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Physician Health and Well-Being: Wintertime Depression

Wintertime Depression
By John A. Patterson MD, MSPH, FAAFP, ABIHM
Founding co-chair LMS Physician Wellness Program

Wintertime Depression
John A. Patterson MD, MSPH, FAAFP, ABIHM
Founding Co-chair, LMS Physician Wellness Program

Does the cold, dark winter take a toll on your mood? It does mine.

          Many of us feel an effect on our mood this time of year. Terms such as ‘winter blues’, ‘wintertime depression’ and ‘winter-onset depression’ refer to a potentially serious form of depression called ‘seasonal affective disorder’ (abbreviated SAD) which affects people during the coldest and (most importantly) darkest, months of the year. Though most people are affected from the fall into the winter, some suffer this annual change in mood in the spring and early summer.

          Common symptoms of SAD include depression, anxiety, low energy, loss of interest in previously pleasurable activities, physical symptoms such as headache, changes in appetite, weight and sleep, impaired concentration and memory, social withdrawal and isolation from friends and family. As with depression of any kind, it is important to take seriously any of the above symptoms, especially if they are a recurrent annual experience that persists for more than a few days or if they interfere significantly with work or personal life. It is especially important to seek professional help if there are any suicidal thoughts or a dependency on alcohol or other recreational drugs as a form or escape, denial or self-medication.


     Although the exact cause of SAD is unknown, there are several possible contributors. A reduction in natural daylight in fall and winter can affect the body’s internal clock, causing changes in circadian rhythms and blood levels of hormones and chemicals important in mood regulation – such as serotonin, dopamine, endorphins, oxytocin and melatonin.

          About 5% of Americans experience moderate to severe SAD symptoms and up to 20% experience a mild form. Women are affected by SAD more than men. People living in the far northern and far southern latitudes, farthest from the equator, where winters are darkest, are more affected. Those with a personal or family history of depression of any kind are more likely to be affected.

          As with other forms of depression, self-care approaches may help SAD and are worth trying if symptoms are mild, especially if such approaches have helped in previous years. Letting more light into the home and office can help- especially early morning light. Spending more time with supportive friends, family and pets can help. Vigorous physical exercise can help most forms of depression, including SAD. Exercising outdoors combines both these approaches. Yoga, meditation, mindfulness training, prayer, massage and acupuncture may be helpful. Although several herbs and supplements are promoted as having anti-depressant activity, some of them may also have adverse health effects, including interacting with medications or nutritional supplements.

          There is no diagnostic test for SAD. To establish the diagnosis of SAD and distinguish it from other forms of depression, it is necessary to document the recurrence of symptoms for at least 2 consecutive years at the same time of year. There must be depression-free intervals between periods of depression and other causes of depression must be ruled out.

          Once a diagnosis of SAD is made, there are several interventions that may work singly or in combination. These include anti-depressants, mental health counseling, light therapy (phototherapy) or a combination of approaches. Phototherapy involves sitting a few feet away from a light box with bulbs that emit light simulating the daylight wavelength spectrum. Phototherapy may worsen symptoms in those with bipolar disorder and menstrual irregularities, so this must be monitored. Confidence in safety and efficacy are increased by selecting a reputable product. Tanning beds should not be used for phototherapy as their light is high in ultraviolet rays that can harm both the eyes and skin.

          Anti-depressant medications used for SAD include those used for other forms of depression and selected after a thorough review of symptoms and medical history. Anti-depressants may take several weeks to show a beneficial effect. This is why it is important to discuss several treatment options and stay in close contact with prescribers or therapists during treatment.

          Any conversation with your prescriber, mental health counselor or chaplain/spiritual counselor must honestly describe the extent of the symptoms being experienced, especially if there has been any thought of self-harm or suicide. Many people, especially men, minimize the severity of such symptoms, believing they should be able to ‘snap out of it’ on their own. Mental health counseling can provide help not provided by medication alone. There are several ways to use such counseling to manage overall stress and re-train thoughts, attitudes and behaviors such that they are more mood-elevating and life-affirming.

          Please remember that it is not a sign of weakness to ask for help and share the extent of your emotional anguish with a trusted friend, faith community member, PCP or mental health professional. I did – and it helped. I also received my new light box in the mail yesterday. It’s shining on me right now as I type…….May you be well !

Resources
National Institute of Mental Health (NIH) – Seasonal affective disorder

Yale School of Medicine (Psychiatry) – extensive review of S.A.D.

About the Author

Dr Patterson is past president of the Kentucky Academy of Family Physicians and is certified in family medicine, integrative holistic medicine, mind-body medicine, hatha yoga, yoga nidra, Mindfulness-Based Stress Reduction (MBSR) and physician coaching. He teaches MBSR for UK Health and Wellness. He is on faculty of Saybrook College of Integrative Medicine and Health Sciences (Pasadena), the Center for Mind Body Medicine (Washington, DC) and U of Rochester (NY) Mindful Practice in Medicine. He operates the Mind Body Studio in Lexington, where he offers consultations and classes for persons with stress-related chronic conditions and burnout prevention for health professionals, teachers, businesses, faith communities and non-profits- emphasizing a mindfulness-based approach to promoting resilience, managing stress, preventing burnout and cultivating compassion.He can be reached through his website at www.mindbodystudio.org