SEASONAL AFFECTIVE DISORDER (DEPRESSION)

 

Ozodi Thomas Osuji

 

       Generally, our people deny their mental health issues. As they see it, mental health issues are for other people and not for them. Indeed, when they do think of mental health issues, at all, they tend to think of the psychoses (schizophrenia, mania, delusion, organic mental disorders etc) and are not aware that there are all sorts of mental disorders.

         The American Psychiatric Association estimates that one out of every four persons (25% of the population) has some treatable mental disorders, ranging from severe psychoses (where there are delusions and hallucinations) to the various personality disorders, to anxiety disorders, dissociative disorders etc.

        Nigerians and Africans are human beings and, as such, have the same mental health issues that other people have. Alas, Nigerians, been largely poor and ignorant of these issues, do not even know when they have mental health issues!

        Worse, when they hear you use a mental health term, they turn around and use it on you (such as the clown in New York who read my employing the term neurotic and called me a neurotic, while presenting the classical symptoms of neurosis: parading his titles to make him seem important in other peoples eyes, because, deep down, he feels unimportant and needs externalities to make him seem like he is somebody…inferiority, compensatory fictional superiority feeling, and allied vanity, pride and infantile narcissistic behaviors…see Alfred Adler, The Neurotic Constitution.  New York: Ayer, 1987).

     

        This season is called the season for affective disorders (seasonal affective disorders).  The affective disorders are mania and depression (etc).

       Briefly, in mania (there many levels of it, including cylothymia) the individual feels euphoric, excited and happy for no good reason, feels like a person who won millions in the lotto, exhibits poor judgment (sometimes he writes bad checks for money he does not have in the bank), and generally engages in stupid behaviors. Onset is characterized by lack of sleeping and hypo-manic activities (such as thinking that he has ideas that could save the world; engages in grandiose projects to make him become rich; may go for a week or more without sleep etc).  The individual is often found laughing to himself.  Mania, aka bipolar affective disorder, affects about 1% of the population, worldwide. Generally, blacks score high on the mania scale in the Minnesota Multiphasic Personality Inventory, MMPI (the primary personality test in the USA).

       The other arm of affective disorders is depression. Clinical depression, aka major depression, is characterized by a feeling that life is not worth living; a lack of interest in the activities of daily living, such as, lack of interests in work, sports, friendship, food, personal grooming, sex, fatigue, tiredness, not wanting to get up from bed in the morning, and wanting to be left alone and to die etc).  The depressed person is generally pessimistic (whereas the manic is the polar opposite, wildly optimistic) and feels that his life is worthless and valueless. He often contemplates suicide as a way out of what he sees as a bleak situation. Self mutilation is common.  There are levels of depression, from major depression (just described) to milder forms of it, such as dysthymia, adjustment disorder with depressed emotions (situational depression felt when one loses ones job, loses ones significant others, is poor, does not have the money to buy expensive Christmas gifts for his significant others etc).

       Mania is treated with medications (Lithium, Depakote, Tegretol etc…the neuro-scientific assumption is that in mania the brain, Central Nervous System, CNS, produces excess of certain excitatory neurotransmitters, such as norepinephrine and these medications help to reduce their level in the brain hence reduce the excited behavior of the manic person’s nerves); depression is treated with anti depression medications (these days, with the various serotonin reuptake blockers, such Prozac, Zoloft, Paxil etc…the assumption is that the depressed person is not retaining sufficient serotonin, a neurotransmitter, in the appropriate nerve receptors and these medications block the re-absorption of serotonin hence retains much of it in the brain…it takes about two weeks to do so …and alleviates depression).

        These days, the general assumption is that whereas these affective disorders may have other causal factors (?) that they are, by and large, correlated with certain observable changes in brain chemistry. Therefore, they are amenable to biochemical and pharmacological treatment.

        If you have any of these affective disorders, please go see your medical doctor and get appropriate treatment.

 

       During Christmas season, generally, folks visit with their loved ones. Those who do not have close friends to be with tend to feel depressed. There tends to be high levels of depression during Christmas session.

       Nigerians, on the surface, appear gregarious and sociable and would seem to have friends hence are not lonely. But when you come close to them and get to know them as they are, not as they pretend to be, you recognize how lonely some of them are. Their loquaciousness is, among other things, an attempt to be close people so as to reduce their underlying existential aloneness. We are all born alone, live alone and will die alone. Friends are surface thing. I talked to a Nigerian, a chap that calls me every abusive name under the sun, right here in Seattle, and, thereafter, he was calling me day and night. That told me that he feels lonely and is mildly depressed (and do not know it).

        For our present purposes, many of our people are mildly depressed and do not even know it. Mild depression does not require medical intervention but psychotherapeutic intervention (talking to a therapist or to any perceptive person helps one cope with the exigencies of living in an impersonal world where nobody cares for us…as the Igbos say: “Onye ma mkpa me?” who knows my problems, no body. We are all alone in the whole wide universe and know it; to be a human being is to suffer existential and phenomenological depression. Ultimately, we shall all die and this is depressing thought, hence what Ernst Becker called Denial of Death. What a bummer is this life of ours.

 

        During the winter moths, as it were, the sun takes a vacation. (In Seattle, for example, it is cloudy most of the time and, generally, dark by 5PM and remains dark until almost 9AM).  What this means is that folks are living in near darkness, most of the time.

       Darkness is depressing. It literally does something to the body (may be help reduce the level of serotonin in the body?). Whatever, what is empirical is that during the winter month’s folks tend to feel more depressed than they do during the sunny months?

       The term seasonal affective disorder applies to the depression folks feel during the absent sunshine winter months.

 

        If you experience seasonal affective disorder please see your physician for treatment. Do not delude yourself with bravado and tell yourself that you are immune from depression and other affective disorders.  These mental disorders occur in Nigerians and Africans, as they occur in other people. It just so happens that they are mostly untreated in Nigerians.  The last time I was in Nigeria and had the opportunity to observe folks in my village, I was shocked at how many of them had mental disorders, especially personality disorders. Boy, many of the women in the village had borderline and or histrionic personality disorders. They were almost always quarreling with other people and threatening to kill themselves if they were not the centers of attention.

      For our present purposes, this is the season of affective disorders. I have briefly described the symptoms. Depression is often masked by over eating, over drinking of alcohol, doing drugs, over sexing etc. Observe yourself, your spouse and children and if any of them seem to have these issues, please go get them the help they need.

 

     Have a Merry Christmas and a Happy New Year.

 

Ozodi Thomas Osuji

December 14, 2006

 

Robot  Villager

# 1 For our present purposes, this is the season of affective disorders. I have b...Read the full article. Posted by Robot| 16.12.2006 02:26

DoubleWahala  Villager

# 2 During the winter moths, as it were, the sun takes a vacation. (In Seattle, for example, it is cloudy most of the time and, generally, dark by 5PM and remains dark until almost 9AM). What this means is that folks are living in near darkness, most of the time. Darkness is depressing. It literally does something to the body (may be help reduce the level of serotonin in the body?). Whatever, what is empirical is that during the winter month’s folks tend to feel more depressed than they do during the sunny months? You are absolutely correct on this. When I first came to this country, I happened to arrive just at the beginning of fall. I wasn't prepared for the seasonal change; longer nights and shorter days. I always felt slightly depressed, without realising why. Until I came across some literature regarding the syndrome. That was my aha :idea: moment. I usually combat it by indulging in extended work-outs. This naturally builds up my 'feel-good' hormones. It also helps to have friends and family that you can reach out to. DW Posted by DoubleWahala| 16.12.2006 03:59

Abraxas  Villager

# 3 Hi, Dr. Ozodi OSUJI! Thank you for opening our eyes in the year 2007. May God, in His/Her/Its infinite mercy grant you more opportunities to show the light wherever darkness chooses to prevail. Merry Xmas, and a paranoia-free 2007 and beyond. Feliz Navidad, y una Feliz Año Nuevo. Muchas gracias. Don Juan Carlos ABRAXAS (III) Posted by Abraxas| 16.12.2006 07:41

techsista  Villager

# 4 Excellent contribution on seasonal affective disorder and other mental health illnesses. The New York Times recently did a piece on seasonal affective disorder, which they describe as a form of hibernation. Solutions include melatonin and lightboxes that emit full-spectrum UV light. I use a lightbox myself in winter time because after consulting with a doctor, I discovered a few years ago that I have seasonal affective disorder. The lightbox works for me and also helps with jet-lag. The other thing that works for me is traveling somewhere tropical in winter-time - the S.A.D. symptoms vanish immediately and the effects last for a couple of weeks after I return to the US. I'm including the NY Times article for those that might be interested. December 5, 2006 PERSONAL HEALTH; Getting a Grip on the Winter Blues By JANE E. BRODY It is that time of year again, when despite the ratcheting up of festivities for the holidays, fully one person in five in the United States ratchets down. The cause is a now well-known but still infrequently treated disorder, winter blues or SAD, for seasonal affective disorder. There are several remedies to help those affected by SAD escape an affliction that leaves many wanting to climb into bed, put their heads under the covers and not come out until spring. Indeed, some experts refer to SAD as a form of hibernation. The problem typically starts gradually as the days become shorter in late summer or fall and peaks in midwinter in regions where there may be just 9 or 10 hours of daylight, if that. For the estimated 14 million severely affected American adults, SAD can send them into a tailspin that makes it difficult if not impossible to fulfill daily responsibilities and derive any joy from life. An additional 33 million people are less severely affected but may experience declines in energy, cheerfulness, creativity or productivity in the dark days of winter. The most commonly used treatment is exposure for up to several hours a day to high-intensity artificial light, in an effort to simulate the longer days of summer when people with SAD function at top speed. Jet Lag and Circadian Rhythm Dr Alfred J. Lewy, a psychiatrist who has been studying the biology behind SAD, describes it as a form of jet lag, a concept he proposed 20 years ago. He recently published experimental evidence that he says attests to the validity of this theory. If true, this would make SAD a disturbance in the circadian rhythm, the 24-hour pattern that normally aligns the sleep-wake cycle with all the other bodily rhythms. Dr. Lewy suggests that with the delayed dawn and shorter days of fall and winter, the rhythms of people afflicted with SAD drift out of phase with the sleep-wake cycle, as if they had traveled across many time zones. With jet lag, recovery occurs over a matter of days, and the circadian rhythm once again becomes synchronized with day and night. ''In people with SAD, this adjustment takes five months,'' Dr. Lewy said. If his theory is substantiated by further research, it may one day be possible to treat SAD with tiny daily doses of time-released melatonin, the substance in the brain that regulates the sleep-wake cycle. Melatonin naturally increases in the evening, causing sleepiness, and falls off as morning approaches. The idea would be to tailor the administration of melatonin in a way that realigns the out-of-sync circadian rhythm in people with SAD, just as tiny doses (much smaller than those typically sold in health-food and drug stores) of melatonin can be used to speed recovery from jet lag. In his study, conducted with three colleagues at Oregon Health Sciences University, Dr. Lewy identified two types of SAD patients. About two-thirds required morning light or evening melatonin to correct their body clocks. The remainder needed evening light or morning melatonin to put their body rhythms back on track. Currently, there is no commercial source of time-release low-dose melatonin that could be used, with or without light therapy, to help people with SAD. Current Remedies Dr. Norman E. Rosenthal, a native of South Africa who discovered his own serious problem with SAD while a resident in psychiatry at the New York State Psychiatric Institute in 1976, has become an expert in diagnosing and treating the problem. His knowledge and experience in helping himself and countless patients afflicted with SAD are summarized in ''Winter Blues: Everything You Need to Know to Beat Seasonal Affective Disorder,'' whose revised edition the Guilford Press published this year. Dr. Rosenthal aptly describes SAD as ''an energy crisis.'' Patients are not depressed in the usual emotional sense, but rather feel as if their batteries have run down. The symptoms of SAD do mimic those of serious depression. Patients say they have to drag themselves out of bed in the morning, even after 10 hours of sleep, and force themselves to perform necessary chores. They feel leaden and would just as soon not see anybody or do anything. They find it difficult to concentrate and think clearly and quickly. Sex drive often dwindles markedly but is often replaced by an insatiable appetite for carbohydrates -- breads, pasta, potatoes, rice and sweets -- that results in weight gain. Many people with SAD have two wardrobes, the one for winter being two sizes larger. The most common remedy is light therapy. But not just any light. Patients are advised to sit in front of a specially designed light box that emits about 10,000 lux from a fluorescent bulb, most often in the morning for at least 45 minutes. Some patients require hours of light therapy each day to ward off the symptoms of SAD, which may mean having one light box at home and a second at work. Among commercial sources for these light boxes is the Center for Environmental Therapeutics, which sells them for $200. Its Web site, www.cet.org, is a useful source of information about SAD. Among other light-enhancing suggestions from Dr. Rosenthal are planning a winter vacation in a sunny climate or relocating to someplace nearer the Equator, where the days are longer in winter. (But, he cautions, first be sure you can tolerate the summer there.) Helpful Machines and Therapies For those who remain in northern latitudes, Michael and Jiuan Su Terman of the New York State Psychiatric Institute at Columbia University, who have conducted pioneering studies of SAD remedies, suggest considering a ''dawn simulator.'' This device gradually turns on a bedroom light every morning while you are still asleep, helping ease SAD symptoms by making the body think that it is experiencing the early sunrises of summer. This might also help people who do not have SAD but who hate getting up in the morning when it is still dark out. The Termans have also found another helpful gadget, a negative-ion generator. They showed that sitting in front of a machine that emits negative ions at a high rate for 30 minutes every morning was as effective as sitting in front of a light box for the same time. The generators are available for $165 from the Center for Environmental Therapeutics (Michael Terman is the president of its board). The advantage of this device is that it can be used while sleeping. A third approach that has proved effective is cognitive behavioral therapy, when used with or without light therapy. Kelly J. Rohan of the Uniformed Services University of the Health Sciences in Bethesda, Md., found that this therapy, a brief form of psychotherapy that helps people change negative thoughts and behaviors, was as effective as light therapy in a study of 23 patients with SAD. And unlike light therapy used alone, cognitive behavioral therapy helped prevent a relapse of SAD symptoms the next winter. Dr. Rosenthal also recommends eating a diet relatively high in protein and low in carbohydrates and performing regular physical exercise, which is especially helpful if it is outdoors in the morning or, if indoors, in front of a light box. Posted by techsista| 16.12.2006 09:26