a special program of the National Emergency Medicine Association (NEMA) 

Week: 557.6 Guest: Dr. Jack Vaeth, Psychiatrist, Sheppard Pratt Hospital, Balto., Md. Topic: The Winter Blues Producer/Host: Steve Girard

HEART OF THE MATTER / WEEKEND PUBLIC AFFAIRS PROGRAM 24:00 ( 2 segments of 12:00 each )

NEMA: The weather's gotten cold, the snow and ice have become a daily part of life again. Yep, it's winter. And you feel it very deeply, in fact, you are tired more than usual, you're not eating the same, and you're really down. Is it a natural thing? Or is it something that adversely affects your life each year at this time? Today we're addressing the Winter blues...with Dr. Jack Vaeth, a psychiatrist with the Sheppard Pratt Health System in the Winter blues is a real phenomenon?

VAETH: Absolutely, Steve, Winter blues is a slang term or a nickname for what we call Seasonal Affective Disorder, where there are groups of people who experience depression, but they only experience it during certain times of the year...and so the traditional pattern would be - and it is seemingly rather physiological or biological in nature - these people will become more depressed as Fall goes into Winter, and as Winter progresses, become very depressed. And when we pop from Winter to Spring, some of these people will not only feel better, but actually feel better than better, and actually feel almost a little high...or a little more revved up than they usually are. So, they'll go from one extreme to the other, and we call that Seasonal Affective Disorder. There is a reverse form, believe it or not, it's much rarer and it's even harder to treat. And these are people who get depressed during the summer, but are happiest during the Winter. And when I say depressed, I do mean very depressed, not just, "Oh, I don't like the winter time, it's cold and it's not fun. But these are individuals who get, show very biological changes:decreased sleep, decreased energy, poor concentration, tearfulness...some even feeling suicidal. So, it's a very real phenomenon.

NEMA: As a real phenomenon....there are researchers out there trying to figure out its causes. What have they found so far to be the underlying reasons for this deep, cold weather depression.?

VAETH: There have actually been several theories, and probably some of the most prominent, ongoing theories involve the changes in the light. And where these theories stem from is some of these people improve greatly when they are treated with photo-therapy, or light therapy...where they wake up an extra hour early every morning, and sit in front of a specially designed lamp that regulates a certain amount of light energy to what we think is the back of your eye, that connects to the middle of your brain, which may regulate the secretion of several of them being melatonin, which we know is very popular in the news. And so, you know, this is one of many theories, but light seems to play a role in this, and the theory would be that some of us are just more sensitive to environmental changes. And then that brings forth these biological changes within us.

NEMA: I know this is an aside, since we're talking about the Winter blues...but since you mentioned a Summer depression syndrome, let me ask you since the Summer provides all the light and heat we could want, what is behind the blues then?

VAETH: That's the most difficult one, because we're really left puzzled. And one of the reasons is because many of the traditional forms of treatment for any type of depression is relatively ineffective in these people....when compared with some of the other types of depression, including the winter blues type. So, the summer blues, because it's relatively rare, and it's harder to treat when we find it, we're really up in odds on causes and effective treatments on this, but fortunately, it's a very rare disorder.

NEMA: Let's get into the treatment... you mentioned the traditional they apply to Seasonal Affective Disorder?

VAETH: Sure...and some of those routine treatments would be therapy, as well as the use of certain medications that are very helpful in all types of depression. the difference with this one being... is instead of an individual taking a medication for 12 months out of the year, they may just need it for four or five months, and then can basically go off of it in the Spring through the Fall. And so it's just a temporary measure, or stopgap, but something that we found very effective...and people who can't put aside an hour or two every day to sit in front of a lamp...and people whose lifestyles actually prohibit that type of timing. So, it's very difficult to get people to comply with sitting down an hour or two a day to do anything.

NEMA: Let's go through a checklist that someone can use to find out if they are seasonally affected....

VAETH: Sure, the first thing is... Does it only occur in the Winter? If you're quite sure, for several years, this has been a Winter phenomenon, and clearly breaks in the Spring...then you'll want to look at the following symptoms: Number one, am I having difficulty sleeping. That is, either not getting enough sleep, which is the most common. Or sometimes the reverse....sleeping a large amount of time. If your normal sleep pattern's 8 hours, and you're sleeping 14, for example. Number 2, am I losing interest in things around me? As if I don't care about my hobbies or my friends or my social activities. Number 3, is my concentration impaired in any way? Has my energy level dropped? Do I feel fatigued? And how has my appetite changed? Appetites very much like sleep, it often goes down, but may go up...and with people with seasonal disorders, they may often crave certain foods and usually these are sweets or some other carbohydrates. So their preference in foods will actually change during these months. A feeling of pervasive hopelessness, helplessness, worthlessness, and of course, on the worst end of that, feeling like you don't even care whether you live or die anymore.

NEMA: And that's the time to seek professional help...or for a parent or friend who notices these changes to intervene. Again, perhaps shifting gears just a bit here....when we speak about the holiday blues, I would imagine that to be a different animal from the seasonal depression we just talked about....

VAETH: And I think you're entirely right. What we think of as the holiday blues is a very circumscribed time, mostly going from Thanksgiving into December, and maybe some of the post-holiday blues period of early January. I tend to think that if we change Christmas to the month of April, we'd still see people with the holiday blues. And I think you're point of it being different stems from the fact that it may be a lot more environmentally related. For example, as we come across any major anniversary in our life, whether it's a 40th birthday or the death of a loved one last year at this time, or whatever...our routine is interrupted enough that we start reflecting on our lives, and so Christmas gives us that opportunity, often, to look back and see, instead of what we have, we tend to harp on what we don't have. So, a lot of people with holiday blues are looking at their shortcomings in life, much the way someone goes through a crisis on their 40th birthday. The problem is that during the Christmas season, we see ideal examples of life, and then we reflect on ours and see that we don't lead these ideals: the perfect wife, the loving children, the perfect amount of money to do whatever you want with it...or even if you have the perfect amount of money, the perfect amount of time you have to spend with the people that you should be around. And as we reflect on these, we see the shortcomings in our lives: divorces, separations, substance abuse problems, being in a dead-end job, having not achieved what we thought we needed to. So, holidays give us these moments to reflect back. The other problem with holidays, and interrupting our routines is, we're often exposed to seemingly new situations: having to visit friends or family that we might rather not see, but are just going through the motions to keep things smooth in the family and neighborhood. They also cause us to reflect back on our childhood, and if Christmas was a particularly bad time for you as a child, certainly we would expect that to continue into adulthood. So again, Christmas is a time when the pace may quicken around us, but it also causes us to reflect within ourselves on what's been going on in our own lives.

NEMA: In this case, if a depression begins around or just after the holidays, how does a person know when a common holiday blues situation is getting worse, or deeper?

VAETH: If your situation is somehow adversely affecting your relationships socially, or within your family, or your occupational or academic...or educational endeavors, in any way...then you should have it looked into. So, if your life in general is going smooth, and no one notices a problem, then you're probably doing okay. But when interference's start taking place in other avenues of life, that's when we look to professionals for help.

NEMA: It seems important that people recognize the good things that come with the holidays without trying to compare our homes, our gifts, our lives with the idealized snapshots packaged for us by advertisers, or told to us in holiday stories from the 'old days'....

VAETH: ...and it's impossible to attain, and it's important that we look back into our lives at the good things. Look how far I've come...look what obstacles I've been able to surmount. And even more importantly, let's stop looking back, and draw a line and say, "Okay, it's Christmas, 1996. This is what I'm going to accomplish in 1997"!

NEMA: If you are depressed each and every winter...and as we heard, more than just "I hate the cold"...a real systemic and social affliction - or if you have had a deep holiday depression this year that you just can't seem to snap out of, and it's lasted more than a few weeks...please contact your doctor, and consult with him on whether you may need counseling or treatment. Thanks to Dr. Jack Vaeth of Sheppard Pratt Health Systems in Baltimore. I'm Steve Girard.

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TEASE: A medication for heart attack patients which was pushed back in ranks is once again coming to the fore...we'll talk with a Harvard researcher, next on The Heart of the Matter.