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 Psychological & Emotional Health

November 2009
Winter Blues
Dr Savita Date Menon
Are you SAD? No, I do not mean the teary, weepy, nobody-loves-me kind. Do you feel down and depressed often? Are you low on interest and energy? Not too good with sleep? Food is the last thing on your mind and you are losing weight without any pain? Life looks pretty bleak and hopeless? These symptoms describe some or many of you.

If you see a pattern that for the last few years this suffering falls on you at the same time each year, you may be 'SAD', or you may be undergoing Seasonal Affective Disorder. SAD is a type of depression that is triggered by seasons – mostly winter. Come winter, some experience SAD; and with spring, the symptoms seem to vanish. Changes in the amount of daylight during different times of the year seem to be the reason for SAD.
While there are no India-specific SAD studies, the harshness of Indian summers, the relentlessness of the monsoons in Mumbai and other parts of the country, the annual onslaught of cyclones in Orissa may be more relevant weather triggers for SAD in India.

Moods and Affects
What is an Affective Disorder? How do you know that what you are going through is more than just a loss of job or relationship? That you need help? That there is a name to what you are going through and hence treatment can set you right and get you back on track?

Affective Disorders, Mood Disorders, Major Depressive Disorders are terms often used interchangeably. The difference is mainly that 'mood' refers to a sustained internal emotional state, while 'affect' refers to the external expression of present emotional content.

Mood may be normal, elevated or depressed. We, the so-called normal people, experience a wide range of moods and have an equally large repertoire of affective expressions. But we are in control, more often than not, of our moods and affects. Mood disorders are a group of clinical conditions marked by a loss of that sense of control and a subjective experience of great distress.

Some people experience an elevated mood called 'Mania'. They show expansiveness, flight of ideas, seem to need very little sleep, have a heightened self esteem, grandiose ideas and plans. They love to talk and may even show an appetite for good cuisine and good humour.

Some others experience a depressed mood called Depression. They have low levels of energy and interest, sleep and appetite are affected, and feelings of guilt and hopelessness may be seen. They may even have thoughts about suicide and death. Concentration is difficult and speech may be slow and restricted.

The difference between normal moods, moodiness, mood swings and a mood disorder is, that the latter almost always results in impaired social, interpersonal and occupational functioning -- unless detected, diagnosed and treated.

Depression Checklist
  • Depressed mood most of the day, almost everyday.
  • Sad, empty, tearful most of the time. In children and adolescents –irritable mood most of the time.
  • Reduced interest or pleasure in almost all activities of the day, almost everyday.
  • Weight loss without any effort (over five percentof body weight in a month)
  • Increase or decrease in appetite and sleep.
  • Loss of energy or fatigue
  • Feelings of worthlessness
  • Feelings of excessive and inappropriate guilt.
  • Feeling of hopelessness.
  • Recurrent thoughts of suicide and death.
If these symptoms are not on account of grief, terrible loss, major illness, some addiction, significant distress, if they are extended over a two weeks period or more, and if you see several symptoms together, then it's safe to let the alarm bells ring.

Nature has been unkind to women, since a lifetime prevalence of 15% could go up to 25% in this gender. Family and friends often dismiss the symptoms of depression as understandable reaction to stress, grief etc. It is also attributed to a weak-willed personality or attention seeking for some secondary gain. On the other hand, it is also the most commonly used name by society at large since it appears to be the least unacceptable disorder to have in the family or in self.

While age and race do not show any significant difference in incidence, marital status does seem to matter. The divorced, separated, those with no/few close interpersonal relationships show a higher incidence against common belief that marriage makes people SAD!
The Manic Checklist
  • Inflated self esteem.
  • Feelings of grandiosity, thoughts, plans.
  • Need very little sleep. Three hours seem fine.
  • Talk too much. Talk non stop.
  • Thoughts flying from topic to topic.
  • Short attention span. Easily distracted.
  • Very purposeful behaviour.Too goal directed.
  • Increased involvement in pleasure– good food, good wine, buying sprees, indiscreet sex, foolish business investments.
If these symptoms persist for over 1-2 weeks, if they are not connected with a medical condition and if they are severe enough to disturb family, social, worklife, the earlier you seek treatment, the better.
Winter onset depression is most likely caused by the body's reaction to lack of sunlight. Light therapy is one treatment option to replace the lack of sunlight. A specially made light box or a light visor worn on the head like a cap is used with exposure upto 30 minutes each day. As always, side effects need to be watched for such as eyestrain, headache, fatigue, irritability, inability to sleep, skin sensitivity. Tanning beds are advised against, due to UV rays.

Medication is also used. Behaviour therapy is always a big help in coping better: Get Outdoors as much as possible, especially on sunny days. Eat lunch outdoors, go for long walks, soak up the sun on a park bench, go out in the sun whenever your circumstances permit.

Avoid negative coping methods like alcohol or nonprescription drugs. They will lead to additional problems.

Eat right. Overeating and comfort foods provide short-term comfort. Food is no cure for depression.

Exercise regularly. Exercise burns stress hormones and relieves anxiety. It is said to be the best internal antidepressant solution. The feel-good hormones, endorphins, released at the end of an exercise session further combat depression.

Manage your stresses since these may be the trigger points aggravating your SAD. Understand, analyse, prioritize, accept - use some or all of these methods with positivity.

Stay connected. Your close friends will provide you support, lend you a shoulder, make you feel stronger. If nothing, you will benefit from a few light moments spent together.

Take a trip out of town. This may be the perfect holiday time for you if weather is the only cause of your problems!
Dr. Savita Date Menon is a clinical psychologist, popular speaker, columnist and a guest faculty at Harvard Medical School, USA

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