When You're Feeling More Than "Blue"

    Phil Wuertz, MS, LCSW, LMFT, Deaconess Clinic Behavioral Health













    Seasonal affective disorder (SAD) is a specific kind of depression that affects people seasonally. The vast majority are those who are affected during the colder/darker months. For reasons that aren't fully understood, some people develop depression that is considered to be related to less sunlight. 

    Although some individuals do not necessarily show these symptoms, the classic characteristics of SAD include oversleeping, daytime fatigue, carbohydrate craving and weight gain. Additionally, many people may experience other features of depression including decreased sexual interest, overall fatigue, hopelessness, suicidal thoughts, lack of interest in normal activities and decreased socialization. Some people report starting to feel this way in the fall, while others remain fine until January or so.  It can really vary from person to person.

    While no specific gene has been shown to cause SAD, many people with this illness report at least one close relative with a related condition, such as depression. Scientists have identified that a chemical within the brain called serotonin may not be functioning correctly in many patients with SAD. The role of hormones, specifically melatonin, and sleep-wake cycles during the changing seasons is still being studied in people with SAD. Some studies have also shown that SAD is more common in people who live in northern/darker areas (e.g., Canada and Alaska as opposed to California and Florida).


    Treatment Options for SAD
    Many people with SAD will find that they feel better with light therapy. Light therapy consists of regular, daily exposure to a “light box,” which artificially simulates high-intensity sunlight. About 30 minutes daily in front of a light box can make many SAD patients feel better. If you're prone to SAD, it's a good idea to start light therapy even a little before the time symptoms usually start. So if you know you're prone to SAD, and typically start feeling down in mid-November, perhaps you start your light therapy on Halloween. Light therapy boxes can be found online through various retailers, and sometimes at "natural" food/retail stores.

    Scientific studies have shown light therapy to be very effective, and as effective as antidepressants in many cases of non-severe SAD. Light therapy may also work faster than antidepressants for some patients. Some people may choose treatment with both light therapy and antidepressant medications and find the combination of these treatments to be helpful. Prior to purchasing a light box, it may be a good idea to talk with your doctor (your primary care provider). He or she may be able to give you some recommendations regarding how to best use the light for your needs.

    If you think you may have SAD--whether this is your first season, or you can look back and realize that it may have been happening for several years--you should talk with your doctor about it. A full medical evaluation of a person who is experiencing these symptoms for the first time should include a thorough physical examination as well as blood (e.g., thyroid testing) and urine tests (e.g., pregnancy testing, drug screening). A medical evaluation is appropriate because SAD can often be misdiagnosed as hypothyroidism or other medical conditions. Also, there is some discussion about how vitamin D may be helpful in the treatment/prevention of SAD. Again, discuss this with your doctor.


    Depression
    Major depression is a mood state that goes well beyond temporarily feeling sad or blue. It is a serious medical illness that affects one’s thoughts, feelings, behavior, mood and physical health.

    Each year depression affects 5-8% of adults in the United States. This means that about 25 million Americans will have an episode of major depression this year alone. Depression occurs 70 percent more frequently in women than in men for reasons that are not fully understood. Without treatment, the frequency and severity of these symptoms tend to increase over time.
     

    So what are the symptoms of major depression and how is it diagnosed?
    Depression can be difficult to detect from the outside, but for those who experience major depression, it is disruptive in a multitude of ways.

    It usually causes significant changes in how a person functions in many of the following areas:

    • Changes in sleep. Some people experience difficulty in falling asleep, waking up during the night or awakening earlier than desired. Other people sleep much longer than they used to.
    •  Changes in appetite. Weight gain or weight loss demonstrates changes in eating habits and appetite during episodes of depression.
    • Poor concentration. The inability to concentrate and/or make decisions is a serious aspect of depression. During severe depression, some people find following the thread of a simple newspaper article to be extremely difficult, or making major decisions often impossible.
    • Loss of energy. The loss of energy and fatigue often affects people living with depression. Mental speed and activity are usually reduced, as is the ability to perform normal daily routines.
    • Lack of interest. During depression, people feel sad and lose interest in usual activities.
    • Low self-esteem. During periods of depression, people dwell on memories of losses or failures and feel excessive guilt and helplessness.
    • Hopelessness or guilt. The symptoms of depression often produce a strong feeling of hopelessness, or a belief that nothing will ever improve. These feelings can lead to thoughts of suicide.
    • Movement changes. People may literally look “slowed down” or overly activated and agitated.
     

    Video Resource
    There is a video I'd like to share with you.  Made by the World Health Organization, it truly helps describe the feelings of depression in a way that is highly relatable and can help you explain your feelings to others in way they can understand. Click to watch.
     

    What treatments are available for depression?
    There are a couple of well-established types of treatment for major depression:
    • Medications. Medications often effectively control the serious symptoms of depression. It often takes two to four weeks for antidepressant medications to have their full effect.
    • Psychotherapy. Several types of psychotherapy have been shown to be effective for depression, including cognitive behavioral therapy (CBT) and interpersonal therapy (IPT). Support groups offer opportunities to share frustrations and successes, referrals to specialists and community resources, and information about what works best when trying to recover. Research has shown that mild to moderate depression can often be treated successfully with either medication or psychotherapy alone but that both together are often more helpful. Severe depression appears more likely to respond to a combination of medication and psychotherapy.
    Other forms of treatment that may be helpful, either combined with the more traditional treatments or alone, include exercise, and complementary and alternative medicine.


    Additional Resources
     
    http://www.nami.org/template.cfm?section=Depression
     
    http://www.nami.org/factsheets/depression_factsheet.pdf
    Posted: April 23, 2014 by Jessica Gerlach
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