Healthcare South
   Healthcare South
Healthcare South Home Page About Healthcare South Visit our pratices Useful forms Locate the information you are looking for Great links! Contact us How to benefit from our web site Patient information for new and current patients Parent resource and information center Health information for you and your family

ASK THE DOCTOR: Blue Christmas: Depression is more than just down in the dumps
By DR. JIM MITTERANDO

< Part 2 >

Q I have been feeling down lately. It seems every fall and winter I feel blue but this year is worse. I'm not sure how I'm going to make it through till spring.

A This time of year - with short days, cold weather and holidays on the horizon - is a common time for depression to set in.

Depression affects one in four women and one in eight men. It's an illness that involves the body, mood and thoughts. It affects the way you eat and sleep and feel about yourself. It is not the same as a passing ‘‘blue'' mood nor is it a sign of weakness or a condition that can be willed away. People with depression cannot merely ‘‘pull themselves together'' and get better. Without treatment, symptoms can last for months or years.

Symptoms:

  • No interest or pleasure in things you used to enjoy, including sex
  • Trouble concentrating and making everyday decisions
  • Feeling sad or numb
  • Crying spells
  • Decreased motivation
  • Feeling worthless, hopeless or guilty
  • Increased isolation from family and friends
  • Change in appetite; unintended change in weight
  • Problems sleeping, or wanting to sleep all of the time
  • Increased anxiety
  • Fatigue
  • Thoughts about death or suicide.

If you have several of these persistent symptoms, see a doctor or therapist.

What causes depression?

Your brain has chemical messengers (serotonin and norepinephrine) that help control your moods. When you don't have enough of these chemicals or your brain doesn't respond to them properly, you may become depressed.

Depression can be genetic (meaning it can run in families). Depression also can be linked to events in your life, such as the death of a loved one, a divorce or losing a job.

Most times, depression can simply creep up with no major life event causing it.

Decreased sunlight exposure with shorter days in the winter can cause chemical changes in the brain that make many people have the winter blues. Some people are more susceptible to depression with these chemical changes and experience what is called seasonal affective disorder.

Taking certain medicines, abusing drugs or alcohol, or having other illnesses can also lead to depression.

Hormonal factors - such as monthly menstrual cycle changes, pregnancy and menopause - may contribute to the higher rate of depression in women. In fact, drugs affecting serotonin (Prozac, Sarafem, Zoloft, Paxil, Celexa, Lexapro) can help with symptoms of premenstrual syndrome. Many women also face additional stresses such as responsibilities both at work and home, single parenthood, and caring for children and aging parents.

I will address treatment of depression including medications and counseling in my next column, two weeks from today. Medications and counseling take one to two months to fully work. During that time it is important to help yourself.

Depression makes you feel exhausted, worthless, helpless and hopeless. Such negative thoughts and feelings make some people feel like giving up. It is important to realize that these negative views are part of the depression and do not accurately reflect the actual circumstances. Negative thinking will disappear as your depression responds to treatment replaced by more positive thoughts.

What you can do

  • Set realistic goals in light of the depression and assume a reasonable amount of responsibility.
  • Break large tasks into small ones, set some priorities.
  • Try to be with other people and to confide in someone.
  • Participate in activities that may make you feel better.
  • Exercise, go to a movie, a ball game, or participate in religious or social activities.
  • Expect your mood to improve gradually, not immediately. Feeling better takes time.
  • Postpone important decisions - like marriage, divorce, job change - until the depression has lifted.
  • Let your family and friends help you.
  • Avoid alcohol and recreational drugs, which will make the depression worse.
  • Take your medication daily and realize it takes time to work.
  • Seek counseling.
  • Call your doctor, therapist, family, friend, priest or rabbi if you think you may harm yourself or simply dial 911 or the suicide hotline.

Helping a friend or family member with depression When helping a friend or family member with depression, make sure they seek treatment. This may involve encouraging them to stay with treatment until symptoms begin to abate, or to seek different treatment if no improvement occurs.

On occasion, it may require making an appointment and accompanying the depressed person to the doctor. It may also mean monitoring whether the depressed person is taking medication.

Offer emotional support through understanding, patience, affection and encouragement. This can be real difficult when the person is very depressed and not wanting to reach out. Engage the depressed person in conversation and listen carefully.

Do not accuse the depressed person of faking illness or of laziness, or expect him or her ‘‘to snap out of it.'' Do not ignore remarks about suicide. Report suicidal thoughts to the depressed person's therapist or doctor.

Encourage participation in some activities that once gave pleasure, such as hobbies, sports, religious or cultural activities. Be gently insistent if your invitation is refused. Do not push the depressed person to undertake too much too soon.

Eventually, with treatment and time, most people do get better. Remind them of this fact.

My next column, in two weeks, will discuss treatments including counseling, antidepressants, light therapy, exercise and stress reduction techniques.

Dr. Jim Mitterando is a family doctor at Cohasset Family Practice and a staff member at South Shore Hospital in Weymouth.

Readers should send questions to: Ask the Doctor, The Patriot Ledger, P.O. Box 699159, Quincy, MA 02269-9159, or by E-mail to his attention at features@ledger.com.

Questions of general interest will be answered in this column. The information in this column is not intended to diagnose individual conditions, and individual replies are not possible. Readers should see their own doctors about specific problems.

Copyright 2004 The Patriot Ledger
Transmitted Tuesday, December 07, 2004

.