens more often or if it's very severe that trauma can also be significant in long-term consequences.
And then of course who the perpetrator is makes a big difference. Often it's a family member and that is much worse than someone that you don't know who is causing this severe abuse.
While it is not yet really understood why some children have long-term consequences and others don't, even when they have similar circumstances, so often siblings will experience the same abuse in the same household environment, and may not have the same consequence. And they postulated that resilience is often used or the term used to describe why these children are able to cope with this abuse or neglect. Most children are not born with the resilience; it comes from either within themselves or from the family environment or from the community in which they live.
There are often a lot of different things that can contribute to resilience including good self esteem, having a good sense of humor, strong positive attachments with people around you, and good emotional regulation.
Some of the psychological consequences of abuse can occur immediately after the abuse. These things that we would see are children isolating from their friends or from their family or having extreme fear around strangers; or the loss of ability to trust anyone. These immediate emotional effects can lead to depression, anxiety, long-term trust issues, relationship instability, and self doubt. When the abuse occurs in an infant and in younger children it primarily affects their ability to form strong healthy attachments.
In a document titled, Call to Action On Behalf of Maltreated Infants and Toddlers it reported that half of infants in foster care who have been mistreated experience some type of cognitive delay. Of these they all have lower IQ scores, language difficulties, learning disabilities, and other challenges compared to other children who have not been abused.
Later in childhood the abuse can lead to formation of borderline personality disorder, severe major depression, anxiety disorders, and in some cases PTSD. There have been some studies that show a connection in suicide rate and depression rates in women associated with child and adolescent sexual abuse. Other studies have shown that over 50% of women that have an eating disorder have suffered some type of sexual abuse.
While not all children of abuse will struggle with emotional or behavioral problems, more than half of the youth reported some type of abuse and therefore were at increased risk of emotional or behavioral problems.
Some of those behavioral problems that can occur in adolescents include having to repeat a grade because they keep failing and have to start over, using illicit substances, alcohol, tobacco, prescription drugs, criminal activity of any type, skipping school and early teenage pregnancy.
Some studies have also shown an increase in this high-risk sexual behavior and there is a nine times increase in the criminal activity of adolescents and in adults who have suffered childhood abuse or neglect.
As mentioned briefly, substance abuse is a huge problem in this population. There is a lot of research that consistently reports the increased likelihood of abuse and neglect will lead to cigarette smoking, drinking alcohol, and using street drugs and other prescription drug abuse in men that have greater than six episodes of abuse or neglect in their lifetime. They have an increased likelihood of more than 4,000% that they will use IV drugs later in their life.
Lastly this abuse behavior seems to create a cycle of abuse that is passed down from generation to generation to generation. Girls from physically abusive homes were 1% to 7% more likely to perpetrate youth violence; and 8% to 10% more likely to perpetrate interpersonal violence.
In boys who experience sexual violence in their adolescence or childhood were 3% to 12% more likely to commit youth violence, and 1% to 17% more likely to commit an interpersonal violence.
Abuse and neglect in childhood clearly leads to a range of different consequences later in life. Even though some children seem to escape the long-term problems from abuse, everyone suffers the short term. The cost to the individual, the family, the community is so high when abuse or neglect goes unnoticed, and the symptoms go untreated. It is important to recognize when abuse is happening and to seek help from counselors, primary care providers, pediatricians, psychologists, psychiatrists, and anyone who can help and perhaps avoid more long-term problems from childhood abuse and neglect.

Announcer: We're your daily dose of science, conversation, medicine; this is The Scope. The University of Utah Health Sciences Radio.

Interviewer: Anorexia is an eating disorder that is more common than you would think. One out of a hundred women has struggled with anorexia at some point in their life. Has anorexia associated with mental illness? We'll find out next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use. For a happier and healthier life. You're listening to The Scope.

Interviewer: We're talking with Dr. Jason Hunziker Psychiatrist at the University of Utah. Dr. Hunziker, how is anorexia related to mental illness?

Dr. Jason Hunziker: So anorexia is an eating disorder that often has fatal consequences. The disorder itself is a disorder of people who generally will restrict the intake of food to the point that it causes significant organ damage and eventually death. The way it's related to mental illness, is that often people who struggle with anorexia, have other mental illnesses that come along with that.
So as their bodies continue to decline in nutrients and muscle mass and their organs start to slow down and they're having trouble with their bowels, they start to get more and more depressed and they start to get more and more anxious. Often these patients struggle with severe anxiety around food. Their focus on food is so great that they will even buy cookbooks and they'll cook these fabulous meals for their families and their friends and not once eat any of that food.

Interviewer: Wow that's interesting.

Dr. Jason Hunziker: They'll exercise until they pass out on the treadmill, just to get thin. And that anxiety and that perfectionist behavior leads to more and more depression, more and more anxiety. Which then, ultimately sometimes, unfortunately, these patients get to the point that they want to kill themselves.

Interviewer: So bringing it back to the beginning, where does it all start? Like it's got to start from somewhere, right? In their teens...

Dr. Jason Hunziker: That's a good, that's a really good question. Often patients with anorexia have learned this from their environment. It's, there's really no good evidence of where exactly the anorexia comes from and why one person has anorexia and yet their sister doesn't. But what we do know is that there's a strong family history often in people with anorexia.
We do see this usually happen at puberty time so when people's bodies are changing and developing, we start to notice this illness getting more and more prominent. There is strong evidence of course in the teenage years that girls want to look like the other girls and they all feel like they need to be at a certain weight or certain height. And when they can't be that, they struggle and then they start adapting these maladaptive patterns of eating and exercise that eventually leads to anorexia.

Interviewer: So is it safe to say that maybe the root of the problem with anorexia comes from maybe... cultural norms?

Dr. Jason Hunziker: It comes from cultural norms, it comes from... we see it in things like ballet classes and gymnastics and cheerleading, in those environments where weight is put as a high priority. We also see it in young kids who have been very anxious their whole life. And so they worry that they're going to be different or look different or feel different, and so they change themselves or attempt to change themselves in the way they think.

Interviewer: When you see somebody with anorexia, you can kind of tell a little bit, can't you? But, are there other signs or symptoms that you kind of you look, and you might wonder.

Dr. Jason Hunziker: Things that you can find or see with that is that if you notice dramatic weight changes, if you notice that your significant other or your sibling or your girlfriend or boyfriend or whoever, is moving food around on the plate but doesn't really seem to eat it. Or is more interested in cooking these fantastic meals but you never really see them eating anything. Or right after meals, they're spending all this time in the bathroom. Or you start to notice laxative boxes in the garbage cans or those types of things, then you'll have those suspicions. They also tend to wear big baggy clothes to kind of hide their body.

Interviewer: But you're aware that you're thin, why would you want to hide it?

Dr. Jason Hunziker: Yeah that's a really good question and that's kind of the conflict is, they're not aware that they're thin. They feel like they're not thin enough.

Interviewer: What are some of the long term effects then? Because obviously we know that the short term effects is just weight and maybe depression...

Dr. Jason Hunziker: Depression, anxiety are really short term problems. But addiction becomes a problem. They'll start taking caffeine tablets and that'll advance to stimulants and then they're using all types of things to try to suppress their appetite, so that they can lose weight. Bone density problems are a big issue. They lose a lot of bone mass and they end up with fractures and broken hips at 25 years old because they just don't have the right bone structure. Heart problems because of changes in electrolyte balances. A lot of young women end up having heart attacks and other heart abnormalities because of the loss of nutrients.

Interviewer: Can this be treated?

Dr. Jason Hunziker: Definitely. The treatment is actually what they call re-feeding.

Interviewer: Okay.

Dr. Jason Hunziker: And so we have to give people the nutrition to get their brain functioning at a level that's high enough to actually engage in treatment. After you get them to the point that they're a little healthier, they have weight coming back, we do a lot of intensive therapy which has shown to be the most effective way to help people with anorexia. We examine their relationship with food and what it is about the food, and their thoughts about body and image and try to deflect away from weight, but some more focused on being healthy. How do we be healthy with who we are, and we often treat depression, that's associated with this. We treat the anxiety that's associated with this. We'll treat family issues that's clearly associated with this. So that everything is looked at as one big unit that we can focus on to help this person get well.

Interviewer: If the person doesn't want to get treated or they just don't come in for treatment, can that anorexia be something that is life threatening?

Dr. Jason Hunziker: Definitely, and that's usually the unfortunate part of this is that some people end up taking their own life because they get so despondent at the fact that they can't reach that goal that they've set for themselves, that they just get overwhelmed and end up harming themselves. Others unintentionally harm themselves by taking all those other supplements or stimulants or whatever else, that actually unintentionally overdose themselves. The bodies just shut down, unfortunately, with a lot of these patients. They end up being so malnourished that they just, is incompatible with life and their bodies just give up.

Interviewer: Any final thoughts?

Dr. Jason Hunziker: My final thought is I think we need to recognize this immediately. We need to provide support and not be accusatory or...

Interviewer: Don't be the police.

Dr. Jason Hunziker: Exactly. Don't make them guilty, don't be forcing food down, in their face because that's not going to help. Getting them to a professional, getting them to a therapist, there's eating disorder clinics available. If it's severe enough they need to be hospitalized and then start treatment. And just be understanding because this is a life long process that they're going to struggle with.

Announcer: We're your daily dose of science, conversation, medicine, this is The Scope. University of Utah Health Sciences Radio.

Interviewer: Family dinners, holiday parties, jingle bells and presents. It's that joyful time of the year again. But you go feeling depressed and moody. Coming up on The Scope, how to deal with holiday depression.

Announcer: Medical news and research from University Utah physicians and specialists you can use for happier, healthier life. You're listening to The Scope.

Interviewer: We're talking with psychiatrist Dr. Jason Hunziker from the University of Utah. Jason, the holidays are here and you're supposed to be happy. But why are some people depressed?

Dr. Jason Hunziker: Have you ever been to one of those holiday parties before? They can be very stressful, and often we think about families, and we think about our childhood, growing up, and all of those things that are very nostalgic to us. However, as life goes on families change and traditions are thrown away. And some people have a hard time changing those traditions and moving forward.

Additionally, you see family members that maybe you don't see all the time; you have work parties, and you have to buy Christmas gifts. You have to plan meals and entertain and clean house and everything has to be just right. And it gets very overwhelming, particularly if you don't stop and take time for yourself.

Interviewer: And this might seem like a silly question, but how can you tell if it's getting stressful?

Dr. Jason Hunziker: I think when you can tell that things are getting too overwhelming is when your sleep starts to get disrupted; you are shorter with people in your family or others at work. You start to dread Christmas altogether. You're finding yourself sitting in your room crying occasionally. You are more emotional when you're interacting with others. I think that the time that you need to really pay attention so that that doesn't turn into something else.

Interviewer: When is it to the point where you say, okay, this is getting serious? I have to go see a doctor.

Dr. Jason Hunziker: I think the best predictor of how we're going to do over the holiday season is how we've done during all the holiday seasons. And I think if you know that holidays are very stressful for you, get in early and go see the doctor early so that you can start to feel better and enjoy your holidays rather than feel miserable and can't wait until they're done.

Interviewer: So we'll say it's Christmas; I'm depressed and I don't want to see anyone, which means I obviously don't want to see you. I don't want to go see a doctor. Am I going to get worse?

Dr. Jason Hunziker: It's really important to recognize when you are feeling that way and not pretend that these emotions don't exist and that you are supposed to be happy so you're going to be happy. You need to acknowledge those emotions and those feelings and then get in and do something before it gets to the point where you don't want to do anything. If it gets to the point where you're isolating, that you're contemplating hurting yourself, that you're drinking alone in your bedroom so that you can avoid contact with anybody, those are things you really need to look at and get in and get some help.

Interviewer: Usually I feel like when you're depressed, you don't want to admit that you're depressed. What are some signs and symptoms that close friends and family members can look out for in case someone around them is getting depressed?

Dr. Jason Hunziker: I think one of the big things that families notice is that change in your personality where if you're the type of person who is readily engaged with people, you're always wanting to be at parties, but you start to isolate and you start to avoid conversations; you're not answering your phone; I think people will recognize that, and that's a danger sign. If you're sleep pattern is disrupted, your significant other often will recognize that and be able to say, hey, you were up all night, what's going on. I think that's important to pay attention to.

A lot of people during this time of year will eat more than they normally do when they start to feel depressed. And then they feel guilty about eating so much and that becomes a problem. Alcohol is a huge problem during this time of year because there is alcohol at all of these parties and people who tend to drink more during the holiday season could be somebody who is feeling depressed or sad and that could be the time to get in and talk with somebody.

Interviewer: Okay, so how do I avoid all of this? I'm aware of my problems, but I'm not at the point where I need to go see a doctor. How do I get better and avoid getting worse?

Dr. Jason Hunziker: I think reaching out to other people is really important. I think often times people feel left out during the holiday season, but there is so much going on in the community that you can go volunteer somewhere at a soup kitchen and just giving back to somebody and helping and getting that human contact is very important to help you feel good during the season. I think you need to be realistic about what you expect from the holiday season. You can't expect everything to be the same as it always was, and you can't expect all those traditions to be the same. Traditions change; families change; change your traditions with your family. If your kids are grown and they're out of the house and they're scattered all over the place, have a cell phone conference with them. Enjoy the holiday that way so that you can have a new tradition rather than longing for the old tradition and doing nothing at the same time.

Interviewer: What are some other common issues that could lead to holiday depression?

Dr. Jason Hunziker: Another problem that happens during the holiday season is we don't stick to a holiday budget. We tend to spend a lot of money that we don't have, charge up a lot of credit cards; and then right after Christmas we have this huge remorse. And right in January when we get our first bill from Christmas it gets even worse. So stick to a plan. I think planning ahead is always a good idea as well.

If you're going to entertain or you're going to have a party, plan way ahead so that you're not rushing around at the last minute because you forgot a certain spice that needs to be in your pie. If you have it all lined up and it's all laid out, then the stress level will go down.

And don't abandon your healthy habits. We tend to do that all the time. We stop exercising, and we start drinking more; we eat all the junk food. All of that stuff is going to make you stressed. You're going to be unhappy. You're going to be depressed, because you just ate a whole pie last night.

So be careful to keep exercising; that's another way to keep yourself happy as well. That will help you feel better.

And I think the last thing to do is to make sure you have time for yourself. It goes back to the exercising, but maybe even take in a moment, ten minutes, to meditate and think about why the season is important to you and what is most important about the season so that you don't feel stressed and overwhelmed. And you can remember why it is that you're putting yourself through all of this in the first place, and the importance of that to you and your family.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, the University of Utah Health Sciences Radio.

Seasonal Affective Disorder is not the same as winter blues. Ignoring your symptoms could make the holiday season less than jolly.

I'm Jason Hunziker, Psychiatrist at the University of Utah. And that's what coming up on The Scope.

Often with the winter blues even though you're feeling down and sad, your emotions can change based on the environment that you are in. If you're watching a show that's funny or happy you can laugh, or if somebody tells you a joke you can get happy or it's fun to out with your friends and it's still fun to go skiing, but other times you're feeling down and stressed.

With seasonal affective disorder your mood doesn't generally change. Things don't make you happy anymore and you don't find pleasure in those things that you used to find pleasure in. You're interest level drops and you prefer to stay by yourself rather than be around other people. Often you feel you are pretending to be happy just so that others around you won't know how sad you really are. The difference is the symptoms last longer, they are more severe, and they impact all aspects of your life.

Sometimes the patients are able to go through the whole winter without any treatment and it doesn't cause much disruption. However because this is a sub-type of depression, it can lead to more significant symptoms and problems.

This is different than just feeling the so called winter blues or seasonal funk as some people will say, because it actually impairs your life and the life of those around you when you have this type of depression.

The way that this can affect others in your life is that many of these symptoms of depression include isolation, avoidance, irritability, poor sleep, overeating, weight gain, sadness, crying episodes, all of those things which can impact your family and friends and coworkers.

The cause of season affective disorder is still not clear; however there are a few theories on how this illness comes about. One of those theories is the biological clock or circadian rhythm suggesting that because of less sunlight in the fall and winter you are more likely to have moments of depression and sadness.

Another theory is that melatonin levels also change when seasons change and then based on your melatonin production or melatonin levels you will also experience changes in your mood pattern.

And lastly serotonin levels are always looked at when we're talking about depression and changes in the serotonin particularly around stressful times such as the holidays can increase people's sadness and difficulty in coping with stress.

The literature would suggest that women are at a much higher risk of this illness than men; however when men do get seasonal affective disorder their symptoms are much more severe and place them at higher risk of self harm and suicide.

Those of us who live further from the equator are also more at risk, mainly because the changes in the dark and light patterns in our seasons make us more at risk. If you have a family history of someone with depression or anxiety or substance use disorder, you are also more at risk of this sub-type of depression.

The most common age that we start to see seasonal affective disorder is sometime around 20 years old. The age range generally is between 20 and 40; however depression can come at any time during your life. And if you do notice the symptoms of seasonal affective disorder what are you going to do about that? I think the important thing is to go in and talk to your primary care doctor, your family practice doctor, your nurse practitioner or whoever your healthcare provider is so that you can get the appropriate care and treatment for this syndrome.

The important things that you should talk to your doctor about when you recognize that these symptoms may be more than just the winter blues include when these symptoms start every year. If you notice that every year in September you start to have trouble sleeping, eat more, have trouble moving around, that's important for your doctor to know.

Looking at your history and telling your doctor how long these symptoms have been present, if it lasts from September to December, or if you've ever been suicidal, or if you notice you're drinking more alcohol during that time, it's very important for your doctor to know. If you have family history about depression, bipolar disorder, other mental illness your doctor should also know that as well.

And then after this appointment your doctor may suggest to you several different types of treatment. One of the most commonly recommended treatments for seasonal affective disorder is light therapy. Even though this treatment is not FDA approved, there is a lot of anecdotal evidence that the light therapy will work for this illness. Light therapy is composed of a box that sits on your desk or that you can carry with you that essentially is bright light that shines into your eyes for anywhere from 15 minutes to 2 hours a day to help you with your mood symptoms; based on the theory that the change in the amount of light that we get every day this treatment will help improve your mood symptoms.

Additional therapy could be medication use including SSRI medications like Prozac or Paxil or Zoloft or other medications like Wellbutrin that can be taken during this period of time that you have your symptoms and then with the help of your doctor you could come off of those medicines for the remainder of the year.

The holiday can be very stressful, family parties, family get togethers, seeing people that you really don't want to be around can be stressful at this time and having someone you can go to and talk to about these symptoms is very beneficial for most patients.

updated: December 21, 2021
originally published: December 10, 2014