12/10/99

Holiday Cheer or Tears?

Strolling carolers and twinkling lights don't bring cheer to everyone during the holidays. For many, the office parties, TV specials and anticipated family gatherings stir up more sadness than joy.

Can the stress of the holidays lead to depression? We read in the newspapers that more and more children are taking medication for depression. What is causing this? Can depression be prevented?

For answers to these questions, I turned to Anita Lopker, MD, a psychiatrist in private practice in Westport. What follows is her informative and compassionate report about what depression is, how to recognize it, approaches to treatment and measures that may help prevent or lessen symptoms.

Dr. Lopker writes:

"We are indeed recognizing depression more frequently nowadays in both children and adults, now that our understanding of the illness has advanced. Depression is a medical illness that affects both the mind and the body. We are only beginning to fully understand the true nature of depression, as our knowledge of both the brain and the mind expands to give us a more complete picture of its causes and the proper treatment.

"Like many other medical illnesses, depression used to be thought of as a moral or spiritual disorder. Its physiological roots were completely misunderstood due to a lack of knowledge. As technology advanced, so did our knowledge and understanding of the physiological basis of depression.

"In the past half-century, tremendous advances in treatment have grown out of our increasing knowledge of the anatomy and physiology of depression. For example, we now know that the vulnerability to depressive disorders tends to be transmitted with the same gene that encodes for creativity, and that vulnerability to the development of depressive disorders tends to run in families, as does creativity.

"We also know that the presence of depression in an individual is associated with changes in the fine structure of the communication portions of nerve cells in the brain. Nerve cells in the brain work together via constant communication and interchange to regulate all of our sleeping and waking moments in life. Information is exchanged between nerve cells via chemical messengers stored and received in the ends of nerve cells. When depression occurs, the nerve cells in the brain are lacking sufficient amounts of stored chemical messengers to adequately communicate with each other so that mood, sleep, eating, socializing, motivation, concentration, and attention can be properly regulated. Medications which improve the symptoms of depression are those which will restore the availability of chemical messengers so that there is proper communication between nerve cells.

"The symptoms of depression differ somewhat in children and adults. In general, the symptoms of depression may include disordered mood, disordered sleep, disordered eating, disordered cognition (concentration, attention, memory and, in some cases, perception), disordered social and interpersonal interactions, decreased motivation and zest for living, inappropriate feelings of guilt, and excessive concern over physical health and/or physical symptoms. In children, physical symptoms and complaints as well as irritability are likely to be more prominent, and deterioration in school functioning may be an important clue to the presence of depression.

"Depression can be triggered by stressful experiences. The holiday season is often a stressful time of year, and people with recurring depressions may be especially vulnerable around this period. Certain factors do help to prevent depression: adequate sleep, regular aerobic exercise, good nutrition, a strong social support network, and lack of familial conflicts. When children develop depression it is important for a mental health professional to carefully evaluate whether there is unresolved conflict in need of attention in the family. Treatment of depression may include antidepressant medication, individual therapy, and family therapy.

"Our understanding and recognition of depression have been increasing exponentially over the past fifty years. In the U.S., depression occurs in 0.9% of preschoolers, 1.9% of school aged children, and 4.7% of adolescents. The mean age of onset of depression is 11 years old. Epidemiological studies show that the incidence of depression has been increasing since the 1940's, and that there is an increasingly younger age of onset. This suggests an interaction between the environment and genetics. So in addition to our increased ability to recognize and treat depression, the illness is becoming more common.

"It is interesting to speculate that this environmental factor may be at least partly due to changed dietary habits resulting in a decreased intake of essential fatty acids in our society, but we don't know yet. We do know, however, that especially during this holiday season, it's wise to pay attention to those factors that tend to protect from depression: adequate rest, regular exercise, good nutrition, supportive relationships with friends and family, and a positive, joyful outlook on life."

Anita M. Lopker, M.D.
Email: alopker@snet.net
Phone: 203-454-7686

Dr. Lopker completed her Doctor of Medicine (MD) degree at the University of Rochester School of Medicine and her Postdoctoral training in psychiatry at the Yale University School of Medicine, Department of Psychiatry. She has taught psychiatry at Yale; conducted several research studies in psychiatry; and published several articles in professional journals. She currently practices psychiatry in Westport, CT, specializing in Eating Disorders. She is also considered an expert on the psychiatric manifestations of Lyme Disease.

LINKS:

Seasonal Affective Disorder (SAD)

Depression

Please send questions or comments to bbruno@snet.net.