Author: Sian Ferguson

As a tea lover, I frequent health stores often, looking for new and delicious flavors. Recently, when I bought a box of rose tea, the cashier told me the tea contains adaptogens. Adaptogens? I thought. What are adaptogens?
Being a fairly skeptical person, I suspected it was just another meaningless buzzword that was created to market health foods. But when I began my research, I found out that adaptogens have been used for their anti-stress properties in traditional Ayurvedic medicine for centuries. While more studies on adaptogens are needed, the existing evidence on their chemical properties is very encouraging.
Here’s what you need to know about using adaptogens.

What are adaptogens?

Adaptogens is a term used to refer to plants that have an anti-stress affect on the body. They affect the central nervous system, and can have either a stimulating or a relaxing effect.
“Adaptogens are typically herbs or other plants that help the body handle stress. They act on the body’s production of the stress hormone, cortisol,” explains Sunny Brigham, MS, CNS, a board-certified clinical and integrative nutrition specialist. Brigham uses adaptogens with clients who experience anxiety and stress-related fatigue, as well as stress-induced irritable bowel syndrome (IBS).
While adaptogens are definitely trending at the moment, they’ve been used for a very long time in traditional Ayurvedic medicine. The first modern scientific trials on adaptogens were conducted during World War II in the Soviet Union, where researchers focused on whether adaptogens could help increase the stamina of military personnel. Over the next few decades, adaptogens became widely used by the USSR, where they played a part in the space exploration program, the Olympic games, and the Arctic and Antarctic expeditions.
Since then, adaptogens have become popular in the West, too, especially among natural healthcare practitioners.

What types of adaptogens are there?

There are many different adaptogens out there, and while all of them are associated with soothing stress, they all have their own particular benefits and drawbacks.
Fortunately, most of them are safe—but it’s still important that you speak to a qualified healthcare provider before you take them. Even though adaptogens can be bought without a prescription, they can interfere with the medications you’re currently taking, Brigham points out.
“Adaptogens are fairly safe but some [like rhodiola and ginseng] can be stimulating and should not be taken in the evening.” She goes on to say, “Others can interact with medications, such as ginseng. It’s important that individuals investigate their medication interactions before taking any herbal supplements.”

Here’s a brief guide to different types of adaptogens:

Ashwagandha

Ashwagandha, also known as Withania somnifera, is probably one of the more well-known and well-studied adaptogens. “Ashwagandha is best used for minor nervousness or anxiety related to increased stress. It may also be helpful with increasing concentration levels and boosting the immune system,” Brigham says. “Ashwagandha should not be used in pregnant or lactating women as it can have a mild sedative effect.” A review of human trials shows that ashwagandha is probably effective at regulating stress, but further studies are needed. Studies also suggest that the herb may have anti-inflammatory and antioxidant effects in addition to its anti-stress properties.

Cordyceps Mushrooms

Cordyceps mushrooms are particularly good for boosting the immune system, Brigham explains. “There is insufficient information available to determine if cordyceps are okay to be used in pregnancy. With this information, I probably would not use them in pregnant or lactating women.”
Brigham also says that she wouldn’t use cordyceps on people using blood thinning medication or those with immune disorders. “There is some evidence, in animal studies, that show cordyceps inhibit platelet aggregation, the clumping together of platelets to form blood clots around wounds,” Brigham explains. “If someone is on a blood thinning medication, taking cordyceps could cause further blood thinning and increase the chances of bleeding.”

Eleuthero

Joseph Feuerstein, MD, associate professor of clinical medicine at Columbia University and director of integrative medicine at Stamford Hospital, says eleuthero is good for fatigue related to excess exercise, so he recommends it to his active patients. “Eleuthero seems to be okay in pregnant women but should be used with caution in those with hypertension,” he adds.

Ginseng

“Ginseng can be slightly stimulating to help combat stress-related fatigue,” Brigham says. “It can also be used to help boost the immune system.” Ginseng seems to be safe for pregnant women. Studies have also suggested that ginseng improves male sexual functioning.

Holy Basil

Also known as tulsi, holy basil has a mildly stimulating effect, says Brigham. This means it can be used to help combat stress-related fatigue. There’s a fair amount of scientific evidence to show that tulsi does, indeed, reduce stress. While Brigham says it’s fairly safe to use, it shouldn’t be used if you’re pregnant or lactating.

Passionflower

While many adaptogens are stimulating and shouldn’t be taken in the evening, passionflower has a very calming effect and thus can be taken before sleep, says Brigham. “Passionflower helps the hamster get off the wheel so our brains can relax and we can sleep,” she explains.

Reishi

Much like cordyceps in function, reishi is good for boosting the immune system, Brigham explains. Again, she cautions people against using it if they’re on blood thinning medication.

Rhodiola

Feuerstein says that he uses rhodiola to help with fatigue associated with low mood. Studies have shown that rhodiola might be effective at reducing symptoms of depression and easing mental fatigue, but those trials were small and more evidence is needed. Brigham notes that rhodiola should be avoided by people who have high blood pressure, nervous system disorders, or sleep issues. Brigham also says she wouldn’t give rhodiola to pregnant people.

Schisandra

Schisandra, while an adaptogen, is most commonly used to support the liver and digestive system, as it can reduce diarrhea. However, it can cause digestive issues in some people, Brigham explains. Namely, it can cause acid reflux, heartburn, and stomach pain.
Feuerstein emphasizes that you should consult a medical practitioner before using any adaptogen. “Much of the time, use of adaptogens is based on clinical experience of the practitioner,” he says. “It is important that you use them under the guidance of a medical professional so you get the right dose of the right herb made by a pharmaceutical-grade manufacturer to ensure quality and purity.”
While adaptogens are fairly safe and easy to obtain without a prescription, Brigham also notes that she wouldn’t give them to children. “They are pretty safe and many people use them. Kids are under more stress in school today than we ever were,” she notes. “I’d prefer, though, to teach them stress reduction techniques and proper sleep habits so they don’t need adaptogens.”

Is there a lack of scientific evidence on adaptogens?

While the scientific evidence on adaptogens is very encouraging, it’s also limited. You’ll notice that many of the herbs outlined by Brigham and Feuerstein need to be studied more to confirm their effectiveness.
Feuerstein agrees that there’s not enough evidence out there when it comes to adaptogens. Part of the reason is because studies into medicinal herbs aren’t well funded, he says, which means that the trials which have been done—although promising—are quite small.
“I do believe there is a lack of quality trials in reference to herbs today,” Brigham says. “There’s also a lack of peer-reviewed sources as well.” However, Brigham remains optimistic about the effects of adaptogens given the fact that they’ve been used by humans for centuries, and given her personal and professional experience with adaptogens.

How can I integrate adaptogens into my diet?

Adaptogens often come in form of tinctures, teas, or pills. They could also be eaten: For example, I use passionflower in my smoothies. Brigham says that most people don’t enjoy tinctures because they have an unpleasant taste, so many people opt for teas or pills instead. “Teas are great because you can make a combination of various adaptogens from bulk herbs,” she says. “The same can be said for pills. Most pill-form adaptogens are blends.”
Feuerstein says that he generally uses standardized herbal extracts in pill form to ensure quality. The clinical studies that are available use high doses, and those doses would be too high to add to a food or tea, he explains.
While your healthcare practitioner should be able to recommend a reputable brand, there are some great brands you can look out for, says Brigham. “My favorite sources for quality herbs or adaptogens are Gaia Herbs, Mountain Rose Herbs, Frontier Co-op, Oregon’s Wild Harvest, and Pacific Botanicals. There are ready-made supplements available as well, but the purchaser should ensure the source of the herbs [in them] is from a quality source,” says Brigham.
While there is a need for more scientific evidence, adaptogens might be worth trying if you struggle with stress, anxiety, and fatigue. Consider speaking to an integrative medical specialist if you’d like to use them: They’ll be able to ensure that you’re taking them safely, and they’ll help you choose the best kinds of adaptogens for your specific health concerns.

Before I became an egg donor, I had a lot of questions about the process: What does egg donation entail? Are there any long-term health effects of donating your eggs? What should I know before I donate?
I googled it, but unfortunately there’s a lot of confusion and misinformation out there. This is probably because egg donation is often stigmatized. I read a lot of information online, but I wanted to know more. After all, it was a big decision.
I wanted to hear about egg donation from real donors—not just fertility specialists and egg donation agencies. Unfortunately, because of all the moralizing that surrounds egg donation, few egg donors really talk about their experiences.
So here I am, a three-time egg donor, telling you about my personal experience with egg donation as well as the scientific research behind the process. If you’re considering egg donation—or want to understand what the process is like for a donor—read on to find out what you need to know.

Who can become an egg donor?

Firstly, you’re probably wondering whether you fit the criteria for donation.
Generally speaking, egg donors are between the age of 18 and 35, although this can vary depending on the clinic you want to work with. You have to have a low chance of passing on genetic diseases. In addition to fitting specified health criteria, a potential donor will also have to undergo a scan and blood tests to ensure they’re qualified to donate.
If you have certain reproductive conditions, like endometriosis, it might not be advisable to donate eggs, even if a clinic would allow you to do so. “For women with endometriosis, there is evidence that ovarian reserve may be lower and procedural risks slightly higher if they have ovarian cysts,” says Rashmi Kudesia, MD of CCRM. Kudesia is board-certified in reproductive endocrinology and infertility by the American Board of Obstetricians and Gynecologists.
If you check all the boxes for becoming an egg donor, remember that certain characteristics—like having an education beyond high school, such as a college degree—can also make you more appealing to prospective recipients. Fitting the criteria is one thing, but you’ll still need to be matched to potential parents. This can take a while after you sign up and depends on how many potential parents the agency works with and your personal characteristics. It took me around eight months to be matched.

What exactly happens during the egg donation process?

Once a potential donor applies—either with a clinic or an egg donation agency—they wait to be matched with potential recipients (also known as intending parents or IPs). Once matched, the donors will undergo some blood tests and scans, says Kelly Rodgers, a five-time egg donor and egg-donation coordinator with Extraordinary Conceptions. The screening process involves a trans-vaginal ultrasound and a follicular count. The follicles are the small sacs in the ovaries where the eggs develop, and it’s important that donors have a healthy number of follicles—a number that needs to be determined by a donor and their healthcare provider.
If all is well, Rodgers says, contracts will be drafted and signed. The donor will go on to have hormone injections once a day for the next 10 days, give or take, with the dosage depending on their personal biology and determined by a fertility specialist.
“These medications are typically self-administered—which is not as hard as it sounds—via very skinny needles right under the skin, typically in the lower abdomen or outer thigh,” Kudesia explains. The medication contains synthetic versions of naturally occurring hormones called follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which are used by the body to promote ovulation during the menstrual cycle.
“While on medications, donors will have a handful of monitoring appointments to see how her body is responding to the the medication and, if necessary, travel to the intended parent’s clinic for about seven to 10 days leading up to the egg retrieval,” Rodgers says. This could include more trans-vaginal ultrasounds and blood tests. The scans will help fertility specialists determine when to schedule the retrieval, which is also known as an egg pick-up. The retrieval is a non-invasive surgery, meaning it doesn’t involve cutting into your body. Instead, an implement is inserted through the vagina and a needle enters the ovary. The eggs are retrieved through this needle. You’ll either be under general anesthetic or a deep sedation, so you aren’t able to feel anything during the retrieval.
There might be a mild discomfort when you wake up, but generally it isn’t painful. You should be discharged on the same day, after which you should go home and rest. You’ll get your period within the next ten days after the retrieval. After this, you’ll probably be more fertile than usual. Following one full menstrual cycle, your fertility will be back to normal according to Rodgers.
After your retrieval, the donated eggs will be fertilized and placed in either a surrogate’s uterus or the uterus of the female IP.

What are the short-term health effects of egg donation?

The most concerning issue when it comes to egg donation is ovarian hyperstimulation syndrome, or OHSS. It occurs when the medication used to facilitate egg retrieval elevates your estrogen levels, says Kudesia. “Because these levels induce water to be drawn out of your bloodstream into the abdomen, severe OHSS can cause bloating and swelling, nausea and vomiting, low urine output, and a risk of blood clots,” she explains. In some severe cases, the donor might have to be hospitalized and given IV fluids. They might also need excess abdominal fluids to be removed.
Kudesia points out that egg donors only have a 1 to 2 percent chance of developing a serious case of OHSS. “Though anyone who has a robust response to ovarian stimulation may have a few rough days around the time of their egg retrieval, it is quite rare to see a severe OHSS case these days,” she notes.

How can egg donation impact my future fertility? Can it impact my health?

Here’s where things become a bit more controversial: While many experts deem egg donation to be safe judging from the current research, many donors would like more long-term studies on egg donation. Many donors go on to have their own children, but at present there aren’t any long-term studies that have monitored the impacts of egg donation on donor health.
Raquel Cool, co-founder of We Are Egg Donors, a global forum for egg donors, is one of the people advocating for more studies. Cool is currently working on a book compiling personal accounts from donors as well as data on their retrievals. “We are big advocates for more research on donor health,” she says. “We’d like more transparency on how eggs are retrieved, how many overstimulate and to what extent of severity, and finally, how egg donation impacts our health down the line. There have been no long-term studies on donor health outcomes.”
On the other hand, Kudesia feels the research that’s currently available is a firm enough indicator that there aren’t any long-term effects of donation. “Though we do not have registries or long-term cohort studies to specifically report on egg donors, we nonetheless have a lot of scientific data from which to extrapolate long-term effects,” she says. Kudesia points out that the egg donation process mirrors the first half of an IVF cycle. It involves the same medication and retrieval process as IVF patients undergo, and IVF has been around since the ’70s, which is one of the reasons she considers egg donation to be safe.
“Multiple scientific papers, following tens of thousands of women for up to 30 years after IVF, have established the long-term safety of the procedure for moms and babies,” she says. Those studies haven’t found any long-term risks of ovarian or breast cancer, for example, Kudesia says
The studies that look specifically at egg donors also haven’t found any risks of egg donation, Kudesia says. “I would echo the statement of the American Society for Reproductive Medicine, which is that though there is no evidence of long-term risk.” She goes on to say, “Prudence suggests that women be informed of the possible risks, and limit the number of times they donate to six cycles.” She adds that fertility clinics must take precautions to avoid OHSS. “Though I would be thrilled to see more specific literature on this topic, what exists is very reassuring to me for women and clinics following the guidelines.”
Before donating, it’s important not only to understand the research or lack of research on the long-term medical effects of donation, but also the emotional impact it may have on you as a donor.

What are the emotional impacts of being an egg donor?

Many potential donors are curious about how egg donation will affect them on an emotional level. Of course, this is a difficult question to answer because the process affects everyone differently.
Kudesia states that donors need to be mentally prepared to donate their eggs. “All donors meet with a mental health professional to make sure they’ve thought through the possible ramifications of possibly having genetic offspring out in the world,” she explains. “If, after that discussion, you have any reservations at all, I would not recommend donating.”
My personal experience with egg donation has been emotionally rewarding. I’ve never regretted my choice, and I feel great about my decision to donate. However, not everyone has the same experience.
Some people experience remorse about not having a relationship with their offspring, for example. You might not get pregnant with or birth the child, but in terms of DNA, the child is biologically yours. In that sense, it can be difficult to know they exist without being able to contact them. Most donors I know, myself included, aren’t bothered by this, but it’s something you have to consider before donating.
Another aspect to consider is whether you’d want an open, semi-open, or totally anonymous donation. Certain clinics and egg donation agencies only facilitate anonymous donations, while others facilitate open donations, semi-open donations, or a mixture of the two. This is usually stated quite clearly on their websites. Personally, I’ve done one anonymous donation and two open donations, where I’m still in contact with the recipient families.

Could I be paid for egg donation?

According to international law, you’re not allowed to sell your eggs because they’re bodily tissues, but you can be compensated for your time since you might lose out on other forms of income while donating. More often than not, you’ll have to take time off work or studying and your personal life to become an egg donor.
Rodgers notes that the time commitment is something every donor needs to understand. “While the donation itself, in which you are on medication and undergoing the egg retrieval, is roughly two weeks, the medical screening process and legal contract finalization can add approximately six weeks time.” If you travel overseas to donate, as I did, it can be even more time-consuming.
In addition to compensation, you shouldn’t be expected to pay any medical expenses associated with the donation as those should be covered by the egg recipients. This usually includes covering any emergency expenses in case you have any health complications, like OHSS. Your contract should include the exact details of what is covered by the agency or recipients. If an agency asks for any money up front, be wary.
Also note that in some places, including the U.S., you might be taxed on any funds you receive in compensation for donating. In other places, like Australia, donors aren’t usually compensated at all according to Cool. If you’re curious about compensation, speak directly to the agency or clinic you’d like to sign with.

How do I know which egg donation agency or clinic to sign with?

While many agencies and clinics genuinely care about their egg donors, others might not treat their donors well. This is why it’s important to do a background check before signing up.
Cool notes that according to accounts by donors shared on We Are Egg Donors, there is a notable difference between the way donors in the U.S. are treated compared to donors in other countries. “Unfortunately, in the U.S. we see more instances in which higher numbers of eggs are retrieved, more cases of OHSS, greater challenges with withdrawing consent, and women feeling like they are being treated more like a number than a patient,” Cool says.
Your chances of getting OHSS are higher if more eggs are retrieved, since a higher egg count is usually associated with a higher amount of follicle-stimulating medication. As such, a clinic might overstimulate donors to get more eggs—at the price of the donor’s health. “High numbers are becoming so normalized within the industry that we see experienced donors rejected for subsequent cycles, or questioned about their medical records because they are considered ‘low producers’—yet their past cycle figures are between five and 20 [eggs], which is considered a safe and optimal range,” Cool says.
“Some clinics offer their clients (that is, the egg recipients) a cost savings option: a ‘shared cycle,’ in which a donor is stimulated to produce eggs—in one cycle—for two or three recipients rather than one,” Cool explains. This incentivizes clinics to over-stimulate donors so that they can collect more eggs for each of their clients. This is why carefully vetting agencies and clinics is important.
“I would do my best to vet agencies or clinics through word of mouth or reviews,” says Kudesia. “A clinic is perhaps the easier setup to vet, as all success rates are publicly reported and available online. Picking a clinic with high volume and success rates might help ensure that their methods prioritize patient safety and experience rather than trying to maximize egg number at any cost,” she adds. Kudesia also suggests you discuss the process with the agency or clinic before signing up, including the strategies they use to minimize your chances of getting OHSS. “Getting detailed, compassionate answers to these questions would be reassuring. Being rushed or pushed into donating should be immediate red flags,” she says.
When I donated my eggs, I was very well prepared: I researched a lot beforehand, I asked plenty of questions, and I thought about the emotional impact of donating before I did it. For those reasons, I felt confident in my decision and the people caring for me during the retrieval procedures.
Your generosity as an egg donor can mean the world to someone who wants to start a family, but it’s important that you’re well informed about the entire process before you start this journey.
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You might have heard of Hashimoto’s disease, an endocrine disease that’s become more visible in the media over the past few years. Recently, celebrities like model Gigi Hadid and Jane the Virgin actress Gina Rodriguez have spoken up about the realities of life with Hashimoto’s.
Rodriguez in particular has spoken about how she’s struggled with depression, forgetfulness, fatigue, and fluctuating weight—all of which are symptoms of Hashimoto’s disease. Hadid has also shared on social media how difficult it is to live with Hashimoto’s while working in the modeling industry, where her weight is constantly under scrutiny.

Hadid and Rodriguez are not alone. According to Andres Palacio, MD, an endocrinologist with Tenet Florida Physician Services, Hashimoto’s disease can be found in up to 10 percent of the population. Studies indicate that Hashimoto’s may be up to eight times more common in women than in men.

But despite the fact that the condition is fairly common, many of us aren’t familiar with the signs and symptoms of Hashimoto’s. If you think you could potentially have Hashimoto’s disease, or if you’re simply curious and want to learn more, read on.

What is Hashimoto’s disease?

Hashimoto’s disease is an autoimmune disease, meaning that the body’s immune system attacks the bodily tissues. It’s also recognized as a chronic illness.
Hashimoto’s specifically affects the thyroid gland, which is a part of the endocrine system. The endocrine system is responsible for regulating the hormones throughout the body. According to Palacio, other than in cases caused by an iodine deficiency, Hashimoto’s disease is the most common cause of hypothyroidism.

Hashimoto’s disease can also cause thyroiditis, which is an inflammation of the thyroid. Because of this, Hashimoto’s disease might also be called Hashimoto’s thyroiditis. It’s important to note that thyroiditis isn’t always caused by Hashimoto’s disease, nor is it only linked to hypothyroidism. “[Thyroiditis] can be caused by viruses or autoimmune processes. It can present both as hyperthyroidism [producing too much hormone] or hypothyroidism [producing too little hormone],” Palacio notes.

Hashimoto’s disease is most likely to appear in people between the ages of 40 and 60. You’re also more likely to have Hashimoto’s disease if you have other health conditions such as Addison’s disease, rheumatoid arthritis, lupus, autoimmune hepatitis, vitiligo, pernicious anemia, and type 1 diabetes.

What are the symptoms of Hashimoto’s disease?

Because the disease attacks the thyroid gland, people with Hashimoto’s have low levels of thyroxine, a hormone made in the thyroid that is essential for many bodily functions such as digestion and brain development.  
Palacio notes that Hashimoto’s can sometimes include the development of a goiter. According to the American Thyroid Association, a goiter occurs when the thyroid swells, making it look like a large mass in the neck near the Adam’s apple. It’s important to note that a goiter could be caused by hypothyroidism or hyperthyroidism. As such, it can be caused by Hashimoto’s disease, but it can also be caused by conditions, such as Graves’ disease, that cause hyperthyroidism.

According to Mayo Clinic and the American Thyroid Association, the symptoms of Hashimoto’s disease include:

• Sore, stiff, or weak muscles
• Weight gain
• Fatigue
• Pale, dry skin
• Constipation
• A puffy face
• Menorrhagia (excessive or prolonged menstrual bleeding)
• Depression
• Brittle nails and hair loss
• Memory loss

Because hypothyroidism affects thyroid levels, Hashimoto’s can also lead to high cholesterol, which can in turn cause heart conditions.

How is Hashimoto’s disease diagnosed?

Hashimoto’s disease is diagnosed by measuring thyroid-stimulating hormone (TSH) along with thyroid peroxidase (TPO) antibodies, Palacio says. Since Hashimoto’s is an autoimmune disorder, it’s usually accompanied by a high amount of TPO antibodies.
Unfortunately, getting a diagnosis isn’t always easy.
Kathryne struggled to find a diagnosis for her extreme fatigue for 18 years before she was finally diagnosed with Hashimoto’s disease just three years ago. The 52-year-old strategist and mother says that “It became so extreme that I could barely walk up a short flight of stairs. At that time, I was only being seen by regular, general practice doctors. I didn’t have any idea what was going on, so I didn’t know that I should have pushed harder for answers. It was many, many months before they even thought to do a thyroid test,” she recalls. For the next 10 years, she was treated for hypothyroidism.

Despite the fact that her other symptoms seemed like Hashimoto’s disease, her doctors dismissed it. During this period, she developed a bald patch, found her hair thinning, and had a rash. When her rash flared up, she would experience extreme fatigue and pain. Yet she still couldn’t find someone who could provide her with effective treatment.

Both naturopaths and traditional medicine failed to help her. Eventually, she found a functional medicine doctor who ordered a full thyroid panel and confirmed that she had Hashimoto’s disease. Since then, she’s been able to find an effective form of treatment.

How can Hashimoto’s disease be treated?

Hashimoto’s is a chronic illness, meaning there is no cure. But it can be effectively treated with medication.
“The main recommendation for patients when they have Hashimoto’s is to take their medication appropriately—on an empty stomach, with water, and at least 60 minutes before having any food,” Palacio says.
The medication often prescribed for Hashimoto’s is levothyroxine, a synthetic version of thyroxine that ensures that hormones are at an optimum level. Palacio notes that people being treated will also have to have their hormone and antibody levels checked every six to 12 months.

Kathryne says that her doctor, a practitioner of functional medicine, has taken a different approach to her medication. Her doctor has reduced her levothyroxine dosage, prescribed liothyronine, and adjusts her medication based on both her lab results and symptoms.
“My doctor recently started me on LDN (‘low dose’ micro doses of naltrexone), and she is carefully monitoring my thyroid panel, including TPO, to make adjustments to my dosages of levothyroxine and liothyronine as necessary,” Kathryne explains. Naltrexone is an opiate antagonist, and LDN is a fairly common treatment for people with autoimmune disorders such as Hashimoto’s disease.

Many people try gluten-free diets if they have disorders like Hashimoto’s disease. This is because various studies suggest celiac disease is prevalent in people who have endocrine autoimmune disorders. While many people believe that a change in diet can help them, that’s not something Palacio personally recommends to his patients. “There is no scientific evidence that there is a need to change the diet if the patient has hypothyroidism,” Palacio explains.
That said, certain lifestyle changes could help manage the symptoms of Hashimoto’s disease. Healthy lifestyle changes are never a bad idea, but they’re especially imperative with a chronic illness such as Hashimoto’s disease. Kathryne says she feels best when she eats a Whole30 diet, practices yoga daily, gets regular exercise, and sleeps well.

As mentioned earlier, Hashimoto’s is linked to depression. Lifestyle changes might be necessary to address any mental health difficulties experienced as a result of Hashimoto’s. For those who do experience depression, psychotherapy (also known as talk therapy) might be useful.
Although Kathryne struggled to find an effective approach, she finally found a form of treatment that’s right for her. “I haven’t had a serious flare-up since then. My energy level is much better,” she says. “I still have to be careful about overexertion. I work very hard at maintaining a healthy balance of diet, exercise, and especially rest. I now feel better than I have in almost 20 years,” she says.
If you suspect you have Hashimoto’s disease, don’t let healthcare providers dismiss your symptoms without offering any explanation. It might take awhile to find a doctor who takes your symptoms seriously, as Kathryne’s case shows, but her story also shows that persevering is worth it.
“Don’t stop looking until you find a healthcare provider who really listens to you and looks at a wide array of test results,” Kathryne says. “Healing can take a long time, so don’t give up.”

When I was in my first year of university, I couldn’t figure out if I was miserable or depressed. I cried often, I struggled with my sleeping patterns, my immune system was weak, and I felt irritable and unmotivated all the time. Am I depressed? I wondered. Or am I just moody?
While I felt sad, it eventually became clear that it wasn’t a bad mood or a response to one specific life change—I had depression. And while help was available, I needed to acknowledge that I was depressed before anything could get better.

We often associate depression with sadness, and we often use the word depressing or depressed to mean very sad. Some people even use it to talk about relatively normal life events: “I’m so depressed he canceled our date!” or “This history class is so damn depressing.” For this reason, it can be difficult to tell whether you’re truly depressed or simply upset. Like me, you might be asking yourself, Am I depressed, or am I feeling sad, hopeless, or unmotivated?
While someone can experience sadness and depression at the same time, there is a big difference between being sad and being depressed. Sadness is a feeling, while depression is a medical condition. Depression is treatable, but before you begin treatment, it’s important to know what you’re dealing with.
Here’s what you need to know about the difference between depression and general sadness.

Am I depressed or am I sad?

Depression is a mental illness—a mood disorder, to be specific—while sadness is a mood or feeling. This distinction might seem simple, but if you’re struggling with a low mood, it can be hard to tell the difference.
That said, there are a few notable differences between depression and sadness or lack of motivation.
“In sadness, there are mostly feelings of emptiness and loss. In depression, there is a persistent depressed mood and inability to anticipate happiness or pleasure,” says Danielle Forshee, PsyD, LCSW, a practicing psychologist.
“Feelings associated with sadness are likely to decrease in intensity over the course of a few days or weeks and occur in waves,” Forshee adds. “These waves tend to be associated with thoughts or reminders of what it is that is making you sad. The depressed mood of depression is more persistent and not tied to specific thoughts. Usually thoughts in depression are associated with self-criticism or pessimism.”

In other words, when you’re sad, your sadness is associated with a specific issue. When you’re depressed, on the other hand, it’s chronic: It’s a lens that obscures the joy around you. Depression makes you struggle to find happiness or joy in your surroundings.
Something else to note, Forshee says, is that your self-esteem is usually relatively intact when you’re sad. With depression, on the other hand, it’s common to feel worthless or self-loathing.
If you’re asking yourself Am I depressed? consider which of those scenarios applies to you.
Finally, while you can overcome sadness with time, positivity, and the support of friends, depression is a real illness that needs to be treated proactively with the help of professionals.

What causes depression?

Another key difference between sadness and depression is its cause. Sadness is usually caused by a certain event or issue, and while depression can be triggered by a specific situation, the true cause of depression is extremely complex.
You may have heard that depression is caused by a “chemical imbalance” in the brain. Many experts have pointed out that while this explanation isn’t exactly wrong, it’s a little oversimplified. “Depression isn’t likely caused by just one thing, but rather a complex interplay of many things such as genetic predisposition to having low moods, trauma and negative experiences, levels of concentrations of certain neurotransmitters, nerve cell connection function, and nerve circuit functioning,” explains neuropsychologist Amy Serin, PhD, founder of the Serin Center.

“There is a difference between sadness, which is often a temporary acute reaction to a difficult life situation,” says Serin, “and depression, which is a longer-lasting state in which a person can experience a loss of pleasure in life, fatigue, sleep changes, physical symptoms, feelings of worthlessness and hopelessness, and even suicidality.”
[pullquote align=”center”]Depression is chronic: It’s a lens that obscures the joy around you.[/pullquote]
There can also be significant physiological differences between people who feel sad but are not struggling with depression and those who are depressed, including hormonal differences. “Stress plays a role in modulating depression,” Serin explains. “Individuals with emotional or physical stress produce more corticotropin releasing hormone (CRH), a hormone that is often elevated in depressed individuals. When CRH returns to normal levels, mood states improve and depression lessens,” she says.
It’s important to remember that there are a number of physiological factors that come along with depression. An effective treatment program will address multiple facets of your experience to make depression more manageable, and professionals who are qualified to help treat depression know it isn’t as simple as changing your attitude, which is important for you to keep in mind too.

I think I’m depressed, but I don’t feel sad all the time.

A common misconception about depression is that depressed people only experience sadness, all of the time. In reality, depression can include a range of negative emotions and even physical feelings including anger, numbness, lethargy, or irritability.
“Depression is a complex condition which may present differently across a range of people,” explains Lekeisha A. Sumner, PhD, a board-certified clinical psychologist. “Sadness may not be the most prominent symptom. For example, for some people it may present with more physical complaints or irritability than low mood.”
So, while depression is often accompanied by sadness, it’s certainly possible to feel other negative moods—annoyance, apathy, or demotivation, for example—more than sadness.

Instead of crying constantly, you might find yourself struggling to function and complete day-to-day tasks, or you might be easily annoyed or upset, or you might struggle to find the joy in the things that previously brought you pleasure.
Depression isn’t just about how you feel—it’s also linked to a number of physical symptoms. “Many people with depression show up in their doctor’s offices with vague pain that can include chronic joint pain, limb pain, back pain, gastrointestinal problems, fatigue, sleep disturbances, and appetite changes,” Serin notes.
Serin explains that while most people believe there’s a strong division between mind and body, mental illnesses like depression—and even moods, like sadness—can affect the body profoundly. “We know that invoking even a small amount of sadness will increase someone’s level of perceived pain, so it makes sense that individuals with depression literally feel more physical symptoms than non-depressed people, even in the absence of other medical causes,” she says.

This might feel very overwhelming, especially since depression is linked to such a wide array of physical, mental, and emotional effects. But it’s important to remember that there’s a lot of hope for those who are depressed, and effective treatment will address your physical and emotional symptoms.

How is depression diagnosed?

If you find yourself asking Am I depressed?, the best person to help you work your way toward an answer is a trained expert.
Sumner strongly recommends being evaluated by a professional if you think you may be depressed.
“A professional can determine the subtleties among symptoms of major depression, dysthymia, grief, and normal sadness,” Sumner explains. “If you have been experiencing persistent sadness for at least two weeks, you would likely benefit from a professional evaluation,” she says.
According to Forshee, to meet criteria for major depressive disorder, [linkbuilder id=”6503″ text=”symptoms of depression”] must have been present every single day for at least two weeks. The symptoms are:

1. Depressed mood most of the day (feeling sad, empty, hopeless)
2. Little or no pleasure in almost all activities that previously you derived pleasure from
3. Significant weight loss/decrease or increase in appetite nearly every day
4. Sleeping way too much or not sleeping at all
5. Feeling physically slowed down
6. Feeling very fatigued or having a loss of energy nearly every day
7. Feelings of worthlessness or excessive and inappropriate guilt nearly every day
8. Limited ability to think/concentrate or indecisiveness nearly every day
9. Recurring thoughts of death, suicidal thoughts without a plan, or a suicide attempt, or having a plan for committing suicide

Other types of depression include:

• Bipolar disorder
• Seasonal affective disorder (SAD)
• Postpartum depression
• Premenstrual dysphoric disorder (PMDD)

Even if you don’t consistently experience all the symptoms associated with major depression or don’t think you’ll be diagnosed with another type of depression, you should still talk to a professional if you’re struggling with your mental health. You don’t need a diagnosis in order to receive help; therapy can benefit people whether they have a diagnosed mental illness or not.

If I am depressed, how can my depression be treated?

Many people think they can simply cure depression on their own if they just have a positive attitude. While staying positive is a great start, depression is a medical condition and it should be approached as such. We all need a little help sometimes, and there’s no shame in seeking help if you think you may be depressed. Just as you wouldn’t (or shouldn’t) attempt to cure appendicitis on your own, it’s important to look for professional help if you have depression.

If you think you may be depressed, your first port-of-call should be a therapist of some kind. If you have health insurance, you should be able to search in-network providers online through your insurer’s provider directory. (Note that they may be listed as behavioral health professionals.) If you’re unsure which therapist to visit, look for reviews online, ask for a recommendation from your general physician or friends, or try an online therapy portal like BetterHelp or Talkspace. Psychotherapy—that is, talk therapy—is a great way to improve and maintain your emotional health, whether you have a mental illness or not.
[pullquote align=”center”]“If you have been experiencing persistent sadness for at least two weeks, you would likely benefit from a professional evaluation.”
—Lekeisha A. Sumner, PhD[/pullquote]
Sumner says that one of the most effective treatments for depression is cognitive behavioral therapy (CBT). “CBT is based on the premise that maladaptive cognitions, such as beliefs or paradigms about one’s world, surroundings, themselves, and the future, contribute to automatic thoughts that lead to distress,” she explains.
With CBT, a therapist can help you recognize these problematic beliefs, thought patterns, and behaviors so that you can change them. Changing your thought patterns and behaviors might help relieve your depression. Serin points out that CBT has been shown to literally alter the hippocampus in the brain, which provides further evidence that CBT is an effective treatment for those who are depressed.

Another possible facet of your treatment plan could be trying antidepressant medication, such as selective serotonin reuptake inhibitors (SSRIs). Serin says that serotonin, which regulates sleep, appetite, mood, and pain perception, is one of the many chemicals associated with depression. “SSRI antidepressants seem to work by changing serotonin transmission in the brain and possibly by increasing neurogenesis (the formation of new neurons) in areas such as the hippocampus—which is an important brain structure that is often smaller in individuals who are depressed,” Serin says. While antidepressants are often stigmatized, they can be life-saving.

So I’m depressed. What else can I do?

“It is important to note that neurochemicals associated with depression can be altered with treatments that are not medication,” Serin says. In other words, while medication can be necessary and life-saving for many people with depression, there are other treatment options that you can explore.
“Meditation, improved sleep, exercise, and other healthy behaviors have also been shown to reduce depression in many studies,” she says. Serin also recommends getting enough sleep, maintaining a healthy diet, and creating social connections with supportive people to maintain your mental health.

Of course, maintaining a healthy diet can be tough when you’re struggling with depression. Depression can affect your appetite, causing you to eat too much or too little. And even if you have an appetite, depression often means you don’t have the energy to cook healthy, filling food, causing you to resort to eating what the internet has lightheartedly dubbed “depression meals.”
When you have the energy to do so, you might find it helpful to stock your cupboard and fridge with easy-to-make food: tea, whole-grain bread, nut butter, protein shakes, fruit, and frozen veggies can all be your allies when it comes to addressing your depression. Try to freeze leftover soup and keep it in your freezer for emergencies. Don’t feel bad if you need to call for delivery, pick up takeout, or buy ready-made food: Eating anything is better than eating nothing at all.
If you find yourself wanting to focus on your feelings, Sumner recommends trying expressive writing through journaling, which can help you express and process your emotions. Some studies suggest that gratitude journaling can be used to boost one’s self-esteem and general well-being, not to mention writing your feelings down is a great way to remember what to discuss in your next therapy session!

Sumner also recommends getting at least 20 minutes of sunlight a day. According to the Mayo Clinic, getting enough sunshine is important in regulating your serotonin levels as well as your sleep patterns.
In addition to all of these suggestions, Sumner recommends engaging with positive, supportive people. She also suggests you increase the pleasurable activities you engage in throughout the day. Take time to do the things that make you feel relaxed, happy, or excited. This could include taking a walk, reading, or watching a funny show. It can be hard to get yourself out of the house or even respond to texts when you’re in the throes of depression, but if you’re feeling up to it, these small things can help lift your mood.
While depression sometimes seems impossible to deal with, it can be treated effectively. Many people who have depression still manage to have happy, full, exciting lives—they just need to take extra good care of their mental health.
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Many of us get nervous when it comes to public speaking. We might feel slightly frazzled or shy in social situations. We might even avoid large gatherings or unfamiliar social spaces.
But what does it mean if you have a constant fear of social situations? What if you worry about events for days or weeks before they take place? What if your avoidance of social situations affects your career, schooling, or relationships? What if your anxiety is affecting you on a physical level, causing you to become sweaty or nauseated around others?
If you have experienced these symptoms, you’re not alone. According to the National Institute of Mental Health, recent statistics suggest about 12.1 percent of U.S. adults experience social anxiety disorder at some point in their lives. There are a few risk factors that increase your chances of having social anxiety disorder, including being divorced or widowed and experiencing stressful life events. Women and girls are more likely to experience social anxiety disorder.
“Having negative social experiences and growing up in stressful environments are two environmental factors that can contribute to the development of social anxiety disorder,” says Amy Serin, PhD, a neuropsychologist and founder of The Serin Center. “As with most diagnoses, there is a dynamic interplay between genetics and environment that can determine the eventual development of a disorder.”
Fortunately, Serin notes, social anxiety disorder can be effectively treated. Here’s what you need to know.

What exactly is social anxiety disorder?

Social anxiety disorder isn’t simply about being shy or introverted, although a socially anxious person may appear that way to others. Social anxiety disorder typically leads people to avoid social situations entirely, or to have great difficulty in those situations. In some cases, the anxiety stems from being afraid of how people perceive them.
“Introverts simply recharge their energy during solitude but can have no anxiety when dealing with others. There is a preference for being alone versus being with others,” Serin says. “Shyness may be a less severe form of social anxiety and occurs when a person may clam up or prefer to avoid social interaction in general.”
Social anxiety disorder, on the other hand, includes severe stress responses to social situations. “Social anxiety disorder typically presents as marked fear in social situations, above and beyond what one would typically expect given the situation,” says Jana Scrivani, PsyD, a licensed psychologist with expertise in the diagnosis and treatment of social anxiety.
Before a psychologist diagnoses someone with the disorder, certain criteria must be met. Psychologists use the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria to inform their diagnosis. “In order for a fear of social situations to be considered a disorder, it must interfere in someone’s life,” says Scrivani. In other words, the social anxiety must make it difficult for someone to function to be considered a disorder. “Additionally, the distress needs to persist for at least six months, and not be attributable to something else,” she says. For example, if someone avoids school because of a long-term illness or an unpleasant encounter with a particular teacher or classmate, that’s not attributable to social anxiety.
Anxiety disorders can also be accompanied by a number of physical symptoms including heart palpitations, excessive sweating, shaking, hot and cold flashes, shortness of breath, dizziness and lightheadedness, and trouble swallowing. These might seem like symptoms of the flu, but are often linked to anxiety. Anxiety results in these physical experiences by producing a flight-or-fight stress response in our bodies, which in turn affects our hormonal system and ultimately impacts our physical health.

Can social anxiety disorder be treated?

Social anxiety disorder is difficult to live with, but it can be treated successfully, says Scrivani. “I’ve worked with many people throughout the years who have made significant strides in overcoming social anxiety!” she says. “The first step would be to look for a provider who is experienced with social anxiety disorder.”
Seeing a therapist is often the first step in managing social anxiety. One of the most effective treatments for social anxiety disorder is cognitive behavioral therapy (CBT), says Lara Fielding, PsyD, EdM, an Los Angeles-based clinical psychologist and author. CBT is commonly used because numerous studies have shown that it’s an effective treatment for social anxiety disorder. CBT teaches people different ways of thinking, understanding, and reacting to situations.
Another effective form of therapy for social anxiety disorder is acceptance and commitment therapy, or ACT. This involves linking the client’s values with the necessity to persist through the anxiety. Their values are used to motivate them to work through their anxiety.
Exposure therapy is usually used in combination with CBT to treat social anxiety disorder. Fielding explains that during CBT, a therapist might encourage their client to create a hierarchy of feared social situations. These situations range from mildly anxiety inducing to unbearably anxiety inducing. The therapist might then guide them to gradually expose themself to those situations, starting with the least worrisome situation. “The client must stay present to the anxiety until the peak has passed, without engaging in any reassurance-seeking or other safety behaviors, until the anxiety begins to extinguish on its own,” Fielding says. After repeated exposures, the anxiety begins to subside and the client starts to feel more in control.
Fielding also notes that mindfulness-based CBT is incredibly effective for the treatment of social anxiety disorder. With anxiety disorders, you experience primary reactions and secondary reactions. The secondary reactions involve you fearing your anxiety and wanting to avoid that discomfort. “In mindfulness the aim is to practice letting go of the reactivity in such a way that the primary pain is accepted, so the secondary reactivity does not take hold.” Fielding says.
You’ll take note of your heart pounding, your instinct to run away, and so on. You’ll accept this discomfort and learn that it doesn’t have to dictate your actions. “Mindful awareness of the relationship between the thinking, feelings, and action impulses begins to paradoxically reduce the secondary reactivity,” she says.
There are other forms of therapy for social anxiety, such as psychodynamic therapy. However, Fielding says these forms haven’t been studied thoroughly enough. “This type of therapy has little or no evidence for being effective with serious anxiety disorders,” she explains. “CBT and ACT have multiple randomized controlled trials—the gold standard of science—showing them to be effective.”
Serin reiterates that social anxiety disorder can be treated. “At Serin Center, we have treated hundreds of individuals with social anxiety disorder with a combination of neurofeedback, therapy, and bilateral alternating stimulation,” she says. Neurofeedback involves mapping brain activity and then using that to inform therapy, while TouchPoints are wearables that vibrate on alternating sides of the body, altering the body’s flight-or-fight response. This soothes the wearer when they’re feeling anxious.
Anxious about seeing a therapist? Do some research first to put your mind at ease. Ask for referrals from friends. Consider online therapy options like Talkspace or BetterHelp if the idea of a face-to-face conversation is too intimidating. Remind yourself that it’s an investment in your life: You are worth your own effort.

Other Ways to Manage Social Anxiety Disorder

While therapy should be your first port-of-call when it comes to addressing social anxiety disorder, it’s great to have other stress management techniques, too. These coping skills can help you in between sessions or while you’re still looking for a therapist, but they can’t replace a professional healthcare provider altogether.
Here are some techniques to consider.

• Practice deep-breathing exercises to help you manage your anxiety. This skill can help you soothe yourself in seconds, whether you’re at home, in the bathroom at the office, or in a quiet room at a party.
• While alcohol or drugs can seem like great social lubricants, relying on them should be avoided. “Resist the urge to use alcohol or other non-doctor-prescribed drugs to manage social anxiety,” Scrivani suggests. “Those coping mechanisms only serve to mask the anxiety, and instead of realizing that you can face a particular situation, you’ll attribute your ability to cope to the alcohol or drug.”
• While your intuition might tell you to avoid social situations, this avoidance makes it worse. “Avoid the avoidance trap!” Scrivani says. “The longer you avoid an anxiety-provoking situation, the more fear and anxiety that situation will elicit the next time you’re faced with it.”
• Remember that, in most social situations, people aren’t scrutinizing you. Gently remind yourself that people are usually self-conscious—they’re thinking about themselves, not you, Scrivani says.
• Consider joining support groups for social anxiety. These groups could be online or in-person. Yes, it seems ironic to suggest a meetup to people with social anxiety, but it can sometimes be comforting and healing to speak to those who have the same fear as you while dealing with that fear. Try meetup.com to find a local support group.
• If you’d like to talk to someone, consider calling an anxiety hotline. A trained responder can listen to your concerns and help you manage your anxiety. Here’s a helpful list of international hotlines, including some that are anxiety specific.
• In some cases, medication might be prescribed as a treatment for social anxiety disorder.

While having social anxiety might make you feel hopeless, it can be effectively managed. “It’s important to understand the diagnosis is not a life sentence of anxiety, avoidance, and narrowing down of potential to avoid social interaction,” Serin says. “It’s important to understand that there is hope for people with social anxiety disorder and there are many professionals who can help.”

How to Support a Child Who Has Social Anxiety

Social anxiety can manifest at a young age. Some statistics show that about 9.1 percent of U.S. teenagers ages 13 and 18 have social anxiety disorder.
It’s important that parents are aware of the signs so that they can support their children who might have the disorder. Young children can experience significant struggles to reach out for help, as they might not have the vocabulary to explain how they feel.
The most notable sign of social anxiety disorder is if your child tends to avoid social situations. Another is if they seem particularly uncomfortable or noticeably quiet in social situations. Fielding says that the child might even become angry when they have to engage socially, especially in environments outside their comfort zones.
“The most important and effective thing anyone can do to help a loved one struggling with social anxiety (or any mental health struggle) is start from a position of understanding and validating the difficulty the other person is having,” says Fielding. “Loved ones can often invalidate the person struggling by telling them to just relax or trying to reassure them too often.” In other words, you might want to remind your child that there’s nothing to be worried about—but if you do this too often, it might come off as dismissive and invalidating.
Another thing you shouldn’t do is contribute to your child’s avoidance of social situations, Fielding says. The more someone avoids an anxiety-inducing situation, the scarier the situation can become. While avoiding anxiety-inducing situations seems like a quick fix, it can wind up reinforcing the anxiety.
Instead, Fielding suggests responding compassionately to your child and helping them habituate to social situations—that is, helping them get used to interaction by gradually increasing their exposure. If you’re going to a family event, for example, don’t expect them to socialize for hours right away. Go for only an hour or two. Afterward, point out how they were able to handle it. Use this achievement to praise them rather than to invalidate their initial fears.
If their anxiety seems severe, consider taking them to see a counselor or a psychologist who works specifically with children and adolescents. The counselor can treat your child while giving you helpful pointers for supporting them.
The most important thing to remember about social anxiety disorder is that it’s treatable. It is totally possible to manage the symptoms of social anxiety disorder so that you can live a full life without anxiety interfering. And, while therapy can be a difficult experience, it’s worth it—after all, your mental health is worth the investment.