Dr. Adrian Jacques J. H. Ambrose, MD

Some people with bulimia may have swollen parotid glands (salivary glands near the cheeks) that give their face a puffy "chipmunk" appearance. Their skin may look dehydrated and dull from repeated purging. Red scars and marks on the backs of the knuckles are prevalent in those with bulimia. Eating disorder experts may refer to these as "Russel's sign," named after a well-known psychologist.

However, others with bulimia may not show any outward signs of having an eating disorder. They may deliberately hide their eating habits or conceal their purging after a meal. It is important that family members and friends help loved ones with bulimia seek treatment. While many people with bulimia are still able to lead outwardly successful and active lifestyles, bulimia may have lasting and severe consequences to one's health. Electrolyte imbalance from bulimia is particularly dangerous and may lead to heart attack or stroke. Similarly, continued dehydration and disturbances in electrolyte levels can cause kidney damage and reduced kidney function.

Treatment for bulimia typically includes therapy and nutrition counseling. Eating disorder support groups, both online and in person, are often beneficial to recovery. Medical professionals may also look to treat the mental health problems that frequently accompany bulimia, which are body dysmorphia, post-traumatic stress disorder (PTSD), and depression. Dietary specialists can assist patients with reintegrating foods into their diet and increasing consumed calories. Some patients may attend inpatient rehabilitation or eating disorder clinics, which provide all of the above treatments in a residential facility.

Fortunately, many people recover from bulimia and are able to fully restore their health.

We don't yet know what causes depression, but it's thought that it is a combination of genetic, biological, environmental, and social influences. Because of this, the most effective treatments for depression combine medication with psychotherapy. Therapy, especially cognitive-behavioral therapy, can be extremely helpful in resolving the negative thoughts and feelings that come with depression. It gives patients new tools that they can use themselves to cope when their depression is making them feel down.

Some of the common medications used to treat depression include antidepressants such as SSRI's (Prozac, Paxil, Zoloft) or atypical antidepressants (Cymbalta, Wellbutrin). It's important to remember that these medications have different effects on everybody, and no one medication works right for everyone. Patients may have to try a couple before finding the one that works just right for them. If the first medication they try doesn't work, they should talk to their doctor about trying something else. In extreme cases where medication is not enough, electro-convulsive therapy and hospitalization may be the answer to keeping a severely depressed person safe.

Depression is a difficult illness to deal with, but it is more common than believed and there are many people who can help. With the right treatment, individuals with depression can get back to fully enjoying life again.

Young adults ages 18 to 30 are most commonly diagnosed with SAD. For unknown reasons, more women have SAD than men. Those who have a preexisting mood disorder, mental illness, or live in a region with cloudy and dark weather are also more likely to have SAD. People with SAD may experience:

• Feelings of hopelessness
• Fatigue
• Daytime exhaustion
• Loss of interest in activities
• Weight gain
• Social withdrawal
• Oversleeping
• Headaches
• Increased desire for carbohydrates
• Difficulty focusing

The causes of seasonal depression are uncertain. It is suggested that the reduced daylight and sunshine of winter and fall can alter the chemistry of the brain. Sunlight may assist in the production of serotonin, a hormone that regulates mood and happiness. Less exposure to sunlight may result in decreased serotonin, leading to SAD. Other potential causes include disrupted circadian rhythms, vitamin D deficiency, and increased melatonin (sleep hormone).

A variety of treatments are used to alleviate SAD. Patients usually benefit from more than one treatment. Light therapy is a special lamp that lets off intense light. The therapy is performed at home with patients keeping the lamp a few feet away from them as they complete their regular activities. Two types of light therapy include the light box (consistently bright lamp) and the dawn simulator (lamp that gradually becomes brighter and brighter). Light therapy may be partnered with other treatments for SAD, such as:

• Antidepressant medication
• Increased sunlight exposure
• Vitamin D supplements
• Psychotherapy

SAD is more than feeling disappointed by shorter winter nights or rainy days; it is months of depression that can drastically influence mood and behavior. Fortunately, people with SAD typically respond quickly to consistent light therapy and other treatments. Self-care and relaxation are also vital to the SAD recovery process. For those with SAD, treatment can be the first step to making four or five months of the year enjoyable once again.