Tag Archives: neurotransmitters

T’is the Season for Depression, And How to Shake it Off

It is definitely the heart of winter, mid-February, and we would be lucky if we had a week that didn’t have frigid temperatures, snowfall and blizzard-type winds, and long nights. Compared to the spring and summer seasons, winter in the northeastern hemisphere of the United States challenge even the happiest of people — weather conditions force us to stay indoors as much as possible, unless we emancipate ourselves from the city during these times into a cabin in the woods with hot cocoa and recreational activities meant for the season.

I am willing to bet however we aren’t all as lucky; city life and the responsibilities that come with it keep us close to it even in the harshest winter weather conditions. Compound that feeling of being trapped with heavy layered clothing, dangerous walking and commuting conditions, and gray, dreary short days that at 5 pm remind you it is wintertime with it’s pitch black quick nightfall.

Understandably this time of year, after the holidays have passed, depression sets in full force. There are those of us, however, who suffer a more consistent, cyclical type of depression this time of year called Season Affective Disorder or SAD. SAD has been recognized and included in the diagnostic classification system of the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition as major depressive disorder with seasonal pattern. In most cases, seasonal affective disorder symptoms appear during late fall or early winter and go away during the sunnier days of spring and summer. However, for those people with the opposite pattern, meaning have symptoms that begin in spring or summer may be suffering from a major depressive disorder.

Let’s look at this table below, courtesy of information from the Mayo Clinic:

Mayo Clinic Table

There is a clear difference identified between Major Depression affected by SAD, Fall and Winter SAD stand alone, and then a category that actually has a Spring and Summer SAD! Obviously, the most popular kind is in the fall and winter, however there are those who have difficulties thriving in the Spring and Summer and display the symptoms listed above.

After serving a distinguished career at the National Institute of Mental Health researching cyclical mood patterns, Norman E. Rosenthal, MD, currently a Clinical Professor of Psychiatry at Georgetown University Medical School and Medical Director of the Capital Clinical Research Associates, in Rockville, Maryland, sheds light on the topic in an interview  with Psychiatry (As published in NICH website).

Dr. Rosenthal claims, “Every year, as the days become short and dark, people with SAD develop a predictable set of symptoms. They slow down and have a hard time waking up in the morning. Their energy level decreases, they tend to eat more, especially sweets and starches, and they gain weight. Their concentration suffers, and they withdraw from friends and family. As you can imagine, their work and relationships suffer, and they can become quite depressed. This symptom cluster often lasts for four or five months until the days become longer again. Since the syndrome is linked to a lack of light, people with SAD may become depressed during cloudy weather at any time of year, or if they are confined to windowless offices or basement apartments.”

He also says that SAD in its full form affects productivity in work or school, affect interpersonal relationships, and causes a marked loss of interest or pleasure in most activities. There is a milder form of seasonal disorder which is called the winter blues and yields similar symptoms of decreased energy and increased appetite.  This can also affect enthusiasm and productivity. For instance, people with SAD report sleeping an average of 2.5 hours more in winter than in the summer, whereas people with winter blues sleep 1.7 hours more (the general population sleeps 0.7 hours more in the winter).

So how do we combat depression, SAD or otherwise?

Typical Major Depression that is not directly affected by SAD are affected by Dopamine and Serotonin levels. A Study in the International Journal of Neuroscience in 2005 by TIFFANY FIELD, MARIA HERNANDEZ-REIF, MIGUEL DIEGO, SAUL SCHANBERG, and CYNTHIA KUHN determined that in studies cortisol was assayed either in saliva or in urine, significant decreases were noted in cortisol levels (averaging decreases 31%). In studies in which the activating neurotransmitters (serotonin and dopamine) were assayed in urine, an average increase of 28% was noted for serotonin and an average increase of 31% was noted for dopamine. These studies combined suggest the stress-alleviating effects (decreased cortisol) and the activating effects (increased serotonin and dopamine) of massage therapy on a variety of medical conditions and stressful experiences. They suggest that massage therapy improves overall wellness that can be utilized as an external source of increasing the happy neurotransmitters.

In some cases, Norepinephrine was also tagged to be part of the major depression cycle. See the image below:

Norepinephrine-Dopamine-Serotonin Venn
Norepinephrine-Dopamine-Serotonin Venn

The three neurotransmitters combine to maintain mood, focus and learning. Interestingly enough however, the serotonin-norepinephrine connection is what mostly determines the increase in depression, while dopamine-serotonin here is claimed to be highly involved in learning. Would it be safe to say then if the focus was on new learning and equipping one with new skills, that this may also offset major depression with chemical intervention to stabilize the serotonin-norepinephrine channels? New learning has been related to initially boosting dopamine which attracts wellness and confidence, and in turn effects the serotonin levels and pulls away from the norepinephrine pull to depression.

However, learning something new is only a small part of the solution. There are many more complex factors in major depression such as genetics, environmental situations, lifestyle choices which includes work-rest-exercise balance, diet and sleep.

For those with SAD on either the Fall-Winter Seasons or the Spring-Summer Seasons, Dr. Rosenthal says commonly used therapies include Light therapy, psychotherapy, and medications are the main treatments for SAD. Also, stress management and exercise programs can be helpful. Although the first controlled studies of light therapy were conducted only 25 years ago, this treatment has subsequently become the mainstay of SAD therapy throughout the world.

Mayo clinic also indicates that one’s biological clock (circadian rhythm) is part of what is affected by SAD sufferers. The reduced level of sunlight in fall and winter may cause winter-onset SAD.The changes in the season can disrupt the balance of the body’s level of melatonin, which plays a role in sleep patterns and mood. Reduced sunlight can cause a drop in serotonin that may trigger depression.

Dr. Rosenthal agrees with the need for therapeutic sunlight. He says, “Sixty to 80 percent of SAD sufferers benefit from light therapy. The amount of light varies from person to person. The best light therapy units are about 1ft by 1.5ft in surface areas and use white fluorescent lights behind a plastic diffusing screen, which filter out ultraviolet rays. Mornings seem the best time for light therapy to work, although the treatments can be divided during the day. Most people respond to light therapy within 2 to 4 days of initiating treatment. Although the amount of time needed varies, most people need between 30 and 90 minutes (10,000lux) of light therapy per day.”

In the New York Times article by Roni Rabin in 2011, “A Portable Glow to Help Those Winter Blues,” it quotes a 2006 multicenter double-blind randomized controlled trial that compared bright-light therapy head to head with the popular antidepressant Prozac (fluoxetine) in 96 subjects found the two treatments equally effective for alleviating winter depression, though light produced results faster, usually within a week, and with fewer side effects.

Presently, popular companies like Verilux, Nature Bright, and Northern Light Technologies have come up with consumer based light boxes that can be used all year round at home and in other locations with lack of light. Dr. Andrew Weil, a doctor and author who focuses on holistic health recommends SAD sufferers must sit in front of the light for about a half an hour per day. Light therapy is reputed to work in 80 percent of all cases of SAD. This treatment can relieve symptoms within a few days, but sometimes takes as long as two weeks or more. He cautions that  while light boxes can be purchased without a prescription, a physician or other mental health professional can provide guidelines as to how to use a light therapy box for maximum effectiveness and may recommend a particular light box (you may need a doctor’s prescription if you’re seeking insurance coverage for the cost of a light therapy box).

Exposure to natural sunlight as well during the long winter months is recommended as well as a walk outside during the morning hours, however that is dependent on lifestyle and weather conditions unfortunately. The bottomline is this: whether it is major depression or SAD that causes you to be frozen in your own life, aiming for the serotonin-dopamine increase will ultimately be the key to off-setting the symptoms and hopefully improve the quality of living in the long run.

Love with the Brain, the Mind and the Body

Sitting at a table at Tillie’s, my favorite, independent Brooklyn café, I find myself easily distracted. The people are much more interesting to watch than my work is to complete. A guy of about 23 years walks in. He’s nearly 6 feet tall, very thing, longer, thick wavy dark hair—in a word attractive. I decide to watch him. What is his story? Does he go to school? He orders a large Raspberry Iced-Tea…or I assume that’s what he’s ordered because it looks exactly like mine, and that is what I ordered. He takes out his phone and fiddles with it. Boring. I got back to my work. About thirty minutes later, a girl walks in. Tall, dark olive skin, black long straight hair, very thin—in a word attractive. She is carrying a medium size white bag, most likely with food in it. He looks up and tries very hard to hide the smile the smile that is growing inside of him at the sight of HER, her walking through the door weaving among the chairs toward HIM. She hands him the bag and sits down in one swift smooth motion, maybe she’s a dancer, She, too, cannot hide the smile. The bag is more than a bag, perhaps an expression of love. She leaves to get something to drink. He immediately opens the bag and pulls out a small note—filled front and back—about the size of post-it—the smile trying so hard to stay hidden returns. He reads the note, more in lover with her than ever.

Love. Almost as essential as breathing. Why? Because love is ubiquitous. People love with their entire self: their brains, their minds, their bodies; No one loves with just their hearts.

According to Helen Fisher at Rutgers University, there are 3 stages; lust, attraction, and attachment. Robert Sternberg proposes a similar idea: the love triangle. The love triad includes: intimacy, commitment and passion, which Sternberg demonstrates is found in the seven different types of love determined by the power of each point of the triad:

1. Consummate: highest level of level, equal presence of intimacy, commitment and passion

2. Infatuated: Includes only passion

3. Fatuous: Includes equal amounts of passion and commitment

4. Empty: Includes only commitment

5. Companionate: Includes intimacy and commitment

6. Romantic: Includes intimacy and passion

7. Liking/friendship: Includes only intimacy

However, each researcher’s theory on love show the impact of love on they brain, the mind and the body.

The Brain on Love

Love literally changes our brain.

The brain on love is akin to the brain on drugs given the release of hormones that occur especially in Helen Fisher’s second stage of love: Attraction. In this is stage, greater than normal levels of dopamine are released in the brain. Dopamine release triggers the reward and pleasure center in the brain; the same chemical released when using cocaine. In addition, to dopamine, many other neurotransmitters and/or hormones are released: cortisol, serotonin, norepinephrine, oxytocin, and vasopressin. The release of these neurotransmitters are literally changing the wiring and firing of the neurons. Therein, changing the brain, which changes the mind and the body. In Sternberg’s love triad, commitment, the active decision to stay in the relationship, represents the brain. A connection to people’s evolved pre-frontal cortex and executive function skills such as goal-directed  or task-directed persistence. Loving only with the mind would be considered empty love according to Sternberg.

The Mind on Love

The mind on love leads to sharing, trust, and intimacy.
The mind on love leads to sharing, trust, and intimacy.

The mind on love is a result of the release of serotonin. Helen Fisher found that serotonin is responsible for the inability of one to stop thinking about his or her partner and the rose-colored glasses effect. The ability to see the object of affection as more desirable and the relationship as more unique than others. This can be equated to intimacy on Sternberg’s love triangle. Dr. Arthur Aron demonstrated the ability to create intimacy even within a lab setting when complete strangers were paired with one another and given approximately 45 minutes to discuss 36 questions. After the discussion participants were asked to look into each other’s eyes for 4 minutes without speaking. Two participants after this experiment ended up married. According to Sternberg, intimacy is critical in many types of love including: consummate, companionate, romantic and liking/friendship. Intimacy represents the mind on love because it has the ability to occur despite the absence of an end-goal or physical attraction.

The Body on Love

The Body on love is felt by the heart.
The Body on love is felt by the heart.

This is the most common reference to love because people associate love with their hearts. Indeed, loving another person involves a change in heart-rate. However, this due to the release of cortisol and norepinephrine. Yet, the bodily changes, which cue people to the fact that they are experiencing a strong and separate emotion from those on a daily basis is the most easily identifiable because it involves the body. According to Helen Fisher, body love is the first stage of love: lust. It leads to the other stages taking place. Dr. Aron, found that it takes only 90 seconds to determine if someone finds another attractive. The body on love associated with romantic love or what is perceived to be romantic love, but may in fact include: consummate, infatuated or fatuous types of love.

One does not fall ‘in’ or ‘out’ of love One grows in love. ~ Leo buscaglia

 

Regardless of how love is categorized, labeled, or defined, the experience of love, regardless of type is unique to very. Love is universally acknowledge, felt and expressed. The great equalizer so to speak; given the uncontrollable impact it has on the brain it can make the most eloquent speaker a mumbling mess or turn the introverted intellect into a dashing diva. Fall…leap…sneak…grow love in whatever form. Love is meant to be experienced with the brain, the body and the mind…not just the heart.

Celebrate. Love. Everyday.