Tue, Oct-31-17, 07:47
Depression & SAD: How to get through the miserable month
From The Times
31 October, 2017
How to get through the miserable month
There’s a reason why November is so depressing. But there are ways to beat the blues
Dr Michael Mosley
According to the Danish writer Henrik Nordbrandt, there are 16 months: “November, December, January, February, March, April, May, June, July, August, September, October, November, November, November, November.”
I also find November long and miserable. The clocks have gone back, the days are shorter, it’s cold and damp and there is a long way to go until the Christmas holidays. I’m clearly not alone because the “misery index”, which is created by adding up Google searches for terms such as “depression”, “anxiety” and “stress”, shows that we find November one of the most challenging months of the year.
A study published last year in the journal Epidemiology showed further striking evidence that November has a particularly malign and baleful influence. By inspecting hospital records between 1995 and 2012, Danish researchers discovered that the number of people diagnosed with moderate to severe depression jumps by 11 per cent every November.
According to one of the researchers, Dr Soren D Ostergaard, the increase in November is too large and too consistent to be a coincidence. He also thinks that although they were looking at people with moderately severe depression it is likely to be true for other, less severe forms.
He believes the rise is triggered by Danish clocks going back an hour at the end of October, as in the UK. As he put it: “We are relatively certain that it is the transition from daylight saving time to standard time that causes the increase in the number of depression diagnoses and not, for example, the loss of daylight, or bad weather. In fact we take these phenomena into account in our analyses.”
Although Danes and other northern Europeans are prone to seasonal affective disorder (SAD), triggered by reduced exposure to sunlight, Ostergaard thinks the reason for this particular November surge is likely to be psychological rather than physical. As he points out, turning back the clocks “very clearly marks the coming of a period of long, dark and cold days”.
I am very interested in this because last year I was diagnosed with moderate SAD. Like most people with SAD I get more gloomy and introspective as the winter wears on. I also become more stressed and anxious. I sleep badly, find it harder to get motivated and I develop a serious craving for sugary carbs. You may be thinking, “Who doesn’t?” but there is evidence that people with SAD have, during the winter months, higher than normal levels of something called Sert (a serotonin transporting protein). Higher levels of Sert mean lower levels of serotonin, a neurotransmitter linked to feelings of wellbeing and happiness. Which could explain why, in winter, SAD people feel so low.
I’m not bad enough to need antidepressants or psychotherapy, but this year, for the first time, I decided to do something about it. I bought a light box, which sits beside my computer, bathing me in 10,000 lux of bright white light for an hour or so in the mornings while I sit tapping away. I also go on early-morning walks with our dog, since exercise outdoors in the morning light seems to be particularly effective at reducing the impact of SAD.
Irrespective of whether you get SAD or not, what else can you do to keep the winter blues at bay? Well, you could try changing what you eat.
This year an Australian group published the results of an impressive study looking at the impact of food on mood. The Smiles study (Supporting the Modification of Lifestyle Interventions in Lowered Emotional States) involved randomly allocating 67 patients with moderate or severe depression, most of whom were on medication or having psychotherapy, to either a Mediterranean-style diet or “social support”.
Those allocated to the Mediterranean-style diet were asked to eat more vegetables, fruits, nuts, red meat, eggs, fish and olive oil. They were asked to drink red wine, rather than beer or spirits, and to cut back on sweets, refined cereals, fried food, fast food, processed meats and sugary drinks.
After 12 weeks there were impressive differences between the two groups, with those on the Mediterranean diet getting much lower scores for depression and anxiety. In fact, 32 per cent of those on the Med diet went into remission (no longer “depressed”) compared with 8 per cent in the control group. Those who stuck closest to the Mediterranean diet enjoyed the biggest improvement in mood.
What is it about the Med diet that does this? No one knows, but some of the components (such as the fish and the olive oil) have a well-established anti-inflammatory effect and there is mounting evidence that many cases of depression may be linked to inflammation caused by the body’s immune system reacting to infection or stress. So as well as a change in diet, you could try reducing your stress levels by turning to yoga, gardening or mindfulness.
As part of a mental health special for the BBC series Trust Me, I’m a Doctor, we decided to put these three different stress-busting approaches to the test. With the help of Professor Angela Clow and Dr Nina Smyth from the University of Westminster we recruited 68 volunteers and split them into four groups.
Our first group was asked to join Green Gym, a charity that encourages people to get their hands dirty planting trees, sowing meadows and establishing wildlife ponds. It’s a combination of gardening and socialising that also contributes to the community. Our second group was sent to a weekly yoga class, while a third was prescribed a daily dose of mindfulness, a form of meditation that focuses the mind on the sensations of the present moment. We also had a control group which was asked to go about daily life as usual.
Of these activities the only one I have tried is mindfulness, which I started doing four years ago while making a Horizon documentary about optimism. I went to see Dr Elaine Fox, who was then at the University of Essex, but is now a professor of psychology and affective neuroscience at the University of Oxford. Fox asked me to wear an electrode skullcap so she could measure the levels of electrical activity on the two sides of my brain while I was resting.
Studies have shown that people who are prone to higher levels of pessimism, neuroticism and anxiety tend to have greater activity on the right side of their frontal cortex than the left. The results of the various tests confirmed what I already knew; I am a pessimist with a brain that, as Fox kindly puts it, “is on the negative side of the spectrum”.
Then I went to try mindfulness meditation for six weeks. There are lots of different approaches, but the one I tried was a guided meditation via an app. You sit in a comfortable chair, rest your hands on your thighs, close your eyes, then for the next few minutes try to focus on your breath.
You pay attention to the sensation of the breath going through your nostrils, filling your chest, expanding and contracting your diaphragm. You try to stay focused on the task and when you notice that your thoughts have drifted, which they will, gently bring them back to the breath. It is surprisingly hard to do, but like any form of exercise it gets easier. At the end of the six weeks I felt noticeably calmer, but what had happened to my brain?
I went back to Fox to be retested and the results were striking. Whereas before I had brain activity consistent with that of a pessimist, now there was a much better balance of activity between my two hemispheres, suggesting a sharp reduction in negative thoughts and emotions.
Mindfulness is not a universal panacea and it certainly doesn’t work for everyone. Nor is it side-effect free. There have been reports that mindfulness can lead to feelings of depersonalisation (feeling detached from one’s mental processes or body) and increased anxiety. Vulnerable people, such as those with post-traumatic stress disorder, should be particularly careful before undertaking mindfulness. That said, most people who stick with it seem to benefit.
So how did the people in our Trust Me experiment get on? Clow measured their levels of the stress hormone cortisol before and after, as well as asking them to fill in psychological questionnaires. The blood tests and the questionnaires showed that after eight weeks the gardening and the yoga groups had improved compared with the controls, although mindfulness came out on top. Yet what I found particularly interesting was the wide range of responses. Although some people got a lot of benefit from these different interventions, others got none. It turned out that the best predictor of whether you would benefit or not was whether you enjoyed it.
So as November begins I have quite a list of things to do. Early morning walks, turning on the light box, squeezing in a bit of mindfulness and making sure the cupboards are full of lentils and olive oil, and the fridge is stuffed with oily fish and multicoloured vegetables. I will contemplate yoga (unlikely) and think about gardening (perhaps later). I will also keep a mood diary. I don’t expect miracles, but by this time next November I hope to be a smiling, stress-free optimist.
Trust Me, I’m a Doctor: Mental Health is on BBC Two on November 1 at 9pm GMT