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Dr. Zipperman is offering tele-health appointments for medication management and psychotherapy.

Blog Post: Rx for Dog

As a psychiatrist who practices from a standpoint of holistic (whole person) care, I am always thinking of interventions that aside from medications and therapy, that can benefit my patients.  After reading a Facebook post by Zach Snow of Marley's Mutts, I thought about the power of dogs to heal emotional wounds, especially when individuals are resistant to reach out for help in the traditional channels of Western medicine.  By writing about this topic, I hope to reach the person who stumbles across my website that might not be in a place to click the 'request a new appt.' button.  Facebook has to me boiled down to a means to follow my beloved animal rescue organizations and certain individual bull dogs/ pit bulls who have become ambassadors for their breeds, having been pulled out of dog fighting and abuse, yet still embodying an indomitable love and patience for humans; in addition to comical personalities that their adoptive parents anthropomorphize through Facebook posts.

The gentleman in the picture below is Zach Snow of Marley's Mutts Dog Rescue, one of the groups I follow on Facebook.  Zach and his team take abused dogs into prisons to help rehabilitate both humans and dogs. He also rescues dogs from shelters and abuse to connect the animals when ready with new forever homes. In the links below, Zach tells his moving story of living as a severe alcoholic, nearly dying from liver failure, but through rescuing Hooch (the red Mastiff below who had his tongue cut out as part of dog fighting) and other neglected dogs, Zach found inspiration for sobriety and a new life. It's a reminder to me of the power of dogs to heal. This is a theme I embrace in my life with my own dog Lucy who is featured on this website. Lucy is always there, patient and generous in her love, to brighten my day.

Even if a person is locked into solitude or despair, seemingly unreachable, a dog can uniquely accept them exactly where they are, for however long it takes, to ever so gently draw them into an emotional connection. And in so doing, heal and strengthen the best parts of the human spirit. Dogs freely give of themselves even when abused, asking so little in return; yet we as a society forget about them in shelters and reach for more medications or other substances to numb, we reach for money and acclaim, status and attention from our partners and friends. We wait for approval from society but it is never really enough because conditional validation by this or that, it only goes so deep and it can be taken away.  What if the true remedy is simply in a set of floppy ears, a wiggly butt, and big brown loving eyes greeting you at the door, showering you with all the approval you need so that you know today, there is a living being who relies on me and who will love me unconditionally, braving the world by my side.

The reality is some can't adopt a dog and/or don't want to take on the responsibility of pet ownership.  I get that.  But you can still share in the uplifting experience of engaging with animals in need by volunteering, donating funds, or in advocacy against destructive practices like bully breed bans. The discrimination against Pit Bulls, Mastiffs, and other similar breeds is based on stereotypes that tear the deep bonds between families and dogs apart, forcing owners to decide between obtaining housing and their pets, leaving animals suffering and lonely in shelters. Those dogs in shelters need a friend to take them on a walk, so if you can't have a pet, you can still be a recipient of their healing powers by volunteering at a shelter or with a rescue agency.

If you already know of this which I speak, don't forget to write your legislators to support bills strengthening animal abuse laws and join in with others to strive to eliminate breed bans which devastate people and animals.  We have to ask ourselves, how do we feel when we are stereotyped and distilled down to a category, a label?  Because a dog has a block head, they are associated with people's fears and biases but the reality is that aggressive dogs are a result of abuse or neglect, improper socialization, and/or irresponsible breeding.  It is not surprising that aggressive people pick dogs to reflect them in the guard dog breeds and then impart to them negative traits. When dogs are given love they reflect back the same, which is in fact the source of the healing. The dogs reflect back our love and amplify it.  As evidenced in Marley's Mutt's stories, dogs like people, can be rehabilitated which helps us remember that there is none of us who is a lost cause.

If you think you have what it takes to bring a dog into your home, think through that commitment first to make sure you are ready and then adopt, don't shop!  Buying expensive puppies, especially at pet stores or from breeders who have not been vetted by agencies that regulate responsible breeding, fuels the rise of puppy mills, a place where dogs are a commodity who's sole purpose is for profit and to that aim, dogs are abused and neglected. There are so many dogs waiting in shelters for a home through no fault of their own, waiting to give of themselves unconditionally.  See if you fall in love with those eyes staring through the links of a kennel, if you don't you can always keep walking.  Plus, puppies are a lot of work and an adult dog gives more, takes less.

Consider adopting a foster animal who has been temperament tested, in that way you can better predict if an animal will fit into your lifestyle.  If you aren't a runner or hiker, don't adopt a sporting breed.  Often times pit bulls and other bully breeds make for mellow, low maintenance pets for people who work outside the home during the day. A foster agency near you can be found at and they can help you decide if you ready for a companion animal and what type of pet would be best suited for you.   

Lastly, read about Hooch pictured below and vote for Hooch as an American Humane Association 'Hero Dog' at .  You can read about Zach Snow at or by following Marley Mutt's Facebook page at .

Michelle Zipperman M.D.


Blog Post: What to do when you’re not sure what to do in Seattle. Is perfectionism holding you back?
This is the time of year that we fall in love with Seattle.  The sun glistens on the lake, mountains are picturesque in the background, bicyclists and joggers abound, and it seems like everyone has a happy dog in tow.  So why is it that when I ask my patients ‘what do you like to do for fun?’ or ‘Are you enjoying the weather?’ sometimes there is a rather long pause. 

Depression is often both the cause and result of isolation and anxiety stops people in their tracks, prevents them from pushing outside of a comfort zone.  Often there is a critical voice that overrides the want of fun, the want to be part of the mass exodus to go outside and enjoy the summer.  People tell themselves, “You don’t know how to do that sport.” “You are too out of shape.” “It won’t be fun.”  “Doing activities alone is sad.”  The critical tone becomes self-defeating and instead of experiencing the invigoration of a hike or a day cycling, people watch others enjoy themselves as they peer out the window.  It doesn’t help that Seattleites are sometimes hard to engage with invitations because they have pre-planned the three months of summer well in advance, packed full every free moment with scheduled outings. After a few shot down spontaneous invitations to their friends, people can lose motivation to try to find adventure buddies.

You have two options when it comes to adventure, 1) wait for the exact perfect scenario where you feel comfortable and adept  2) through caution to the wind and face what it means to be alone or uncoordinated or a little lost.  With option 2, you have the chance to meet new people, have the benefits of endorphins with exercise and the, oh so therapeutic, exposure to fresh air and beautiful scenery.  What is the worst that could happen if you were to try something new?  Feeling awkward.  What is the worst that could happen if you DON’T try something new?  Depression, low self-esteem, isolation.

So here are my top ten suggestions to enjoy the summer fun in Seattle even if you aren’t the Northwest poster-child for being active.

1.The obvious is to get a trail guide either online or in a book and go on a hike.  Just go.  The trails are well marked typically if not a bit crowded.  Get a discover pass and/or Forest Service Parking pass ahead of time. Hear the rustling of the wind in the trees and take pause in front of a tumbling brook.  Your stresses will melt away.  Go by yourself or join a hiking club or meetup.

2. Get a bicycle.  It doesn’t have to be expensive but we have the treasure of the Burk-Gilman Trail at our doorstep.  On the trail,  you will find young, old, fit, not so fit, all sorts.  Go at your own pace.  If you like it, you can join a cycling club. 

       3. Search Groupons for outdoor activities.  Maybe you just need the right idea for what to do and you will find all sorts of novel activities in Groupon form.  Often companies make it easy and inexpensive to take you outdoors and keep you safe. 

       4. Take a class….. REI, KAF adventures, various mountaineering schools, community center classes; ones that cater to beginners.  With a class, you can spend the day kayaking, hiking, backpacking, rock climbing, cycling, soccer, Frisbee … you name it.  Also, you have compadres in a group and you might walk away with new friends.

       5. Check out some meetups.  Again, just go.  What’s the worst that could happen?  You feel awkward but so does everyone else.  Break the Seattle Freeze and contribute to the solution of bringing people together.  Go to and explore groups with common interests, ideally groups who get you outside to get your Vitamin D levels up. 

       6.Take a book or your e-reader to the park and have a date with yourself.  Bring a picnic, water, and sunscreen.  Take Fido if he/she can hang. 

       7. Just go for a walk.  Put one foot in front of the other and walk out the door.  See where it leads you. 

       8. Join a club like Evergreen Mountain Biking Club, Cascade Cyclists, or the Sierra Club.  They will walk you through learning a new activity.

       9.  Invite the friends you have to go try new activities like take a ferry ride, visit a festival or outdoor concert, or go to the dog park.  Don’t wait to be invited, invite someone else or even a few people.  Find friends who are willing to adventure without a lot of advance planning. Being spontaneous is liberating.  Friends can be younger, older, different backgrounds and personalities; just don’t pre-judge folks,  instead find willing partners.

       10. Volunteer!  Pasados Animal Sanctuary, The Zoo, pet adoptions, hiking trail clean up, work at a marathon/bicycle race, coach a sport, volunteer at a festival. There is no better way to feel good than to give of your time and energy towards a meaningful cause.

Don’t delay.  Summer is upon us.  Carpe Diem. 

“Do not be timid or squeamish about your actions.  All life is an experiment”.  Ralph Waldo Emerson

Dr. Z



Blog Post: Why am I so sad? Alternative Treatments for Depression.

As I woke up this morning with my cup of Joe, I contemplated what can I offer today to make this world a better place.  Of course I have a long list of 'to do's' that I am having to set aside in order to focus on this task, some are pressing, but I am a strong believer that I need to practice what I preach.  The art of meditation is the process of interrupting the mindless worries and responsibilities, to quiet our minds and bodies, to focus on one intention.  Yoga is the same sort of endeavor and it is called a practice because it is not always easy to make it happen even for me, it takes P-R-A-C-T-I-C-E.  What better time to start then today?!  So my blog today is part of this practice, to set an intention to help others. 

One of the things that I teach is that giving to others is an excellent way to improve mood and alleviate depression, also create deep fulfillment and well-being which are protective against relapsing back into depression.  I started off this morning on Balanced Living's Facebook page and created a post with a call to action to consider consciously making a plan to give to friends, family, the planet, animals, wherever the heart takes you but the call was for altruism (giving to others at the expense of using some of one's own resources) and philanthropy (moral motivation to do good in this world) . 

Then I thought about today's blog and I started reviewing research articles.  I came across which is an easy to understand synopsis demonstrating that giving to others improves one's degree of happiness.  Also, I thought about one of my favorite books, 'The Happiness Hypothesis'  which explores ancient civilizations, philosophers and common maxims that refer to happiness, looking deeper to see if there are proven truths to be found in common proverbial sayings.  In summation, those references highlight correlations between degree of happiness and meditation, quiet surroundings, the ability to be still in mind and body; also, being a part of a community, spiritual or otherwise and yes, the process of giving to others improves one's degree of happiness. A short commute is also not surprisingly given mention as correlated to happiness. Coming from L.A.,  all I can say is "Amen".

You see, it makes sense from an evolutionary perspective.  We are mammals meant to love and nurture, to commune in order to maximize our shared resources.  Our intellect and character features are in part genetically determined and those traits which increase happiness are propagated because happiness leads to longer lives, better relationships, and improved health.  This is revealed in the fact that men who are married typically live longer than men who are single, in their later years.  Why is that?  It is because elderly men tend to be less likely to engage with friends and community when they are single compared to married men while women who are more naturally prone to look to other women for support, don't have that same pattern.  Creating community and relationships causes us to focus on others and that increases health and happiness.

The black widow is a different creature, she has a set of characteristics which lends itself to a more isolationist way of existing and that works for her but humans are communal creatures.  When we let are dark moods isolate us we become self-absorbed, often we end up in our own head space with circular thinking and negative self-talk.  What if we decided to do things differently today? 

What if we woke up in the morning with gratitude that we have the opportunity to make this world a better place.  Maybe it is helping a coworker move after work, forgiving someone who hasn't asked for it, complimenting the Barista at Starbucks; maybe today you can advocate for animals or mentor the unemployed, or maybe just be patient in the grocery store line.  If you find that giving to others does in fact cause your worries and sad mood to drift away, then use that tool repeatedly, construct your life in a way where time is allotted and scheduled in to give to others.  Also, spontaneously make an effort to meet a need when it presents itself.  After all, some of giving is a matter of self-preservation and self-care because guess what, when you give to others, others will give back to you and you no longer feel so alone. First there must be an action (you give) to have the reaction (you receive) and so many people are feeling morose because they are not receiving enough love in their lives.  Love comes when it is given.   

Now to those who excessively focus on caregiving for others at the expense of tending to their own needs, then I recommend therapy to stay more in balance.  Anything in excess is not a healthy coping skill and more often than not, it is more about avoidance of dealing with one's problems then selflessly  helping others.  Also, there are times when the depression is just too dark and deep to enact these concepts; for those who struggle on that level, reach out for help from a qualified psychologist or psychiatrist who can empower you to return to a place of strength where you can give.

Today, I offer to you a Sanskrit/ Buddhist mantra which can be sung, 'Shanti, Shanti, Shanti' which means peace to mind, body, and soul.  This morning I'm walking the walk, interrupting the 'business' to give to others because after all, I'm hoping the universe will also commune back to me and present me with happiness today.  Let's see together how this goes.    


Dr. Z



How Do I Know If I’m Depressed?

Of course, you know if you’re physically hurt, such as if you have a headache or you fracture a toe. But sometimes it’s less easy to tell whether you may be having behavioral health issues such as depression.

At this point in time, the best tool we have to diagnose depression comes from the Diagnostic and Statistical Manual of Mental Disorders, commonly known as DSM-V, now in its fifth edition. The diagnostic criteria in the DSM-V is based on research by psychiatrists, psychologists, and other mental health professionals.

Symptoms of Clinical Depression

The DSM-V indicates a diagnosis of depression if five or more of these symptoms have been present over a consecutive two-week period and represent a change from previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure:

  • Depressed mood most of the day, nearly every day
  • Markedly diminished interest or pleasure in all or almost all activities most of the day, nearly every day
  • Significant weight loss when not dieting or a decrease or increase in appetite nearly every day
  • Difficulty sleeping or sleeping too much nearly every day
  • Noticeably physically agitated or slowed down, as observed by others nearly every day
  • Fatigue or loss of energy nearly every day
  • Feelings of worthlessness or excessive or inappropriate guilt nearly every day
  • Diminished ability to concentrate or make decisions nearly every day
  • Recurrent thoughts of death or suicide

These symptoms can cause significant distress or impairment in social relationships, problems at work, and other functional areas of life. 

It should also be noted that symptoms of clinical depression are not due to the direct physiological effects of substance abuse, medications, or another medical condition (i.e., hypothyroidism). 

If you have been experiencing these symptoms and think you may be depressed, don’t hesitate to seek help from a behavioral healthcare provider who can get you the help you need, whether it includes medication and/or therapy.

Behavioral activation therapy is one method used to treat depression. This involves encouraging the patient to participate in activities that can improve mood, such as exercise, socializing, learning new skills, and working on relationships. 

You can try behavioral activation therapy at home! Here's how.

3 Steps of Behavior Activation Therapy

  1. Make a list of three or four activities you enjoy, like reading a book, taking a walk, or trying a new recipe.
  2. Also list three or four responsibilities you have every day, like getting your kids off to school, eating breakfast each morning, or cleaning your room. 
  3. Try doing at least one thing from your list each day, and use a journal or scale of 1 to 10 to record how you feel before and after. 
Do you feel a sense of accomplishment after cleaning your room? Do you feel more or less depressed after exercise?

At Balanced Living Psychiatry, Dr. Michelle Zipperman is expert at diagnosing and treating depression using integrative psychiatry practices, including behavioral activation therapy. To learn more, contact our Seattle, Washington office today for an appointment.

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