February 5, 2021 • 17 mins
How to tell if you're struggling with sadness or depression—and what to do in both cases.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:05):
Bees are challenging times, but you don't have to navigate
them alone. Welcome to how can I Help? I'm doctor
Gale Saltz. I'm a clinical Associate Professor of psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:27):
hopefully with understanding, insight and advice. Today, I'm going to
answer your questions about feelings of sadness, blueness, and even depression.
Feeling sad sometimes is a normal human emotion. It's not
abnormal to feel sad, especially in reaction to loss, to
(00:48):
struggle or difficulty. Right now, so many more people are
having losses, actual losses of lives of those they love,
economic losses, job losses, losses of the ability to maintain
and start new relationships, loss of their regular way of life,
of feeling safe, of the ability to participate in usual
(01:12):
developmental milestones like graduations and funerals. With so much loss,
it's not surprising that many more people are struggling with
feelings of sadness, and sometimes more than normal sadness, sometimes
clinical depression. But if you're feeling sad and having depression.
There is something you can do about it. Today, I'm
(01:35):
going to answer questions about feeling sad and about depression.
So let's get to it and see how can I help.
Question one, Dear doctor Salts, I find myself feeling sadder
over the past few months than normal. I don't have
(01:57):
much of an explanation for it other than COVID. Is
this normal? Do you have any advice? One out of
every ten people will develop a clinical depression in their lifetime.
In fact, clinical depression often runs in families, such that
having a first degree relative who has had a depression
(02:17):
means you might be at higher risk. Depression can happen
without any trauma or loss, or for that matter, any
stressor in your environment. But it's also true that a
difficult stress can precipitate a depression for some people. This
pandemic has been an exceedingly difficult stressor for most people.
(02:39):
But when you say not much of an explanation except COVID,
I say that's all the explanation you need. The question
is whether your increased sadness is just that, or whether
it's more than that, whether it's depression and requires you
to get treatment. Feeling sad some of the day, but
(02:59):
how having some days you're really not very sad. Being
able to concentrate and do your work, being able to
maintain your usual relationships and not withdrawal or socially isolate
would indicate you have more sadness, not surprising at this
difficult time filled with imposed life change is loss and
(03:21):
no clear ending in sight. But if you've had more
than two weeks of also feeling hopeless, helpless, or worthless,
of feeling these bad feelings most of the day every day,
of also noticing either that you have very low energy
and you feel kind of slowed down, or feeling agitated
(03:44):
and jittery and irritable, of having any interference with your
normal sleep, such as having difficulty falling asleep, or of
waking up much too early and being unable to get
back to sleep, or possibly of sleeping more than normal
and sleeping a lot of the day. Another symptom would
(04:06):
be appetite change, be either a loss of appetite or
an increase in appetite, but especially of desire to eat carbs.
If you no longer take pleasure in anything, something called
a hedonia, So the things that used to give you pleasure,
just don't now if you've lost a feeling of having
(04:27):
sexual desire, if you're having difficulty concentrating and you can't
concentrate to read or on a show, or on your work,
and certainly if you have thoughts that life isn't worth living,
or you have thoughts about death, or particularly if you
have thoughts of death by suicide, then this is clinical
(04:49):
major depression. There are things that you can do at
home to address your mood, particularly to help with sadness.
For example, aerobic sercise has been shown to boost mood,
and actually doing it for thirty minutes with your heart
rate up three to four times a week does over
time not only boost mood, but as well as medication
(05:12):
does for mild to moderate clinical depression. The practice of
mindful meditation has been shown to help mood, and actually
other forms of meditation like transcendental are also thought to
be helpful. Talking with others for social support is very
helpful in relieving sadness, especially those who you trust to
(05:35):
be empathic and understanding. Doing things to help others, particularly
in an organized fashion, actually over time is shown to
help your mood, and the practice of gratitude, for example,
listing three things at the end of the day for
which you feel grateful over the course of just two
weeks is shown to boost mood. If, however, what you're
(06:00):
feeling is more like clinical depression, it's very important to
be evaluated by a mental health professional and start either
psychotherapy or medication, or preferentially both if it is severe.
There are several types of psychotherapies that are known to
be helpful in depression. They include psychotherapy such as cognitive
(06:24):
behavioral therapy, psychodynamic psychotherapy, and something called acceptance psychotherapies. There
are also multiple classes of medications known to be helpful
and useful in treating depression. These are all individual choices,
one that you should make with the professional, but certainly
(06:44):
getting evaluated and treatment when you have clinical depression is important.
The reason it's so important is that the way the
brain works when you feel a feeling that you haven't
had before, for example, depression, the wiring through which that
feeling state moves is originally very unused, and that means
(07:08):
it's very small, like a country road. But the more
that you feel that feeling, the more activity that's happening
in that wiring, the stronger the connection becomes so what
started as a country road becomes essentially a super highway.
This phenomenon is called the kinetic effect. And the reason
(07:29):
that it's concerning is that when you leave depression untreated,
besides the fact that it can go on an extremely
long time, and it can also wreak havoc on your life,
both socially and in terms of work, and of course
there's always the risk and concern about suicidal thinking. In
addition to all those things, untreated depression means that you
(07:54):
are more likely to relapse and have a depression again
in the future because that country road has become a
super highway. So for many reasons, it's very important to
get treatment, and the earlier in the course the better.
How can I help with Dr Gayale Salts will be
(08:14):
back after this short break? Question two? Hello, Dr Salts,
This seasonal depression really a thing. I find myself much
more tired and lazy as it becomes colder and the
(08:36):
daylight hours shrink. How do I keep from falling into
a winter slump? So the short answer to your question
is yes, seasonal depression is very much a thing, and
many people don't recognize they have it. The best way
to think about whether what's happening to you right now
(08:56):
might be seasonal depression is to think back about previous
years in this winter time time frame and think about
whether you had some struggles with your mood, or at
least your mood wasn't as good as it is often
in the other seasons. Now, the interesting thing about seasonal
depression is most people do get it at this time
(09:19):
of year when the days are shortest and there's a
lot of clouds, and it's kind of steely and gray,
and basically there's less sunlight outside. And I'll explain why.
But some people actually do get seasonal depression during other
seasons instead. For example, there is such a thing as
springtime seasonal depression, which is less related to the light phenomenon,
(09:41):
but that person always gets depression at that same time
of year. So the crucial fact is do you find
that your depression reoccurs each year at the same time
of year. Winter time is known to be the most
common time that people with seasonal depression and become depressed,
and it does seem to have something to do with
(10:03):
less sunlight availability and going outdoors less, so being physically
exposed to sunlight less We don't know the exact mechanism,
but it seems to have something to do with the
impact of sunlight on your circadian rhythm and that changing
somehow the neurochemicals in your brains such that it precipitates
a depression. The symptoms of seasonal depression are often very
(10:29):
similar to clinical depression as I described earlier, but they
tend to be more of the variety of sleeping too
much and eating too much in the form of carbs
as opposed to losing your appetite and having difficulty sleeping. Otherwise,
the symptoms are very similar, feeling very sad, maybe hopeless
(10:49):
and helpless much of the day, very low energy, feeling
slowed down. It can become serious. There are people who
have feelings about aside even with seasonal depression, for example,
life isn't worth living, or even have thoughts of death
by suicide. But many people with seasonal effective disorder mostly
(11:12):
find that they just feel incredibly blue and down and
low energy this time of year. The reason it's important
to understand whether it's seasonal effective disorder as opposed to
clinical major depression outside of having a seasonal pattern is
what you might try to help yourself with. While seasonal
(11:37):
effective disorder can be treated with psychotherapy and definitely also
with medication, many people find that light box therapy is
uniquely well suited for them for treatment for seasonal effective disorder.
The reason is that it is a way of correcting
the amount of sunlight you get, which seems to be
(11:59):
the issue, and in addition, there are remarkably few to
no side effects with light box therapy. Now many places
sell light boxes that they call a lightbox um and
they might even call it, you know, something like a
happy box. But true light box therapy must be done
(12:21):
using an actual therapeutic light box, which is not a
lot of what you see randomly sold. Light boxes for
therapeutic use must have a minimum of what's called ten
thousand lucks, which refers to the strength of the light,
and thousand lucks is extremely strong. In addition, therapeutic light
(12:44):
boxes have a limited band of UV light that is
being used. This is important because that strength of light
using all of the UV bands would be not safe
frankly for your eyes and for your skin. So it's
important to get the correct light and it's important to
(13:08):
use it correctly as well, which is basically every morning,
for starting with fifteen minutes, working your way up to
thirty minutes over the course of a week or two.
You want to place the light six to twelve inches
from your face, but you don't want to look directly
at the light. It's not good for your eyes to
(13:28):
stare directly at the light. You want to be looking
at straight ahead or it's something else. You must have
your eyes open. So the idea that you could sit
in bed with your eyes closed and have a light
on your face won't work. But you could be, for example,
reading a book. You could be looking at your computer,
you could be watching your TV, you could be eating
(13:48):
your breakfast. You can do just about anything you want
as long as your face is looking forward at an
angle the light box is shining on your face. Some
people find that maybe at the start they might experience
a mild headache, but most people don't even have that.
And the big caveats are that somebody who has a
(14:10):
family history or any personal history that might suggest bipolar disorder,
a type of mood disorder where in addition to having depressions,
you might also experience what are called hypomania's or manias,
which are these periods of extremely up an agitated mood
and you feel sped up. That is someone who should
(14:32):
not use a light box, and certainly not without being
under the care of a physician, because light therapy has
an active effect, and that effect can take someone who
is bipolar disorder and make them hypo manic. It's also
true that some people with certain eye disorders where they
have a particular sensitivity to light might want to talk
(14:55):
with their eye doctor before about the safety of using
light therapy. And if you have questions about this, most
practitioners you can get a one or two sessions with
somebody to simply make sure that you've got the correct
light box and that you're using it correctly. But light
therapy has actually been around for a long time. Besides
being used for seasonal effective disorder, it's used to correct
(15:18):
circadian rhythm for people who have sleep disorders. In that sense,
it's often used by people who are trying to manage
jet lag. It's been used for many things that it
actually can be really effective, and in fact, if you
discover that you have seasonal effective disorder, often recommended then
in the fall, before your disorder would even happen in
(15:40):
the winter, but when the clocks change and the days
get shorter, that you start light therapy, and you may
be able to prevent yourself from having any depression at
all that season. In addition, of course, psychotherapy can be
helpful for seasonal effective disorder UM, as can medication. I
(16:02):
hope that was helpful to you. When it comes to
your mood, it is important to be your own advocate
by increasing your awareness how you actually feel day to day.
In fact, just the practice of self observation can help
you feel a little better and certainly flew you in
as to what you should do the best help yourself.
(16:23):
You can do this by creating a mood temperature journal.
Have a pad for each day, you note the date,
and then on a scale of one to ten, where
one is feeling no sad and ten is feeling the
most sad and miserable you have ever felt, rate your temperature.
(16:44):
After days of doing this, you'll have a pretty good
idea of how you're doing in terms of your mood
and whether your move is to add some coping tools
as I described at home, or whether it's time to
speak to a professional. YEA, Do you have a problem
I can help with? If so, email me at how
(17:06):
Can I Help? At Seneca women dot Com, all senders
remain anonymous and listen every Friday to how can I
Help with me? Doctor Gail Salts
Bees are challenging times, but you don't have to navigate
them alone. Welcome to how can I Help? I'm doctor
Gale Saltz. I'm a clinical Associate Professor of psychiatry at
the New York Presbyterian Hospital, a psychoanalyst, and best selling author,
and I'm here every week to answer your most pressing questions,
(00:27):
hopefully with understanding, insight and advice. Today, I'm going to
answer your questions about feelings of sadness, blueness, and even depression.
Feeling sad sometimes is a normal human emotion. It's not
abnormal to feel sad, especially in reaction to loss, to
(00:48):
struggle or difficulty. Right now, so many more people are
having losses, actual losses of lives of those they love,
economic losses, job losses, losses of the ability to maintain
and start new relationships, loss of their regular way of life,
of feeling safe, of the ability to participate in usual
(01:12):
developmental milestones like graduations and funerals. With so much loss,
it's not surprising that many more people are struggling with
feelings of sadness, and sometimes more than normal sadness, sometimes
clinical depression. But if you're feeling sad and having depression.
There is something you can do about it. Today, I'm
(01:35):
going to answer questions about feeling sad and about depression.
So let's get to it and see how can I help.
Question one, Dear doctor Salts, I find myself feeling sadder
over the past few months than normal. I don't have
(01:57):
much of an explanation for it other than COVID. Is
this normal? Do you have any advice? One out of
every ten people will develop a clinical depression in their lifetime.
In fact, clinical depression often runs in families, such that
having a first degree relative who has had a depression
(02:17):
means you might be at higher risk. Depression can happen
without any trauma or loss, or for that matter, any
stressor in your environment. But it's also true that a
difficult stress can precipitate a depression for some people. This
pandemic has been an exceedingly difficult stressor for most people.
(02:39):
But when you say not much of an explanation except COVID,
I say that's all the explanation you need. The question
is whether your increased sadness is just that, or whether
it's more than that, whether it's depression and requires you
to get treatment. Feeling sad some of the day, but
(02:59):
how having some days you're really not very sad. Being
able to concentrate and do your work, being able to
maintain your usual relationships and not withdrawal or socially isolate
would indicate you have more sadness, not surprising at this
difficult time filled with imposed life change is loss and
(03:21):
no clear ending in sight. But if you've had more
than two weeks of also feeling hopeless, helpless, or worthless,
of feeling these bad feelings most of the day every day,
of also noticing either that you have very low energy
and you feel kind of slowed down, or feeling agitated
(03:44):
and jittery and irritable, of having any interference with your
normal sleep, such as having difficulty falling asleep, or of
waking up much too early and being unable to get
back to sleep, or possibly of sleeping more than normal
and sleeping a lot of the day. Another symptom would
(04:06):
be appetite change, be either a loss of appetite or
an increase in appetite, but especially of desire to eat carbs.
If you no longer take pleasure in anything, something called
a hedonia, So the things that used to give you pleasure,
just don't now if you've lost a feeling of having
(04:27):
sexual desire, if you're having difficulty concentrating and you can't
concentrate to read or on a show, or on your work,
and certainly if you have thoughts that life isn't worth living,
or you have thoughts about death, or particularly if you
have thoughts of death by suicide, then this is clinical
(04:49):
major depression. There are things that you can do at
home to address your mood, particularly to help with sadness.
For example, aerobic sercise has been shown to boost mood,
and actually doing it for thirty minutes with your heart
rate up three to four times a week does over
time not only boost mood, but as well as medication
(05:12):
does for mild to moderate clinical depression. The practice of
mindful meditation has been shown to help mood, and actually
other forms of meditation like transcendental are also thought to
be helpful. Talking with others for social support is very
helpful in relieving sadness, especially those who you trust to
(05:35):
be empathic and understanding. Doing things to help others, particularly
in an organized fashion, actually over time is shown to
help your mood, and the practice of gratitude, for example,
listing three things at the end of the day for
which you feel grateful over the course of just two
weeks is shown to boost mood. If, however, what you're
(06:00):
feeling is more like clinical depression, it's very important to
be evaluated by a mental health professional and start either
psychotherapy or medication, or preferentially both if it is severe.
There are several types of psychotherapies that are known to
be helpful in depression. They include psychotherapy such as cognitive
(06:24):
behavioral therapy, psychodynamic psychotherapy, and something called acceptance psychotherapies. There
are also multiple classes of medications known to be helpful
and useful in treating depression. These are all individual choices,
one that you should make with the professional, but certainly
(06:44):
getting evaluated and treatment when you have clinical depression is important.
The reason it's so important is that the way the
brain works when you feel a feeling that you haven't
had before, for example, depression, the wiring through which that
feeling state moves is originally very unused, and that means
(07:08):
it's very small, like a country road. But the more
that you feel that feeling, the more activity that's happening
in that wiring, the stronger the connection becomes so what
started as a country road becomes essentially a super highway.
This phenomenon is called the kinetic effect. And the reason
(07:29):
that it's concerning is that when you leave depression untreated,
besides the fact that it can go on an extremely
long time, and it can also wreak havoc on your life,
both socially and in terms of work, and of course
there's always the risk and concern about suicidal thinking. In
addition to all those things, untreated depression means that you
(07:54):
are more likely to relapse and have a depression again
in the future because that country road has become a
super highway. So for many reasons, it's very important to
get treatment, and the earlier in the course the better.
How can I help with Dr Gayale Salts will be
(08:14):
back after this short break? Question two? Hello, Dr Salts,
This seasonal depression really a thing. I find myself much
more tired and lazy as it becomes colder and the
(08:36):
daylight hours shrink. How do I keep from falling into
a winter slump? So the short answer to your question
is yes, seasonal depression is very much a thing, and
many people don't recognize they have it. The best way
to think about whether what's happening to you right now
(08:56):
might be seasonal depression is to think back about previous
years in this winter time time frame and think about
whether you had some struggles with your mood, or at
least your mood wasn't as good as it is often
in the other seasons. Now, the interesting thing about seasonal
depression is most people do get it at this time
(09:19):
of year when the days are shortest and there's a
lot of clouds, and it's kind of steely and gray,
and basically there's less sunlight outside. And I'll explain why.
But some people actually do get seasonal depression during other
seasons instead. For example, there is such a thing as
springtime seasonal depression, which is less related to the light phenomenon,
(09:41):
but that person always gets depression at that same time
of year. So the crucial fact is do you find
that your depression reoccurs each year at the same time
of year. Winter time is known to be the most
common time that people with seasonal depression and become depressed,
and it does seem to have something to do with
(10:03):
less sunlight availability and going outdoors less, so being physically
exposed to sunlight less We don't know the exact mechanism,
but it seems to have something to do with the
impact of sunlight on your circadian rhythm and that changing
somehow the neurochemicals in your brains such that it precipitates
a depression. The symptoms of seasonal depression are often very
(10:29):
similar to clinical depression as I described earlier, but they
tend to be more of the variety of sleeping too
much and eating too much in the form of carbs
as opposed to losing your appetite and having difficulty sleeping. Otherwise,
the symptoms are very similar, feeling very sad, maybe hopeless
(10:49):
and helpless much of the day, very low energy, feeling
slowed down. It can become serious. There are people who
have feelings about aside even with seasonal depression, for example,
life isn't worth living, or even have thoughts of death
by suicide. But many people with seasonal effective disorder mostly
(11:12):
find that they just feel incredibly blue and down and
low energy this time of year. The reason it's important
to understand whether it's seasonal effective disorder as opposed to
clinical major depression outside of having a seasonal pattern is
what you might try to help yourself with. While seasonal
(11:37):
effective disorder can be treated with psychotherapy and definitely also
with medication, many people find that light box therapy is
uniquely well suited for them for treatment for seasonal effective disorder.
The reason is that it is a way of correcting
the amount of sunlight you get, which seems to be
(11:59):
the issue, and in addition, there are remarkably few to
no side effects with light box therapy. Now many places
sell light boxes that they call a lightbox um and
they might even call it, you know, something like a
happy box. But true light box therapy must be done
(12:21):
using an actual therapeutic light box, which is not a
lot of what you see randomly sold. Light boxes for
therapeutic use must have a minimum of what's called ten
thousand lucks, which refers to the strength of the light,
and thousand lucks is extremely strong. In addition, therapeutic light
(12:44):
boxes have a limited band of UV light that is
being used. This is important because that strength of light
using all of the UV bands would be not safe
frankly for your eyes and for your skin. So it's
important to get the correct light and it's important to
(13:08):
use it correctly as well, which is basically every morning,
for starting with fifteen minutes, working your way up to
thirty minutes over the course of a week or two.
You want to place the light six to twelve inches
from your face, but you don't want to look directly
at the light. It's not good for your eyes to
(13:28):
stare directly at the light. You want to be looking
at straight ahead or it's something else. You must have
your eyes open. So the idea that you could sit
in bed with your eyes closed and have a light
on your face won't work. But you could be, for example,
reading a book. You could be looking at your computer,
you could be watching your TV, you could be eating
(13:48):
your breakfast. You can do just about anything you want
as long as your face is looking forward at an
angle the light box is shining on your face. Some
people find that maybe at the start they might experience
a mild headache, but most people don't even have that.
And the big caveats are that somebody who has a
(14:10):
family history or any personal history that might suggest bipolar disorder,
a type of mood disorder where in addition to having depressions,
you might also experience what are called hypomania's or manias,
which are these periods of extremely up an agitated mood
and you feel sped up. That is someone who should
(14:32):
not use a light box, and certainly not without being
under the care of a physician, because light therapy has
an active effect, and that effect can take someone who
is bipolar disorder and make them hypo manic. It's also
true that some people with certain eye disorders where they
have a particular sensitivity to light might want to talk
(14:55):
with their eye doctor before about the safety of using
light therapy. And if you have questions about this, most
practitioners you can get a one or two sessions with
somebody to simply make sure that you've got the correct
light box and that you're using it correctly. But light
therapy has actually been around for a long time. Besides
being used for seasonal effective disorder, it's used to correct
(15:18):
circadian rhythm for people who have sleep disorders. In that sense,
it's often used by people who are trying to manage
jet lag. It's been used for many things that it
actually can be really effective, and in fact, if you
discover that you have seasonal effective disorder, often recommended then
in the fall, before your disorder would even happen in
(15:40):
the winter, but when the clocks change and the days
get shorter, that you start light therapy, and you may
be able to prevent yourself from having any depression at
all that season. In addition, of course, psychotherapy can be
helpful for seasonal effective disorder UM, as can medication. I
(16:02):
hope that was helpful to you. When it comes to
your mood, it is important to be your own advocate
by increasing your awareness how you actually feel day to day.
In fact, just the practice of self observation can help
you feel a little better and certainly flew you in
as to what you should do the best help yourself.
(16:23):
You can do this by creating a mood temperature journal.
Have a pad for each day, you note the date,
and then on a scale of one to ten, where
one is feeling no sad and ten is feeling the
most sad and miserable you have ever felt, rate your temperature.
(16:44):
After days of doing this, you'll have a pretty good
idea of how you're doing in terms of your mood
and whether your move is to add some coping tools
as I described at home, or whether it's time to
speak to a professional. YEA, Do you have a problem
I can help with? If so, email me at how
(17:06):
Can I Help? At Seneca women dot Com, all senders
remain anonymous and listen every Friday to how can I
Help with me? Doctor Gail Salts
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