Major depressive disorder (MDD) is one of the most common mental health conditions in the U.S., according to the National Institute of Mental Health.
The disorder is a serious health condition that can cause people consistently poor moods, lose interest in activities they previously enjoyed, and lack joy or pleasure in their lives.
Many times, major depressive disorder can be exacerbated in the fall or winter when there is less sunlight. That seasonal depression, or seasonal affective disorder, is a different type of depression, explained Andrea DeSimone, DO, chair of the psychiatry department at Bayhealth Medical Center in Dover, Delaware.
Bayhealth is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
“To meet the criteria for seasonal affective disorder, you must first meet the criteria for MDD," Dr. DeSimone said. “Seasonal affective disorder is depression that occurs during certain times of the year and then resolves. This cycle must occur for two years to meet criteria for the specific type of major depressive disorder."
Dr. DeSimone explained the impact major depressive disorder and seasonal affective disorder can have on patients and offered advice on how physicians can help diagnose and treat depression in a recent episode of “AMA Update.”
Identify symptoms of depression
To diagnose someone with major depressive disorder, that person must display five of nine symptoms, Dr. DeSimone said. Those symptoms are:
- A change in sleep patterns.
- A loss of interest in things they used to like doing.
- Feelings of guilt or worthlessness.
- A loss of energy.
- Not being able to concentrate.
- Changes in appetite.
- Changes in activity level.
- Thoughts of suicide.
- Not being able to feel joy or pleasure.
The lack of joy or pleasure must be one of the five symptoms, according to Dr. DeSimone.
Ask how a patient is feeling
What's important for physicians to remember is that depression can be invisible, so asking patients how they are feeling can help start a conversation that could lead to a diagnosis. It also can have an enormous impact on the patient.
"Many times, patients with MDD feel very alone," Dr. DeSimone said. "That connection with someone who values them enough to take the time to ask about their mental health can be, quite literally, lifesaving."
Primary care doctors are not the only physicians who should check in on their patients' mental health. As Dr. DeSimone explained, many patients visit subspecialists but do not routinely visit a primary care doctor.
That is why it is important for all doctors to keep tabs on their patients’ mental well-being.
"While a subspecialist may not be an expert in treating depression, that doesn't mean that they can't be supportive to a patient who's in need," Dr. DeSimone said.
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Recognize treatment options
There are multiple ways to treat major depressive disorder and seasonal affective disorder. For example, psychotherapy can be transformative for patients with depression.
Medications can also be an effective way to treat depression, Dr. DeSimone said, but there can be side effects. Selective serotonin reuptake inhibitors are the most common medication used to treat depression but can cause significant sexual side effects, as well as weight gain in adults. For older adults, the medication can also cause low sodium in the body.
"This is why I try to reserve medications for moderate to severe depression," Dr. DeSimone said, "and only after discussing these potential risks with my patients."
Light boxes can also be used to treat patients with seasonal affective disorder. These devices are designed to mimic sunlight—with minimal UV light—and are often used for 30–60 minutes a day. However, data does not exist to indicate light boxes can prevent seasonal affective disorder, Dr. DeSimone said.
Encourage a healthy lifestyle
"While there is no sure way to prevent depression," she said, "there are absolutely some steps that patients can take to maintain a healthy lifestyle, which has been shown to impact mental health in a positive way."
Those steps include eating a balanced diet of fruits, vegetables, whole grains, and unprocessed foods. It also is important to get regular physical activity, particularly walking, jogging, yoga, or strength training.
Dr. DeSimone also believes physicians will soon be able to leverage precision medicine to help patients with major depressive disorder and seasonal depression. Research from Stanford Medicine identified different biotypes of depression and that each can respond differently to specific treatments. That knowledge will further help physicians move forward.
"For example, patients with one subtype that had overactivity in the cognitive regions of the brain had the best response to venlafaxine, which is a different type of antidepressant, versus any other subtype," she said. "Those with another subtype, whose brains had higher activity in regions associated with problem-solving, had better effects with psychotherapy alone.”
“Hopefully, in the future, we'll gain more clarity on predicting what particular interventions might work well for certain patients," Dr. DeSimone said.
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