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Major Depressive Disorder with Seasonal Pattern

Webinar Series December Topic: Seasonal Affective Disorder

 

Mindy Altschul, Director of Clinical Social Services.

On December 12th, Mindy Altschul, director of clinical social services at Carrier Clinic®
, hosted a webinar on Seasonal Depression called “Seasonal Affective Disorder: Surviving the Cold and Dark” in alignment with the beginning of the winter season.

This post provides a breakdown of the information discussed during the webinar and is intended for mental health professionals, people struggling with Seasonal Depression/Seasonal Affective Disorder (SAD), and their family members/friends. Through this information, we seek to promote better mental health care for SAD and give those who suffer from this disorder options for getting help. Skip down to read that information. We are also sharing the video recording that you may watch/download if interested.

Seasonal Affective Disorder: Surviving the Cold and Dark from BizBudding Inc. on Vimeo.

Seasonal Affective Disorder: Surviving the Cold and Dark

This post will cover: 

  • Understanding Winter ‘Blues’ versus something   more clinically significant e.g., Major Depressive   Disorder with Seasonal pattern
  • Suggested Coping strategies
  • When and how to reach out for help

Stress, Anxiety, and Depression (the ‘real’ S.A.D.)

Not all stress is bad or detrimental. Stress can be thrilling and exciting in small does- stress can motivate us to perform
In response to danger (a stressor), your body prepares to face a threat or of flee to safety- flight, fight or flee response. Biologically your pulse quickens, you breathe faster, your muscles tense your brain uses more oxygen and increases activity- all functions aimed at survival. However, stress is exhausting when it is too much.

Acute Stress

  • This is the most common form of stress -can be considered routine stress
  • Comes from demands and pressures of recent past and anticipated demands and pressures of the near future
  • Episodic acute stress
    • Type A personality- excessive competitive drive, aggressiveness, impatience, and harrying sense of time urgency
    • Ceaseless worry, worry warts, see disaster around every corner and pessimistic

Chronic Stress

  • Grinding stress that wears people away every day after day
  • Socioeconomic stress, like that of poverty
  • Dysfunctional families
  • Being trapped in an unhappy marriage or in a despised job
  • The stress of never seeing a way out of a miserable situation or unrelenting demands and pressures for seemingly indeterminable amounts of time
  • Can stem from traumatic, early childhood experiences that became internalized and remain forever painful and present

Physical impact of stress:

  • Low energy; Headaches; Upset stomach; Aches, pains, tense muscles; Chest pain – heart disease; Rapid heart beat – high blood pressure; Insomnia

Emotional/psychological/mental health symptoms of stress:

  • Becoming easily agitated; frustrated and moody; Feeling overwhelmed; Having difficulty relaxing and quieting the mind; ultimately can lead to Anxiety and or Depression

Anxiety

Anxiety consists of a combination of the below symptoms:

  • Excessive nervousness and worry (apprehensive expectation) occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).
  • The individual finds it difficult to control the worry. The apprehension and worry are associated with three or more of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):
  • Restlessness or feeling keyed up or on edge
  • Being easily fatigued
  • Difficulty concentrating or mind going blank
  • Irritability
  • Muscle tension
  • Sleep disturbance (difficulty falling or staying asleep or restless unsatisfying sleep)
  • The anxiety worry or physical symptoms cause clinically significant distress or impairment in social occupational or other important areas of functioning.

Depression

Symptoms of depression include:

  • Clinical depression diagnoses based upon symptoms being present for the same 2 week period and represent a change from previous functioning
  • Depressed mood OR
  • Loss of interest or pleasure and
  • Subjective report or observed sadness, emptiness, or feelings of hopelessness.
  • Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day subjective report or observation.
  • Significant weight loss when not dieting or weight gain or decrease or increase in appetite nearly every day.
  • Insomnia or hypersomnia nearly every day.
  • Psychomotor agitation or retardation – observable by others as well as self-report.
  • Fatigue or loss of energy nearly every day.
  • Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
  • Diminished ability to think or concentrate, indecisiveness nearly every day.
  • Recurrent thoughts of death, recurrent suicidal ideation without a specific plan or suicide attempt or specific plan for committing suicide.
  • The symptoms cause clinically significant distress or impairments in social, occupational or other important areas of functioning.

Major Depressive Disorder with Seasonal Pattern

Major Depressive Disorder with Seasonal Pattern (or SAD) is more than just a case of the “winter blues.” Here is how this type of depression is defined and diagnosed.

  • Now classified as Major Depressive Disorder with Seasonal Pattern; had been termed Seasonal Affective Depression (SAD).
  • Depression with seasonal pattern – recurrent major depression where there has been a regular temporal relationship between the onset of major depressive episodes in major depressive disorder and a particular time of year (e.g. in the fall or winter months)
  • Does not include cases in which there is an obvious effect of seasonally related psychosocial stressors (e.g. regularly being unemployed every winter)
  • Full remissions occur at a characteristic time of year (e.g. depressions disappear in the spring).
  • *Diagnosed after at least two consecutive years of more intense symptoms.
  • In the last 2 years, two major depressive episodes have occurred that demonstrate the temporal seasonal relationships.
  • Seasonal episodes substantially outnumber the non-seasonal episodes that have occurred over the individual’s lifetime.

Risk Factors of Seasonal Patterned Depression:

  • Seasonal patterned depression affects about 5 % of the US population. It is four times more common in women than men and typically starts when a person is between ages 18 and 30.
  • A relationship has been established between seasonal patterned depression and latitude of residence. There is an increasing community prevalence of seasonal patterned depression across locations moving progressively north up the east coast of the USA from Florida to New Hampshire. Seasonal patterned depression is rare within 30 degrees of the equator.
  • Only about 1% of Florida residents have some winter specific discomfort or depression, compared to 9 percent of those who live in New England or Alaska who suffer from seasonal patterned depression.

Circadian Rhythm

Circadian rhythm – A circadian rhythm is a roughly 24-hour cycle in the physiological processes of living beings, including plants, animals, fungi, etc. In a strict sense, circadian rhythms are endogenously generated,( endogenously meaning having an internal cause) although they can be modulated by external cues such as sunlight and temperature. Circadian rhythm can be referred to as your body clock. In the most basic sense, the circadian rhythm is generally a 24-hour cycle in the physiological processes of living beings.

Within these rhythms, there are clear patterns of brain wave activity, hormone production, cell regeneration, and other biological activities.

Circadian rhythms generate from within us and determine our sleeping and feeding patterns. Although these rhythms originate from within us, they can be modulated by external cues such as sunlight and temperature. In winter, the days get shorter and the nights longer. Exposure to sunlight lessens. Sensitivity to the lack of sunlight that results from winter’s shorter days disrupts our circadian rhythm.

Most of us are affected by the seasonal changes – it is normal to feel more cheerful and energetic when the sun is shining and the days are longer, or to find that you eat more or sleep longer in winter.

How the Circadian Rhythm & Less Sunlight Affects the Brain

As seasons change, people experience a shift in their internal biological clock so that it is normal to be affected by typical symptoms to some degree. Symptoms of winter depression lie along a severity continuum.

The lack of sunlight causes the brain to work overtime producing melatonin, the hormone that regulates your body clock and sleep patterns and a hormone that has been linked to depression. Seasonal patterned depression has been linked to this biochemical imbalance in the brain that can be prompted by shorter daylight hours and less sunlight in winter.

Getting natural light in the winter is more difficult; when we travel to and from work or school it’s dark because the days are shorter. Also, because it’s cold out we are less likely to venture outdoors and get direct exposure to sunlight which keeps the body clock in sync.

Of note – the body clock system (or circadian rhythm) is also related to the brain’s appetite hardwiring which might explain why people experience more food cravings in winter. There is the ‘expected’ holiday weight gain that folks attribute to Thanksgiving; Christmas and New Year’s Eve, but there are also physiological and environmental factors at play here.

It can be normal to gain 5 or 6 pounds over the winter but with Seasonal aspect of depression or what was formally known as Seasonal Affective Disorder weight gain can be far more than that.

Seasonal Pattern Assessment Questionnaire

This questionnaire is a diagnostic tool that can be used to assist in the determination of a Seasonal Patterned Depression diagnosis.

 

 

Coping – the R’s

  • Recognize – recognize your (body’s) response to stress.
  • Reorganize – develop healthy habits, e.g. exercise.
  • Reduce – volume of things we’re involved in – type A personality, overachiever, etc.
    • Are you doing too much?
    • When you wake up in the morning do you look forward to what’s on your ‘plate’ for the day?
    • Are you excited to start the day?
    • Set priorities, what must get done and what can wait. Learn to say no to new tasks.
  • Relax – put your body in a state that’s incompatible with stress – relaxation techniques, breathing, yoga, etc.
  • Release – an added bonus of developing healthy habits – exercising reduces muscle tension that is mobilized during a stress response.
  • Rethink – what your mind tells you about a potential stressor determines whether it becomes an actual stressor – negative thoughts vs. positive thoughts.
  • Reach out for help – emotional and social support and for professional help.

Treatment Options/Solutions for Seasonal Patterned Depression

  • Get as much sunlight as possible – Light enters the eye which activates a body clock system that is similar to what controls seasonal breeding and hibernation in animals
  • To compensate artificial light boxes or ‘sun box’ lights with special fluorescent tubes that mimic the sun’s beneficial rays are available and are considered the go-to treatment for those with any level of winter depression
  • ‘Simulate dawn’ via daily early morning exposure to this light source. Dawn-simulating alarm clocks whose illuminance gradually increases over a 30 to 90 minute period while the patient remains asleep, prior to their usual awakening time.
  • Increase outdoor exposure.
  • Exercise – exercising outside—especially where bright light is present—is even more beneficial.
  • Eat winter mood foods
    • Squash – a great source of magnesium and potassium
    • Eggplant (which contains fiber, copper vitamin B1 and manganese)
    • Sweet potatoes – full of pantothenic acid, vitamin B6, biotin, and anti-inflammatory flavonoids
    • Turmeric – assists with immune-inflammatory or stress pathways and hypothalamus-pituitary-adrenal axis activity.
  • Increase Vitamin D intake. Since we get most of our Vitamin D from the sun, it’s a good idea to take a vitamin D supplement. There is some correlation between vitamin D deficiency and depression.
    • Foods high in Vitamin D – certain fishes- swordfish; salmon; tuna; milk; yogurt, eggs, cereals fortified with vitamin D.
  • Antidepressant medications are widely used in the treatment of seasonal patterned depression.
  • Cognitive behavioral therapy

When to Get Help

If you are experiencing any of the following symptoms of SAD, you should seek help:

  • You may feel so awful that you don’t want to get out of bed.
  • If you are starting to miss days of work, calling in sick and arriving late.
  • If you find yourself unable to perform the demands of your job because of the symptoms of your depression.
  • When you are turning to drugs and/or alcohol when you are either anxious or depressed, this is a warning sign that you cannot ignore. Many people who suffer from addictions also have an underlying mood disorder.
  • If you are beginning to have thoughts of harming others or yourself this is a warning that you need to get help right now.
  • When loved ones and friends become vocal and tell you that your depression is noticeable and that it is causing them distress and worry, it is time to listen.
  • If your depressed mood lasts for more than two weeks or is seriously interfering with your ability to function at work, with your family, and in your social life, or is causing you to contemplate or plan to commit suicide, consult with a mental health professional as soon as possible.
  • This is a warning sign you cannot ignore. If you are doing things like cutting or other self-harm, then it is time to seek immediate treatment. If you are having thoughts that you want to kill yourself because you can’t stand the pain anymore, then this is the time when you tell someone about these feelings. Don’t keep these thoughts a secret.

How to Get Help

Types of professionals and institutions who can offer you help for depression and anxiety:

  • Your family doctor
  • Clergy/chaplain
  • Mental health specialists, including:
  • Psychiatrists
  • Clinical Psychologists
  • Social Workers
  • Licensed mental health counselors
  • Your employer-provided Employee Assistance Programs (EAPs)
  • Nearby university or medical school-affiliated mental health clinics
  • Your local hospital
  • Community mental health centers
  • Your Health Maintenance Organizations (HMO) or Health Insurance company

You can also visit Carrier Clinic’s What to Do area of our website for more information about where to begin.

References

  • Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition, DSM-5, American Psychiatric Association
  • 5 things you should know about stress, National Institute of Mental Health
  • Stress: The different kinds of stress, American Psychological Association
  • Stress symptoms: The effects of stress on your body, WebMD
  • Common Sign and Symptoms of Stress, The American Institute of Stress
  • Mood Disorders Association of Manitoba, Inc: Seasonal Pattern Assessment Questionnaire
  • Seasonal Affective Disorder; Depressed Test.com
  • Seasonal Affective Disorder; Psychiatry.com
  • Seasonal Affective Disorder; nimh.nih.gov

Carrier Clinic

If you or someone you know is in crisis and in need of immediate help, call 911, go to the closest emergency room, or call Carrier Clinic’s 
24-hour-a-day, 7-days-a-week Access Center at 1-800-933-3579.

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