Major Depressive Disorder and Initial Treatment Options

With the holidays approaching, depression and anxiety come to the fore for many people. Stresses relating to social gatherings, travel, entertaining, and financial stress can trigger depression or make existing depression worse. For some people with depression, it follows a seasonal pattern. In most of the cases, the episodes begin in the fall or the winter and remit in the spring.

Major Depressive Disorder is a Serious Condition that Deserves Medical Attention

One severe form of depression, major depressive disorder (MDD), not only has the potential to cause disability, but it also has a high rate of recurrence. Seeking treatment for MDD can be tricky, due to the fact that most people visit a primary care physician as opposed to a psychiatrist. In 2017, the National Institute of Mental Health estimated that over 7% of adults in the US had at least one major depressive episode.

Major depression episodes that occur in a seasonal pattern are often characterized by overeating (especially carbohydrates), sleeping more than usual, weight-gain, but still maintaining energy throughout the day.

Symptoms to Watch Out for If You Feel You May be Experiencing MDD

We don’t encourage self-diagnosis but it’s very important to be self-aware and seek help when you suspect your mental health is unwell. There are a number of behavioral characteristics that are present that may be indicative of having MDD. Symptoms to watch out for include a depressed mood most or all of the time, feelings of helplessness and hopelessness, the onset of phobias, rumination, excessive concern over physical health.

Choosing a Treatment Option That’s Right for You

Choosing a treatment option can be overwhelming. There’s a lot to consider: severity of the depression being experienced, lifestyle, demographics and physical health. Gelhorn, et. al. surveyed peer reviewed literature to determine how patient preferences affect treatment outcomes for depression disorders. For practitioners, it is important to take into account patient preference for treatment along with a clinical evaluation.

Many patients find healing using first-line treatment options including antidepressants, psychotherapy, and cognitive therapies like cognitive behavioral therapy (CBT). Certain studies have analyzed the efficacy of antidepressants along with non-drug treatment options. Second-generation antidepressant medications have also been shown to produce positive treatment response. We typically find that counseling combined with an anti-depressant medication works best. 

Symptoms to Watch Out for If You Feel You May be Experiencing MDD

We don’t encourage self-diagnosis but it’s very important to be self-aware and seek help when you suspect your mental health is unwell. There are a number of behavioral characteristics that are present that may be indicative of having MDD. Symptoms to watch out for include a depressed mood most or all of the time, feelings of helplessness and hopelessness, the onset of phobias, rumination, excessive concern over physical health.

Choosing a Treatment Option That’s Right for You

Choosing a treatment option can be overwhelming. There’s a lot to consider: severity of the depression being experienced, lifestyle, demographics and physical health. Gelhorn, et. al. surveyed peer reviewed literature to determine how patient preferences affect treatment outcomes for depression disorders. For practitioners, it is important to take into account patient preference for treatment along with a clinical evaluation.

Many patients find healing using first-line treatment options including antidepressants, psychotherapy, and cognitive therapies like cognitive behavioral therapy (CBT). Certain studies have analyzed the efficacy of antidepressants along with non-drug treatment options. Second-generation antidepressant medications have also been shown to produce positive treatment response. We typically find that counseling combined with an anti-depressant medication works best. 

Seasonal Affective Disorder is More Serious than Just Seasonal Sadness

After many years of conjecture, mental health experts are gaining a deeper understanding of Seasonal Affective Disorder (SAD,) a condition that affects many adults. SAD is characterized by episodes of major depression, mania, or hypomania that regularly occur in particular seasons.

SAD is Triggered by a Transition in the Season and Not Necessarily a Particular Season

The two recognized patterns of SAD are fall/winter onset and spring/summer onset. Most people who experience SAD have depression symptoms in the winter that generally lift in the spring or summer. SAD is not classified as a separate mood disorder, but as a subset of major depressive disorder.  

People who suffer from fall/winter onset SAD can experience multiple symptoms, including increased appetite, reduced energy, weight gain, increased sleep, and carbohydrate craving. The symptoms mirror those for people suffering from major depressive disorder.

Spring/summer onset SAD, also known as summer depression, is also characterized by typical depression symptoms such as decreased appetite, weight loss and insomnia.

Assessment of and Treatment of SAD

In order to assess the severity of SAD, a Patient Health Questionnaire (PHQ) is administered. Patients with severe major depression often score 20 or more points on the questionnaire and often have suicidal thoughts. Patients who score less than 20 points often have mild-to moderate cases of SAD a do not have generally have suicidal thoughts.

Medical practitioners have developed a roster of modalities to alleviate SAD symptoms, including:

·         Antidepressants

·         Light therapy

·         Sleep hygiene

·         Daily outdoor walks

·         Aerobic exercise

·         Enhanced indoor lighting

First-Line Treatment of SAD

The recommended first line treatment for patients with severe SAD is antidepressants combined with light therapy, although antidepressants alone may be sufficient. For patients with less severe cases, light therapy alone is considered to be a reasonable first line treatment alternative.

Sleep regulation is particularly important for treating AD, since insomnia and hypersomnia are common symptoms of the disorder. SAD therapy includes focusing on the sleep-wake cycle and minimizing blue light exposure from electronic devices within two hours of going to bed.

Second-Line and Third-Line Treatments for More Extreme Cases of SAD

For patients who are unresponsive to first line therapies, additional steps may be required. Second line therapies involve modifying a patient’s medication and incorporating the form and amount of light therapy used. Third line therapies can incorporate psychotherapy into the equation.

It is important to realize the symptoms of SAD if you or a loved one experience recurring, seasonal depression. Seeking out a qualified mental health professional is an essential first step towards regaining your mental well-being.

 Are You Struggling with Seasonal Affective Disorder? Help is Close-at-Hand! Contact Us Today to Book an Appointment.

Shift Work and Sleep Disorders

Shift-Work is Becoming More Prevalent in the Job Market and with it Sleep Disorders are Becoming More Common

Shift-workers now make up 15% of the job-market as many are willing to accept the alternative schedule for higher pay and a chance to bring in extra income for their families. Many are unaware that the sleep-deprivation caused by shift-work is recognized as a circadian rhythm sleep disorder in both the International Classification of Sleep Disorders and the Diagnostic and Statistical Manual of Mental Disorders. Middle-aged men in high-stress professions including first-responders have a particularly high risk of developing a sleep disorder and other health complications according to a 2018 study done at the Division of Sleep and Circadian Disorders in Boston, MA.

Shift Work Can Cause Many Different Kinds of Sleep Disorders

Circadian sleep disorders describe an inability to fall asleep at any desired time and usually occur when there is a “mismatch between the clock hour at which sleep is attempted and the underlying biological time at which sleep is promoted by the circadian timing system”. Many shift workers fall into this category, however, others also develop insomnia which is generally characterized by a difficulty initiating sleep but can also include a difficulty maintaining sleep, waking up earlier than normal with an inability to fall back asleep and resisting a healthy sleep schedule.

Another Sleep Disorder that can develop with shift-work is Obstructive sleep apnea syndrome (OSAS) which carries tremendous workplace risks that should be taken seriously by employers due to the syndrome’s impact on neurocognitive functioning. Several studies indicate that Obstructive sleep apnea syndrome has an adverse effect on inductive and deductive reasoning, attention, vigilance, learning, and memory which are all vital functions for the average shift-worker.

Even Shift-Workers Have Time to Take Care of Their Mental Health

There is a need for shift-workers to recognize and prioritize their mental health including sleep disorders. Limited access to proper treatment facilities and limited time with which to attend appointments for Circadian Sleep Disorders, OSAS, Insomnia and Chronic Sleep Insufficiency contribute to the prevalence of these disorders. Gastrointestinal disorders, greater likelihood of depression, and increased risk of cancer and cardiovascular disease are just some of the adverse consequences that can develop if these Sleep Disorders go untreated.

Mental Health Care Does Not Necessarily Mean Down-Time or Medication

It may help to promote the fact that treating Sleep Disorders does not always have to involve significant time off work or medication. Centerway Behavioral Health believes in developing individualized treatment plans that suit the patient’s lifestyle. Contact us to learn more about our approach and the Sleep Disorders we can provide treatment plans for.