Join us each month as we discuss the health topics that matter most to you in The Prevention Plan's 2011 Better Health webinar series. In addition to learning clinically-based information about various health topics, you will also learn practical tips you can apply to your everyday life to help you manage or improve your health. Winter got you down? Now that the holidays are over, many people enter a state of winter blues. Fortunately, there are ways to boost your mood, many of which you may not have thought of. Join us as we discuss how you can shake those winter blues and get back to being you.

1. Depression: Battling the Winter Blues
January 2012

2. Outline
 What is Depression?
 Types of Depression
 Seasonal Affective Disorder (SAD)
 Do You Know the Signs?
 Treatment
 Physical Activity and Nutrition
 Common Myths About Depression
 Conclusion
Content Source*
This presentation is for informational purposes only. It should not be taken as medical advice. Please check with
your doctor for customized recommendations for you which will be based on, among other things, your prior
medical history, current medical status and your doctor’s understanding of your health risks and needs.
*If otherwise not indicated

3. The doctor of the future
will give no medicine ,
but will interest his patients
in the care of the human frame,
in diet , and in the
cause and prevention of
disease .
Thomas Edison, Inventor

4. Definition
 Depression is a common mental disorder that presents with
depressed mood, loss of interest or pleasure, feelings of guilt
or low self-worth, disturbed sleep or appetite, low energy,
and poor concentration.
 These problems can become chronic or recurrent and lead to
substantial impairments in an individual's ability to take care
of his or her everyday responsibilities.
Source: World Health Organization

5. Depression Costs
 Workplace Costs of Over $34 Billion per Year in Direct and
Indirect Costs
 Major depression is associated with more annual sick days
and higher rates of short-term disability than other chronic
diseases
 People suffering from depression have high rates of
absenteeism (in some cases, three times more sick days than
non-depressed workers) and are less productive at work
Source: National Alliance on Mental Illness

6. Background
 Depression and anxiety are two major causes of illness and
death in the United States and are associated with reduced
quality of life, social functioning, and excess disability.
 Psychiatric conditions such as depression can contribute to or
worsen chronic diseases.
 Depression and anxiety frequently co-occur and when they do
they have an even greater impact than when they occur
alone.

7. Some Types of Depression
 Major Depression
 Atypical Depression
 Psychotic Depression
 Dysthymia
 Manic Depression
 Postpartum Depression
 Postpartum depression
 Premenstrual Dysphoric Disorder
 Seasonal Affective Disorder (SAD)

8. Seasonal Affective Disorder (“Winter Blues”)
 Seasonal affective disorder, or SAD, is a type of depression
that affects a person during the same season each year.
 Anyone can get SAD, but it is more common in:
– People who live in areas where winter days are very short or there are
big changes in the amount of daylight in different seasons.
– Women.
– People between the ages of 15 and 55. The risk of getting SAD for the
first time goes down as you age.
– People who have a close relative with SAD.

9. Symptoms
 Difficulty concentrating.
 Low energy and fatigue.
 Reduced interest in daily activities, especially social activities.
 Moodiness (depressed, sad, or unusually quiet).
 Increased appetite.
 Cravings for complex carbohydrates (such as pasta and bread).
 Weight gain.
 Increased sleep.
 Loss of interest in sex.
 Irritability.
 People with SAD may either have symptoms of major depression or minor
depression.

10. Do You Know the Signs?
Someone who is depressed has feelings of sadness or anxiety that last for
weeks at a time. He or she may also experience:
 Feelings of hopelessness and/or pessimism
 Feelings of guilt, worthlessness, and/or helplessness
 Irritability, restlessness
 Loss of interest in activities or hobbies once pleasurable
 Fatigue and decreased energy
 Difficulty concentrating, remembering details, and making decisions
 Insomnia, early-morning wakefulness, or excessive sleeping
 Overeating, or appetite loss
 Thoughts of suicide, suicide attempts
 Persistent aches or pains, headaches, cramps, or digestive problems that
do not get better, even with treatment

11. Exams and Tests
 Before diagnosing you with seasonal affective disorder (SAD),
a doctor will ask about your medical history.
 Your doctor may order blood tests to check for other
conditions, such as hypothyroidism, that could be causing
your depression.
 He or she also may ask you to complete a questionnaire
regarding changes in your sleep patterns, social activity,
mood, weight, appetite, and energy levels.

12. Examples of Questions
 The questionnaire may ask the following:
– Do you feel a dramatic reduction in energy when the days get shorter?
– Do you have difficulty waking up in the morning?
– Do you sleep more than you used to or sleep too much?
– Are you eating more than you used to or more than you should?
– Have you gained weight?

13. Evaluation (Cont.)
 Your doctor may also do a mental health assessment, which
includes an evaluation of your emotional functioning and your
ability to think, reason, and remember (cognitive functioning).
 The assessment may also include written or verbal tests and
lab tests (such as blood and urine tests).
 During the interview, your doctor will assess your
appearance, mood, behavior, thinking, reasoning, memory,
and ability to express yourself and may ask about your
personal relationships and family history of SAD.

14. Treatment: Light Therapy
 Research has shown that light therapy is an effective
treatment for SAD.
 There are two types of light therapy:
– Bright light treatment: you sit in front of a "light box" for a
certain amount of time (usually in the morning), and dawn
simulation, which is done while you sleep.
– Dawn simulation: done while you sleep. A low-intensity
light is timed to go on at a certain time in the morning
before you wake up, and it gradually gets brighter.

15. Treatment: Light Therapy
 Light boxes are available commercially and use fluorescent
lights that are brighter than indoor lights but not as bright as
sunlight.
 You place the light box at a specified distance from you on a
desk or in front of a chair and use it while you read, eat
breakfast, or work at a computer. Light therapy is usually
prescribed for 30 minutes to 2 hours, depending on the
intensity of the light used and on whether you are starting out
or are using it to maintain a response.
 Ultraviolet light, full-spectrum light, tanning lamps, and heat
lamps should not be used.

16. What’s Better and For How Long?
 Some people find dawn simulation light therapy more convenient because
it works as they sleep.
 Light box therapy, which some studies have shown to be most effective if
done in the morning, may be less convenient for people who have busy
schedules.
 Some studies have found that dawn simulation therapy is not as effective
as bright light (light box) therapy.
 It may take as little as 3 to 5 days or up to 2 weeks before you respond to
light therapy. Stopping light therapy will likely cause you to relapse back
into depression.
 Light therapy will need to be continued for the entire time you are
depressed. People who discontinue treatment usually lapse back into
depression.

17. Is Light Therapy safe?
 Generally safe, may use it together with other treatments.
 The most common side effects of light therapy include:
– Eyestrain or visual disturbances.
– Headaches.
– Agitation or feeling "wired."
– Nausea.
– Sweating.
 You can relieve these side effects by decreasing the amount of
time you spend under the light.

18. Is light therapy safe? (Cont.)
 People who have sensitive eyes or skin should not use light therapy without
first consulting a doctor.
 If you have eye problems or you take medicines that make you light-
sensitive, ask your doctor about whether light therapy is safe for you. Before
you start treatment, tell your doctor about any other conditions you have
and about the medicines you are taking .
 Important to discuss with your doctor first.

19. Exercise
 Being physically active during the daytime, especially first thing in the
morning during winter, may help improve your energy level and relieve
depression. Moderate exercises like walking, stationary cycling, and
swimming are a good way to start an exercise routine. Muscle
strengthening exercises are important as well.
 Moderate activity for at least 2½ hours a week. One way to do this is to be
active 30 minutes a day, at least 5 days a week. Moderate activity means
things like brisk walking, brisk cycling, or shooting baskets. You notice
your heart beating faster with this kind of activity.
 Vigorous activity for at least 1¼ hours a week. One way to do this is to be
active 25 minutes a day, at least 3 days a week. Vigorous activity means
things like jogging, cycling fast, or cross-country skiing. You breathe
rapidly and your heart beats much faster with this kind of activity.

20. Research on Exercise and Depression: A long history
 Franz & Hamilton, 1905; Vaux, 1926: suggested a relationship
between exercise and decreased depression
 Since the early 1900s, there have been over 100 studies
examining this relationship
 During the 1990s there have been at least five meta-analytic
reviews (Craft, 1997; Calfas & Taylor, 1994; Kugler et al.,
1994; McDonald & Hodgdon, 1991; North, McCullagh, & Tran,
1990) that have examined studies ranging from as few as nine
(Calfas & Taylor, 1994) to as many as 80 (North et al., 1990)

21. Depression and Exercise Findings
 Across these five meta-analytic reviews, the results
consistently show that both acute and chronic exercise are
related to a significant reduction in depression.
 The findings indicate that the antidepressant effect of
exercise begins as early as the first session of exercise and
persists beyond the end of the exercise program (Craft, 1997;
North et al., 1990).
 These effects are also consistent across age, gender, exercise
group size, and type of depression inventory.

22. Mental Health Benefits of Physical Activity
Reduced anxiety
 Best results with “aerobic exercise”
 Best after weeks of regular exercise
 Best benefits to those who are low fit to begin with
 Best benefits for those high in anxiety to begin with
Reduced depression
 Best after weeks of regular exercise
 Best when done several times a week
 Best with more vigorous exercise
 Best for those who are more depressed
Source: The Influence of Exercise on Mental Health Daniel M. Landers ; SERIES 2, NUMBER 12, OF THE PCPFS RESEARCH DIGEST

23. Nutrition
 Eating a healthy, balanced diet is helpful for any type of depression and may
help relieve some of the symptoms of SAD.
 Initial research suggests the following complementary treatments may be
helpful in treating symptoms of SAD, although there currently is not enough
scientific evidence to prove their usefulness.
– There is some evidence that an herb called St. John’s wort may help ease depression
symptoms.
– Melatonin is a hormone that may help regulate your biological clock (circadian
rhythms). But you need to take a very low dose at a specific time of the day.
 Be sure to check with your doctor before you try these complementary
therapies, because they may interact with other medications you are taking.
 You should not take St. John's wort if you are taking other antidepressants. St.
John's wort may also cause light sensitivity. If you are using light therapy, you
may want to discuss with your doctor whether St. John's wort is right for you in
the treatment of SAD.

24. CDC's Behavioral Risk Factor Surveillance System (BRFSS)

25. Depression vs Obesity by State

26. Depression Treatment: Medications
 Types of antidepressants include:
– Selective serotonin reuptake inhibitors (SSRIs)
– Serotonin and norepinephrine reuptake inhibitors (SNRIs)
– Norepinephrine and dopamine reuptake inhibitors (NDRIs)
– Atypical antidepressants
– Tricyclic antidepressants
– Monoamine oxidase inhibitors (MAOIs)
– Other medication strategies

27. Depression Treatment: Other
 Psychotherapy
– Cognitive behavioral therapy is one of the most commonly used therapies.
This type of therapy helps you identify negative beliefs and behaviors and
replace them with healthy, positive ones.
• It's based on the idea that your own thoughts — not other people or situations —
determine how you feel or behave. Even if an unwanted situation doesn't change,
you can change the way you think and behave in a positive way.
– Interpersonal therapy
• The precise focus of the therapy targets interpersonal events (such as interpersonal
disputes / conflicts, interpersonal role transitions, complicated grief that goes
beyond the normal bereavement period) that seem to be most important in the
onset and / or maintenance of the depression.
– Psychodynamic psychotherapy
• Psychodynamic therapy focuses on the psychological roots of emotional suffering.
Its hallmarks are self-reflection and self-examination, and the use of the
relationship between therapist and patient as a window into problematic
relationship patterns in the patient’s life. Its goal is not only to alleviate the most
obvious symptoms but to help people lead healthier lives.
Source: International Society for Interpersonal Psychotherapy, American Psychology Association

28. Depression Treatment: Other (cont.)
 If standard depression treatment hasn't been effective, your psychiatrist
may consider whether you might benefit from a less commonly used
procedure, such as:
– Electroconvulsive therapy (ECT). In ECT, electrical currents are passed
through the brain. This procedure is thought to affect levels of
neurotransmitters in your brain. Although many people are leery of ECT and
its side effects, it typically offers immediate relief of even severe depression
when other treatments don't work. It's unclear how this therapy relieves the
signs and symptoms of depression. The most common side effect is confusion,
which can last from a few minutes to several hours. Some people also have
memory loss.
– Vagus nerve stimulation. This treatment uses electrical impulses with a
surgically implanted pulse generator to affect mood centers of the brain. This
may be an option if you have chronic, treatment-resistant depression.
– Transcranial magnetic stimulation. With this treatment, powerful magnetic
fields are used to alter brain activity. A large electromagnetic coil is held
against your scalp near your forehead to produce an electrical current in your
brain.

29. Depression Treatment: Important to keep in mind
 May require hospitalization
 Alcohol and Illicit Drugs are not a treatment. It may seem like
alcohol or drugs lessen depression symptoms, but in the long
run they generally worsen symptoms and make depression
harder to treat

30. Advice for caregivers
 Sometimes family members and friends are not sure how to help
someone who has seasonal affective disorder. It may help to:
– Spend time with your loved one even though he or she may be
withdrawn or quiet.
– Offer to help with daily tasks that temporarily may be too difficult to
do alone. But it is important that you do not enable the person to
remain depressed by taking over all of his or her daily responsibilities.
– Take a walk or do some other type of exercise activity together.
Getting out first thing in the morning for a walk may be helpful.
– Help the person to stay with the prescribed treatment plan.

31. Suicide Warning Signs
 Parents should be particularly vigilant for signs that may indicate that
their child is at risk for suicide. Warning signs of suicidal behavior in
children include:
– Many depressive symptoms (changes in eating, sleeping, activities)
– Social isolation
– Talk of suicide, hopelessness, or helplessness
– Increased acting-out behaviors (sexual/behavioral)
– Increased risk-taking behaviors
– Frequent accidents
– Substance abuse
– Focus on morbid and negative themes
– Talk about death and dying
– Increased crying or reduced emotional expression
– Giving away possessions

32. Some Common Myths
 Depression is not a real medical illness.
 Even if depression is a medical illness, there’s nothing that can be
done about it.
 Depression is no different from getting the “blues” – and this is
just a normal part of life.
 Depression only happens when something bad happens in your
life, such as a breakup, the death of a loved one, or failing an
exam.
 People who think they have depression are just feeling sorry for
themselves.

33. Some Common Myths (Cont.)
 Depression is something that strong people can “snap out of” by
thinking positively. If you can’t, you are weak.
 Depression will go away by itself.
 Depression is a normal part of getting older.
 Depression only affects women.
 Depression does not affect children or teenagers — their
problems are just a part of growing up.
 If someone in your family suffers from depression, you will inherit
it.
 Talking about depression only makes it worse.

34. Worksite Awareness
 Raise your own awareness and the awareness among managers through
training on the signs and symptoms of depression
 Managers and employees who are able to recognize the signs and
symptoms of depression such as tardiness, complaints of fatigue,
reduction in work output or quality, safety problems or accidents, and
changes in attitude may help in the early identification and referral to
screening and treatment services for affected employees
 Regular surveys to ascertain information about relationships among
coworkers (e.g., conflicts); job demands such as time pressures or physical
demands; and assess the level of support provided by supervisors and
colleagues which may contribute to the mental health of workers and be
used to develop training, communications, or other interventions to
address mental health in the workplace

35. Worksite Interventions
 Employee Assistance Programs (EAPs) can offer information
and referral services for employees with symptoms of
depression
– Active EAPs are one of the most effective ways employers support
employees with depression or other mental health problems, by
offering counseling and referral services.
 It is important to recognize that EAP programs are generally
contracted benefits outside of the organization
 Worksite health promotion programs such as physical activity
are good adjunct therapies in preventing and treating
depression
– Employees who participate in physical activity programs can decrease
depression symptoms and sometimes avoid mild depressive episodes

36. Treatment Works: Get Help for Depression and Anxiety
 Many Americans suffer from mental conditions
such as depression and anxiety.
 Studies show these health problems and
illnesses affect about 1 in 5 Americans.
 A tough situation such as a natural disaster, the
loss of a loved one, or financial distress can
trigger or increase depression and anxiety.
 Depression is a true and treatable medical
condition. Most people get better with
treatment.
 Try not to let hopelessness or shame stop you
or a friend from getting medical help. Take
action.

37. Where to Find Help
If you or someone you care about is in crisis, please seek help
immediately.
 Call 911
 Visit a nearby emergency department or your health care
provider's office
 Call the toll-free, 24-hour hotline of the National Suicide
Prevention Lifeline at 1-800-273-TALK (1-800-273-8255); TTY:
1-800-799-4TTY (4889) to talk to a trained counselor

38. Additional Resources
 National Institute of Mental Health (NIMH)
Phone: (866) 615-6464
http://www.nimh.nih.gov/
 American Psychiatric Association (APA)
Phone: (703) 907-7300
http://healthyminds.org/cmhdepression.cfm
 Depression and Bipolar Support Alliance (DBSA)
Phone: (800) 826 -3632
http://www.dbsalliance.org/
 Substance Abuse and Mental Health Services Administration (SAMHSA)
Phone: (800)-789-2647
http://www.samhsa.gov/
http://whatadifference.org/index.html

39. Other: National Alliance on Mental Illness (www.nami.org)
http://www.nami.org/template.cfm?section=Education_Training_and_Peer_Support_Center

40. www.ThePreventionPlan.com
The material presented in this presentation was for informational purposes only. It should not be taken as medical advice. Please
check with your doctor for customized recommendations for you which will be based on, among other things, your prior medical
history, current medical status and your doctor’s understanding of your health risks and needs.