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Depression: The Winter Blues? Chasing the Winter Blues Away

Depression: The Winter Blues? Chasing the Winter Blues Away. Richard P. Lafleur MD, FACP Medical Director Anthem Blue Cross in NH January 13 th , 2011. Agenda. Prevalence Definition Difference of Depression and SAD(Seasonal affective disorder) Effects Treatment Prevention.

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Depression: The Winter Blues? Chasing the Winter Blues Away

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  1. Depression: The Winter Blues? Chasing the Winter Blues Away Richard P. Lafleur MD, FACP Medical Director Anthem Blue Cross in NH January 13th, 2011

  2. Agenda Prevalence Definition Difference of Depression and SAD(Seasonal affective disorder) Effects Treatment Prevention

  3. Prevalence http://www.cdc.gov/Features/dsDepression/ -accessed 1/5/11 Depression affects 1 in 10 U.S. Adults

  4. State Specific Distribution http://www.cdc.gov/Features/dsDepression/- accessed 1/5/11

  5. Who is Affected More often meeting Criteria • Persons 45-64 years of age • Women • Blacks, Hispanics, non-Hispanic persons of other races or multiple races • Previously married • Individuals unable to work or unemployed • Alcohol Use

  6. Major Depression Feelings of Sadness Interferes with daily life Interferes with normal functioning Causes pain for the individual Cognitive issues Interferes with normal relationships http://www.cdc.gov/Features/dsDepression/- accessed 1/5/11 http://www.mayoclinic.com/health/seasonal-affective-disorder/ -accessed 1/5/11 Seasonal Affective Disorder (SAD) Feelings of sadness Occurring for 2 consecutive years During the same season every year Periods of depression followed by periods without depression No explanations for changes in mood or behavior What is depression?

  7. Causes Usually a combination of factors but no single cause • Genetics • Biochemical • Serotonin • Norepinephrine • Dopamine • Environmental • Physical stress • Psychologic factors • Emotional stress • MRI and PET scan changes in areas of the brain that affect mood, thinking, sleep, appetite and behavior consistant with neurochemicals “out of balance”

  8. SAD Associated Features • Female • Living far from Equator • Family history • Serotonin Levels low • Melatonin levels disrupted • Disruption of normal Sleep cycles (Circadian rhythm) http://www.cdc.gov/Features/dsDepression/- accessed 1/5/11 http://www.mayoclinic.com/health/seasonal-affective-disorder/ -accessed 1/5/11

  9. Effects of Depression • Absenteeism • Short term Disability • Decreased Productivity • Declining Health in Chronic Disease • Osteoartrhitis • Coronary Artery disease • Cancer treatment • Diabetes • Obesity • Relationship problems-personal, employment

  10. Treatment Standard Accepted treatment • Medication • Serotonin – fluoxetine, sertraline, citalopram • Serotonin and Norepinephrine combinations-Venalfaxine, duloxetine • Psycho therapy • Light therapy (more effective for SAD) • Electroconvulsive therapy (shock therapy-ECT) for severe cases http://www.cdc.gov/Features/dsDepression/- accessed 1/5/11 http://www.mayoclinic.com/health/seasonal-affective-disorder/ -accessed 1/5/11

  11. Treatment (cont) Less studied but frequently advocated (may have role in prevention) • Exercise • Diet • Healthy eating • Supplements- • Melatonin • St. Johns Wart (may interact with other drugs) • Omega – 3 fatty acids • Cold water fish, salmon, amkeral • Flaxseed • Soybean • Canola oils http://www.cdc.gov/Features/dsDepression/- accessed 1/5/11 http://www.mayoclinic.com/health/seasonal-affective-disorder/ -accessed 1/5/11

  12. Prevention • There is no known way to prevent depression or SAD • Therapies which may help symptoms- Prevention? • Exercise • Improved depression symptom scores • Community based Intervention Programs have shown decreased depression score in older adults • Supplements-as noted previously • Mind-Body therapies • Acupuncture • Yoga • Meditation • Guided Imagery • Massage therapy http://www.mayoclinic.com/health/seasonal-affective-disorder/ -accessed 1/5/11

  13. What can you do • Recognize • Medical Evaluation • Encourage Healthy behaviors • Reduce Stress/ stress management • Get plenty of rest • Exercise regularly • Refrain from alcohol (remember alcohol is a depressant) • Socialize- !! • Take a trip– to a sunny environment ! Might be the best Prescription

  14. Questions?

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