Pandemic, economy, disaffection can amplify SAD feelings

The Pacific Northwest’s drizzly, gray winters sometimes leave even then the most upbeat among us feeling down. 

This year, the added stressors of a global pandemic, a contentious election, and heightened awareness of systemic racism have created an intensity of pressure not experienced by most of us.  Most primary care providers have noticed an uptick in the number of patients seeking help with their mental health.  If you have concerns about your mood, please reach out.  The good news is that mood disorders are very common and we know a lot about how to treat them effectively.

To get a better handle on this, we spoke with Bryna Dunaway McCollum, MHS, PA-C, at the UW Medicine Northgate Clinic.

Q: What is Seasonal Affective Disorder or SAD? 

A: Seasonal Affective Disorder (SAD) is understood as a subtype of depression, either major depression or sometimes bipolar disorder.  It most commonly occurs during the fall and winter months but can happen during spring or summer as well.  Changes in the circadian rhythm and light exposure may play a role in these mood disorders.  In addition to standard treatments of medication and psychotherapy, light therapy boxes can play a role in the treatment of Seasonal Affective Disorder, or SAD. If you are interested in light therapy, talk to your medical provider about recommendations.  Typically a light device of 10,000 lux or higher is recommended for 30 minutes per day, usually in the morning.  

Q: What symptoms should I watch for?

A: While everyone feels sad or down from time to time, depression is different.  Lack of interest in doing your normal activities, sleeping or eating too much or too little, fatigue, loss of pleasure, or feelings that you have let yourself or your family down can all be symptoms of depression. If these symptoms last for more than two weeks and interfere with your ability to function at home, work, or school, this is depression. Please call your primary care provider or mental healthcare provider for help.  If you have any thoughts that you would be better off dead or hurting yourself in any way, please seek help right away by calling a crisis help line, 911, or going to the emergency room.  

Q: How common is depression?

A: About 25% people will experience depression at some point in their lifetimes.  It can happen to any person at any age.  Seasonal Affective Disorder, a particular type of depression, is estimated to affect between 0.5% to 3% of people per year.  

Q: Why do some people experience depression and others don’t?

A: Many factors can contribute to depression including genetics, neurotransmitters in your brain, having other medical illnesses, and stressful life events.  Thought patterns and relationships also can play a role in depression.  

Q: How can depression get worse all by itself?

A: Depression can feed on itself, which is a very important point.  Folks who have depression often withdraw from their normal activities such as exercise, hobbies, or social activities as a way to cope.  But this backfires and usually makes people feel worse.  

Q: What can I do to help myself feel better?  

A: One common, evidence based technique is called behavioral activation.  This means starting to do certain activities not necessarily because you feel up for doing them but because you know they are good for you.  Keeping a journal can help with this.  For instance, if you are planning to go for a walk outside with a friend you might rate your feelings as a 2 out of 10 before you go and then when you come home from the walk you might notice that your feelings are up to a 4 or 5 out of 10.  

Another technique is to look for all-or-nothing, black-or-white thinking patterns which are more common when people are feeling depressed.  If you find these try to replace them with a healthier thought.  For instance, you might find yourself thinking “I don’t have time for a full 30 minute workout today so there is no point in exercising.”  Try to replace that thought with something more helpful like “Even if I go outside and exercise for five or 10 minutes, that will be better than zero minutes.”  

Q: Should I consider a medication to help treat my symptoms?

A: There are many safe and effective medication options for the treatment of depression.  While most people respond to the first medication that is tried, dosage adjustments or switching to another medication may be necessary.  One exciting recent development in psychiatric treatment is the availability of pharmacogenomic testing to guide medication choices more precisely.  These tests may be used if you haven’t had an adequate response to the first medications you have tried or if you have had side effects with them.  The tests consist of a cheek swab done in a provider’s office and it identifies common genetic mutations which may alter your body’s ability to process medications.  

24-hour crisis phone lines 

• King County 206.461.3222, 866.427.4747
• Snohomish County 800.584.3578
• Crisis Text 741741 for access to a trained crisis counselor
• National Suicide Prevention Lifeline 800.273.8255
• WA Listens, nonclinical support for people experiencing stress due to COVID-19 - 833.681.0211

– Barbara Clements - bac60@uw.edu, 253.740.5043

For details about UW Medicine, please visit http://uwmedicine.org/about.