Are the Winter Blues Getting Bluer?
- sjpdragonlady
- Feb 25, 2024
- 13 min read
Updated: Mar 4, 2024
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Depression is becoming more common over time
The National Institute of Mental Health estimates that 21 million US adults (8.3% of the population) experienced symptoms of depression in 2021. At least 4 million teens (16%) also experienced depressive symptoms. Over half of depressed individuals receive no care or treatment for their symptoms. The Meadows Mental Health Policy Institute estimates that in the United States, depression annually costs almost $188 billion. The bulk of these costs are for health care, which total $134 billion. Work-related costs include $21 billion in lost wages and $33 billion in lost productivity. Depression disrupts people's ability to work, form relationships, pursue hobbies and enjoy high quality of life. Suicide annually takes 850,000 lives worldwide, and is the 4th leading cause of death among 15-29 year olds. The rate of depression is increasing over time. There was a significant jump in depression rates during covid, but depression rates were trending upwards prior to covid and have continued to increase since the public health emergency was declared over.
Gallup
What are the symptoms of depression?
Symptoms may include:
Feelings of helplessness and hopelessness
Loss of interest in daily activities
Appetite or weight changes-- more than 5% loss or gain in a month
Sleep changes-- insomnia or oversleeping
Anger, irritability or low tolerance
Loss of energy
Strong feelings of worthlessness or guilt
Reckless behavior
Concentration problems
Unexplained physical complaints
People with depression may not have all these symptoms, or may have symptoms that are not on this list!
Gallup Poll
What causes depression?
Depression is not caused by any one factor. It is multifactorial, which means that it is caused by interactions between a variety of triggers. It likely is associated with neurotransmitters (chemicals that send signals in the brain), genetic vulnerabilities, function within certain parts of the brain, and stressful life events. One small difference between individuals can lead to one person developing depression and another not.
One structure of the brain, the hippocampus, is 9-13% smaller in depressed women (although it may be depression that causes the hippocampus to be smaller, rather than vice versa.) Brain activity in the amygdala is higher when an individual is sad or frightened. The basal ganglia, another part of the brain, are smaller and structurally different in people with depression. Changes in the activity of several neurotransmitters, including dopamine, norepinephine and seratonin have been linked to depression. There is likely a genetic tendency to depression, as individuals with depressed family members are 2-3 times more likely to be depressed (20-30% risk of depression in this group). Stressful experiences or illnesses also tend to trigger depression.
Northwestern Medicine
Who is most susceptible to depression?
There are no groups that are free of depression.
However there are specific things that increase risk:
Childhood Trauma, including abuse
Advanced age (elderly)
Medications such as steroids or tretinoin
Conflict with family or friends
Death or loss
Female sex
LGBTQ+
Family history of depression
Major events (even good ones, like moving, graduating, getting married)
Social isolation
Chronic diseases, including chronic pain
Poor nutrition
Alcohol or substance abuse
Socioeconomic challenges
Significant stressful events (including natural disasters)
The many faces of depression:
AI/AN = American Indian / Alaskan Native | NH/OPI = Native Hawaiian / Other Pacific Islander
National Institute of Mental Health
National Institute of Mental Health
How do I know if I have depression?
Common symptoms of depression include feeling sad or hopeless regularly, but may also include feelings of anger or irritability. You may lose your interest in activities that usually give you pleasure, including sex. You may feel extra hungry or lose your appetite completely, and may sleep too much or have difficulty falling asleep and getting enough sleep. Energy, mood and concentration may be poor. If you suspect depression, visit your family doctor or psychiatrist. They will talk with you, and may use a questionnaire to determine the degree of your symptoms. If you are diagnosed with depression, your physician may refer you for talk therapy or prescribe medications.
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Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke, colleagues
with an educational grant from Pfizer
UpToDate PHQ9 Depression Calculator
IF YOU BELIEVE YOU HAVE DEPRESSION,
PLEASE SEE YOUR FAMILY PHYSICIAN OR PSYCHIATRIST!!
Does the environment really affect my mood?
The environment can affect your mood in several ways:
Seasonal Affective Disorder-- less sunlight and fresh air can increase depression
Environmental disasters-- significantly harms the mental health of survivors
Global warming-- raises the likelihood of depression, anxiety, and dementia
Worry about climate change-- leads to stress and depression
Gary Randall The New York Times Getty Images
Seasonal affective disorder is a psychiatric problem in which seasonal shifts in weather and sunlight can impact a person's mood. Most people experience flaring depression in the winter when there are fewer hours of daylight and they spend less time outdoors because it is colder and darker. Some people actually have more depression symptoms in the summer, although this is less common. As a result of shifting weather patterns, in some parts of the country winters are getting more extreme, and there may be more cloudiness and rain or snow. This can make mood shifts more extreme, and make the winter blues more challenging for susceptible people.
Environmental disasters are becoming more common. According to the National Oceanic and Atmospheric Administration, the frequency and cost of climate disasters have risen significantly in the past 20 years. These events may include hurricanes, tornadoes, floods, fires and droughts. The number of significant natural disasters worldwide per year has increased ten-fold in the past 60 years, from 39 in 1960 to 396 in 2019. In recent years, the annual death toll from environmental disasters typically ranged between 20,000-50,000 lives, although has topped 250,000. In 2023 alone, the estimated economic cost of natural disasters was $380 billion. These numbers are sobering and are enough to cause feeling of sadness in many mindful individuals. Almost 30% of survivors of natural disasters will develop symptoms of depression, with up to 25% developing post-traumatic stress disorder.
Increasing temperatures independently increase the likelihood of depression. Heat waves have been associated with mental and behavioral disorders, including higher risks of depression, anxiety and dementia. During heat waves, there are also more hospitalizations for emotional health diagnoses. One study indicates that occupational heat stress in workers is associated with emotional distress.
Eco-anxiety, or climate anxiety, is being increasingly recognized as a psychological diagnosis. Climate anxiety is extreme worry about the current and future harm caused to the environment by human activities. The World Economic Forum states that eco-anxiety is a growing mental health crisis. A survey done by Yale University indicates that at least 10% of US adults feel anxious about global warming at least several days each week. Another survey indicates that 67% of young American adults are concerned about the impact of climate change on their mental health. UNICEF estimates that one billion children will be at "extremely high risk" due to climate change. More than 80% of surveyed children indicate that they are at least "moderately worried" about climate change.
The University of Colorado suggests the following to help cope with eco-anxiety:
Focus on what you can control
participate in climate change initiatives
write or call legislators to encourage them to take action
build sustainable habits around energy use, composting, recycling, consumerism
select food options with a lower environmental impact (less meat, grow veggies)
change the way you commute to school or work
engage family and friends in conversations about climate change
donate to meaningful organizations or causes
2. Avoid overload-- focus on one or a few climate related projects
3. Practice compassion-- offer kindness to yourself and to others
4. Take a break from climate-related news
participate in other activities you enjoy
catchup with friends and family
take a break from your news and social media accounts
spend time in nature walking, hiking, biking or doing other activities
take a day off to practice self-care
enjoy time with a supportive community that shares your concerns
5. Remember that you're not alone
6. Talk to someone about how you're feeling
CLIMATE MENTAL HEALTH
ABC, Dr Joshua Wortzel
What improves depression?
Antidepressant medications
Herbal supplements
Talk therapy or counseling
Self-help techniques, programs and apps
Avoiding alcohol and other substances
Getting sufficient sleep
Healthy nutrition
Participation in activities you enjoy
What different antidepressants are available?
Selective Serotonin Reuptake Inhibitors (SSRIs)
Examples: sertraline, paroxetine, citalopram, escitalopram
Action: increases serotonin levels in the brain; currently the primary preferred medication for depression
Side effects: sexual dysfunction, headache, irregular hearbeat (less common)
Serotonin/Norepinephrine Reuptake Inhibitors (SNRIs)
Examples: venlafaxine, desvenlafaxine, duloxetine
Action: increases serotonin and norepinphrine levels in the brain
Side effects: high blood pressure, headache sweating, osteopenia
Atypical Antidepressants
Examples: bupropion, mirtazapine
Action: various; primarily increases dopamine and norepinephrine levels in the brain
Side effects: liver stress, sedation, weight gain, seizures
Serotonin Modulators
Examples: trazodone
Action: increases serotonin levels in the brain
Side effects: nausea, diarrhea, sedation, liver stress
Tricyclic Antidepressants (TCAs)
Examples: amitriptyline, nortriptyline, doxepine, desipramine
Action: increases norepinephrine and serotonin levels in the brain
Side effects: dry mouth, urinary retention, constipation, seizures, low blood pressure
Monoamine Oxidase Inhibitors (MAOIs)
Examples: selegiline
Action: increases serotonin, norepinephrine and dopamine levels in the brain
Side effects: serotonin syndrome, sexual dysfunction
Talk to your doctor about which medication might suit you best!
Never change your medication without consulting your doctor!
Be particularly mindful when taking multiple medications (such as antidepressants) due to medication interactions!
Keep antidepressant medications (like all prescription medications) out of the reach of children and pets!
Gisborne Dental House
What if antidepressants don't seem to work for me?
Some people have treatment resistant depression, which means that multiple common antidepressants may not work for them. It is estimated that up to 30% of patients with depression may not respond to multiple antidepressants. Sometimes an individual must try several different medications to find the one that works best for them with the least amount of side effects. Often a person will respond well to the same medication that a family member does well with. There is also a test called the GeneSight test, that uses a swab from the inside of the cheek to determine which medications are likely to benefit a specific person. If medications are not working, therapy may be helpful. Improving basic factors like sleep, nutrition and exercise can also be helpful.
GeneSight
Does the environment impact my depression medications?
Many psychiatric medications, such as antidepressants, can affect the way that people respond to the environment. For example, many medications may affect the way people sweat, and can impact their ability to tolerate environmental conditions like heat. Some medications may make people tend to have low blood pressure in the heat, and others may make people think sluggishly in the heat. There can be a higher risk of heat exhaustion in people taking antidepressants. Heat exhaustion is a medical emergency and requires and urgent trip to the nearest emergency room!
Symptoms of heat exhaustion include:
Heavy sweating
Cold, pale, and clammy skin
Fast, weak pulse
Nausea or vomiting
Muscle cramps
Tiredness or weakness
Dizziness
Headache
American Academy of Family Physicians
Heat symptoms associated with common antidepressants:
Psychology Today
TCA's: Tricyclic antidepressants
SSRI's: selective serotonin reuptake inhibitors
SSNI's: selective serotonin/norepinephrine reuptake inhibitors
If your medications make you heat-sensitive, be sure to hydrate really well on hot days!
Is talk therapy helpful?
Yes, it is! A combination of medications and therapy work better than either treatment does by itself! Counseling can help improve depression, anxiety and other mental health conditions. Therapy helps patients develop increased confidence, improved decision making abilities, better coping skills, enhanced problem solving, and improved conflict resolution. It can also brighten mood, reduce medical costs, improve communication and lead to better relationships. Since 2020, approximately 30% of American adults have seen a therapist. In 2021, approxmately 42 million people in the United States received counseling or treatment for mental health.
verywell health
What can I do to improve my mood?
Exercise
Create artwork
Read
Do a self-help program
Take a class
Spend time with a friend
Listen to music
Write poetry
Meditate
Spend time with a pet
Cook
Take a shower
Spend time outdoors
Write in a journal
Notes: these suggestions are not intended to replace a physician's insight and advice on each patient's individualized treatment!
Day One App All Axess shutterstock
If you are thinking about harming yourself,
seek urgent professional health, go to the Emergency Room!
If you are thinking about harming youself, CALL FOR HELP!
DIAL 988!
If you are looking for more help:
Which apps can support my mental health?
The Department of Psychiatry at University of California, San Francisco, recommends the following apps:
Useful Wellness, Mental Health Apps
Articles tell us what to do, but apps help lead us and remind us to practice self-care every day. Below are apps we recommend, and many have been shown to be effective in evidence-based research. These high quality apps have been made available to UCSF, with some also free to the general public.
The Stress Free UC Study found that Headspace, used daily for just 10 minutes, reduced stress in a meaningful way and the benefits lasted for two months after stopping use. Headspace can be done in the morning or evening, alone or with family, or anytime you need to take a break.
Please consider trying one of these apps.
Meditation and relaxation
Headspace: Two-week free trial for the general public.
Health Minds Program App: Always free. Meditation and mindfulness skills.
Calm: Seven-day free trial. A meditation, sleep, and relaxation app.
Stop, Breathe & Think: Always free, and for kids too.
Insight Timer: Always free. This is not a daily app, but rather a great library where you can search for various types of meditations and lengths by excellent teachers.
10% Happier: Free and paid options available. (Seven days free, then $99 per year.)
UCLA Mindful App: Free. Meditation by Diana Winston.
Mindfulness Coach: Mindfulness Coach 2.0 was developed to help veterans, service members, and others learn how to practice mindfulness. The app provides a gradual, self-guided training program designed to help you understand and adopt a simple mindfulness practice.
Coping with anxiety and depression
Sanvello: A program for reducing stress and treating anxiety and depression that includes a coach or groups.
Meru Health: A program for clinical anxiety or depression that uses an app and therapist, and biofeedback monitor is optional. Referral from a health care provider is necessary.
Happify: Some free content, including stress reduction and cognitive techniques to address anxiety.
MindShift CBT: Free content, including cognitive behavioral therapy strategies to address general worry, social anxiety, and panic.
PTSD Coach: Created by VA’s National Center for PTSD and the Department of Defense’s National Center for Telehealth & Technology. This app provides you with education about post-traumatic Stress Disorder (PTSD), information about professional care, a self-assessment for PTSD, opportunities to find support, and tools that can help you manage the stresses of daily life with PTSD.
PTSD Family Coach: In conjunction with PTSD Coach, the PTSD Family Coach app is for family members of those living with PTSD. The app provides extensive information about PTSD, how to take care of yourself, how to take care of your relationship with your loved one or with children, and how to help your loved one get the treatment they deserve.
Mothers and Babies Online Course: A well-validated, web-based program for depression (available in both English and Spanish) for pregnant women, new mothers, and those who want to support them.
COVID Coach: Created for everyone, including veterans and service members, to support self-care and overall mental health during the coronavirus pandemic.
Spiral Up! Stress Overload App by EBT: Emotional brain training (EBT) turns toxic negative emotions into positive feelings in 1–2 minutes based on a new technology of emotion science (summary at ebt.org). The method’s free app is available at spiralup.org or at your app store as Spiral Up!
Insomnia
CBT-i Coach - Free cognitive behavioral therapy for insomnia, available for iOS and Android.
Additional apps
If you are interested in finding mental health apps, please consider using PsyberGuide — a helpful non-profit site developed by UCSF alum and UC Irvine professor Stephen Schueller, PhD, that provides expert reviews on mental health apps (both credibility and user experience) and offers solid recommendations.
Ember Opinion:
The app Sanvello is great at tracking your progress so you can see how you're improving and motivate you to try, but some people complained that it is hard to navigate through. Average rating of 4.8 out of 5. The app Happify is easy to personalize and can help you grow where you need to. Someone also commented that their therapist “very much approved”, but it is more of an app for people just starting with Cognitive Behavioral Therapy because of its more informal approach with therapy. It includes science based games and activities. Average rating was 4.5 out of 5. The app Spiral Up has easy steps to follow and really help people become happier, but there are some things in the app that don’t work properly, including sometimes not loading your progress. The average rating was 4.7 out of 5. In my Opinion the Happify app is the best because the fun activities and games can help keep unmotivated people interested. It also was approved by a therapist which is always a plus.
Protect the environment from your antidepressants!
depositphotos
When antidepressants get into the water, they can damage our environment and harm the fish that live in the water. Antidepressants get into the water in a number of different ways. As medications are eliminated from the body through urine or stool, they get into the wastewater when people taking these medications use the restroom. Also, many people will flush unwanted or excess medication down the toilet. Wastewater treatment facilities don't do a great job of clearing these medications from water before it returns to nature. Accordingly, some of metabolized antidepressants will end up in lakes, rivers and oceans. Some will even end up in our drinking water and in our fish dinners! Antidepressants in the water may affect the behavior of fish, alter their swimming, feeding and reproduction, and affect
their ability to survive. We don't know yet how people especially children) might be affected after drinking water and eating fish with high levels of metabolized antidepressants in them.
Alliance for Aging Research
Don't flush your drugs down the toilet unless the bottle indicates this is ok, or the medication is on the "flush list"!
Harvard Health suggests protecting our water by:
4 ways to reduce your pharmaceutical footprintLimit bulk purchases. Volume discounts make the price attractive, but big bottles of unused pills create an opportunity for medications to end up in the water. Use drug take-back programs. A federal law went into effect in 2010 that makes it easier for those programs to be organized at a local level, so you may see one in your community. The federal Drug Enforcement Agency has held two national drug take-back days and is likely to organize some more. Do not flush unused medicines or pour them down the drain. This is the very least you can do. But the FDA advises that certain powerful narcotic pain medications should be flushed because of concerns about accidental overdose or illicit use unless you can find a drug take-back program that will accept them. We've posted a list of the narcotics on our Web site at /healthextra. Be careful about how you throw medications into the trash. Medications thrown into the trash end up being incinerated or buried in landfills, which is preferable to flushing them or pouring them down the drain. If you put them in the trash, remove them from the packaging, crush them, and seal them in a plastic bag with some water. You're supposed to add sawdust, cat litter, coffee grounds, or some other unappealing material to the bag. That isn't for environmental reasons, but to cut down on the chances that a child or animal might eat the contents. You should also be careful to peel off any identifying information from containers of prescription medicine. |
What is being done on a larger scale to protect our water?
There is a lot of work happening to both monitor levels of antidepressants in our water, and to evaluate possible strategies to eliminate antidepressants from wastewater before it reaches our rivers, lakes and oceans. Traditional wastewater treatment doesn't remove medications from the water. There is research into using sludge or plants to clear pharmaceutical products from wastewater. There are also procedures that rely on light, chemical reactions or electricity to remove medications from water. It is important to ensure that wastewater is treated as thoroughly and appropriately as possible. It is critical that untreated wastewater doesn't get flushed to lakes, rivers and oceans!
Science Direct
MDPI Water
The EPA has taken a four-pronged approach that involves public education, stepped-up monitoring of water supplies, partnerships with health care facilities and agribusinesses to reduce waste, and eventually, perhaps, new regulations. As an introductory step toward possible regulation, the EPA has added 10 pharmaceutical compounds — one antibiotic and nine hormones — to its watch list of potentially harmful contaminants that warrant greater investigation.
The Natural Resources Defense Council, an environmental group, has called on drug manufacturers to design "eco-friendly" drugs that are absorbed by the body more efficiently or will break down in the environment after they're excreted. The organization has also asked companies to implement techniques to limit bioactive waste generated in their manufacturing processes.
How US sewage plants can remove medicines from wastewater:
New research shows that technologies are available, but the upgrades can be expensive
Learn more about protecting our water
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