What it is, treatments for it, and the stigma of mental illness

By Adam Hocking

Editor

MARSHFIELD — Dr. Veeresh Bajaj, a psychiatrist at Marshfield Clinic, defines seasonal affective disorder (SAD) as a kind of depression that occurs in relation to changing seasons. With Marshfield’s semi-arctic climate, Bajaj said that nearly all cases of SAD he sees come when fall turns to winter, though it can occur in other seasons.

When a little extra irritability or frustration turns into something more — feelings of apathy, low frustration tolerance, trouble sleeping, increased appetite — there is a possibility that SAD is playing a role.

Bajaj said that if all it takes is an extra cup of coffee to shake off the winter blues, that is likely just normal psychological and seasonal ebb and flow, but if you are experiencing more issues, there could be something wrong.

“When it starts to affect your functional status — that you’re skipping work — then it’s something that needs to be treated,” Bajaj said. “You can have depression any time of the year, and if it has a seasonal flavor to it, … that would be seasonal affective disorder,” Bajaj said.

“Seasonal affective disorder is not very well understood. There’s some people (who) say it’s because of serotonin levels of the brain. Some people say it’s because there’s not enough sunlight (in the winter),” Bajaj added.

Bajaj said treating SAD can be similar to treating depression but that the use of a therapeutic light box, which emits light and is designed to mimic sunlight, can be useful. Medication and talk therapy can also be helpful, but Bajaj said that treatment will differ case to case based on a person’s biology and severity of symptoms. Exercise, Bajaj added, can have a major positive impact on mental health.

The winter season, Bajaj said, “affects I think most of us in some way or the other. … Does it translate to a problem? That’s where the difference lies.”

Bajaj added that SAD is most commonly observed in women and estimated that 40-50 percent of patients already with depression see symptoms intensify in the winter, and 10-20 percent of the population that does not have depression may experiences some depressive symptoms with the onset of winter.

The stigma of mental illness

“Depression is very enigmatic,” Bajaj said. “Some people say it’s a weakness. That’s a big misconception.”

According to the Youth Risk Behavior Survey, which poses questions to Marshfield’s eighth, 10th, and 12th grade students on topics such as mental health, nearly 22 percent of high school students and just under 21 percent of middle school students reported feeling “so sad or hopeless every day for two weeks or more in a row that they stopped doing some usual activities during the past 12 months.” Just fewer than 13 percent of high school students and nearly 15 percent of middle school students reported seriously considering attempting suicide in the past 12 months.

Bajaj noted that because of the stigma associated with mental illness, people may be hesitant to talk about it or ask for help like they would with a physical condition like a heart issue.

“Depression you inherit. It runs in the family. It is as biological as it gets,” Bajaj said.

He added that scientists are simply further behind in understanding the brain when compared to the rest of the body.

The causes of depression, Bajaj said, can vary greatly. Some may suffer due to trauma experienced in their youth, others because of a genetic predisposition to the disease. Different treatments will be more effective depending on the root cause of the depression, Bajaj said.