The New Year is Here, But the Happy is Not
Illustration By Michael Rushbrook
Fall’s carnival of colors has given way to winter’s various shades of gray. The corner where the Christmas tree stood yawns a hollow sigh. The mailman is back in his routine of bringing bills instead of cheery holiday greetings. The parties have petered out.
On December 31st it seemed as if the guests would take you up on your invitation for them to “sit deep and come often.” But January’s cold walls welcome in a different kind of guest; a dull invisible one that you can’t quite put your finger on. Was it there all the time, while you were distracted by boughs of holly, or is this a new guest that rang in with the New Year? Is it the post-holiday blues or something more insidious?
Mild to moderate depression and anxiety can accompany changes in the routine, whether those changes are due to the abrupt drop-off of activity associated with the end of the holidays, a new baby, an illness or a loss. If feelings of sadness or worry persist for more than two weeks, warns Dr. Lynn Tyson, psychiatrist and medical director of Augusta AmericanWork Mental Health and Addictive Disorders Clinic, it’s time to seek a doctor’s input. For most people with mild to moderate depression, talking with their primary care physician, internist or gynecologist is a good first step. Doctors evaluating for depression will screen to rule out other medical illnesses that could cause the symptoms, such as thyroid problems, anemia, cardiac disease or cancer.
Red flag warning signs of mild to moderate depression and anxiety may include a decrease in motivation, difficulty concentrating, generalized worry and lack of interest in activities previously enjoyed. Other troubles may include nervousness, restlessness, change in sleep patterns (sleeping too much or inability to sleep) and change in eating habits (overeating or under eating). These symptoms can be particularly troublesome when they begin to impact interpersonal relationships with friends, family and spouse, as well as job performance.
In the past, depression carried the stigma of being a character flaw that a person could fix if he or she just tried hard enough. That notion still lingers problematically in the back of many people’s minds. Research, however, definitively demonstrates that, like heart disease or high blood pressure, depression is a biologically based medical condition that can be successfully treated with medication.
Chemicals made by the body, notably serotonin, norepinephrine and dopamine, act as messengers from cell to cell in the brain. Part of their job is to send information about mood and emotion. When these chemicals become imbalanced, either because there isn’t enough of a certain one or because the cells can’t receive the chemicals’ message, depression or anxiety can result. Antidepressants—the medications used to treat depression, anxiety and other related illnesses—operate on the brain to either stimulate increased release of these messenger chemicals or to increase sensitivity of cells to receive the messages. While not a cure for depression and anxiety, “[Antidepressants] are an effective treatment,” says Dr. Tyson.
A common fear of antidepressants that patients express is that they are addictive. This suspicion is unfounded. Unlike with addictive substances, the body does not build up a quick tolerance to antidepressants nor do cravings for the drug develop. In fact, it takes several weeks for antidepressants to produce a change. “To really kick in,” says Dr. Tyson, “it takes two to four weeks, and six to 12 weeks to reach full effectiveness.”
With women two times more likely than men to be diagnosed with depression, gynecologists, like Dr. Sarah Speese, frequently consult with patients they suspect may be silently suffering with depression. She notes that hormone changes associated with puberty, childbirth and peri-menopause seem to trigger symptoms of depression and anxiety in some patients. “I don’t have any qualms about giving a woman an antidepressant if she’s not functioning properly and we’ve tried other things to help her out,” says Dr. Speese. For various reasons, though, patients may express reservations about a prescription for antidepressants. They worry someone might find out or that they’ll gain weight. They are concerned about sexual dysfunction. Sometimes it’s the husband who discourages the use of medication. The greater risk, however, is that symptoms may worsen, leading to severe depression.
Antidepressants do have side effects, which differ depending on the individual drug. Dr. Tyson says, “Antidepressants are very safe medications. The side effects are minimal and can be managed.” Some antidepressants increase appetite while others suppress it. Some cause drowsiness while others cause wakefulness. Additional side effects may include diarrhea, constipation, dizziness, decrease in libido or sexual dysfunction. Luckily, with so many options now available for doctors to prescribe, patients can find one that is a good fit for their specific needs. As with any medication, not all patients experience side effects. For those who do, explains Dr. Tyson, doctors can prescribe an antidepressant with side effects that work for the patient. For example, someone having difficulty sleeping can be prescribed an antidepressant with a side effect of mild sedation.
The primary treatment issue for those with mild to moderate depression and anxiety is not the nailing down of an effective antidepressant. It is that they often delay seeking help. This reluctance relates to the belief that the depression and/or anxiety will pass or that one should be able to overcome it through sheer will and determination. Dr. Speese advises women struggling with symptoms of depression to ask their girlfriends how they’re managing to cope. “Girlfriends are usually open with each other,” says Dr. Speese. Since the use of antidepressants, as determined by a recent Centers for Disease Control study, has increased 400 percent since 1988, it’s very likely that at least one person, if not more, within her group of friends is using an antidepressant.
Dr. Tyson encourages people whose spouse, family member or friend is exhibiting some of the red flag symptoms for depression and anxiety to urge their loved one to see a doctor. Untreated symptoms can worsen. “Every day I’m seeing folks in my practice who waited to come in and it really impacted negatively on themselves and their families,” says Dr. Tyson. Depression in the elderly, characterized by memory problems, confusion, social withdrawal, loss of appetite, weight loss, inability to sleep, irritability and vague complaints of pain, frequently goes untreated. Yet success rates for interventions are extremely high. Dr. Tyson says that treatment options for depression are effective in 80 to 90 percent of cases.
Treating depression and anxiety should include more than simply taking a pill. Antidepressants are not miracle drugs, but they do relieve debilitating symptoms so that people can initiate important lifestyle adjustments. Regular exercise (30 minutes, three times a week) and a well-balanced diet have both been shown to diminish symptoms. Maintaining a strong social support network, which tends to suffer when a person feels anxious and depressed, provides a buffer. Cognitive-behavioral therapy with a mental health professional can help address issues of abuse, loss or other trauma and improve coping strategies. Other things that can assist in warding off depression are daily meditation, participation in a faith-based organization, volunteering and/or participating in a support group.
Dr. Speese, who notes that women in particular tend to pile on obligations, suggests also practicing the art of saying, “No.” Take some things off your plate. Divide and conquer the work at home. Don’t try to take on the world and the tasks of daily living all by yourself. Ask for help.
For a person with depression, lifestyle changes accompanied by a daily dose of an antidepressant will substantially lift the shades of gray draped over the horizon. At this point in progress, many patients are tempted to quit taking their antidepressants. Both Dr. Speese and Dr. Tyson agree that for some patients, antidepressants are a solution to a temporary state and not necessary for the long haul. Other patients may need to continue taking antidepressants for an extended period of time.
In either case, it’s best to taper off of the medication under a doctor’s supervision. “Going cold turkey is not a good idea,” says Dr. Tyson. When quitting antidepressants, some people may experience withdrawal symptoms such as nausea. These symptoms are not life threatening, but they are uncomfortable. Tapering off also provides the doctor and patient a way of monitoring whether or not the patient is truly ready to quit. If during the process symptoms of anxiety and depression resurface, immediate action can be taken. Dr. Speese prefers her patients, when advisable, to taper off in the spring when the weather is warming, the daylight hours are lengthening and they’re primed to feel better anyway, as opposed to the winter months.
It’s not a character flaw to require an antidepressant for months or years or a lifetime. Depression and anxiety are medical conditions caused by chemical changes and imbalances in the brain. They are not due to personal weakness. Just like you would control your diabetes with medication and lifestyle changes, so, too, you should control your depression. Sure, it could be the coming-down-from-Christmas blues, but prolonged sadness also may be something more serious. Discuss it with your doctor and discover a solution.
*The Georgia Crisis and Access Line for assistance with access to mental health and substance abuse services in Georgia is (800) 715-4225.