The Most Depressing Day of the Year
How failed New Year's resolutions, debt and weather conditions lead to a peak in depression.
By Maia Szalavitz for MSN Health & Fitness
Poets, publicists and psychiatrists all have their candidates for the bleakest time of the year. According to one equation devised by Dr. Cliff Arnall, a British researcher from Cardiff University, Jan. 18 is 2010’s most depressing day.
His formula for this bleak prediction takes into account factors like post-holiday blahs and debt, failed New Year’s resolutions and, this year, the nasty chill that has reached much further south than usual. This particular peak in seasonal affective disorder (SAD) isn't the only time that we're prone to feeling low. Research also indicates that new antidepressant prescriptions peak around Thanksgiving and suicide rates are highest during the spring.
If April is a difficult month for your mood, this correlates to T.S. Eliot’s choice, characterized as "the cruellest month." So what can you do if you are feeling the winter blues—and how do you know when you should seek help?
Identifying the signs of depression Says Michael Terman, Ph.D., director of the Center for Light Treatment and Biological Rhythms at Columbia University Medical Center, “Most people with winter depression feel fatigued during the day, have difficulty getting out of bed in time for work, and start snacking—or even gobbling—carbohydrates. But that can also happen with nonseasonal depression. Seasonal or not, we usually see reduced work performance and concentration, reluctance to engage socially or sexually, underlying anxiety, not to mention despair.”
He adds, “Some people with depression—whether seasonal or nonseasonal—experience insomnia, reduced appetite, and agitation more than lethargy. All taken together, it's not so much the symptoms that differ but rather the timing. In one sardonic sense, you're 'lucky' if you have seasonal rather than nonseasonal depression, because you can be confident about when you'll feel better!”
If you’ve had persistent depression symptoms for more than two weeks, it’s time to get professional help, according to Allen Dietrich, M.D., professor of Medicine at Duke University, “Thoughts of self-harm suggest that a person should seek help right away.”
Winter depression—technically a form SAD—tends to occur annually and run between November and April. “You may be more likely to attribute depressed mood to work stress than to seasonal change,” says Terman, “The seasonal pattern can get complicated: There are cases when nonseasonal depression turns seasonal and vice versa.”
It is not known why suicides are more common in April when winter depression generally lifts, according to Teodor Postolache, M.D., director of the Mood and Anxiety Program at the University of Maryland School of Medicine. Some have hypothesized that this occurs for the same reason that antidepressants can be linked with suicide—energy and the ability to plan often return before mood lifts, enabling suicidal behavior previously inhibited by lethargy.
However, the lag between the peak time for suicides and the time when winter depression starts lifting is too long for this to be the whole explanation. Fortunately, most winter depression doesn’t turn into full-blown major depression, let alone suicide—about three times as many people suffer from a milder form that can often be treated with self-help measures.
“The symptom picture is the same,” says Terman, “But the effects are not so debilitating. You may prefer not to socialize, but you go through with it when it's called for. You push harder to get work done, but you do it.”
Terman serves on the board of directors of the Center for Environmental Therapeutics (CET)—a nonprofit group focused on environmental measures like bright-light therapy to treat conditions like depression and to improve health. The site contains several self-assessment tools including one to help diagnose SAD and other types of depression and one that can help you track symptoms to monitor recovery and find signs of relapse.
Light therapy Therapy with specially designed bright lights—which are sold commercially for about $100-$200—is the treatment of choice for SAD and can also work in less severe cases. Sunlight is believed to raise serotonin levels and pace the biological clock—reduced exposure to sunlight during the winter consequently lowers levels of serotonin and other important neurotransmitters, which can be associated with depression.
Disruption of circadian rhythms maintained by the body clock interferes with sleep—and sleep-related problems are also linked with low mood. As a result, light therapy can even help with some cases of depression that are not seasonal. However, if lights are used incorrectly, they can actually make things worse.
The timing of light therapy needs to be adjusted in relation to how much of a morning person (“lark”) or night person (“owl”) you tend to be. CET has a self-assessment test for these qualities as well.
“Light therapy is the first-line treatment for SAD, with a record of faster response with fewer residual symptoms than the alternatives. It's also the most practical approach for initial treatment because if improvement doesn't occur within a couple of weeks, there is time left in the season to try medication,” says Terman. There is controversy, however, over blue lights that are sold as depression treatments.
“There is no cogent justification for using blue lights at this time,” Terman says. “There have been no clinical trials showing blue light superior to the recommended white light. There is research evidence that 'narrow-band' blue-light exposure might harm retinal structures in the eye, especially over long-term use.”
Postolache, however, sees potential promise in these lights, saying, “We have [newly discovered] receptors in the eye that project to the body clock. Those receptors respond most strongly to blue light.” He says that we are exposed on a daily basis to more blue light from the sun than these lights could generate and notes that “we live under a blue sky.”
He thinks more research is needed to determine how these lights might be best used, and if there could be harmful effects. White-light therapy has far fewer side effects than medications do—but some people find the light a bit intense and get headaches. Others may become slightly fidgety.
As with drugs, however, these symptoms tend to pass as people adjust. Results should usually be felt after about a week—and an early sense that the light is cheery tends to predict good response. Postolache says that light therapy should be used only under the supervision of a doctor and that the dose and timing of light use needs to be specifically tailored to the individual.
If light exposure produces agitation or overly extreme changes in mood, see your doctor or therapist immediately, as this may be a sign of bipolar disorder—and light exposure can occasionally produce a shift from a depressed into a manic state in people with this condition. If light therapy alone doesn’t work, combining it with medication and talk therapy may be necessary. Nutrition, exercise and family There are also numerous self-care tactics that can help lift depression.
“The brain, body and mind work together,” says Catherine Monk, assistant professor of clinical psychology in psychiatry at Columbia University, suggesting exercise and proper nutrition. The omega-3 fatty acids found in fish oil may be especially helpful for both depression and bipolar disorder.
Terman has some counterintuitive tips as well. Although getting extra sleep may seem a rare source of pleasure if you have winter depression, doing so can exacerbate the condition.
“Don't sleep in on weekends,” he says. “Commit yourself to planned morning family activities, even if it's a challenge. This will prove helpful all week long.”
If you don’t live in an overly lit area, such as a city, keep the shades open when you go to bed to take advantage of early morning light before you wake up. Even as you sleep, your body can sense light levels and this helps keep your body clock in sync. Avoiding bright light for three hours before bedtime can also help synchronize your clock.
If you use a computer during that time, Terman says, “Turn down your monitor brightness to a low but comfortable level.” Even if your winter depression creates a tendency to gain weight, Terman advises eating breakfast. “Have protein-rich breakfasts, low on the carbs.” He also suggests getting outside and walking at lunchtime, even in cold weather—both for the exercise and the light.
Finally, he says, “If you can motivate yourself, an aerobic workout every other day may lessen the intensity of the depression.”
Maia Szalavitz is a journalist and author who covers the intersection of mind, brain and behavior. She is a senior fellow at Stats.org, a media watchdog organization, which investigates coverage of science and statistics. Her experience as a former heroin and cocaine addict brings a unique perspective to her work.
Her most recent book, co-written with leading child trauma expert Bruce D. Perry, M.D., Ph.D., is "The Boy Who Was Raised as a Dog and Other Stories from a Child Psychiatrist's Notebook: What Traumatized Children Can Teach Us About Loss, Love and Healing" (Basic, 2007). All materials copyright (c) 2010 by MSN Networks and Maia Szalavitz.