January 28, 2015

Breaking depression’s icy grip

By Steve Diogo

For many people, the onset of fall means more than raking leaves and breaking out bins of sweaters stored since June. Along with shortening days and dropping temperatures come signs of the onset of Seasonal Affective Disorder (SAD), a type of depression that occurs annually.

While there are cases of summer-onset SAD, the majority of people with SAD feel the effects in winter. It is estimated that as many as half a million Americans suffer from winter-onset SAD. Erik Nelson, MD, UC Health University of Cincinnati Physicians psychiatrist and member of the psychiatry faculty at the University of Cincinnati (UC) College of Medicine, says symptoms of winteronset SAD include depressed mood, changes in appetite and weight, fatigue, difficulty concentrating, changes in sleep (often oversleeping) and loss of interest in formerly enjoyable activities.

For recovering addicts, SAD is serious stuff. Researchers have found strong connections between substance abuse disorders and depression, and untreated depression can be a major source of relapse in recovering addicts. According to a National Institutes of Health study, almost one-third of individuals with depression had a coexisting substance use disorder at some point in their lives, and men with alcohol dependence were found to have rates of depression three times higher than the general population; alcohol dependent women had four times the rates of depression.

No one knows for sure what causes SAD, but researchers believe there are a few specific factors that may contribute to the disorder. Reduced sunlight may disrupt an individual’s internal clock, leading to feelings of depression. Melatonin—the hormone that encourages sleep—reaches its highest levels during fall and winter, when the nights are longer. The change in season can also cause low levels of serotonin, a brain chemical that affects mood.

Nelson says there are three options for treatment of SAD:

1. Light therapy, generally with a specially designed lamp giving off light that mimics the full spectrum and intensity of sunlight. Such devices are generally used for about 15 to 30 minutes in the morning, indirectly in the face. The light can be used while doing something else, such as reading or exercising.

2. Antidepressants. Bupropion (trade name Wellbutrin) has been approved by the FDA to treat seasonal major depressive episodes, but the proper medication for any individual case should be determined in consultation with a physician.

3. Cognitive behavioral therapy, a pragmatic interactive therapy that has the goal of changing specific behaviors. Properly conducted, Nelson says, it can reverse some of the depressive thoughts and feelings.

As with all mental health issues, only your physician is qualified to diagnose whether or not you suffer from SAD. If you feel yourself slipping into depression, contact your physician immediately to stave off the threat of relapse.

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