Episode 37: Winter Blues?

Please excuse any typos, transcripts are generated by an automated service

Dr. Melissa Smith 0:00
It’s January, the holidays are over your cash is spent. The snow is gray, and so is your mood. So how do you know if you’re dealing with a winter doldrums? Or if you’ve got some depression on board? Well Join me as I break it down for you, and most importantly, give you some solutions to help you thrive through the winter months.

Dr. Melissa Smith 0:26
Hi, I’m Dr. Melissa Smith, welcome to the Pursue What Matters Podcast, where we focus on what it takes to thrive in love and work. January can be a tough time for so many of us, the glow of the holidays has faded. And quite frankly, there can be very little to look forward to. There aren’t many holidays, we’ve got MLK Day, Martin Luther King Day, Presidents Day, and if you’re really lucky, you might have some sort of spring break planned in April. But boy, you know, in January, that can feel a long way off. And you know, you can add to that some sometimes crushing weight of big goals that you may feel you are not progressing on the stress of work, family life, and the very real impact of seasonal affective disorder, also known as SAD. And if that’s not enough to make you want to hibernate, like the bears, I don’t know, what would. I really think they’re onto something there. So you know, maybe they’ve got it all figured out.

Dr. Melissa Smith 1:53
So before you climb back under your covers this, you know, as if you could, wouldn’t that be nice, don’t fear because I’ve got you covered today, we’re going to break down, you know, the winter blues, seasonal affective disorder, and depression and really help you get a better handle on some of these mood issues. Because the reality is that during this time of year, it is not uncommon to question whether you might be experiencing depression. And of course, you know, depression is a very serious mental health concern that you want to be very proactive about. But the symptoms of depression, absolutely present along a continuum. And so I think it’s really helpful to understand that continuum and understand your own experience of symptoms. And then of course, that can be really help you to know that can be really helpful. So that you know what might be most effective for you in terms of intervention. So you know, because this is, this is what’s true, there is a lot that you can do to help yourself when it comes to, you know, mood disturbances, whether that is you know, the winter blues, whether that is seasonal affective disorder, of course, whether that is major depressive disorder. And so let’s jump in and wrap our hands around this topic. Okay, so first of all, let’s, let’s understand some of the numbers a little bit more. So, in the United States, approximately 16 point 2 million adults or 6.7% of American adults have had at least one major depressive episode in a given year. So about 6% of the adult population in any given year. So it’s, it’s not really that uncommon, if you think about it on a yearly basis, to experience a depressive episode. And then 10 million Americans suffer from seasonal affective disorder or SAD, so I’m going to sometimes use the term SAD. So just so you know, that’s what I’m referencing seasonal affective disorder. And don’t worry, I will define that fully in just a minute.

Dr. Melissa Smith 4:19
So 10 million Americans struggle with seasonal affective disorder, and another 10 to 20% experience, a more mild version of seasonal affective disorder. And then I think this one’s really interesting. So SAD is four times more common in women than in men. So, you know, some of the research around SAD is, you know, trying to get a better handle on this and you know, there’s some question about whether there might be a hormonal component that goes into sad because you know, four times more common among women definitely makes you wonder about what might be going on there? So first of all, let’s define depression and help you get a clearer picture of some of the differences along the continuum. And so, you know, that’s something that I’ll be talking about a lot throughout the podcast is this continuum of symptoms. And I want you to think about where you might fit along this continuum, right. And if you think about a continuum is kind of a line where, you know, points right next to each other along the continuum are pretty similar. But as you move along that continuum, points on either extreme are extreme opposites. And so when we think about mood disturbances, you know, those symptoms absolutely move along a continuum.

Dr. Melissa Smith 5:47
So let’s clearly define major depressive disorder, which is what we think about when we think about clinical depression. That’s kind of a common name. But the technical name is major depressive disorder, or major depressive episode of major depressive disorder. So in order to make a diagnosis of depression, the individual and this is, you know, we’re talking about adults here, the individual must be experiencing five or more symptoms during the same two week period. And at least one of the symptoms should be either depressed mood, or loss of interest or pleasure. So those two symptoms are really the Hallmark symptoms of depression. so depressed mood, which makes sense, and loss of interest or pleasure, but they need to be experiencing five or more of the following symptoms in the same two week period. And those symptoms include first depressed mood, most of the day, nearly every day, okay, so you kind of think about the course of a day.

Dr. Melissa Smith 7:01
Second is markedly diminished interest or pleasure, and all or almost all activities most of the day, nearly every day. And so you think about things that maybe you used to enjoy a lot, that used to bring a lot of pleasure, a lot of interest, and they just don’t do anything for you anymore. That’s what we would think about when we think about markedly diminished interest or pleasure in all or almost all activities.

Dr. Melissa Smith 7:32
The third symptom is significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day. And so, you know, you might think that’s curious that there’s either this kind of either extreme, but it can present either way, where there is either significant weight loss, or loss of appetite, or significant weight gain, or increase in appetite. And then the next symptom is a slowing down of thought, and a reduction of physical movement. And so this symptom is definitely noticed by others. And it’s not just the individual’s subjective feelings of restlessness or of being slowed down. So other people in your life definitely notice like, okay, it feels it seems like you’re kind of operating in slow motion. And so other people are definitely noticing that reduction of physical movement. The next symptom is fatigue, or loss of energy nearly every day. So that’s definitely related to the symptom above, but they’re not the same thing. The next symptom is feelings of worthlessness, or excessive or inappropriate guilt nearly every day. So in that with this symptom, the individual really is very hard on themselves. So they might feel like they’re a failure, they might feel like they don’t have anything of value to contribute. So they’re really, really hard on themselves and they feel guilty about just about everything, and unreasonably so the next symptom is diminished ability to think or concentrate, or in decisiveness nearly every day. So it’s really hard to get things done because they have difficulty thinking, difficulty focusing difficulty making decisions. And then the next and the next symptom is recurrent thoughts of death, recurrent suicidal ideation or suicidal thinking? suicidal ideation is just a fancy word for suicidal thoughts. Without a specific plan, or a suicide attempt or a specific plan for committing suicide.

Dr. Melissa Smith 6:55
So of course, this is a very worrisome symptom, when someone gets to the point of thinking about death or thinking that they would be better off not living or that their loved ones would be better off if they were not living. And then, in order to receive a diagnosis of depression, it’s important to pay attention to the fact that the symptoms must cause the individual significant distress or impairment in social, occupational or other important areas of functioning. And so that’s really important to pay attention to. So these symptoms that I just listed, are really getting in the way. So they’re impacting their relationships, it’s impacting their social life, it’s impacting work, it’s impacting school, it’s impacting major areas of functioning, okay. And when we think about mental health concerns, that is always a really important factor to pay attention to, is the impact on functioning. So the impairment to social, occupational, educational and other important areas of functioning, because it, it helps us to understand severity. And so that gives you have the clear criterion for making a diagnosis of depression. So that’s what we think about when we think about major depressive disorder.

Dr. Melissa Smith 10:00
Okay, second, now, I want to define seasonal affective disorder, or SAD, as it’s commonly known. And this is a specific presentation of major depressive disorder. So when you think about SAD you can think about it as a unique way that depression presents in an individual. And so all of the symptoms that I just described, for depression, all of those fit when it comes with SAD. Now, when it comes to SAD, there is a unique presentation as well. And so that’s what we’re going to talk about here as it relates to SAD. So it’s interesting that 70% of depressed people feel worse during the winter, and better during the summer. And isn’t that interesting. So, you know, this is a really good time for this podcast, because the winter months are a hard time for, for most people who struggle with any sort of mood disturbance, and so 70% feel worse during the winter, and then better during the summer. And so to meet the diagnostic criteria for major depressive disorder with a seasonal pattern, so that’s kind of how they think about it within the diagnostic criteria. So a seasonal pattern, which is, you know, typically those winter months, depression should be present only at a specific time of year, so you know, the fall or the winter, and then full remission occurs at a characteristic time of year. So for example, this spring. And so with SAD, what we see is predictably, in the fall or winter months, people tend to start experiencing an increase in these depressive symptoms.

Dr. Melissa Smith 10:00
But then as they start to experience, more daylight hours, right, as we start to get into the spring months, they start to experience a full remission of those depressive symptoms. And so that is actually a requirement to meet criteria for this seasonal pattern of depression. And so, an individual should also experience at least two episodes of this depressive disturbance in the previous two years. And the seasonal episodes should substantially outnumber the non seasonal episodes. So it’s really important to kind of get a good pattern to kind of track and see, boy, is this really tied to a seasonal pattern, or were there you know, coincidentally, you know, major life stressors that happened during the winter months, that set off a depressive episode. And so you do really want to kind of tease those apart and, and get a very clear understanding of the pattern that’s happening. So that you can see Is it is it really due to the seasonal pattern or are there other factors that are at play here? So individuals with a seasonal pattern are more likely to report A-typical symptoms. So this is where we see a unique presentation of these depressive symptoms. So some of these atypical symptoms, so a typical meeting there, they’re kind of unique. They’re, not what you would typically see with some of the depressive symptoms include hypersomnia. So they like to sleep a lot. So not just like to sleep but feel a strong need for more sleep, also increased appetite. So one of the depressive symptoms is potentially loss of appetite, loss of weight, but with the seasonal presentation, actually, it’s typically it presented as an increased appetite. And then also strong craving for carbohydrates, specifically, okay, so that’s one of the unique presentations of SAD or seasonal affective disorder. But then the mood changes, those symptoms are very similar to what you would see with a typical depression. And so, right, these symptoms usually occur during the fall and winter, when there’s less sunlight, and then of course, usually improve with the arrival of spring, the most difficult months for people with SAD in the US. So if we think about North America tend to be January and February. So we’re right in that window. And so this is, you know, if you recognize that you have this pattern, you have this seasonal pattern, you know, well before January in February, you want to be you want to be very proactive. And then of course, you want to, obviously, harness all your resources during January and February to help yourself, if you recognize that you do have SAD as we think about this continuum, right, it’s also really important to keep in mind that sad is more than just the winter blues. Okay, so the symptoms can be so right, SAD is a presentation of major depressive disorder, which is a serious mental health concern. So the symptoms can be very distressing and overwhelming and can absolutely interfere with daily functioning. Of course, it’s also important to remember that SAD can absolutely be treated, so there’s no need to be hopeless about it. About 5% of adults in the US experience SAD. And it typically lasts about 40% of the year, right? So if we just kind of think about the winter months and sunlight and of course, there’s a lot of overlap there. And like I said before, it’s much more common among women than men. So SAD

Dr. Melissa Smith 12:24
has been linked to a biochemical imbalance in the brain prompted by shorter daylight hours and less sunlight in winter, right, there’s definitely a clear Association there. And as seasons change, people experience a shift in their biological internal clock or circadian rhythm that can cause them to be out of step with their daily schedule. So SAD is more common in people living far from the equator, where there are fewer daylight hours in the winter. So for example, SAD is also a bit more common, not a bit, but quite a bit more common in Nordic countries. So we think about Norway, Denmark, and Sweden. So symptoms and diagnosis we’ve already talked a little bit about this, I just review a few of these, but some of the common symptoms of SAD include fatigue, even with the hypersomnia. So even with a lot of sleep, weight gain associated with overeating and the carbohydrate cravings. SAD symptoms can vary from mild to severe, and can include many symptoms similar to major depression, such as you know, the feelings of sadness, depressed mood, loss of interest or pleasure in activities that were once enjoyed. We’ve talked about the changes in appetite usually eating more craving of the carbs change in sleep, usually this means sleeping too much loss of energy or increased fatigue despite increased sleep hours, and then increase in restless activity. So for example, hand wringing or pacing or slowed movements and speech, feelings of worthlessness or guilt trouble concentrating or making decisions, thoughts of death or suicide or suicide attempts and It’s important to note that SAD may begin at any age. But it typically starts when a person is between ages 18 and 30. So SAD usually presents in adulthood, it’s less common among children. So okay, so we first talked about major depressive disorder, kind of laying the groundwork for that mood disturbance. And then we talked about seasonal affective disorder, which is one of the unique presentations of depression. And obviously one of the, one of the major presentations we see during the winter months. And now I want to talk about the winter blues or winter doldrums, which can actually be a fairly common experience during the winter months. And, you know, I’ve already said this once. But I really want to make it perfectly clear that, you know, the winter blues should not be mistaken for seasonal affective disorder, or a diagnosis of depression. Okay, because they’re not the same thing. But right, it’s, the kind of the winter blues are just, you know, kind of losing your spark can be a little more common in the winter months. But this is where I think that continuum can be really helpful, because you definitely might not have a clear diagnosis of depression or SAD, right? I mean, as you listen to the list of symptoms, you’re like, Oh, no, that doesn’t fit me or definitely not to that extent. But you might notice, you know, some of the symptoms on the list, but maybe, you know, maybe you notice one or two of the symptoms, but they don’t really impair your functioning to a significant degree, right? Like your, you know, they don’t get in the way of your work, or they don’t get in the way of your social functioning. But what maybe what you’ve noticed is, you just kind of lose your spark a little bit in the winter months, or it’s a little harder to maintain your motivation, or connect to hope or to connect to joy. And, you know, that can, I mean, first of all, I think that can happen for lots of us lots of times during the year for lots of reasons. But I think there’s something about these winter months that can make that a little more challenging. So this is where it’s helpful to think about our mental health impact on functioning and symptom severity along that continuum, rather than in discrete categories, in terms of, you know, either I have depression, or I don’t, which I think sometimes is a less helpful way of thinking about

Dr. Melissa Smith 15:50
these things. Because, you know, for instance, if you take the stance of, well, I just listened to that list of symptoms, and I can’t check every box, therefore, I must not have depression, therefore, I don’t know what I’m complaining about, I don’t know why I’m SAD, I just need a backup and push through, you know, you might be in real danger of rejecting your needs, and pushing yourself into a full blown depression, right. And so just because you might not meet criteria for SAD or for depression, it, it, it doesn’t mean you should dismiss your experience or your needs, right, like there’s still so much value in, in attending to your needs, and turning towards your experience, and recognizing like, hey, like, maybe I have lost a little bit of my, of my Spark, and maybe there is value in really nurturing some of my needs, and connecting with some of my passions, so that I can really nurture myself a little bit better. And so I really, I really would invite you to take care in that. I would also say, you know, on the on the other side of that coin, sometimes there can be real value, you know, for someone who is really struggling to receive a diagnosis, because, you know, without sometimes receiving a diagnosis, say of depression, it’s it becomes easy for them to invalidate their experience. But for, you know, whether it’s a professional, you know, like a medical provider or that sort of thing, saying, Hey, listen like you have, you have some significant health concerns here that you need to address. You know, sometimes that can That can feel a little scary, sometimes that can feel a little overwhelming. But it can also be really powerful to have someone say, I see you and I see the struggles that you have, and there are things that we can do to help you, and there are things that you can do to help you. And so, you know, I would just say that there are, you know, there are things about understanding, you know, the diagnosis, that can actually be really helpful. And we don’t ever want anyone to feel dismissed or undermined, you know, based on a diagnosis or based on, you know, not not having a diagnosis. And I always say about, about the use of diagnosis is it is it provides a form of communication, and it’s a tool, and it, it provides a common language. And so in that way, it can be very, very useful. But it’s certainly not the most important part of these conversations, the most important part of these conversations is understanding the lived experience of the individual. And so that’s where I would just invite you to turn towards your experience and learn to develop that awareness of Okay, what are my needs? And how can I help myself? And, and, you know, do I need? Do I need additional support in meeting my needs? And if the answer is yes, then it’s like, let’s help you get that support, by all means. So when you can look at your needs and your symptoms, and your functioning along a continuum, it’s much easier to take a nuanced approach. And you know, to take that proactive approach in terms of being able to assess, you know, what, yep, I can see that I’ve been sad, or you know, that I don’t quite have that spark that I usually have. It’s not that I’m hopeless, or that I think life stinks. But I’d like to get my spark back, when you can turn towards your experience this way, you are much more likely to take a caring stance toward yourself, and a responsible proactive stance, to actually take action, you know, to get your spark back, if that’s the case, right? If we’re talking about the winter blues, and right, if if it looks like you’re, you’re struggling with more, if it’s something more significant, like a seasonal affective disorder, or major depressive disorder, without the seasonal pattern, then you can have, you can receive the additional support that you will probably need, right, given these symptoms, to really get that support and that intervention to help you. And at the end of the day, that’s what we want for you, we want you to get the help to to really help you get your life back.

Dr. Melissa Smith 19:17
So what you know when it comes to our health, so mental, physical, spiritual, all of it, and nuanced, proactive approach is typically best. So you are your best ally, your ability to be curious about your experience will pay huge dividends for you. So to be caring, and compassionate and willing to be aware of your needs, and to move toward those needs with gentleness, will really be so effective for keeping you on a healthy path throughout your life. And in many ways, it can sometimes prevent some of the larger swings that we sometimes see towards the extremes of the continuum, you know, not always because sometimes you can just get hit out of the blue with some of these mood disturbances. But attention and awareness always help, they can always help to intervene more quickly, and to kind of get you back on your path. So when we think about the winter blues, again, this is not too uncommon, especially after the high of the holidays, which is a time that most of us look forward to. There’s lots of celebration, but there’s also a lot of stress, both emotionally, physically and financially, Can I get an amen? They’re like this, the holidays are great, but they’re also kind of stressful. And if you’re not careful, you spend January in February digging out of those stressors. So it was kind of funny, I was at my physical therapist office the other day, and she commented that she spent the past several weeks working the holiday stress out of her patience. So isn’t that true? So of course you know, it was not lost on me that she was telling me this as she was working on me so I kind of had a good laugh about that. So I get it I I’m totally not immune to it. The holidays are great, but they are stressful. They take their toll. So you may be physically emotionally and fighting Actually exhausted come January, and what do you have to look forward to. So there are many holidays and at work, you might have some big deadlines coming up. Or maybe you have some big stretch goals that feel pretty overwhelming to you. It’s just a lot. So hopefully you have a better sense of some of the mood concerns along this continuum. And now let’s move into some solutions to help you tackle these challenges so that you can thrive this winter and really pursue what matters. Okay, so solution number one. So first of all, whenever we discuss mental health concerns, it’s always important to discuss these issues with your medical provider, whether it’s your primary care provider or a therapist, right when it comes to mental health concerns, so they can get you pointed in the right direction. So, you know, obviously, you should not be self diagnosing depression. So, you know, everything that I’ve talked about today is for educational purposes only, definitely don’t be diagnosing yourself based on what you heard today. But you know, talk about it with your primary care provider for sure if if there’s something of concern to you. So it’s a significant health issue, and one that you should be receiving professional support for. So that’s really the first solution. If as you listen to some of the things that that I’ve that I’ve shared today, and you notice that boy, I seem to have a lot of these concerns, it might be a good idea for you to follow up with your primary care provider. So it definitely doesn’t mean that you, you know, have depression, because there can be a lot of things going on. But if you’re noticing some of these symptoms, the best first step is to schedule an appointment with your provider, and have a conversation about what you’re noticing for yourself. And, you know, solution to is that, you know, of course, if you’re not feeling safe, don’t wait for an appointment, go to the nearest emergency department. I’ll also link to the Suicide Prevention hotline, and also the warm line, which is like such a cool phone service to help in addressing concerns before they become crises. So both are excellent resources. But you know, bottom line, if you’re not feeling safe, you need to call 911. Or get yourself to an emergency department. So obviously, safety first, we want you around so that you can pursue what matters and thrive. And the thing about mood disturbances is that they can really skew your perspective. And that’s, that’s one of the things that’s most heartbreaking to me about mood disturbances is that they can just totally mess up our perspective. So we don’t want that. We don’t want that to happen to you.

Dr. Melissa Smith 22:42
Okay, so then, as I discussed before, SAD is a subset diagnosis of major depressive disorder. And so many of the solutions for depression are also going to be the most effective solutions for SAD, but I also have some specific solutions for SAD as there is that unique presentation. And the solutions have been found to be particularly helpful when it comes to addressing SAD, but just know that these solutions can likely also be helpful for addressing major depressive disorder. And vice versa sense. You know, SAD and major depressive disorder are so tightly tied together, so just wanted to put that out there. So let’s turn our attention to solutions for SAD specifically. So SAD can be effectively treated in a number of ways including, you know, light therapy, anti depressant medications, talk therapy or some combination. And while the symptoms will generally improve on their own with the change of symptoms, the symptoms definitely will improve more quickly, with some treatment with some intervention. Okay, so solution three is light therapy, and maybe you have seen light boxes. They’re they’re pretty popular right now you can get them most places you can get them, I think you can buy them at Costco. So light therapy involves sitting in front of a light therapy box that emits very bright light, and it filters out the harmful ultraviolet or the UV rays. It usually requires 20 minutes or more a day, typically first thing in the morning during the winter. Most people see some improvements from light therapy within one to two weeks of beginning treatment and so to maintain the benefits and prevent relapse treatment is usually continued through the winter. So because of the anticipated return of symptoms in late fall, some people may begin the light therapy in early fall to prevent symptoms. So this is this is also good preventive treatment that you would just start in the fall. And so, with these light therapy boxes, oftentimes the recommendation is that you just turn that box on in the morning, like, oftentimes, who will just have it like in their bathroom. And then like, while you’re getting ready, in the morning, you just have that on. So you know, for ladies like, while he or ban, you know, while you’re putting on your makeup, you know, brushing your teeth, that sort of thing that you just have that light box on. So like 20 minutes first thing in the morning, like every day is very, has been shown to be very effective for helping with the seasonal affective disorder. Okay, solution for So, right, the increased exposure to sunlight can help improve the symptoms. So this is where spending some time outside, which can sometimes feel challenging in the winter months. But it can be so helpful. So in addition to the light box, trying to get some time outside, also arranging your home or your office so that you are exposed to a window during the day. You know, obviously, there is exposure to UV light from the sun, which can increase your risk of skin cancer. So you want to be careful of that. So you know, you can check in with your physician about that. But getting outside for some sun can be very, very helpful. So I’m a skier, you know, and it’s when I was young always puzzled me. But at the ski lifts, you know, at the lodges they often have and that I ski at Park City, and at the big lodges, they have these great sun chairs. And oftentimes there are lots of people out sitting on some chairs, and just kind of basking in that sun. That is great. That is a great exposure to sunlight that can help right so take your helmet off, and let your son let your face be touched by the sun, even for like 15 minutes a day. So that you can get a little bit of that sun exposure that sunlight can be really, really helpful. It’s not uncommon to us to be totally bundled up all winter. And so our exposure to sunlight just goes with it just plummets. And so try and get a little bit of time outside. Of course you want to, you know, be sensitive about risk to that UV light. But even 10 to 15 minutes can be super, super helpful.

Dr. Melissa Smith 25:59
You know, the other things that can help is regular exercise, healthy eating, getting enough sleep, staying active and connected, all of those things can be helpful. Getting outside, even if it’s not necessarily in the sun, sun is a bonus. But finding a way to, to get outside, even in the winter months can be very beneficial. And there’s really great research on the benefits of spending time outside. Now I’m an Idaho girl. And we learned very early on that if you could not find a way to have fun outside in the winter, it was going to be a really long, miserable winter because it really, I mean, it seemed like winter lasted at least six months of the year. I mean, sometimes it was like six to eight months of the year like it was long. And so you know growing up like we just found ways to have fun outside and I’m so grateful for that because now as an adult, I love being outside in the winter, whether it’s snowshoeing or hiking or of course skiing. And so just because it’s winter, doesn’t mean you should stay inside. And so there’s really great research on the benefits of nature. And so find ways to get outside so snowshoeing skiing, walking. One of the newer activities, which is really fun are the fatty bikes. My husband has taken that up in recent years. And he loves it he he rides that fatty bike all winter long, so you can ride on the snow really well with those tires. It’s expensive. So maybe, maybe rent and see if you like it, but also just make sure you let the sun reach your skin even a little bit and you’ll get double benefits from being outside and also getting some of that sun. Okay, solution five, activate behaviorally. So one of the ways to make sense of depressive symptoms is that just like the name implies, it depresses the mind and body and you know, this is probably This can be a really fairly normal response to life’s challenges and stressors. So the body moves into a depressed shutdown mode, where everything tends to slow down. So motivation slows mood drops, libido plummets,

Dr. Melissa Smith 27:45
we don’t

Dr. Melissa Smith 27:46
want to get out of bed, we don’t take pleasure in the things that typically bring us happiness. And so the behaviors in this mode, include avoidance and withdraw. And if you’ll think back to those depressive symptoms, they are all about behavioral shut down, okay. And so if you’re not careful, you get caught in a vicious downward spiral of more depressed behavioral activity, which leads to even more depressed feelings. Because here’s the reality. It’s immensely difficult to feel good about yourself, if you fail to get out of bed or off the couch. So I am not saying that your worth is only tied to productivity or achievement. But the truth is that we feel capable when we act. So we feel better about ourselves when we accept challenges, even seemingly small challenges, like getting out of bed and getting showered. And right, if you’re dealing with depression, those can be epic challenges, those can, those can require a lot of effort. So we prove something to ourselves in these small and sometimes heroic acts, so that we are worthy of care and consideration and time. So self efficacy, which is the belief in our ability to act in accordance with goals and desires, increases as we overcome this depressed shutdown mode, and activate ourselves behaviorally. So I cannot highlight how critically important it is to activate yourself behaviorally, when you’re dealing with any of these symptoms, wherever you are on this continuum, it is most likely the last thing you want to do. But it is the most important thing you can do is to activate yourself behaviorally. So don’t worry, I’m going to say more about that. So when you’re feeling depressed, if you remain behaviorally shut down, you will likely right become more depressed, which intensifies this vicious cycle. So every single day, you’ve got to activate yourself behaviorally. So and this is a really cool thing. Because you can turn this vicious cycle into a virtuous cycle. So as you take one step to activate yourself behaviorally, so say you get out of bed and make your bed so you can’t climb back into it. And that’s important, you get a little boost in mood, that helps spur you on to the next activity, say taking a shower, or putting on some exercise clothes. And each activation step you take strengthens this virtuous cycle, and makes it more likely that you will break the behavioral shutdown cycle. Okay, so each step, you’re either strengthening the vicious cycle, or you’re strengthening the virtuous cycle. So steps to help you include first awareness of the cycles. So hopefully, this discussion will help you. So understanding these cycles can be powerful for understanding your experience and seeing how to best intervene. So being able to say, am I stuck in a shutdown cycle right now? I don’t want to do anything. I haven’t gotten off the couch. I haven’t followed through on any of my commitments. I’m stuck in a shutdown cycle. Second, acceptance of where you’re at, and how you might get unstuck. Right. So empathy and understanding is really, really important here. And, you know, so we want empathy and understanding without judgment, and lots of self compassion. So to be able to say, Yeah, you’ve been on the couch for six hours, right? Like, that’s a long time. It’s rough. Like you are going through a rough patch right now. Right? It’s hard. It is hard, you really struggling right now. And then so right, no judgment, lots of empathy, lots of understanding, and then third, active change. So first is awareness of the cycles. Second is acceptance of where you’re at. All right, and how you might get stuck, right, we see how you’re getting stuck. And third act of change. And this is specifically active change toward more valued states of being.

Dr. Melissa Smith 31:17
So with this third step, it’s all about full accountability, action and focus on your values. So this is where we move into problem solving, and behavioral activation. Right, what I just talked about, which is the single most scientifically validated principle for reversing cycles of depressive shutdown. Okay. So this is where we say, Okay, yeah, I think I’m stuck in a behavioral shutdown cycle right now. It’s rough. I’ve man, I’ve been sitting on this couch for six hours, I don’t want to get up. I haven’t followed through on any of my commitments. It’s rough. But you know, what? I, you know, I told my, I told my friend that I would, you know, meet them. I told my friend, I’d meet them for dinner. And my value is keeping my commitment. My value is keeping my commitment. So even though I don’t want to get off this couch, even though it’s really hard and painful, to go somewhere, because right now, I just want to stay here. And I don’t think it’s going to be fun to go hang out with my friend. I want to keep my commitment. I want to keep my commitment. I like my friend, I have some hope. Or people tell me if I get up and do something, it will probably help me. Right. So I’m going on trust, I’m going on faith, I’m going on their word, whatever, whatever it is. But I’m going to activate behaviourally toward a more valued state of being. Right, I’m moving towards my values, right, or I’m going to get up, I’m going to, I’m going to at least put on my exercise shoes, and I’m going to walk around the block, I might not go to the gym, but I’m going to walk around the block, I’m going to get outside for at least 10 minutes. And then I’ll see how I feel. I might not go 20 minutes, but I’m gonna go 10 minutes, like, I’ll go get them now I’ll go to the mailbox. And that is that is behavioral activation toward a more valued state. So So those are three steps to help you. So awareness of the cycles, acceptance of where you’re at, and then active change. So that discussion comes from a great article in Psychology Today, the shutdown syndrome. And I will link to that in the show notes if you want a deeper dive into that discussion.

Dr. Melissa Smith 33:14
Okay, solution six, which is talk therapy. So particularly, I want to focus a little bit on cognitive behavioral therapy, because it is one of the best researched therapies for depression and for SAD. So it’s a form of talk therapy that’s used for lots of mental health concerns, but certainly for depression. So CBT is based on the idea that how we think so cognition, how we feel emotion, and how we act behavior, all interact together. So specifically, our thoughts determine our feelings and our behavior. So that’s kind of the link from the perspective of CBT. And so, you know, the idea is that negative and unrealistic thoughts can cause us distress and result in problems. So when a person suffers with psychological distress, the way in which they interpret such situations become skewed, which in turn has a negative impact on the actions that they take. And so CBT really aims to help people become aware of when they make negative interpretations, and of behavioral patterns, which reinforce the distorted thinking. So cognitive therapy helps people to develop new ways of thinking and behaving, which really, you know, aims to reduce their psychological distress. And CBT is a very common form of talk therapy. So, you know, most therapists that you would call and check in with would be quite familiar with CBT, although it’s always good to check and ask them about their familiarity with it. But CBT can be very, very helpful when it comes to depression. And then solution seven, I want to talk about acceptance and Commitment Therapy, which is another form of talk therapy, and it’s also a Shown effectiveness when it comes to dealing with depression. And it’s a type of therapy that is really focused on helping you accept the difficulties that come with life. And it’s been around for a long time, but it’s

Dr. Melissa Smith 50:14
definitely it’s, it’s become more popular, I would say in recent in recent years. And it’s a form of mindfulness based therapy. And the idea is that greater well being can be attained by overcoming negative thoughts and feelings. So in that way, it’s similar to CBT. So essentially act, and that’s how you would say it. So you’d say act rather than AC T, looks at your character traits and behaviors to assist you in reducing avoidant coping styles. And one of the things I love about act is it really challenges avoidance. And so in that way, I find it particularly useful when it comes to depression. Because right, as I was talking about before, one of the, one of the really pesky problems of depression is avoidance and withdrawal. And so act is really, really great at challenging this avoidance that we see so often in in depression. And so it really targets that specifically. And so I think in that way, it can be very, very helpful. Act also addresses your commitment to making changes, and you know what to do about it when you can’t stick to your goals. So acceptance and commitment, therapy is also very focused on your values. And so, you know, for individuals who really feel very tied to their values and their purpose, it can be very helpful. And so act focuses on three areas, so accept your reactions, and be present, choose a value direction, and then take action. So those would be some of the components to consider. And that can be very helpful. So acceptance and Commitment Therapy, it’s not really a long term treatment, it’s more of a short term therapy, some of the acceptance strategies that are included in Act include letting feelings or thoughts happen without the impulse to act on them. So you learn to notice your thoughts and feelings without reacting to them, which I think is a really great skill, observing your weaknesses, but but take note of your strengths. So I like that as well as more of a balanced approach. Give yourself permission to not be good at everything, acknowledge the difficulty in your life without escaping from it or avoiding it. So there you see that challenge to avoidance, realize that you can be in control of how you react, think and feel. And then another core component of act that I just want to mention briefly, is diffusion. So this is a skill set of learning how to cognitively diffuse some of these psychologically intense experiences. So diffusion involves realizing thoughts and feelings for what they really are. So like passing sensations, or, or rap irrational things that we tell ourselves, instead of what we think they are, like feelings that will never end or factual truth. So the goal of diffusion is not to help you avoid the experience, but to make it more manageable for you. And so with diffusion, we’re just helping you to get a little bit of cognitive distance from your thoughts and feelings. And so some diffusion strategies include, observe what you are feeling, what are the physical sensations, notice the way you are talking to yourself as these feelings are experienced. So what’s what’s the mind chatter? What interpretations are you making about your experience? are they based in reality? So with act, you’re always kind of looking at what’s happening in my head, right? So what are the stories I’m making up versus what is reality and recognizing that they’re not always the same. And then another strategy is to grab onto the strands of your negative self talk and counter them with realistic ones. So again, recognizing the difference there. And so again, acceptance and Commitment Therapy can be really helpful when it comes to mood issues. And then the last solution is the use of medication to address symptoms. So SSRIs or selective serotonin reuptake inhibitors are, you know, typically the first line Treatment when it comes to depression, so it’s, you know, they’re commonly known as the antidepressants. And there certainly are other classes of medications that are used to treat depression. But

Dr. Melissa Smith 55:14
the SSRIs are typically the first line. And these can be very helpful, although they aren’t always necessary. So the way that I think about medications, when it comes to depressive symptoms is that of course, you will still want to engage in the behavioral work related to addressing the depressive symptoms. But medication can really help to lift the cloud. Like if we think about the mood cloud, to help you see more clearly what that work might be. So medication can help you see more clearly the path ahead, so that you can have a better sense of how to proceed. And in that way, you know, medication can absolutely facilitate your progress in overcoming depressive symptoms. So you know, as I’ve talked about throughout the symptoms present on a continuum, and so it’s not a one size fits all. So some individuals absolutely benefit from medication and should, you know, maybe consider medication immediately based on their symptoms, while others may benefit from more of a behavioral focus before considering the use of medication when addressing these symptoms. And so, you know, it’s definitely individually based, this is where it’s really helpful for you to consult very closely with your primary care provider, and take it from there. So hopefully, this podcast has been helpful for you to better understand, you know, the winter blues, but also seasonal affective disorder and then major depressive disorder. The the main goal is to really help you thrive through the winter months so that you can pursue what matters but because obviously, you have important things to do, and we want you to remain steady on your path. So make sure you head on over to my website to check out the show notes. With all the great resources for this episode at www.drmelissasmith.com/episode-37 one more time, that’s www.drmelissasmith.com/episode-37. There you’ll find all sorts of great resources, including a number for the National Suicide Prevention hotline, links to some of the articles that I discussed here. And don’t forget to check me out on iTunes and also Spotify. I’d love it. If you would like to leave a review there. It helps other people to find the show as well. And then of course, I’m on Instagram and Facebook. I’m social. So I’d love to hear from you there love to hear the topics that you would like to hear more about. So definitely check me out on Instagram. I’m @dr.melissasmith on Instagram. So I’m Dr. Melissa Smith. Remember love and work, work and love. That’s all there is. Until next time, take good care.

Transcribed by https://otter.ai