The Winter Blues Are Upon Us...

With the winter months upon us, a number of individuals will suffer from what is known as Seasonal Affective Disorder. This can range from a slight downturn in mood to the development of a severe case of clinical depression. It is important to know the difference between the two extremes to ensure that one does not develop into the other. Depression, or a depressed mood, may refer to a state of melancholia, unhappiness or sadness, or to a relatively minor downturn in mood that may last only a few hours or days. This is quite distinct from the medical diagnosis of clinical depression. However, if the depressed mood lasts at least two weeks, and is accompanied by other symptoms that interfere with daily living, it may be seen as a symptom of clinical depression or some other diagnosable mental illness.

What Is Depression?

In the field of psychiatry, the word depression can also have this meaning of low mood but more specifically refers to a mental illness when it has reached a severity and duration to warrant a diagnosis, whether there is an obvious situational cause or not; see Clinical depression. The Diagnostic and Statistical Manual of Mental Disorders (DSM) states that a depressed mood is often reported as being: "... depressed, sad, hopeless, discouraged, or 'down in the dumps'." In a clinical setting, a depressed mood can be something a patient reports (a symptom), or something a clinician observes (a sign), or both.

A depressed mood is generally situational and reactive, and associated with grief, loss, or a major social transition. A change of residence, marriage, divorce, the break-up of a significant relationship, graduation, or job loss are all examples of instances that might trigger a depressed mood.

Depression can be the result of many factors, individually and acting in concert:

Environment
Reactions to events, often a loss in some form, are perhaps the most obvious causes. This loss may be obvious, such as the death of a loved one, or having moved from one house to another (mainly with children), or less obvious, such as disillusionment about one's career prospects. Monotonous environments can be depressing. A lack of control over one's environment can lead to feelings of helplessness. Domestic disputes and financial difficulties are common causes of a depressed mood. Love, or lack of being able to express your feelings can lead to a feeling of unexplainable sadness or grief.

Psychological Factors
Sometimes the depressed mood may relate more to internal processes or even be triggered by them. Pessimistic views of life or a lack of self-esteem can lead to depression. Illnesses and changes in cognition that occur in psychosis and dementias, to name but two, can lead to depression.

Physiological Considerations
Some general physiological considerations include genetics (i.e. a hypothesised innate disposition to depression), neurochemistry (e.g. high levels of stress hormones such as cortisol, low dopamine activity), sleep patterns, female hormone imbalance (e.g. PMS in women), male hormone imbalance (testosterone) in men, use of medication (e.g. corticosteroids), chronic illness (e.g. diabetes or hypothyroidism), and seasonal factors (e.g. seasonal affective disorder related to hormones and sunlight).

Treatment of depression varies broadly and is different for each individual. Various types and combinations of treatments may have to be tried. There are two primary modes of treatment, typically used in conjunction: medication and psychotherapy. Other alternative treatments used for depression include exercise and the use of vitamins, herbs, or other nutritional supplements.

The effectiveness of treatment often depends on factors such as the amount of optimism and hope the sufferer is able to maintain, the control s/he has over stressors, the severity of symptoms, the amount of time the sufferer has been depressed, the results of previous treatments, and the degree of support of family, friends, and significant others.

Although treatment is generally effective, in some cases the condition does not respond.

Treatment-resistant depression warrants a full assessment, which may lead to the addition of psychotherapy, higher medication dosages, changes of medication or combination therapy, or even a change in the diagnosis, with subsequent treatment changes. Although this process helps many, some people's symptoms continue unabated. The well-documented side-effects associated with traditional forms of medication also inspire many to turn to side-effect free, non-addictive, natural alternatives.