Depression: Battling the Winter BluesJanuary 2012

Outline

What is Depression? Types of Depression Seasonal Affective Disorder (SAD) Do You Know the Signs? Treatment Physical Activity and Nutrition Common Myths About Depression Conclusion

This presentation is for informational purposes only. It should not be taken as medical advice. Please check with your doctor for customized recommendations for you which will be based on, among other things, your prior

medical history, current medical status and your doctor’s understanding of your health risks and needs.

*If otherwise not indicated

Content Source*

The doctor of the future

will give no medicine,

but will interest his patients

in the care of the human frame,

in diet, and in the

cause and prevention of disease.

Thomas Edison, Inventor

Definition

Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration.

These problems can become chronic or recurrent and lead to substantial impairments in an individual's ability to take care of his or her everyday responsibilities.

Source: World Health Organization

Depression Costs

Workplace Costs of Over $34 Billion per Year in Direct and Indirect Costs

Major depression is associated with more annual sick days and higher rates of short-term disability than other chronic diseases

People suffering from depression have high rates of absenteeism (in some cases, three times more sick days than non-depressed workers) and are less productive at work

Source: National Alliance on Mental Illness

Background

Depression and anxiety are two major causes of illness and death in the United States and are associated with reduced quality of life, social functioning, and excess disability.

Psychiatric conditions such as depression can contribute to or worsen chronic diseases.

Depression and anxiety frequently co-occur and when they do they have an even greater impact than when they occur alone.

Some Types of Depression

Major DepressionAtypical DepressionPsychotic DepressionDysthymiaManic DepressionPostpartum DepressionPostpartum depressionPremenstrual Dysphoric DisorderSeasonal Affective Disorder (SAD)

Seasonal Affective Disorder (“Winter Blues”)

Seasonal affective disorder, or SAD, is a type of depression that affects a person during the same season each year.

Anyone can get SAD, but it is more common in:– People who live in areas where winter days are very short or there are

big changes in the amount of daylight in different seasons.– Women.– People between the ages of 15 and 55. The risk of getting SAD for the

first time goes down as you age.– People who have a close relative with SAD.

Symptoms

Difficulty concentrating. Low energy and fatigue. Reduced interest in daily activities, especially social activities. Moodiness (depressed, sad, or unusually quiet). Increased appetite. Cravings for complex carbohydrates (such as pasta and bread). Weight gain. Increased sleep. Loss of interest in sex. Irritability.

People with SAD may either have symptoms of major depression or minor depression.

Do You Know the Signs?

Someone who is depressed has feelings of sadness or anxiety that last for weeks at a time. He or she may also experience:

Feelings of hopelessness and/or pessimism Feelings of guilt, worthlessness, and/or helplessness Irritability, restlessness Loss of interest in activities or hobbies once pleasurable Fatigue and decreased energy Difficulty concentrating, remembering details, and making decisions Insomnia, early-morning wakefulness, or excessive sleeping Overeating, or appetite loss Thoughts of suicide, suicide attempts Persistent aches or pains, headaches, cramps, or digestive problems that

do not get better, even with treatment

Exams and Tests

Before diagnosing you with seasonal affective disorder (SAD), a doctor will ask about your medical history.

Your doctor may order blood tests to check for other conditions, such as hypothyroidism, that could be causing your depression.

He or she also may ask you to complete a questionnaire regarding changes in your sleep patterns, social activity, mood, weight, appetite, and energy levels.

Examples of Questions

The questionnaire may ask the following:

– Do you feel a dramatic reduction in energy when the days get shorter?– Do you have difficulty waking up in the morning?– Do you sleep more than you used to or sleep too much?– Are you eating more than you used to or more than you should?– Have you gained weight?

Evaluation (Cont.)

Your doctor may also do a mental health assessment, which includes an evaluation of your emotional functioning and your ability to think, reason, and remember (cognitive functioning).

The assessment may also include written or verbal tests and lab tests (such as blood and urine tests).

During the interview, your doctor will assess your appearance, mood, behavior, thinking, reasoning, memory, and ability to express yourself and may ask about your personal relationships and family history of SAD.

Treatment: Light Therapy

Research has shown that light therapy is an effective treatment for SAD.

There are two types of light therapy:

– Bright light treatment: you sit in front of a "light box" for a certain amount of time (usually in the morning), and dawn simulation, which is done while you sleep.

– Dawn simulation: done while you sleep. A low-intensity light is timed to go on at a certain time in the morning before you wake up, and it gradually gets brighter.

Treatment: Light Therapy

Light boxes are available commercially and use fluorescent lights that are brighter than indoor lights but not as bright as sunlight.

You place the light box at a specified distance from you on a desk or in front of a chair and use it while you read, eat breakfast, or work at a computer. Light therapy is usually prescribed for 30 minutes to 2 hours, depending on the intensity of the light used and on whether you are starting out or are using it to maintain a response.

Ultraviolet light, full-spectrum light, tanning lamps, and heat lamps should not be used.

What’s Better and For How Long? Some people find dawn simulation light therapy more convenient because

it works as they sleep.

Light box therapy, which some studies have shown to be most effective if done in the morning, may be less convenient for people who have busy schedules.

Some studies have found that dawn simulation therapy is not as effective as bright light (light box) therapy.

It may take as little as 3 to 5 days or up to 2 weeks before you respond to light therapy. Stopping light therapy will likely cause you to relapse back into depression.

Light therapy will need to be continued for the entire time you are depressed. People who discontinue treatment usually lapse back into depression.

Is Light Therapy safe?

Generally safe, may use it together with other treatments.

The most common side effects of light therapy include:– Eyestrain or visual disturbances.– Headaches.– Agitation or feeling "wired."– Nausea.– Sweating.

You can relieve these side effects by decreasing the amount of time you spend under the light.

Is light therapy safe? (Cont.)

People who have sensitive eyes or skin should not use light therapy without first consulting a doctor.

If you have eye problems or you take medicines that make you light-sensitive, ask your doctor about whether light therapy is safe for you. Before you start treatment, tell your doctor about any other conditions you have and about the medicines you are taking .

Important to discuss with your doctor first.

Exercise

Being physically active during the daytime, especially first thing in the morning during winter, may help improve your energy level and relieve depression. Moderate exercises like walking, stationary cycling, and swimming are a good way to start an exercise routine. Muscle strengthening exercises are important as well.

Moderate activity for at least 2½ hours a week. One way to do this is to be active 30 minutes a day, at least 5 days a week. Moderate activity means things like brisk walking, brisk cycling, or shooting baskets. You notice your heart beating faster with this kind of activity.

Vigorous activity for at least 1¼ hours a week. One way to do this is to be active 25 minutes a day, at least 3 days a week. Vigorous activity means things like jogging, cycling fast, or cross-country skiing. You breathe rapidly and your heart beats much faster with this kind of activity.

Research on Exercise and Depression: A long history

Franz & Hamilton, 1905; Vaux, 1926: suggested a relationship between exercise and decreased depression

Since the early 1900s, there have been over 100 studies examining this relationship

During the 1990s there have been at least five meta-analytic reviews (Craft, 1997; Calfas & Taylor, 1994; Kugler et al., 1994; McDonald & Hodgdon, 1991; North, McCullagh, & Tran, 1990) that have examined studies ranging from as few as nine (Calfas & Taylor, 1994) to as many as 80 (North et al., 1990)

Depression and Exercise Findings

Across these five meta-analytic reviews, the results consistently show that both acute and chronic exercise are related to a significant reduction in depression.

The findings indicate that the antidepressant effect of exercise begins as early as the first session of exercise and persists beyond the end of the exercise program (Craft, 1997; North et al., 1990).

These effects are also consistent across age, gender, exercise group size, and type of depression inventory.

Mental Health Benefits of Physical Activity

Reduced anxiety Best results with “aerobic exercise” Best after weeks of regular exercise Best benefits to those who are low fit to begin with Best benefits for those high in anxiety to begin with

Reduced depression Best after weeks of regular exercise Best when done several times a week Best with more vigorous exercise Best for those who are more depressed

Source: The Influence of Exercise on Mental Health Daniel M. Landers ; SERIES 2, NUMBER 12, OF THE PCPFS RESEARCH DIGEST

Nutrition Eating a healthy, balanced diet is helpful for any type of depression and may help

relieve some of the symptoms of SAD.

Initial research suggests the following complementary treatments may be helpful in treating symptoms of SAD, although there currently is not enough scientific evidence to prove their usefulness.– There is some evidence that an herb called St. John’s wort may help ease depression

symptoms.– Melatonin is a hormone that may help regulate your biological clock (circadian

rhythms). But you need to take a very low dose at a specific time of the day.

Be sure to check with your doctor before you try these complementary therapies, because they may interact with other medications you are taking.

You should not take St. John's wort if you are taking other antidepressants. St. John's wort may also cause light sensitivity. If you are using light therapy, you may want to discuss with your doctor whether St. John's wort is right for you in the treatment of SAD.

CDC's Behavioral Risk Factor Surveillance System (BRFSS)

Depression vs Obesity by State

Depression Treatment: Medications

Types of antidepressants include:

– Selective serotonin reuptake inhibitors (SSRIs)– Serotonin and norepinephrine reuptake inhibitors (SNRIs)– Norepinephrine and dopamine reuptake inhibitors (NDRIs)– Atypical antidepressants– Tricyclic antidepressants– Monoamine oxidase inhibitors (MAOIs)– Other medication strategies

Depression Treatment: Other Psychotherapy

– Cognitive behavioral therapy is one of the most commonly used therapies. This type of therapy helps you identify negative beliefs and behaviors and replace them with healthy, positive ones.

• It's based on the idea that your own thoughts — not other people or situations — determine how you feel or behave. Even if an unwanted situation doesn't change, you can change the way you think and behave in a positive way.

– Interpersonal therapy• The precise focus of the therapy targets interpersonal events (such as interpersonal

disputes / conflicts, interpersonal role transitions, complicated grief that goes beyond the normal bereavement period) that seem to be most important in the onset and / or maintenance of the depression.

– Psychodynamic psychotherapy• Psychodynamic therapy focuses on the psychological roots of emotional suffering.

Its hallmarks are self-reflection and self-examination, and the use of the relationship between therapist and patient as a window into problematic relationship patterns in the patient’s life. Its goal is not only to alleviate the most obvious symptoms but to help people lead healthier lives.

Source: International Society for Interpersonal Psychotherapy, American Psychology Association

Depression Treatment: Other (cont.)

If standard depression treatment hasn't been effective, your psychiatrist may consider whether you might benefit from a less commonly used procedure, such as: – Electroconvulsive therapy (ECT). In ECT, electrical currents are passed through

the brain. This procedure is thought to affect levels of neurotransmitters in your brain. Although many people are leery of ECT and its side effects, it typically offers immediate relief of even severe depression when other treatments don't work. It's unclear how this therapy relieves the signs and symptoms of depression. The most common side effect is confusion, which can last from a few minutes to several hours. Some people also have memory loss.

– Vagus nerve stimulation. This treatment uses electrical impulses with a surgically implanted pulse generator to affect mood centers of the brain. This may be an option if you have chronic, treatment-resistant depression.

– Transcranial magnetic stimulation. With this treatment, powerful magnetic fields are used to alter brain activity. A large electromagnetic coil is held against your scalp near your forehead to produce an electrical current in your brain.

Depression Treatment: Important to keep in mind

May require hospitalization

Alcohol and Illicit Drugs are not a treatment. It may seem like alcohol or drugs lessen depression symptoms, but in the long run they generally worsen symptoms and make depression harder to treat

Advice for caregivers

Sometimes family members and friends are not sure how to help someone who has seasonal affective disorder. It may help to:

– Spend time with your loved one even though he or she may be withdrawn or quiet.

– Offer to help with daily tasks that temporarily may be too difficult to do alone. But it is important that you do not enable the person to remain depressed by taking over all of his or her daily responsibilities.

– Take a walk or do some other type of exercise activity together. Getting out first thing in the morning for a walk may be helpful.

– Help the person to stay with the prescribed treatment plan.

Suicide Warning Signs Parents should be particularly vigilant for signs that may indicate that their

child is at risk for suicide. Warning signs of suicidal behavior in children include:– Many depressive symptoms (changes in eating, sleeping, activities)– Social isolation– Talk of suicide, hopelessness, or helplessness– Increased acting-out behaviors (sexual/behavioral)– Increased risk-taking behaviors– Frequent accidents– Substance abuse– Focus on morbid and negative themes– Talk about death and dying– Increased crying or reduced emotional expression– Giving away possessions

Some Common MythsDepression is not a real medical illness.

Even if depression is a medical illness, there’s nothing that can be done about it.

Depression is no different from getting the “blues” – and this is just a normal part of life.

Depression only happens when something bad happens in your life, such as a breakup, the death of a loved one, or failing an exam.

People who think they have depression are just feeling sorry for themselves.

Some Common Myths (Cont.)

Depression is something that strong people can “snap out of” by thinking positively. If you can’t, you are weak.

Depression will go away by itself.

Depression is a normal part of getting older.Depression only affects women.Depression does not affect children or teenagers — their

problems are just a part of growing up. If someone in your family suffers from depression, you will inherit

it.

Talking about depression only makes it worse.

Worksite Awareness

Raise your own awareness and the awareness among managers through training on the signs and symptoms of depression

Managers and employees who are able to recognize the signs and symptoms of depression such as tardiness, complaints of fatigue, reduction in work output or quality, safety problems or accidents, and changes in attitude may help in the early identification and referral to screening and treatment services for affected employees

Regular surveys to ascertain information about relationships among coworkers (e.g., conflicts); job demands such as time pressures or physical demands; and assess the level of support provided by supervisors and colleagues which may contribute to the mental health of workers and be used to develop training, communications, or other interventions to address mental health in the workplace

Worksite InterventionsEmployee Assistance Programs (EAPs) can offer information

and referral services for employees with symptoms of depression– Active EAPs are one of the most effective ways employers support

employees with depression or other mental health problems, by offering counseling and referral services.

It is important to recognize that EAP programs are generally contracted benefits outside of the organization

Worksite health promotion programs such as physical activity are good adjunct therapies in preventing and treating depression– Employees who participate in physical activity programs can decrease

depression symptoms and sometimes avoid mild depressive episodes

Treatment Works: Get Help for Depression and Anxiety

Many Americans suffer from mental conditions such as depression and anxiety.

Studies show these health problems and illnesses affect about 1 in 5 Americans.

A tough situation such as a natural disaster, the loss of a loved one, or financial distress can trigger or increase depression and anxiety.

Depression is a true and treatable medical condition. Most people get better with treatment.

Try not to let hopelessness or shame stop you or a friend from getting medical help. Take action.

Where to Find Help

If you or someone you care about is in crisis, please seek help immediately.

Call 911

Visit a nearby emergency department or your health care provider's office

Call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY: 1-800-799-4TTY (4889) to talk to a trained counselor

Additional Resources

National Institute of Mental Health (NIMH)Phone: (866) 615-6464http://www.nimh.nih.gov/

American Psychiatric Association (APA)Phone: (703) 907-7300http://healthyminds.org/cmhdepression.cfm

Depression and Bipolar Support Alliance (DBSA) Phone: (800) 826 -3632 http://www.dbsalliance.org/

Substance Abuse and Mental Health Services Administration (SAMHSA)Phone: (800)-789-2647http://www.samhsa.gov/http://whatadifference.org/index.html

Other: National Alliance on Mental Illness (www.nami.org)

http://www.nami.org/template.cfm?section=Education_Training_and_Peer_Support_Center

www.ThePreventionPlan.com

The material presented in this presentation was for informational purposes only. It should not be taken as medical advice. Please check with your doctor for customized recommendations for you which will be based on, among other things, your prior medical

history, current medical status and your doctor’s understanding of your health risks and needs.