Depression: Seasonal Depression (Seasonal Affective Disorder)

What Is Seasonal Depression?

Seasonal depression, often called seasonal affective disorder (SAD), is a depression that occurs each year at the same time, usually starting in fall or winter and ending in spring or early summer. It is more than just "the winter blues" or "cabin fever." A rare form of SAD known as "summer depression," begins in late spring or early summer and ends in fall.
Symptoms

People who suffer from SAD have many of the common signs of depression: Sadness, anxiety, irritability, loss of interest in their usual activities, withdrawal from social activities, and inability to concentrate. They often have symptoms such as extreme fatigue and lack of energy, increased need for sleep, craving for carbohydrates, and increased appetite and weight gain.

Symptoms of winter SAD include:

• Fatigue
• Increased need for sleep
• Decreased levels of energy
• Weight gain
• Increase in appetite
• Difficulty concentrating
• Increased desire to be alone
• Symptoms of summer SAD include:
• Weight loss
• Trouble sleeping
• Decreased appetite

How Common Is SAD?

Between 4%-6% of the U.S. population suffers from SAD, while 10%-20% may suffer from a more mild form of winter blues. Three-quarters of the sufferers are women, most of whom are in their 20s, 30s, and 40s. Though SAD is most common during these ages, it can also occur in children and adolescents. Older adults are less likely to experience SAD.

This illness is more commonly seen in people who live at high latitudes (geographic locations farther north or south of the equator), where seasonal changes are more extreme. It is estimated that 1% of Florida residents, 4% of Washington, D.C., residents, and nearly 10% of Alaska residents suffer from SAD.

What Causes SAD?

The exact cause of this condition is not known, but the influence of latitude on SAD strongly suggests that it is caused by changes in the availability of sunlight. One theory is that with decreased exposure to sunlight, the biological clock that regulates mood, sleep, and hormones is delayed, running more slowly in winter. Exposure to light may reset the biological clock.
Another theory is that brain chemicals that transmit information between nerves, called neurotransmitters (for example, serotonin), may be altered in individuals with SAD. It is believed that exposure to light can correct these imbalances.

How Can I Tell If I Have SAD?

It is very important that you do not diagnose yourself. If you have symptoms of depression, see your doctor for a thorough assessment. Sometimes physical problems can cause depression. But other times, symptoms of SAD are part of a more complex psychiatric problem. A health professional should be the one to determine the level of depression and recommend the right form of treatment.

How Is SAD Treated?

Research now shows that light therapy is an effective treatment for SAD. Sometimes antidepressant medicine is used alone, or in combination with light therapy. Spending time outdoors during the day can be helpful, as well as maximizing the amount of sunlight you're exposed to at home and in the office.

What Is Light Therapy, And Is It Safe?

Light therapy, sometimes called phototherapy, is administered by a device that contains white fluorescent light tubes covered with a plastic screen to block ultraviolet rays. The intensity of light emitted (Lux) should be at least 10,000 Lux. The patient does not need to look directly into the light, but reads or eats while sitting in front of the device at a distance of 2 to 3 feet. Light therapy is safe and generally well tolerated.

Minor side effects of light therapy include:

• eye strain
• headache
• irritability
• fatigue
• insomnia

At What Time of the Day and for How Long Should I Use Light Therapy?

Recent studies suggest that morning light therapy is more effective than evening treatments. Using this treatment too late in the day may also produce insomnia. Many health professionals today prefer to treat SAD with 10,000 Lux for 30 minutes every morning. Patients have shown some improvement within 2 to 4 days and reach full benefits within 2 to 4 weeks. The symptoms of SAD return quickly after discontinuation of light therapy, so light treatment should be continued throughout the entire season of low sunlight.

Even though they generate enough light, tanning beds should not be used to treat SAD. The amount of ultraviolet (UV) rays they produce is harmful to the skin and eyes.

Can I Prevent the Onset of SAD?

If you or someone you know has the symptoms of SAD, see your doctor for a thorough examination. You want to make sure that these symptoms are not caused by another form of depression or major medical illness. Other types of depression can result in harm and even suicide.

If you have been diagnosed with SAD, here are some things you can do to help to prevent it from coming back:

Try to spend some amount of time outside every day, even when it's very cloudy. The effects of daylight are still beneficial.

Begin using a light box upon the onset of low sunlight (fall season), even before you feel the onset of winter SAD.

Eat a well-balanced diet, including sufficient amounts of vitamins and minerals as recommended by the FDA. This will help you have more energy even though your body is craving starchy and sweet foods.

Try exercising for 30 minutes a day, three times a week.
Seek professional counseling, if needed, during the winter months.
Stay involved with your social circle and regular activities. This can be a tremendous means of support during winter months.

If your symptoms become severe and you or someone you know are having thoughts of suicide, call your doctor right away or go to the nearest emergency room.

Chronic Depression (Dysthmia)

What Is Dysthymia?

Dysthymia, sometimes referred to as chronic depression, is a less severe form of depression but the depression symptoms linger for a long period of time, perhaps years. Those who suffer from dysthymia are usually able to function adequately, but seem consistently unhappy.

It is common for a person with dysthymia to also experience major depression at the same time - swinging into a major depressive episode and then back to a more mild state of dysthymia. This is called double depression.

Symptoms of Dysthymia Are the Same as Those of Major Depression and Include:

• Difficulty sleeping
• Loss of interest or the ability to enjoy oneself
• Excessive feelings of guilt or worthlessness
• Loss of energy or fatigue
• Difficulty concentrating, thinking or making decisions
• Changes in appetite
• Observable mental and physical sluggishness
• Thoughts of death or suicide

Who Experiences Dysthymia?

According to the National Institute of Mental Health, approximately 10.9 million Americans aged 18 and older are affected by dysthymia.

How Is Dysthymia Diagnosed?

If you are depressed and have had symptoms for more than two weeks, see your doctor or a psychiatrist. Your provider will perform a thorough medical evaluation, paying particular attention to your personal and family psychiatric history.

There is no blood, X-ray or other laboratory test that can be used to diagnose dysthymia.
A mental health specialist generally makes the diagnosis based on the person's symptoms. In the case of dysthymia, these symptoms will have lasted for longer and be less severe than in patients with major depression.

What Treatments Are Available for Dysthymia?

Dysthymia is a serious but treatable illness. Some people with dysthymia may do well with psychotherapy or "talk" therapy alone. But in some cases that is not adequate and your doctor may prescribe antidepressant medication as well.

Bipolar Depression (Manic Depressive Order)

What Is Bipolar Disorder?

Bipolar disorder, also called "manic-depressive" disease, is a mental illness that causes people to have severe high and low moods. People with this illness switch from feeling overly happy and joyful (or irritable), to feeling very sad. Because of the highs and the lows -- or two poles of mood -- the condition is referred to as "bipolar" disorder. In between episodes of mood swings, a person may experience normal moods.

The word "manic" describes the periods when the person feels overly excited and confident. These feelings can quickly turn to confusion, irritability, anger and even rage. The word "depressive" describes the periods when the person feels very sad or depressed. Because the symptoms are similar, sometimes people with bipolar depression are incorrectly diagnosed as having major depression.

Most individuals with bipolar disorder spend more time in depressed phases than in manic phases.

Symptoms

The dramatic and rapidly changing mood swings from highs to lows do not follow a set pattern, and depression does not always follow manic phases. A person may also experience the same mood state several times before suddenly experiencing the opposite mood. Mood swings can happen over a period of weeks, months and sometimes even years.

The severity of the depressive and manic phases can differ from person to person, and even in the same person at different times.
Symptoms of mania ("The Highs"):

• Excessive happiness, hopefulness, and excitement
• Sudden changes from being joyful to being irritable, angry and hostile
• Restlessness
• Rapid speech and poor concentration
• Increased energy and less need for sleep
• High sex drive
• Tendency to make grand and unattainable plans
• Tendency to show poor judgment, such as deciding to quit a job
• Drug and alcohol abuse
• Increased impulsivity

Some patients can become psychotic, seeing and hearing things that aren't there and holding false beliefs from which they cannot be swayed. In some instances they see themselves as having superhuman skills and powers, or think they are god-like.

The symptoms of bipolar depression are the same as those of major depression and include:

• Sadness
• Loss of energy
• Feelings of hopelessness or worthlessness
• Loss of enjoyment from things that were once pleasurable
• Difficulty concentrating
• Uncontrollable crying
• Difficulty making decisions
• Irritability
• Increased need for sleep
• Insomnia or excessive sleep
• A change in appetite causing weight loss or gain
• Thoughts of death or suicide
• Attempting suicide

Who Experiences Bipolar Disorder?

According to the National Institute of Mental Health, over 2 million American adults have bipolar disorder. Bipolar disorder usually begins in early adulthood, appearing before age 35. Children and adolescents, however, can develop this disease in more severe forms and often in combination with attention deficit hyperactivity disorder (ADHD). Some studies have indicated that bipolar depression is genetically inherited, occurring more commonly within families.
While bipolar disorder occurs equally in women and men, women with bipolar disorder may switch moods more quickly -- this is called "rapid cycling." Varying levels of sex hormones and activity of the thyroid gland in the neck, together with the tendency to be prescribed antidepressants, may contribute to the more rapid cycling seen in women. Women may also experience more periods of depression than men.

An estimated 60% of all people with bipolar disorder have drug or alcohol dependence. It has also been shown to occur frequently in people with seasonal depression and certain anxiety disorders, like posttraumatic stress disorder (PTSD).

What Causes Bipolar Disorder?

A definite cause for any type of depression is difficult to determine but may include genetics, changes in the chemical make-up of the brain, and environmental factors like stress and major life changes. More research is being done to determine the relationship that these factors have in bipolar disorder, how they may help prevent its onset, and what role they may play in its treatment.

How Is Bipolar Disorder Diagnosed?

A diagnosis of bipolar disorder is made only by taking careful note of symptoms and their severity, length, and frequency. The most telling symptoms include severe mood swings (going from extreme highs to extreme lows) that don't follow a set pattern. Reviewing collateral history from close friends and family is often very helpful to distinguish bipolar disorder from major depression.

If you or someone you know is experiencing symptoms of bipolar disorder, seek the advice of your family healthcare provider or a psychiatrist. A referral may then be made to an appropriate mental health expert.

A thorough medical evaluation should be performed. Your doctor will ask questions about your personal and family history of mental illness. You may also be asked to complete a depression screening questionnaire -- a series of structured questions that you will be asked to answer verbally or in writing.

What Are The Treatments?

Bipolar disorder is a long-term illness that requires management throughout a person's life. People who have numerous (four or more) episodes of mood changes (rapid cycling) in a year can be much more difficult to treat. Medication is the primary form of treatment, but the additional use of psychotherapy or "talk" therapy is sometimes recommended to help prevent future episodes.

There are many medications available to treat bipolar depression.
Lithium (brand names Eskalith, Lithobid, Lithonate), a mood-stabilizing drug, is the most commonly prescribed medicine for people with bipolar disorder. It has proven helpful in controlling mood swings in both directions from mania to depression and from depression to mania. Lithium will reduce symptoms of mania within two weeks of starting therapy, but it may take weeks to months before the condition is completely controlled. Thus other drugs like antipsychotic drugs or antidepressant drugs may also be used to help control symptoms.

Common side effects of lithium include:

• Frequent need to urinate
• Weight gain
• Increased thirst
• Slight trembling of the hands
• Nausea

Thyroid and kidney problems are a concern, so your doctor will monitor the function of your thyroid and kidneys as well as monitor the levels of lithium in your blood since levels can easily become too high. Anything that lowers the level of sodium in the body, such as switching to a low-sodium diet, heavy sweating, fever, vomiting or diarrhea may cause a buildup of lithium in the body and toxicity. Be aware of these conditions and alert your doctor if you are on lithium and experience them.

The following are signs of a lithium overdose. Call your doctor immediately or go to the nearest emergency room if you experience:

• Blurred vision
• Irregular pulse
• Extremely fast or slow heartbeat
• Difficulty breathing
• Confusion
• Convulsions
• Dizziness
• Severe trembling
• Need to pass large amounts of urine
• Uncontrolled eye movements
• Double vision
• Unusual bruising or bleeding

Depakote is an antiseizure medicine also effective for controlling mania. It is highly effective for people with rapid-cycling bipolar disorder. The drug has some side effects, can cause inflammation of the liver and can decrease the amount of platelets (blood cells needed for blood to clot) that the body makes so your doctor will monitor levels of Depakote as well as liver function and platelet counts.

Common side effects of valproate include:

• Sedation
• Stomach cramps
• Diarrhea
• Indigestion
• Nausea
• Weight gain
• Slight trembling of hands
• Other antiseizure medicines often used to treat bipolar disorder include Tegretol,
• Lamictal, Neurontin and Topamax.

Most people with bipolar disorder take more than one medication. Along with the mood stabilizer -- either lithium or an anticonvulsant, they may take a medication for agitation, anxiety, insomnia or depression.

Many antidepressants can be used with mood stabilizing drugs to manage the depression of bipolar disorder. If used alone, an antidepressant can push a person with the condition into a manic state.

What Can I Expect After Treatment?

For most people, a good treatment program can stabilize severe moods and provide effective symptom relief. Treatment that is continual has proven more effective in preventing relapses and controlling cycling. Those who also have a substance abuse problem may need more specialized treatment.

Can Bipolar Disorder Be Prevented?

There is no known method to prevent bipolar disorder. Because its exact cause has not yet been determined, it is especially important to know its symptoms and seek early intervention. Some people who experience bipolar disorder may become suicidal. By knowing how to recognize these symptoms, there is a better chance for effective treatment and finding coping methods that may prevent long periods of illness, extended hospital stays and suicide.

Depression: Major Depression

An individual with major depression feels a profound and constant sense of hopelessness and despair.

Major depression is manifested by a combination of symptoms that interfere with the ability to work, study, sleep, eat and enjoy once pleasurable activities. Such a disabling episode of depression may occur only once but more commonly occurs several times in a lifetime.

Who Experiences Major Depression?

In the U.S., approximately 10% of people suffer from major depression at any one time and 20%-25% suffer an episode of major depression at some point during their lifetimes. Most people associate depression with adults, but it also occurs in children and the elderly -- two populations in which it often goes undiagnosed and untreated.

Approximately twice as many women as men suffer from major depression. This is partially because of hormonal changes throughout a woman's life: During menstruation, pregnancy, miscarriage and menopause. Other contributing factors include increased responsibilities in both professional and home lives -- balancing work while taking care of a household, raising a child alone, or even caring for an aging parent. However, depression in men may also be underreported.

Men who suffer from major depression are less likely to seek help or even talk about their experience. Signs of depression in men are more often irritability, anger, or drug and alcohol abuse. Repressing their feelings can result in violent behavior directed both inwardly and outwardly, and an increase in illness, suicide and homicide.

What Factors Can Trigger Depression?

• Grief (loss of a loved one through death, divorce, or separation).
• Interpersonal disputes (conflict with a significant other or a superior; physical, sexual, or emotional abuse).
• Role transitions (moving, graduation, job change, retirement).
• Interpersonal deficits (leading to social isolation or feelings of being deprived).
• Not everyone has a trigger for a depressive episode.

How Is Major Depression Diagnosed?

If you are depressed and have had symptoms for more than two weeks, see your doctor or a psychiatrist. Your doctor will perform a thorough medical evaluation, paying particular attention to your personal and family psychiatric history. You may be asked to complete a depression screening test.

There is no blood, X-ray, or other laboratory test that can be used to diagnose major depression. However, your doctor may run some blood tests to help detect any other medical problems that have symptoms similar to those of depression (such as hypothyroidism).

What Treatments Are Available For Major Depression?

Major depression is a serious, but treatable, illness. Your doctor will most likely give you a prescription antidepressant medication. He or she may also suggest that you receive a specialized form of "talking" counseling called psychotherapy.

Certain medicines work better for some people. It is important to talk to your doctor about finding a treatment that fits your lifestyle. It may be necessary for your doctor to try different drugs at different doses. Aside from taking them, there is very little way to determine which medicine will work best for you.

Can Major Depression Be Prevented?

Once you have had an episode of major depression, you are at high risk of having another. The best way to prevent another episode of depression is to be aware of the triggers of depression (see above), know the symptoms of depression in you, and to seek help early if you need it.

Are There Different Types of Depression?

Although these signs and symptoms of depression are characteristic, they can occur in different patterns, like seasonal symptoms, or in association with manic features.
Types include:

• Major depression
• Bipolar depression
• Chronic Depression or Dysthymia
• Seasonal Depression
• Psychotic Depression
• Postpartum Depression
  

What Are the Symptoms of Depression?

These are some of the signs and symptoms of depression that you should be aware of:

• Sadness
• Loss of enjoyment from things that were once pleasurable
• Loss of energy
• Feelings of hopelessness or worthlessness
• Difficulty concentrating
• Difficulty making decisions
• Insomnia or excessive sleep
• Stomachache and digestive problems
• Sexual problems (for example, decreased sex drive)
• Aches and pains (such as recurrent headaches)
• A change in appetite causing weight loss or gain
• Thoughts of death, suicide, or self-mutilation
• Self-mutilation or attempting suicide

Depression Basics

Everyone at one time or another has felt depressed, sad, or blue. Being depressed is a normal reaction to loss, life's struggles, or an injured self-esteem. But sometimes the feeling of sadness becomes intense, lasting for long periods of time and preventing a person from leading a normal life. Depression that has these characteristics is a treatable medical condition called major depressive disorder, one of a number of depressive illnesses. Types of depression include: Major depression, chronic depression (dysthymia), bipolar depression, and seasonal depression (seasonal affective disorder or SAD).

According to a report from the National Institute of Mental Health, nearly 18.8 million Americans over the age of 18 suffer from major depression. Suicide, closely linked to depression, is the third leading cause of death in 10- to 24-year-olds. Unfortunately, most people never seek treatment. Left undiagnosed and untreated, depression can worsen, lasting for years and causing untold suffering, and possibly even result in suicide.