​January 2004

Good Days, Sad Days

by Domenic D'Urzo

Accenti HEALTH : Good Days, Sad Days by Domenic D'Urzo
How often do we hear people saying: "I have my good days and I have my bad days?" Well, the expression is not just a figure of speech but an actual fact. As human beings, we are affected by many phenomena in our environment and we react accordingly, given our own strengths, our coping mechanisms and our support system. Different people react differently to stress, therefore, it is important to distinguish between stress and the person under stress.


The word press is in disuse and, in fact, has never caught on, but press indicates the tribulations, the stressors, the angst of everyday life we all experience. Our individual reaction, however, is the determining factor. The same stressor will hardly perturb one person but may suffocate another. For example, having to pay a hefty bill may not be a source of distress for one person (for whatever reason), but it may cause great anguish to another (for whatever reason). Some people experience stress at a very high level and some (perhaps 10% of the general population) will develop a full blown depression; that is, a clinical depression with signs and symptoms easily recognizable by a clinician and probably even recognizable by the patient.


When a person who has never been diagnosed with clinical depression goes through a period of "downness" and this downness comes seasonally, the diagnosis of Seasonal Affective Disorder, or SAD, may be given.


Seasonal Affective Disorder is different diagnostically from major depression because it comes seasonally, usually beginning in fall or winter each year, sometimes episodically in other seasons, more often affecting women (as in major depression) and usually occurring in the middle years. It is unclear whether it affects persons with depression more often than people who do not have depression. It is manifested by anergia (lack of energy), sadness, fatigue, difficulty concentrating, diminished libido, excessive hunger (especially for carbohydrates), hypersomnia (excessive sleep), and weight gain.


What causes this illness? Many cultures around the world inherently recognize that, as humans, we are creatures of light. The sun is important to our survival. Light is crucial to our existence. We "see the light," we are inundated by "divine light," we sing praises to God and ask we be guided to His "perfect light." Darkness is generally associated with non vision and death, both corporeal and spiritual. Also, as cultural anthropology sustains with solid evidence, we began our existence in the temperate zones of this planet, and we have had to "adapt" to the northern, colder, darker regions of the globe; it could just be that we are still in the process of adaptation.


There is solid scientific evidence to support the biological need we have for light and the ill effects produced by its absence. When daylight diminishes during winter, the body produces more melatonin, which is a hormone implicated in the regulation of sleep. When days are shorter, more production of melatonin will induce more sleep and, unfortunately, more depression in the individuals affected.


The mechanism by which the body "knows" that the days are shorter is through the eyes and skin. The eyes absorb light radiation and transmit it by the optic nerve to the hypothalamus. The hypothalamus increases the output of serotonin which is a mood regulator; the pituitary gland in the brain produces less melatonin which promotes good mood. People who live in areas of the world with less sunlight are more predisposed to Seasonal Affective Disorder, while people in areas of more sunlight are less prone to it. How is SAD treated? Intense exposure to special light and psychotherapy is one avenue. Medication and more psychotherapy is another. Interestingly, the idea that exposure to light is beneficial to depressed people is centuries old.


The setup for light therapy is complex and should be administered by an experienced clinician; it is not the same as sun tanning lamps. The treatment gives good results for a partial cure and should be the first choice of treatment if a diagnosis of SAD is certain. The treatment is pretty involved, taking 30 minutes per day; but the first positive results can be felt within a week. There are contraindications to light therapy for people with certain eye disorders or with diabetes.


Pharmacology is another effective way of treating SAD. The medications in use are the anti-depressants, in particular the fairly new SSRI (Selective Serotonin Reuptake Inhibitors) drugs, and the older but still available MAOIs (Monoamine Oxidase Inhibitors). These drugs are used in the routine management of major depressions and are used if or when a patient cannot tolerate light therapy, when SAD is very debilitating or if light therapy is not available. The use of anti-depressants has been, and continues to be, a breakthrough for the treatment of depression.


I have mentioned psychotherapy as a concomitant treatment with light therapy and with pharmacotherapy for several reasons. Human beings are not biological automatons. They are vibrant spiritual and psychological entities and any therapy that neglects to address emotions, thoughts and reason is lessened by that neglect. We cannot concentrate all our treatment on the iatros (treatment) without addressing also the logos (cause, understanding) of the illness.


People are under considerable press, and the pressure of everyday life can be overwhelming. The fall and winter is the time of year when people are most busy and burdened. Children return to school and they have nine months of daily routine to follow. Adults are back at work and there may be no reprieve for months. There is a lot of time spent indoors, away from people; this is usually a good recipe for depression. The activities pursued are more tedious, and going out means wearing the armour of winter.


Spring and summer, on the contrary, is revitalization time. We look forward to weeks or months of vacation, and for the most part the vacation is expected to be spent outdoors pleasantly basking in the sun, and actively pursuing interests which are fun. The psyche is appeased, general happiness is in the warm air.


We all have our good days and our bad days, but for people who suffer from seasonal depression, fall and winter condition their mood, sometimes making it unnecessarily dreadful.


Dominic D'Urzo is a psychotherapist living in Toronto.



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