HealthLine: Pulling Out of the Doldrums

I had always wondered what the "doldrums" were so I looked up the word on, where else, but the Internet.  Apparently there really is such a term and denotes the intertropical convergence zone encircling the earth near the equator.  In seamen's speech, it describes a period of erratic weather behavior alternating between eerie calm and violent thunderstorms.  No wonder we often equate it with depression.

Nearly two-thirds of individuals with depression do not know they are experiencing the illness.  Many do not seek treatment for this very treatable disorder. Patients will often see their primary care physician for vague symptoms of fatigue, insomnia, weight gain, abdominal pain, headaches, loss of interest in surroundings or irritability.

The underlying pathophysiology theories suggest a lowered level of the neurochemical serotonin in the brain. This may explain the genetic predisposition in individuals of Northern European descent and those persons with blue eyes.  Other factors such as age related brain changes due to dementia or strokes, physiologic vulnerabilities as in previous episodes of depression and psychosocial adversity as that seen in war veterans and victims of sexual, physical or emotional abuse lead to changes in brain circuitry contributing to loss of emotional regulation.  Hormonal changes such as menopausal lowering of estrogen levels in women and lowered testosterone levels in males suggest their influence on controlling moods.

In climates such as ours in the Northwest, seasonal affective disorder is highly prevalent due to the lack of sunlight and disruption of circadian rhythms in the winter months dropping one's serotonin levels.  This most often resolves with the return of sunlight in the summer months.

With appropriate treatment, 70-80% of patients with depression will notice a significant reduction of their symptoms.  The use of psychotherapy alone or in combination with medications have found to be the most effective treatment modalities.  It can take anywhere from 2-6 weeks for medications to take effect and their benefit is that they support the individual to be more active in their counseling efforts.  Lack of sunlight causes Vitamin D levels to fall and contribute to depressive symptoms, which can be easily replaced with over the counter supplements.

There are those who foster the "Woody Allen" theory of treating depression and believe that there is nothing in life that cannot be resolved with Prozac and a mallet hammer.  Being a menopausal women myself, I endorse massive quantities of dark chocolate.

Dr. Ballard is a Board Certified Internist and Geriatrician with a special interest in Women's Health.  She practices in Enumclaw, 360-825-1389. Dr. Ballard's comments are informational only and not to be construed as medical advice.  Consult your personal physician for any medical issues.