Search for tag: "mood disorders"

Interviewer: When depression or bipolar disorder isn't responding to standard treatments, they are referred to as treatment-resistant mood disorders.

Psychiatrist Dr. Brian Mickey from Huntsman Mental Health Institute's Treatment-Resistant Mood Disorders Clinic is an expert at treating these conditions, and today he's going to tell us how visiting a specialist can help people suffering from this condition live happier and more productive lives.

Dr. Mickey, first, when does a treatment-resistant mood disorder become classified as treatment-resistant?

Dr. Mickey: There's no kind of magic formula, but in most cases, we consider if you've had at least two adequate trials, meaning medication trials, psychotherapy trials, that are robust and that lasted long enough and you didn't respond, we would consider that treatment-resistant.

Interviewer: Either through medication or through psychotherapy, you would have to go through at least two of those. And if you weren't seeing an improvement of the symptoms, that would be classified as treatment-resistant.

Dr. Mickey: Right. Exactly.

Interviewer: Okay. When a patient comes to you after it being identified as potentially treatment-resistant, what are the interventions that you offer then initially?

Dr. Mickey: So some of the initial options that we would discuss would be changes to their current medication regimen. That would be a common one. Sometimes people haven't had an adequate treatment trial.

Another option that we would offer within our clinic would be transcranial magnetic stimulation. That's a non-invasive brain stimulation treatment.

We also can offer ketamine infusion therapy. That's an intravenous ketamine infusion that can be helpful for depression.

And so if these less invasive options aren't effective or cause too many side effects, then there are other surgical options that we sometimes will go to next.

Interviewer: Tell me more about the less invasive options. How long do you try those? How many of those do you go through before you kind of get to that point?

Dr. Mickey: That depends a lot on the particular patient, the kind of depression they're having, how severe it is, and, of course, insurance coverage. But typically for people who are functioning fairly well, they're going to work or doing their daily routines, then transcranial magnetic stimulation or ketamine infusion therapy can make the most sense.

Transcranial magnetic stimulation and ketamine infusion therapy are more compatible with maintaining your kind of regular daily routine and the side effects are relatively low for those as well.

For people who have had more severe depression that has been very debilitating or is preventing them from working, or let's say they're admitted to the hospital, then electroconvulsive therapy, or ECT, is what we would think of probably before those other treatments.

Interviewer: Are people intimidated by that name, the fact that you're using electrotherapy? I mean, that could sound kind of scary.

Dr. Mickey: Yeah, I think it can sound scary and if you don't know too much about it or if you only know what you've learned in the movies, then it's very scary.

Interviewer: And what happened like 100 years ago. It's not that anymore.

Dr. Mickey: Yeah, it's very different and it's a very safe treatment. It does have side effects and we counsel people about that, but it can really change the game for people with severe depression.

Interviewer: It sounds like you have a lot of options and tools at your fingertips to help somebody who has gone through some initial treatments and has not been able to handle the symptoms, take care of the symptoms in a way that they're able to go back to their life.

Tell me about a typical patient that walks into your office. Describe what that looks like and the conversation you have.

Dr. Mickey: So a typical patient that we see would come feeling pretty hopeless, I would say, because they've tried many different kinds of treatments and feeling like they've gotten to the end and they don't know what else there is to try.

Typically they've had years of illness, if not decades. And most people that we see also have had this illness since they were very young. So, most of the time, the onset of their illness is in their teenage years or young adulthood.

Typically, people are not able to enjoy life. They're not enjoying their work. They're not enjoying their social interactions. They become less interested in pursuing hobbies and being with other people. Most people have then become kind of socially disconnected, and that can even make things worse, because that's . . .

Interviewer: Yeah, and not finding satisfaction in work. Do these individuals realize that this is happening and are like, "I would love to find satisfaction in my work, but I just can't"?

Dr. Mickey: Right. Most people do, and the way they experience it is usually they're not sure why they're not enjoying it. And of course, we all have stress in our lives, but these are situations where the amount of sadness and mood dysregulation and loss of interest and pleasure is far beyond that. It doesn't make sense in the context. That's kind of what we're talking about here when talking about depression.

Those are the kinds of experiences and symptoms people are having before they're coming to our clinic. And what these treatments can do is they relatively quickly, within a few weeks, start to relieve people of those symptoms. And then the effects can last for months or sometimes even years before people will very often have a relapse.

And so that's something that we also educate people about. This is not a cure. It's a treatment that we can administer for this episode. But that can be a really meaningful difference for people.

Interviewer: And then if a relapse occurs, what then?

Dr. Mickey: For people who've had a recurrence, then we can oftentimes use these same treatments. And so we don't think of them as permanent fixes obviously. And so people will always have this kind of vulnerability. That would be the most typical pattern, that people have recurrences.

But if you understand the patterns, sometimes you can prevent them. That's the ultimate goal, is to prevent a recurrence. But if people do have a recurrence, then we can use these treatments again. And so those are the folks that we see and that I think we can help.

Interviewer: And for those individuals that have suffered for decades, what's the barrier to seeking out more treatment?

Dr. Mickey: There are a number of barriers. One is not knowing about what options there are beyond the things they've already tried. Another is oftentimes just insurance barriers.

Another barrier that people have I think is just fear of the unknown, kind of maybe not quite understanding what these treatment options are really like, which we can help educate people about that.

And then I think another is just that a lot of times people don't want to be a depressed person. It's not a great place to come from. And so you have to sort of admit that you have this condition before you're really going to come to the clinic. I think that can be a barrier as well.

Interviewer: Do you find it common that somebody that is suffering from a treatment-resistant mood disorder is not able to seek out help on their own and generally a family member is needed?

Dr. Mickey: It is pretty common. And I think part of it is that they may not want to think of themselves as a depressed person or they may not realize in some cases how severe things are.

And that's one thing that depression does, is it changes how you see yourself and how you think about the world. It makes you more kind of internally focused and less able to appreciate how far things have gotten in many cases. And I think sometimes people just don't remember how they were when they weren't depressed. So it has these effects on your own cognition and understanding of yourself, which kind of makes it unique.

Interviewer: You mentioned insurance can be a barrier for some people. Is there somebody at Huntsman Mental Health Institute that if somebody is concerned about "How am I going to pay for this?" that could help walk that individual through maybe some of the options if insurance isn't the option?

Dr. Mickey: Yeah, absolutely. In our clinic, we have referral specialists who will do all of those checks ahead of time and help you understand what the financial situation is. You don't want to go into a situation like this and not know what the cost will be. And there's nothing like an extra bill to accentuate your depression. So, yeah, that's an important aspect of the care that we pay a lot of attention to.

Interviewer: Well, it sounds like that you are offering hope to some people that have struggled with mood disorders for a long, long time. As we wrap this up, is there anything that you would say that you would like the listener to take away from our conversation today?

Dr. Mickey: Yeah, I would say that there is hope. And that's a very common reply or response that we get from patients at the end of a consultation. They're often saying, "I didn't even know there were all these options." It's pretty common actually for people to feel quite a bit better just after this single consultation visit before we've even administered any active treatments.

Interviewer: You've noticed a change in your teenager's mood. They're angry, moody, defiant, irritable, and in addition, their school performance or maybe interest in other activity is significantly decreased. You're worried about depression. Is it okay to talk to them about it, or could it cause more harm than good?

Dr. Thomas Conover is a psychologist at University of Utah Health, and what is your advice for parents about how to talk to their teens about these tough topics? Or should they even talk to them about them?

Dr. Conover: Communication is a real key. It certainly is protective and helpful for parents to communicate and inquire with their teen as to what's going on and how they're feeling. And that's something that I think most parents strive for but may struggle with. How do I talk to my teen? What do I talk to my teen about? Is it okay to ask? I would advance to say that it's always okay to ask your child about how they're doing. You seem really sad lately. Is there something bothering you? Is there any way I can help?

Interviewer: No. I mean you probably have to dig a little bit sometimes, huh?

Dr. Conover: You may. I think that there's value in setting an example and leaving the door open by saying those two things. In terms of setting an example, certainly communicating openly oneself is important. Right? So I've talked about various areas of function that a parent might look at for a teen child and use to try to evaluate how serious a problem that they're suspecting maybe. But a parent can show that those things are important themself. Right? A parent can demonstrate that being engage with social activity and self-care and physical activity, you know, which boosts mood, all of those things are important. So a parent may set the stage in their own family by doing those things.

It's always okay to ask your child about how you're they're doing. And even though a lot of times teens may seem outwardly like they don't want someone to ask, I think most of the time people who are struggling even in a small way do want someone to ask. I think it's helpful not to badger. I think if you're met with that initial no on a first inquiry, it's good for a parent to perhaps say, "Well, okay. You know, I hear that you're saying that there's nothing about it that you want to talk about. But just know that I'd be happy to talk to you if you do . . . if you change your mind about that, if you do want to talk about."

I think that's a tough one. It's a tough balance to strike, because I think if a parent is a concerned at all about their child and they try to make that initial ask, first off that's a hard thing to do. You know, you might be thinking about it all day or all week and then, finally on Friday you say, "Oh, we're sitting at dinner and my kid's actually home with me. I'm going to ask." And then, the first thing that they snap back with this, "No. Everything's fine." And the parent might feel kind of rejected by that and, you know, they might respond by shutting down. Right? Going like, "Oh, well, okay. I guess I shouldn't have asked."

I wouldn't advocate for that black and white of a response, nor would I advocate for a parent then saying, "Well, no, I know something must be wrong. I've been watching you all this time, and you just aren't acting yourself. You need to talk to me right now." You know, in most cases, that's not going to be the best approach either. It's, I think, always appropriate to ask and it's always appropriate to maybe give a little space and a little time for the teen to be able to absorb the question and respond. Now, that would be with the exception of a true emergency, and those emergencies do include threats or acts of self-harm or threats or acts of a suicidal nature or serious aggression.

Interviewer: Are you concerned that your teen might be suffering from depression? Now, sometimes it can be difficult to tell the difference between moodiness and actual depression, and that moodiness can be common in a lot of teens.

But psychologist Dr. Thomas Conover says you should look at how your children are doing in what he refers to as key life areas. That's school, extracurricular activities, social, and family life.

Dr. Conover, let's just start with school. Why is school performance one of the clues that you use when evaluating children for depression?

Dr. Conover: For teens, school is their primary area of function. It's, in my mind, equivalent to holding down a job or a career for an adult, right? And so if an adult is still functioning in their primary vocation, then that's a good sign. Same way for a teenager. If he or she is still doing well in school and not seeing a decrement there, then whatever is going on with the teen, you've got some reassurance that things haven't gone completely south.

Interviewer: What about extracurricular activities? Some kids just aren't into school, or don't necessarily perform well in school.

Dr. Conover: Well, I look for their performance in school with comparison to earlier performance too. So if you have a kid who was somewhat of an indifferent student and just wasn't that academically inclined throughout their school life, kind of a solid B/C student, then that's what I would be looking for the child to be doing going forward. So I'm not concerned if there's sort of indifferent performance when that's been the norm.

It's really looking at, "Has that gone downhill?" Do you have a child who normally got straight As and is now getting Bs and Cs, or a child who normally gets Bs and Cs who is now failing or having incompletes? That would be more concerning in terms of school performance.

And for those youths . . . let's say you have a child who's an average student and maintaining that performance, but who is an avid athlete, plays a sport year-round, and is withdrawing from that. That could be a concern as well. So looking at function in the academic realm is important, but there are other areas of function too, right?

So other activities are very important to look at. Social function. A normally developing or typically developing teen is a very social creature. It's a time of life where you're learning how to be independent, and you're transitioning in typical development from being reliant on your family as a primary source of your activities and values to your peer group, which in my mind and experience serves as somewhat of a transition to being fully independent. Having your own ideas about things, your own values, your own priorities for your activities.

So, in that vein, your typically developing 15-year-old is going to really want to be out there and socializing with peers. A lot of times, nowadays, that does take place over cellphones, social media, and the like. And so it's important to take that into account, that just because a teen isn't going out all the time doesn't mean that they're not socially engaged.

But a parent can reasonably expect that their teen is going to be interested in what's going on out there with their peers. And if they're more withdrawn or less interested in that than they used to be, that's a concern.

Then there's also family function, and it is normal and expectable to have a teen be less interested or less enthusiastic about certain family activities than he or she used to be. That is normal and expectable.

Then I would go back to the idea of, "Well, just how pervasive and intense is it?" Do you have a teen who says, "I don't want to go to family dinner at grandma's this Sunday. My friends are going out. I want to meet up with them," but who ultimately you can cajole and negotiate and get the teen to do it? Or do you have a teen who has a big blowup over that and ends up leaving the house and you don't know where they went? I'm giving fairly stark examples, but the gray area in between can be evaluated.

I haven't mentioned the threat of self-harm, or aggression, or worse, suicide. That would be an obvious red flag. If inquiry into a teen's mood or a parent making a request or demand of the teen leads to any sort of threats or acts of self-harm or aggression, then that's something that a parent would want to seek help for urgently.

Interviewer: Moody teenager or depression? When is the time to seek help? That's what we're going to find out today.

Dr. Thomas Conover is a board-certified child and adolescent psychiatrist. He is also board-certified in general pediatrics, and he has taken care of teens with and without depression for over 20 years.

Dr. Conover, when a parent comes to you or walks up to you or sees you at a party or something like that, and they say, "Dr. Conover, I've got a question for you. I've got a teenager. I'm a little bit concerned," what kinds of words do they start to use to describe their concern with their teenager?

Dr. Conover: You'll often hear about moodiness or irritability, being more isolative than usual, simply not wanting to do things with the family the way that they used to. Those are some of the most frequent keywords that parents who are concerned about their child's behavior or mood as a teenager will say to me.

Interviewer: And when you hear those words . . . certainly, when I hear those words, I think, "Well, that's a teenager." Right? So is it a little difficult to determine when to be concerned and when not to be concerned?

Dr. Conover: It sure is. Even as a practicing psychiatrist all these years, if I hear a parent say that their teen is moody or irritable, I don't immediately jump to the assumption that he or she is depressed.

Interviewer: So then you would, I would imagine, start asking some questions, trying to get a little bit more information. What are some of those questions that you would start to ask to start to make the decision whether or not there was something to be concerned about?

Dr. Conover: One question is, "How long has it been going on?" That's a common question in medical inquiry in general. Another is severity. Just how bad of moodiness or irritability are we talking about here? I always think too about how is the youth functioning. That's a really important thing.

So particularly, in a casual setting, if a parent just asks me a question about their teenager, a lot of times I'll ask, "How are they doing in terms of their other life pursuits?" So if a youth seems to be more moody and irritable but he or she is still doing all the things that they would normally do, still functioning in school, still recreating with friends, still engaged in other activities, but just kind of crabby, I'm a lot less concerned.

Not unconcerned, because there are some youth or adults too who are suffering but still managing to eke out their function because it's that important to them to do well in school, or with their sports, or whatever else they do. But I am often reassured if a teen is still doing the things that he or she normally would do despite the apparent problem with mood.

Interviewer: At what point does a parent say, "You know what? We should go talk to somebody"? When does it become something that a parent can help? Because it would occur to me that any of these little symptoms would be something you might want to talk about anyway. If the grades are starting to fall, you might want to approach that topic. If they're defiant a lot more, you might want to say, "I've noticed a change in . . ." Or maybe you don't want to say it like that. Help me out.

Dr. Conover: It's always okay to ask your child about how they're doing. And even though a lot of times teens may seem outwardly like they don't want someone to ask, most of the time people who are struggling, even in a small way, do want someone to ask.

I think it's helpful not to badger. I think if you're met with that initial "no" on a first inquiry, it's good for a parent to say, "Well, okay. I hear that you're saying that there's nothing about it that you want to talk about. But just know that I'd be happy to talk to you if you change your mind about that, if you do want to talk about it."

It's, I think, always appropriate to ask, and it's always appropriate to maybe give a little space and a little time for the teen to be able to absorb the question and respond.

Now, that would be with the exception of a true emergency, and those emergencies do include threats or acts of self-harm, or threats or acts of a suicidal nature, or serious aggression.

Interviewer: So we have a pretty good idea of some of the different behaviors we might see that might indicate that a teen is depressed or heading towards depression. We've learned that the first step really is to try to talk about it and be genuinely concerned and not force, not corner. If you get met with some rejection, give the teen some space. At what point then does a parent seek professional help if they're just so frustrated, they are convinced something is up, and they just don't know what to do?

Dr. Conover: The primary care provider is equipped with enough training and understanding about childhood and teen depression to help to evaluate that and may then refer on to other resources.

Interviewer: I feel my approach would be I'd want to find out even more information. Maybe I might want to go to a professional on my own before I take the step of involving the teen in the process, because I'd be afraid that maybe doing that would somehow damage our relationship or cause problems. What's your take on that?

Dr. Conover: My take on that is twofold. On one hand, I think it's perfectly reasonable for a parent to seek education or support from other resources themselves. An initial inquiry in that fashion might mean that the parent would do some reading. They might get online and go to a reputable source such as the websites for the American Academy of Pediatrics or the American Academy of Child and Adolescent Psychiatry, both of which have really good information about child and teen development and kind of the presentation of various problems and resources for how to respond.

It might take the form of talking to a family member, a friend, a clergyperson, or the parent's own physician. All of those could be things that a parent could do.

On the other hand, I do think people may make the mistake of not asking, not saying something, not doing something for fear that it might damage the relationship. And it has very rarely been the case in my experience, even if asking or stating that observation leads to a fight or argument in the short term.

Interviewer: As that parent that asked you initially if they should be concerned about their teenager walks away, what would be the last thing that you would say to them?

Dr. Conover: "Let me know if there's more help that I could give." You can go off in one direction, make a decision to act, and maybe that initial effort comes up not as fruitful as you had hoped. So I would hope that people would feel open to asking for help again or talking more about it.

But it can be an uncomfortable topic. My experience both as a clinician and as a parent myself is that parents want their kids to be happy. They want them to feel okay. And it can be very, very troubling, very sad to contemplate that their child may not feel okay, that they might not be all right. And so it's really hard to ask and really hard to bring up, because you don't want it to be so.

Dr. Jones: It is really dark in the morning these days. Fall has beautiful colors and the days can be gorgeous, but they're getting short. Are you sad about that?

Announcer: Covering all aspects of women's health. This is The Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: Shorter and darker days in the northern latitudes affect mood for many people. About 1 in 20 people experience seasonal variation in depression, with fall and winter showing a rise in depression. Of those people who are affected with seasonal depression, four out of five are women. This condition has been called Seasonal Affective Disorder, appropriately shortened to SAD syndrome or Seasonal Depression.

In the extremes of latitude up near the Arctic Circle, the winter is associated with increased risks of suicide and the summer with light all day, and night has been associated with increased mood, even euphoria, really increased good mood. Symptoms of SAD include feelings of depression, worthlessness, low energy, and lack of interest in things you usually like to do. Other symptoms and behaviors are a sense of fatigue leading to oversleeping. Spending longer times under the covers with longer, dark days is common. Some women describe carbohydrate cravings, which if you give way to eating those Halloween candies and Christmas cookies can lead to fluctuating levels of glucose which can complicate mood stability and of course can add to seasonal weight gain, which is depressing.

Symptoms start in the fall and get better in the spring. This problem was independent of income and lifestyle factors. According to the National Institutes of Mental Health, the main risks for seasonal effective disorder are age, sex, history of depression, and distance from the equator. The condition seems to start in women in their 20s and 30s.

Why women are so much more likely to be affected isn't well understood. Some researchers have suggested that reduced sunlight can affect serotonin levels, a brain hormone that affects mood. Fluctuating estrogens, which women have and men don't so much, also affects serotonin. Also melatonin, a brain hormone produced in the dark can increase in dark days and adversely affect our sleep-wake rhythm. It can upset our circadian rhythms, which can be associated with depression. So if this is you, what to do?

Number one is phototherapy or bright light therapy in the mornings, and this has been shown to be effective in decreasing symptoms in up to 85% of women with Seasonal Affective Disorder. Now, this is really bright light, brighter than any light bulb, especially now with our new light bulbs. Special devices that deliver 10,000 lux. Lux, L-U-X, is a measurement of light. They are not very expensive and can be bought on the web for about $50 to $100, and some are more expensive than that. Make sure that the light box is designed to treat Seasonal Affective Disorder. You can search light box for Seasonal Affective Disorder and add 10,000 lux to the search term.

This bright light is like medicine. It can suppress melatonin, so it should be used in the morning. Sit about two feet away from the light box for 20 to 90 minutes while reading or doing some work. The light is bright, but don't put your sunglasses on. The UV light that might damage your eyes has been filtered out with these light boxes, so the bright light doesn't damage your eyes. If you find that you're getting out of bed later and later in the fall, using morning bright light therapy will help reset your biological clock so you can get up earlier.

Number two, go outside and get some natural light. In most of the western U.S., we have lots of light in the winter. It's often cloudier in the northeast and the north central states, so it can be harder to find natural, bright light, but just getting outside and going for a walk can make people feel better.

Number three, exercise makes you feel better. Even when it's the last thing you want to do, make an appointment with a friend or a kid and get some exercise. Regular exercise, especially early in the day, not before bedtime, has been shown to help regulate circadian rhythms, which can be important in treating SAD.

Number four, eat this, not that. Try to limit the sugar swings associated with high carb foods and sweets. This is the time to eat your protein and veggies. If you aren't getting enough vitamin D in the winter, which most of us won't because we live in northern cold climates and bundle up, leaving nothing exposed to get our natural vitamin D, you can get vitamin D naturally in fatty fish like salmon and in eggs. Some studies suggest that people with SAD are low in vitamin D and omega-3 fatty acids. Increasing sources of these in your diet is good for your heart and your brain anyway.

Number five. If you know that you're vulnerable to depression and decreased mood in the fall and winter months, get started early on activities and interventions that can help. Don't wait until the darkest days of your mood. Bright light therapy and planned diet and exercise changes early in the fall.

Six. My favorite recommendation is to change your venue. Go south, visiting climates that have more sun. Of course, this can be expensive and disruptive to the family, Thanksgiving and Christmas if mom bugs out to take a holiday on the beach, but it's just a thought. Of course, cranking up the heat in the house, getting a beach blanket and your shorts and sitting in front of a $50 light box is much cheaper, but not so much fun.

Finally, and importantly, this fall and winter holidays can be stressful for women. If you're already struggling with depression, substance abuse, anxiety and the dark days are making it worse, reach out for help to family, friends, and your clinician. You may not believe it in the dark days of your mood, but we can make it better. I'm off to dig up my light box. Thanks for joining us on The Scope.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there's a pretty good chance you'll find what you want to know. Check it out at thescoperadio.com.

Interviewer: Ten percent of people living in Utah are at a higher risk for seasonal affective disorder. We're talking today with Dr. Jason Hunziker. First of all, why are we, living in Utah, at a higher risk?

Dr. Hunziker: There are a lot of theories as to why people who live in the northern latitudes are at higher risk of this type of depression. One of those theories is the fact that there just is not as much daylight in the north as there is closer to the Equator. So the further we get away from the Equator, the shorter the days become, the darker it becomes, and so people get more depressed.

Interviewer: And so, then it's true that sunlight actually makes you happy.

Dr. Hunziker: That's correct. People who live closer to the Equator have less chance of this type of depression.

Interviewer: Are there other risks then, being in Utah, besides not enough sun?

Dr. Hunziker: There are, and people who are at risk that live in Utah are people who are young, they're a lot more at risk. Women tend to be at a higher risk than men, at an almost ten times more likely to get this type of depression than men.

The other thing that occurs in Utah, that doesn't occur in other places, is our inversion. So time away from the sun, even on a bright day, we don't get that because the inversion's there to block the sun. People who live around tall buildings that block the sun tend to get more depressed. If your job is indoors, in the basement with no windows, during the winter you're really at risk.

Interviewer: And especially since we have Daylight Savings here in America, you get out of work at 5:00 and it's already dark.

Dr. Hunziker: That's right.

Interviewer: And so you don't really ever . . .

Dr. Hunziker: That's right.

Interviewer: And then you wake up at, you know, 6:00, 7:00 and it's still dark, and so you never really see the sun.

Dr. Hunziker: That's correct, and it can't just be the light in your office that makes the difference, it has to be the same wavelength as the sun to make a difference, which is why people use light boxes because that does help with most people who have this type of seasonal disorder.

Interviewer: So knowing that people in Utah are at higher risk for depression, tell me from a doctor's perspective exactly how dangerous that is.

Dr. Hunziker: Yeah. So depression can be extremely dangerous, and suicides rates, particularly in Utah, are quite high. And if depression of any type goes unchecked, it can lead to people thinking about ending their life, which is extremely important. So any time you're experiencing a depressed mood, it should be evaluated, at least by your primary care doctor to see if something else needs to be done.

Interviewer: So with depression being so serious, does it often get confused for somebody just being moody, then, because people get moody and they get upset, but when does that become depression? When does it become dangerous?

Dr. Hunziker: The way you can tell is if this lasts every day for at least two weeks, where you're feeling so terrible that you don't want to get out of bed, where you feel like you have to sleep all of the time. You have absolutely no energy, or interest, or desire to do anything with anyone. You notice that you're eating a ton, particularly carbohydrates. With this population that gets seasonal affective disorder, carbohydrates tend to be the big thing that they do. And then, of course, if you start having any thoughts about hurting yourself at any time, that's when it really needs to be addressed.

So in summary, I think that for those of us living in Utah, we are at higher risk, so we need to pay attention to those signs of depression. Particularly women, particularly young people, particularly people who work in environments where they're not around sunlight need to pay attention to this. If you notice that you're having any changes in your mood, please seek help.

updated: December 16, 2022
originally published: December 16, 2015

Interviewer: How do you know if your teenager is just being a mopey teenager or might have depression issues? We're going to find out next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: Dr. Nathan Bexfield is at the South Jordan Health Center part of University of Utah Healthcare, and today we're going to give you some tips as a parent how you can figure out if your child might be suffering from depression or maybe if they're just a mopey teenager, and it can be difficult to tell the two things apart sometimes. So give us some insight.

Dr. Bexfield: So yeah, I think every parent of a teenager wonders how motivated they are to actually get out and do things, but depression is kind of on a whole different level. So with depression, obviously they need to be depressed, and being depressed is like not having really much joy in life. A good example of a kid that may have depression is that maybe this kid enjoyed playing soccer at one point, and that was their passion and they loved it and they wanted to do it a lot, but then suddenly they're not even really wanting to play soccer anymore, and you're wondering, "Well, why don't you get out and play with your friends?"

Interviewer: Yeah, not finding joy in things you used to find joy in.

Dr. Bexfield: Right, exactly. Exactly. Another symptom that can be a little more concerning with kids who might have depression is changes in eating habits. They might eat more than they used to or not eat as much as they used to. Also, watching their sleeping habits. So some kids oversleep. A lot of teenagers will oversleep.

Interviewer: Guilty.

Dr. Bexfield: But these kids are sleeping like 18 hours a day, a crazy amount of sleep, or not being able to fall asleep or stay asleep. So those are the things that you want to look at as well. And teenagers, another thing I find that a lot of them do is they get more irritable. Now I know what you're saying. Irritable teenagers, you're probably like, "Well, every teenager is irritable."

I'm talking like out of proportion irritable like you can't really even have a conversation with them without them just blowing up or getting really frustrated and angry, or crying a lot, extreme sadness. So those are some things I often see in kids of this age. I think extreme cases, there are kids that want to hurt themselves or have thought about suicide, which is very sad, especially to think of a teenage boy or a teenage girl who wants to hurt themselves.

Interviewer: Yeah, I've heard if it gets to that point, that you should seek help immediately.

Dr. Bexfield: Definitely.

Interviewer: If there's any indication that suicide's on the table you should go seek help, because it does one of two things. It either gets the child help and the parent help, or it calls the bluff, if it is bluffing, because sometimes that's what it can be. But what are some other things parents can do? If they recognize what they think to be symptoms of depression, should they seek out help right away or is there something parents can do?

Dr. Bexfield: Definitely. If you are worried about depression in your child you should go see your physician, whether that be your pediatrician or your family practice doctor, but go see your doctor, because we can do some simple screening tests and just have a simple conversation with you and the child, and just kind of find out how things are going. And if your child meets the criteria for someone who has depression, then there are certainly lots of things we can do. The big things that we do that I find works the best is starting an appropriate medication and also getting them into some sort of therapy to allow them to talk things out and have coping mechanisms in place. Sometimes that therapy works even better when the whole family is involved.

Interviewer: Medications, do you find that some parents are little hesitant?

Dr. Bexfield: I do, because there's a little bit of stigma that comes with taking medications for depression or any mental health issue. But the actual truth is there are a lot of people that have gotten a lot of benefit from these medications. So I think this is something that actually helps these kids, and I've seen it in my experience.

Interviewer: How often is depression caused by actually a chemical imbalance in the brain versus just what's going on in their life?

Dr. Bexfield: Well, I think it's a combination of both of those things. Certainly genetics plays a factor in it. If there's a family history of depression, then certainly that child may be a little more prone to depression or anxiety or whatever mental health disorders run in the family. Also, the environment plays a factor. What's your home life? What's your life at school? How are people treating you? How are you being perceived as being treated or how are you perceiving others as treating you? That sort of thing. So I think it's more than just a chemical imbalance versus environment. I think all those factors sort of play in, and once it overwhelms them, then they feel like they're drowning and they can't get up.

Interviewer: You've told me that depression is something that you see more and more often, you feel, in your practice at times, and it seems like you're something very passionate about. So what I'm getting at right now is what would be that one message you'd have to a parent if they think that their child is depressed? Even if they're not sure, because that's a scary step to take, right, to say my child might be depressed?

Dr. Bexfield: That one message I would get out is if you're worried at all, come see your doctor. Let's talk about it. The best case scenario, we can tell you, "Hey, you know what, your child is not really depressed and maybe this is something you guys need to talk about, communicate better," sort of a thing like that." Worst-case scenario is if you don't address it something really bad could happen and your child could end up being harmed.

Interviewer: So even if you have an inkling, no action is worse than action?

Dr. Bexfield: That would be my suggestion, yeah.

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Seasonal Affective Disorder is not the same as winter blues. Ignoring your symptoms could make the holiday season less than jolly.

I'm Jason Hunziker, Psychiatrist at the University of Utah. And that's what coming up on The Scope.

Often with the winter blues even though you're feeling down and sad, your emotions can change based on the environment that you are in. If you're watching a show that's funny or happy you can laugh, or if somebody tells you a joke you can get happy or it's fun to out with your friends and it's still fun to go skiing, but other times you're feeling down and stressed.

With seasonal affective disorder your mood doesn't generally change. Things don't make you happy anymore and you don't find pleasure in those things that you used to find pleasure in. You're interest level drops and you prefer to stay by yourself rather than be around other people. Often you feel you are pretending to be happy just so that others around you won't know how sad you really are. The difference is the symptoms last longer, they are more severe, and they impact all aspects of your life.

Sometimes the patients are able to go through the whole winter without any treatment and it doesn't cause much disruption. However because this is a sub-type of depression, it can lead to more significant symptoms and problems.

This is different than just feeling the so called winter blues or seasonal funk as some people will say, because it actually impairs your life and the life of those around you when you have this type of depression.

The way that this can affect others in your life is that many of these symptoms of depression include isolation, avoidance, irritability, poor sleep, overeating, weight gain, sadness, crying episodes, all of those things which can impact your family and friends and coworkers.

The cause of season affective disorder is still not clear; however there are a few theories on how this illness comes about. One of those theories is the biological clock or circadian rhythm suggesting that because of less sunlight in the fall and winter you are more likely to have moments of depression and sadness.

Another theory is that melatonin levels also change when seasons change and then based on your melatonin production or melatonin levels you will also experience changes in your mood pattern.

And lastly serotonin levels are always looked at when we're talking about depression and changes in the serotonin particularly around stressful times such as the holidays can increase people's sadness and difficulty in coping with stress.

The literature would suggest that women are at a much higher risk of this illness than men; however when men do get seasonal affective disorder their symptoms are much more severe and place them at higher risk of self harm and suicide.

Those of us who live further from the equator are also more at risk, mainly because the changes in the dark and light patterns in our seasons make us more at risk. If you have a family history of someone with depression or anxiety or substance use disorder, you are also more at risk of this sub-type of depression.

The most common age that we start to see seasonal affective disorder is sometime around 20 years old. The age range generally is between 20 and 40; however depression can come at any time during your life. And if you do notice the symptoms of seasonal affective disorder what are you going to do about that? I think the important thing is to go in and talk to your primary care doctor, your family practice doctor, your nurse practitioner or whoever your healthcare provider is so that you can get the appropriate care and treatment for this syndrome.

The important things that you should talk to your doctor about when you recognize that these symptoms may be more than just the winter blues include when these symptoms start every year. If you notice that every year in September you start to have trouble sleeping, eat more, have trouble moving around, that's important for your doctor to know.

Looking at your history and telling your doctor how long these symptoms have been present, if it lasts from September to December, or if you've ever been suicidal, or if you notice you're drinking more alcohol during that time, it's very important for your doctor to know. If you have family history about depression, bipolar disorder, other mental illness your doctor should also know that as well.

And then after this appointment your doctor may suggest to you several different types of treatment. One of the most commonly recommended treatments for seasonal affective disorder is light therapy. Even though this treatment is not FDA approved, there is a lot of anecdotal evidence that the light therapy will work for this illness. Light therapy is composed of a box that sits on your desk or that you can carry with you that essentially is bright light that shines into your eyes for anywhere from 15 minutes to 2 hours a day to help you with your mood symptoms; based on the theory that the change in the amount of light that we get every day this treatment will help improve your mood symptoms.

Additional therapy could be medication use including SSRI medications like Prozac or Paxil or Zoloft or other medications like Wellbutrin that can be taken during this period of time that you have your symptoms and then with the help of your doctor you could come off of those medicines for the remainder of the year.

The holiday can be very stressful, family parties, family get togethers, seeing people that you really don't want to be around can be stressful at this time and having someone you can go to and talk to about these symptoms is very beneficial for most patients.

updated: December 21, 2021
originally published: December 10, 2014