New Treatment Options for Seasonal Affective Disorder

Sad Winter

It’s that time of year….

During the winter months, people are more likely to report feeling tired, depressed, or sad. For many of us, these feelings are a normal response to less sunlight, and an occasional case of the “winter blues” is mild and manageable. Others, however, are struggling with the symptoms of seasonal affective disorder (SAD), a clinical form of depression. What is the difference between the two?

In a recent interview published by the American Psychological Association, SAD expert Kelly Rohan, PhD, explains the signs of the disorder and potential treatments. Rohan is an associate professor of psychology at the University of Vermont who specializes in cognitive-behavioral therapy, theory of depression, and SAD.

According to Rohan, SAD is a pattern of major depressive episodes during the fall and winter months, with periods of full improvement in the winter and spring. “The symptoms of SAD are exactly the same as non-seasonal depression symptoms, which can include a loss of interest or pleasure in normally enjoyed activities, excessive fatigue, difficulty concentrating, a significant change in sleep length and thoughts about death or suicide. The only difference with SAD is the seasonal pattern it follows,” says Rohan in the APA interview.

Widely used treatments for SAD include light therapy, that is, daily exposure to bright artificial light during the months when depressive episodes occur; anti-depressant medications are sometimes prescribed, as well. In recent years, however, Rohan’s lab has been researching the effectiveness of cognitive-behavioral therapy (CBT) for SAD. “CBT is a type of talk therapy used and researched extensively for non-seasonal depression since the 1960s, but we are the first group to apply the treatment to SAD,” Rowan says. “The CBT for SAD treatment we have been testing includes 12 structured sessions, delivered two times per week over six weeks in the winter. The sessions focus on developing skills to improve coping with the seasons. The therapist works with the patient to foster two types of skills: behavioral (doing) skills and cognitive (thinking) skills. The behavioral skills involve identifying, scheduling and doing pleasurable, engaging activities every day in the winter. Over time, these proactive behaviors are meant to counteract the down, lethargic mood and the tendency to give in to ‘hibernation’ urges that are so common in SAD. The cognitive skills involve learning to identify and challenge negative thoughts when experiencing SAD symptoms.”

In Rohan’s clinical trial, patients who had been treated with CBT generally had better outcomes than those who had been treated with light therapy alone. “These results suggest that treating someone initially with just CBT may be more effective in the long term,” says Rohan. “My lab is completing a study to find out if these results hold in a larger, more definitive study funded by the National Institutes of Mental Health.”

What do you think? Could CBT be a promising treatment option for clients with SAD? PAR wants to hear from you, so leave a comment and join the conversation!

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The Geography of Depression

man with globeA new study by researchers at the University of Queensland in Australia shows that rates of depression vary significantly from country to country—and patterns of depression worldwide can be quite surprising. The highest rates were reported in the Middle East, North Africa, and Eastern Europe, where more than 5 percent of the population suffers from depression. The lowest rates were in East Asia, Southeast Asia, and Australia/New Zealand. The least depressed country is Japan, with a rate of less than 2.5 percent. On average, approximately 4 percent of the world’s population has been diagnosed with depression. The study also calculated the “burden of depression” for each country, that is, the number of healthy years lost to depression or depression-related premature death. Using this metric, depression becomes the second-leading cause of disability worldwide.

The authors of the study caution that their findings were based on preexisting data on the prevalence, incidence, and duration of depression; therefore, factors such as access to diagnosis and cultural attitudes about mental illness may have skewed results. The authors of the study also said that reliable surveys from some poorer countries were not available.

The Washington Post created a map of clinical depression rates based on the Queensland study; click on the link to learn more about these findings.

Vulnerability to Depression: Can It Be Contagious?

Researchers have found that college roommates of students who demonstrate vulnerability to depression are more likely to develop that vulnerability themselves over time. The research, conducted by psychologists Gerald Haeffel and Jennifer Hames of the University of Notre Dame, was published in the April issue of Clinical Psychological Science.

Haeffel and Hames examined “cognitive vulnerability,” which they call “a potent risk factor for depression.” Those with cognitive vulnerability tend to interpret stressful life events as the result of factors over which they have no control; they see these events as a reflection of their own deficiencies. Cognitive vulnerability is normally quite stable in adulthood; however, the researchers wanted to examine whether it might be “contagious” during periods of major life transitions—like starting college.

The research involved 103 randomly assigned roommate pairs who had started college as freshmen. When they arrived on campus, the participants completed an online questionnaire that included measures of cognitive vulnerability and depressive symptoms; they completed the same survey twice more, at 3-month and 6-month intervals, when they also answered questions about stressful life events.

The results showed that freshmen who were assigned to roommates with high levels of cognitive vulnerability were likely to “catch” their roommates’ vulnerability to depression. Perhaps even more significant, when the vulnerable mindset “rubbed off” on these students, it affected their rates of future depressive symptoms. Students whose cognitive vulnerability increased over the first 3 months of college had nearly twice the level of depressive symptoms at 6 months than those whose vulnerability didn’t change.

On a more positive note, the study also found that a healthy mindset was also contagious. “Those assigned to a roommate with a more positive thinking style developed a more positive style themselves whereas those assigned to a roommate with a negative style became more negative,” Haeffel said in a recent interview with Time.com. The research does not suggest factors that make one roommate’s style more likely to influence the other.

“Our findings suggest that it may be possible to use an individual’s social environment as part of the intervention process, either as a supplement to existing cognitive interventions or possibly as a stand-alone intervention,” the authors say in press release from the Association for Psychological Science, the publisher of the journal in which the study appears. “Surrounding a person with others who exhibit an adaptive cognitive style should help to facilitate cognitive change in therapy.”

Could a Blood Test Diagnose Major Depression in Teens?

Researchers at Northwestern University Medical School have suggested that depression in teens could be diagnosed with a simple blood test. Their study, published in the April 17, 2012 issue of Translational Psychiatry, identifies 11 biomarkers for early-onset major depressive disorder—one of the most common yet debilitating mental illnesses among young people. If the results are confirmed in larger populations, diagnosis could become a much simpler process, and one that might help teens avoid some of the stigma currently associated with a depression diagnosis.

Early-onset major depressive disorder is a serious mental illness that affects mainly teenagers and young adults. Although 2 to 4% of cases are diagnosed before adolescence, the numbers increase dramatically to 10-25% with adolescence, according to lead researcher Eva Redei, professor of psychiatry and behavioral sciences at the Northwestern University Feinberg School of Medicine. “Not diagnosed, depression affects how teens relate to others. The No. 1 cause of death among the depressed is suicide,” explained Redei in a recent interview with CNN. “If teens are depressed and not treated, there can be drug abuse, dropping out of school. Their whole lives can depend on these crucial and vulnerable years.”

In the study, researchers tested the blood of 28 teens, ages 15 to 19. Fourteen had been diagnosed as depressed, and the others were healthy. The researchers examined a panel of 28 markers that circulate in the blood; results showed that 11 of these markers could, with a high degree of accuracy, predict major depression in the subjects. Depression is currently diagnosed through psychological evaluations conducted by health care providers.

A blood test to diagnose depression could help reduce the stigma associated with this mental illness and help depressed teens to get the treatment and support they need. For many teens who are too embarrassed to ask for help, this blood test could be a huge step in the right direction. “Once you have a measurable index of an illness, it’s very difficult to say, ‘Just pull yourself together,’ or ‘Get over it,’” Redei explained recently to the Los Angeles Times.

Others are cautious in their response to the study. Dr. Lloyd Sederer, medical director of the New York State Office of Mental Health, suggests that this study could give parents and teens false hope about treatment. “When something like this comes out and gets a lot of attention, it’s a false promise to parents, because it’s nowhere ready for prime time,” he said in an interview with the Huffington Post. “Some of the risks have not been considered yet. And does it really shape, in any way, how effective your treatment is going to be now?”

What do you think? In what ways could a diagnostic blood test for depression affect treatment for your clients? PAR wants to hear from you, so leave a comment and join the conversation!

Food for Thought on Eating Disorders

Research from the Agency for Healthcare Research and Quality has found that following a steady increase in the number of hospitalizations for eating disorders from 1999 to 2007, the number of individuals checking into hospitals with these principal diagnoses has fallen by 23 percent from 2007 to 2009, the latest year for which numbers are available. Eating disorders have the highest mortality rate of any psychiatric disorder, with anorexia specifically being the leading cause of mortality in women between the ages of 15 and 24. During this time period, the severity of reported eating disorders decreased, as well.

However, patients found to have eating disorders were often hospitalized for other presenting conditions, such as depression, fluid or electrolyte disorders, schizophrenia, or alcohol-related issues. Statistics showed that although 90 percent of those suffering from eating disorders were female, eating disorders in men increased 53 percent since 2007.

In light of the recent decrease in eating disorders, from 1999 to 2009, hospitalizations skyrocketed 93 percent for the disorder pica. Pica is usually diagnosed in women and children and causes them to eat inedible materials like clay, dirt, chalk, or feces. During the 10-year period, the number of hospitalizations for patients with pica increased from 964 to 1,862.

Why do you think the number of eating disorders in general has gone down while the number of individuals diagnosed with pica has increased?

Upcoming Webinar: An Innovative Approach to Treating Depression

One in 10 American adults experienced depression in 2010, making it one of the most common complaints of those seeking therapy services. In her October 11 webinar, “An Innovative Approach to Treating Depression,” PAR author Dr. Lisa Firestone will present a method for helping treat depression that encourages clients to identify and combat their self-destructive thoughts.

According to Dr. Firestone, when someone is depressed, the hopelessness they feel clouds the lens through which they see the world; this lens is most harsh when it is turned on themselves. To begin challenging the roots of depression, therapists must help clients identify their self-destructive thoughts (“Critical Inner Voices”) and learn to take action in their own self-interest. In this webinar, Dr. Firestone will introduce a cognitive/affective/behavioral modality for bringing these thoughts to the surface, separating from them, and taking action against them. Clinicians will learn how to help clients challenge their Voices, show more self-compassion, and strengthen their sense of self.

To register for this webinar, click here. The webinar will be held October 11, from 7:00 to 8:30 p.m. EST, is worth 1.5 CE units, and costs $25.

Signs of Depression on Facebook?

A new study from the University of Wisconsin School of Medicine and Public Health suggests that Facebook may be a potential tool in finding individuals who are suffering from depression. However, study authors say that it should not be used as a substitute for clinical screening.

Researchers analyzed the Facebook profiles of 200 college sophomores and juniors. Twenty-five percent of the students exhibited one or more symptoms of depression through their online activities, whether those were references to decreased interest or pleasure in activities, a change in appetite, sleep problems, loss of energy, or feelings of guilt or worthlessness. Only 2.5 percent of the profiles displayed enough information to warrant screening for depression.

One of the most interesting findings? Students who complained of depression symptoms often had others in their social networks reach out to help them.