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.

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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. 

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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.

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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.

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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

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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.