Compiled by Brenda S. Rickman
bsrickman@mcloudteleco.com
www.we-r-art.com

Motivation, Depression and S.A.D.

Motivation can come and go - like the change in seasons or ebb and flow of the tide

How can we motivate ourselves when there seems to be no desire to paint or enjoy other activities in our life?

• Plug in your headphones and put on your favorite inspirational music and get rockin'! Play the type of music that seems to make you want to dance.
• Watch an inspirational painting video. Give the techniques try.
• Go through that stack of books and magazines you’ve been collecting. Read the articles on painting techniques and do a few samples to see what you can do.
• Jump into a group class - let the instructor pull you along.  "YEAH! - COME ON NOW!"
• Ask a friend, co-worker or family member to meet you once a week to enjoy your pastime together. It’s always more fun with a friend.

These are the excuses we hear most often for not doing something we enjoy and a few suggestions on how to defeat the excuse.

Depression is one of the most effective killers of Motivation.

More than 20 million Americans experience major episodes of depression, according to the National Institutes of Health. Millions more suffer from moderate or occasional depression. We now know that depression is one of the conditions most often caused by imbalances in brain chemistry, resulting from stress, lifestyle, or genetics. Low levels of the neurotransmitter serotonin are a common feature in depression. The research suggests that low serotonin affects a significant number of people, perhaps the majority of those with depression.

The research shows that low serotonin results when tryptophan levels in the body are depleted. Tryptophan is the raw material that the brain uses to make serotonin. Low levels of serotonin and tryptophan can be an important factor in anxiety, depression, and other uncomfortable moods.

Sleep affects our moods

Tryptophan is also the precursor of melatonin, the hormone that controls our internal clock in response to day-night cycles. Taking a tryptophan supplement can provide double benefit by supporting melatonin production and increasing serotonin to promote relaxation and sleep. Be sure to check with your doctor about using any type of supplements, natural or not.

What is Tryptophan?

Our moods and sleep are regulated by powerful brain chemistry, particularly serotonin, one of our most important neurotransmitters. Low serotonin levels have been identified as a cause of depression in hundreds of research studies. Serotonin is made in the brain from tryptophan, an essential amino acid. Tryptophan is the raw material the brain requires to make serotonin.

Tryptophan is a component of most proteins. Unfortunately, stress can deplete tryptophan. A number of other factors can also lead to tryptophan deficiencies, which in turn result in low levels of serotonin.

Lifestyle Factors that Affect mood  

• Depression can result from frequent or intense stress.  
• High levels of stress hormones (cortisol) and can lower serotonin in the brain.  
• A low protein diet can be a factor, since essential amino acids are missing.  
• Mood swings can be triggered by low blood sugar (hypoglycemia) - from skipping meals or eating too much sugar.  
• Poor digestion or food allergies can also play a role.

It’s been found that people with problems in these areas almost always have mood swings. So eating a good diet and managing your blood sugar are basic in rebalancing mood. If these lifestyle approaches are not part of your program, you're missing a good bet.

One of the most common types of depression is Seasonal Affective Disorder (SAD)

Symptoms include:

• Depressed mood
• Fatigue and lack of energy
• Sleeping much more than usual, increased need for sleep, or difficulty awakening in the morning
• Increased appetite, often including carbohydrate craving
• Weight gain
• Reduced work productivity

Seasonal Depression

Seasonal affective disorder (SAD) is a type of depression that is tied to seasons of the year. Most people with SAD are depressed only during the late fall and winter (sometimes called winter blues) and not during the spring or summer. A small number, however, are depressed only during the late spring and summer.

SAD is most common in young adult women, although it can affect men or women of any age. In North America, SAD may affect as many as 6 of every 100 people, more in the Northern portions of the country than in the South. Another 10-20% of people may have a milder form of seasonal mood change.

Like all types of depression, SAD can have a devastating effect on a person’s life. Fortunately, almost all people with SAD can be helped with available therapies.

The exact causes of SAD are unknown.

• Chemical changes in the brain caused by changes in the amount of sunlight are probably involved. People who live in geographical locations that are dark or cloudy during the winter are most likely to have SAD.

• A tendency to have SAD may run in some families.

SAD may have some of the same symptoms as other types of depression.

• Most people have only some of these symptoms, not all.
  • Depressed mood
  • Loss of interest in usually enjoyable activities
  • Fatigue or loss of energy
  • Feelings of worthlessness or hopelessness
  • Poor concentration, indecisiveness
  • Recurrent thoughts of death or suicide

• The symptoms of SAD come back every year, and for any specific person, they tend to come and go at about the same time each year.

Winter SAD

•      Sleeping more than usual
•      Craving for sugar, starchy foods, or alcohol
•      Weight gain
•      Irritability
•      Conflicts with other people
•      Heaviness of arms and legs
•      Behavior disturbances (in children)
•      People with winter SAD may seek out light places or sunlight, or like to have lots of artificial lights on.

Summer SAD

• Insomnia
• Poor appetite
• Weight loss
• Agitation
• Anxiety

When to Seek Medical Care

Seek medical care if the following occur:

• You think you have SAD or another type of depression
• Feelings of extreme sadness, hopelessness, or emptiness
• Inability to get out of bed or carry on normal activities
• Persistent loss of energy or increased need for sleep
• Unexplained change in appetite for food
• Changes in behavior that cause problems with family, friends, or work
• Feelings of wanting to die, wanting to commit suicide, or hurting yourself

No laboratory tests are available to detect SAD. Your health care provider will make the diagnosis from your symptoms, medical interview, and examination.

How is seasonal depression treated? One of the most effective treatments is bright light therapy. Sitting under a high intensity bright light for 30 minutes every morning can help people who get depressed in the winter. These lights are available from a number of sources, and research suggests that they do not have to be "full spectrum" lights in order to improve mood. The most important ingredient seems to be the intensity of the light. The light should mimic the brightness of being outdoors on a sunny day.

Dietary changes that may be helpful

Cravings for simple carbohydrates are increased in SAD, and women diagnosed with this form of winter depression have been found to eat more carbohydrates, both sweets and starches, than do healthy women. These women also report eating in response to emotionally difficult conditions, anxiety, depression, and loneliness more frequently than healthy women, but eating patterns associated with SAD are distinct from those of women with eating disorders.1

People with SAD process sugar differently in winter compared with summer or after light therapy in winter. Changes in neurotransmitters that may affect cravings also occur in women with SAD. Because consumption of carbohydrates can influence neurotransmitter levels, some authorities have speculated that eating simple carbohydrates may be a form of self-medication in people with SAD. A review of the research on diet and mood found that, while eating simple carbohydrates in reaction to depressed mood does bring about a temporary lift in mood, other evidence suggests that long-term control of negative moods is, for some people, best achieved by eliminating simple carbohydrates from the diet.5 No research has yet been conducted, however, to evaluate the benefits of a diet low in simple carbohydrates (or any other dietary intervention) for people with SAD.

Lifestyle changes that may be helpful

Exercise can ease depression and improve well being, in some cases as effectively as antidepressant medications. One study found that both one hour of aerobic exercise three times per week and the same amount of anaerobic exercise were significantly and equally effective in reducing symptoms of depression. In a preliminary study of women with SAD, exercise while exposed to light was more likely to be associated with fewer seasonal depressive symptoms than was exercise performed with little light exposure. A controlled study of 120 indoor employees used relaxation training as the placebo in a study of fitness training, light exposure, and winter depressive symptoms. Fitness training was performed two to three times per week while exposed to either bright light (2,500–4,000 lux) or ordinary light (400–600 lux). Compared to relaxation, exercise in bright light improved general mental health, social functioning, depressive symptoms, and vitality, while exercise in ordinary light improved vitality only.

How do you differentiate between SAD and normal depression?

You can begin to refine your thinking about that even before you see a doctor by using an automated questionnaire available to everyone on the Web at www.cet.org  It's called the Personalized Inventory for Depression and SAD, and it asks you symptom by symptom what you have and when you have it, and how severe it is. On the basis of that, an algorithm can very confidently say, "This looks like SAD or this does not look like SAD." The smart thing to do is to get the results from that questionnaire and present them to your doctor.

Is diagnosis often delayed?

For that reason, many patients with SAD have resisted coming in for clinical care, because they say, "I'll bear it out, and I know I'll be better." And it's a mistake, because their lives can be severely compromised for five to six months of the year unnecessarily.

How are the holiday blues tied to SAD?

It's not difficult to confuse holiday depression with SAD because of the timing. While some people with SAD begin to feel badly as early as September and October, a large number really don't feel the major slump until after Thanksgiving and towards Christmastime. They'll know, however, that there isn't some emotional connection with the holidays that's triggering their depression if it doesn't let up until April or May, because a holiday depression will pass shortly after New Year's. January and February are the worst months of the year for SAD symptoms.

How is SAD treated?

Winter depression has responded well to a number of different interventions. The primary therapy is bright light therapy in the morning after you wake up. Another light therapy option includes dawn simulation therapy, in which you force an artificial sunrise in your bedroom while it's still dark outside.

Another option is negative air ionization therapy, where you create summer-like conditions in the circulating air environment, either while you sleep or during the day. Negative air ions are very high in the environment in highly humidified environments, but indoors, especially in the winter with the heater on, there's a paucity of negative air ions, and that acts badly on mood.

Another option is standard antidepressant medication, which you really need to use only during the difficult months of the year. What we realize now is that the whole gamut of depression, whether seasonal or not, is modulated by the level of serotonin activity in the brain, and that's why the selective serotonin reuptake inhibiting (SSRI) drugs, such as Prozac or Zoloft or Celexa, are useful as during depression. They activate the serotonin system, and mood lifts. The studies that have been completed so far for SSRI drugs for SAD do show some improvement, but with not the extreme and rapid alleviation of symptoms that we see with light therapy. Seek medical opinion with regards to any medications.

How does bright light therapy work?

When we use bright light therapy, we're introducing a level of light indoors that does not come from any normal home lighting appliance. It's a level equal to outdoor light about 40 minutes after the sun rises.

The light box is set up on a desk or kitchen table such that the angle of light exposure comes down at your eyes. Its action is on the eyes, not the skin, and there are light receptors in the eyes that are specialized for sending signals to the biological clock. When we stimulate those receptors with light at the appropriate time of day for the individual, it resets the clock to its springtime mode, and that's when we begin to see the alleviation of symptoms. The average treatment duration is 30 minutes a day.

What time of day should someone receive bright light therapy?

The optimum time for taking light therapy in the morning is best gauged by determining the onset of melatonin in the evening. In external clock time, this can differ by several hours between individuals, and using the light too early or too late will greatly reduce its benefit.

Melatonin is a nighttime hormone. At a certain point in the evening, levels of melatonin begin to rise because the biological clock has told the pineal gland in the brain that produces melatonin, "Now it's night." In winter, the nights are longer, and so our biological clock is prone to turn off melatonin production later in the morning.

Since we cannot easily measure melatonin, we use another questionnaire whose score is tightly related to melatonin timing. This Automated Morningness-Eveningness Questionnaire is also available on www.cet.org

Are there side effects of light therapy?

It's critical when you use light therapy to use well-designed apparatus that completely screens out ultraviolet (UV) rays. The long-term cumulative exposure to UV rays is bad for the skin, and for the cornea and lens of the eyes. Unfortunately, there is a wide array of apparatus available for sale on the Internet, which has never been medically evaluated, and the Food and Drug Administration has no regulatory policy for this technology. But the Web site of the nonprofit Center for Environmental Therapeutics lists six criteria for choosing a light box.

If you suspect you are being affected by Depression, SAD or other mood problems, seek a trusted medical opinion from your family doctor right away. Don’t let depression ruin many months of your life every year. There is help out there!

Diagnostic Criteria for a Major Depressive Episode (seek medical help immediately)

1. At least five of the following symptoms have been present during the same two-week period, nearly every day, and represent a change from previous functioning. At least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

NOTE: Do not include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or hallucinations.

(1) Depressed mood (or alternatively can be irritable mood in children and adolescents).
(2) Markedly diminished interest or pleasure in all, or almost all, activities.
(3) Significant weight loss when not dieting or weight gain or decrease or increase in appetite.
(4) Insomnia or hypersomnia.
(5) Psychomotor agitation or retardation.
(6) Fatigue or loss of energy.
(7) Feelings of worthlessness or excessive or inappropriate guilt.
(8) Diminished ability to think or concentrate, or indecisiveness.
(9) Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.