Category Archives: Uncategorized

Seasonal affective disorder: feeling down when the temperatures drop

Do you start feeling down in the winter months? You aren’t alone. Seasonal affective disorder, or SAD, presents as a variety of depression-like symptoms caused by your body getting out of its biological rhythm. Winter-onset SAD (the most common type) results from your body “losing its bearings” during the period of reduced daylight. Without sunlight to give your hormones a clue about the natural dawn-dusk cycle, your body’s chemical levels become unbalanced.

Especially if your work routine means arriving at and leaving the office when it’s dark outside, your body may be producing too much melatonin or too little serotonin, hormones involved in your body’s sleep-wake cycle. This kind of imbalance produces the slew of possible symptoms:

  • Fatigue and drop in energy levels
  • A tendency to oversleep
  • Change in appetite, like cravings
  • Weight gain
  • Difficulty concentrating
  • Irritability and anxiety
  • Antisocial behavior
  • Heightened sensitivity to social rejection
  • Lack of interest in normal activities
  • Feelings of guilt
  • Feelings of hopelessness
  • Physical problems, like headaches

While 10 to 20 percent of people in the United States suffer some SAD symptoms (called the “winter blues”), only four to six percent of people meet all the criteria of SAD diagnoses. SAD is more common in women than in men and generally shows in people at least 20 years of age. The risk increases for adults with age or for those that live in regions where winters are long and harsh.

Luckily, there are ways to combat SAD. Melatonin supplements and light therapy (intentionally exposing yourself to more sunlight) are ways of treating SAD. Melatonin is the hormone that your body starts producing when it gets dark in order to prepare you for sleep. Ensuring that your melatonin levels rise and fall on the proper timeline can offset SAD. Light therapy involves using daylight-simulating devices for certain periods of time each day to reach the same goal, and exposure to actual sunlight will do this naturally.

Antidepressants may also be used in some cases, as many antidepressant medications, such as selective serotonin reuptake inhibitors (SSRIs), work by helping to restore serotonin hormone balance.

If you have concerns about seasonal affective disorder or believe you are experiencing symptoms, be sure to discuss it with your health care provider. Visit our website or call (563) 584-3000 to schedule an appointment with Medical Associates today.

Note: SAD may share many symptoms with major depression or dysthymia. Call a doctor IMMEDIATELY if you are experiencing suicidal thoughts.

24-hour National Suicide Prevention Lifeline: 1 (800) 273-8255
Medical Associates 24-hour HELP Nurse: 1 (800) 325-7442



Source links:
Mayo Clinic
American Academy of Family Physicians
National Institute of Mental Health

Sleep Apnea and Heart Disease, Stroke

Elderly man lost in thought

Plain old snoring can get a little annoying, especially for someone listening to it. But when a snorer repeatedly stops breathing for brief moments, it can lead to cardiovascular problems and potentially be life-threatening.

It’s a condition known as sleep apnea, in which the person may experience pauses in breathing five to 30 times per hour or more during sleep. These episodes wake the sleeper as he or she gasps for air. It prevents restful sleep and is associated with high blood pressure, arrhythmia, stroke and heart failure.

Heart disease is the leading cause of death in the United States, and stroke is also a leading cause of death and disability. High blood pressure is a major risk factor for both.

“The evidence is very strong for the relationship between sleep apnea and hypertension and cardiovascular disease generally, so people really need to know that,” said Donna Arnett, Ph.D., chair and professor of epidemiology at the School of Public Health at the University of Alabama at Birmingham and the incoming president of the American Heart Association.

A Common Problem
According to Dr. Arnett, one in five adults suffers from at least mild sleep apnea, and it afflicts more men than women. The most common type is obstructive sleep apnea (OSA), when weight on the upper chest and neck contributes to blocking the flow of air. OSA is associated with obesity, which is also a major risk factor for heart disease and stroke. Besides obesity contributing to sleep apnea, sleep deprivation caused by sleep apnea can, in an ongoing unhealthy cycle, lead to further obesity. In OSA the upper airway closes off because the muscles that hold it open lose tone. The more weight, the more loss of tone and the more severe the sleep apnea. Each time the airway closes, there is a pause in breathing.

A less prevalent type of sleep apnea is called central sleep apnea (CSA). In CSA the brain doesn’t send regular signals to the diaphragm to contract and expand. There is limited snoring and it has been associated with brain stem stroke because the brain stem is where the impulse to breathe comes from.

Listen to Those Snoring Complaints
A roommate or sleeping partner of someone with sleep apnea often notices it. “It’s really hard to detect if you live alone, unless you go through a sleep study,” Dr. Arnett said. People with sleep apnea may be more tired during the day and therefore prone to accidents or falling asleep.

Getting Proper Treatment
Through treatment known as continuous positive airway pressure, or CPAP, blood pressure is stabilized. The CPAP device involves wearing a mask while sleeping. It keeps air pressure in the breathing passages so they don’t close down.

In a sleep study, doctors count pauses in breathing to determine whether the patient has mild sleep apnea, characterized by five to 15 episodes per hour; moderate sleep apnea, defined by 15 to 30 per hour; or severe sleep apnea, meaning more than 30 each hour.

It’s certainly possible to have simple, loud snoring without sleep apnea. But with regular snoring, the person continues to inhale and exhale. With sleep apnea, the sleeping person tends to have periods when he or she stops breathing and nothing can be heard. The good news is treatment that keeps the breathing passages open and oxygen flowing can yield fast results, Dr. Arnett said. “Blood pressure comes down really quite quickly.”

Getting Good Rest
If you’re struggling to get a good night’s sleep follow some of these suggestions:

  • Get regular physical activity, but don’t do it right before bed because that gets your adrenaline pumping and can keep you awake.
  • Limit alcohol consumption to one drink per day for women and two drinks for men; too much alcohol interferes with sleep.
  • Avoid caffeine before bed.
  • Develop a pre-bedtime routine such as taking a warm bath, dimming the lights or having some herbal tea.

If you are experiencing symptoms of sleep apnea, be sure to discuss this with your primary care provider. A referral to a pulmonologist may be necessary. At Medical Associates, Dr. Mark K. Janes is Board Certified in sleep medicine and provides diagnosis and treatment of sleep disorders including sleep apnea. Examination of abnormalities of sleep is available with overnight trend oximetry and polysomnography.




What you need to know about Antidepressants

Antidepressant medications are effective for depression, anxiety, and some pain conditions. However, they might be slower to become effective than other medications that you may have taken. Researchers are uncertain why these medications take weeks to reach effectiveness, but your patience and adherence with taking your antidepressant daily is an important part of getting well. Some patients improve in a couple weeks, and others may not fully respond for 6 to 12 weeks. Not only is the time that you’ve taken the antidepressant important in evaluating your response, each antidepressant has a range of dosages and your healthcare provider may consider dosage increase or other strategies if you are not responding as expected. It’s important to keep follow-up appointments and discuss your response (or lack of response) to the antidepressant medication with your prescriber. Your healthcare provider has other treatment options including increasing the medication dosage, switching to a different antidepressant, adding another medication, or adding psychotherapy.

All medications have potential adverse effects and current commonly prescribed antidepressants have low risk for serious negative effects. Often, mild nausea, dry mouth, headache, bowel habit change, or sleep disturbance are signs that the medication is starting to take effect and these effects frequently go away after a few weeks. If you are concerned that you are experiencing intolerable side effects, or don’t think that you want to continue taking the antidepressant medication, you should contact your prescriber to discuss your concerns. Abrupt discontinuation of some antidepressants can result in unpleasant withdrawal-like symptoms, and some patients develop sudden worsening.

Alcohol and recreational drug use can negatively affect the effectiveness of antidepressant medications. Alcohol and sedatives are powerful drugs that cause depression, and sometimes rebound anxiety, so that antidepressants don’t work very well. Your healthcare provider can more effectively help you if you are open about your alcohol and other drug use.

Once you’ve responded well to antidepressant medication, follow your prescriber’s recommendations for maintenance treatment.

Increasingly, research has found that depression, anxiety, and pain are chronic or recurring conditions over a lifetime, so that the illness is better managed by maintaining on the full dosage that was initially effective. Each individual has personal factors that can be discussed with your healthcare provider to develop your best treatment plan.


lee, yasyn
Dr. Yasyn Lee, Psychiatrist
Medical Associates Clinic




The Department of Psychiatry & Psychology is made up of a specialized support team trained to care for individuals of all ages with emotional, cognitive, and behavioral concerns. Our board-certified psychiatrists, nurse practitioners, and physician assistant, along with our licensed psychologists, provide services that span the full range of mental health disorders and behavior problems. Please call 563-584-3500 or visit our website for more information. 

What is Pelvic Health and how can I Benefit From it?

The term Pelvic Health refers to treatment for men and women of all ages who experience symptoms affecting bladder, bowel, and/or sexual function due to pelvic floor muscles that may be tight, weak, or spastic.

At the bottom of your pelvis, there is a group of muscles that work to control and coordinate bladder and bowel function, aid in sexual function, and provide stability to the pelvic girdle and your core. This group of muscles is called the pelvic floor. Your pelvic floor can become affected during or after pregnancy/delivery, after surgery, due to other injury/trauma, or due to lifestyle factors or disease processes, especially those involving the bladder, bowel, or reproductive systems.

You may benefit from pelvic floor physical therapy, if you have answer “yes” to any of these questions:

  • Do you have an increased frequency of urination?
  • Do you experience leakage or loss of control of urine, stool, or gas?
  • Do you have difficulty emptying your bladder or bowels?
  • Are you constipated or need to strain with bowel movements?
  • Do you have pain with bowel movements?
  • Do you experience pain during or after intercourse?
  • Are there any changes in sexual function?
  • Do you have pain with gynecological exams or tampon use?
  • Are your periods painful?
  • Do you have worsening pain or feelings of instability during pregnancy or after delivery?
  • Do you have pain in the abdomen, hip, low back, or tailbone?

Are you living with any of these conditions? While they are common, these symptoms are not normal and you do not have to endure them each day.

How can Physical Therapy Help?

Pelvic floor physical therapy assesses the pelvic floor muscles, and other closely related structures, looking for reproduction of symptoms, restrictions, tightness, or weakness. From this assessment, an individualized treatment plan will be created to address your specific needs. The source of your symptoms will be targeted to improve quality of life. Pelvic floor physical therapy may also assist in many phases of healthcare from preventative measures, conservative management of a diagnosis, post-operative care, or post-injury/symptom onset.

If you are experiencing symptoms of pelvic floor dysfunction, you may be a candidate for pelvic floor physical therapy. Contact your primary care provider and receive an appointment referral or contact the Physical Therapy Department at Medical Associates directly at 563-584-4465.