All posts on January, 2016


depressionHealthPsychiatrypsychology

Does seasonal affective disorder even exist? Maybe not

When people become depressed during the winter months, it is not the result of reduced exposure to sunlight, according to new research published last week in the journal Clinical Psychological Science.

In fact, the study found no significant correlation between depression and season, latitude or sunlight exposure.

These findings call into question the whole notion of seasonal affective disorder (SAD), a type of depression whose symptoms are described as having a seasonal pattern, usually worsening in the fall and winter and then remitting in the spring and summer.

Seasonal depression has been included in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) since 1987.

“In conversations with colleagues, the belief in the association of seasonal changes with depression is more or less taken as a given and the same belief is widespread in our culture,” said Steven LoBello, the study’s senior author and a professor of psychology at Auburn University at Montgomery, in a released statement. “We analyzed the data from many angles and found that the prevalence of depression is very stable across different latitudes, seasons of the year, and sunlight exposures.”

This study’s results — if true — should not be interpreted as meaning that people who experience depression during the fall and winter months are imagining their symptoms. All these findings suggest, write LoBello and his colleagues in their study, is that “merely being depressed during winter is not evidence that one is depressed because of winter.”

Study details

Although most people are unaware of it, studies that have examined the claim that seasonal changes are behind some recurrent episodes of major depression have had conflicting results. Part of the problem, says Lobello and his co-authors, is that researchers often ask people to recall when they were depressed, a method of gathering data that is vulnerable to inaccuracies and bias. People who have heard of SAD, for example, may tend to remember their symptoms as developing as the days became shorter, whether they did or not.

For their study, Lobello and his colleagues decided to use data that captured symptoms of current depression in a large group of people. They then analyzed that data to see if it was related to measures of sunlight exposure.

The data came from 34,294 American adults, aged 18 to 99, who participated in the 2006 Behavioral Risk Factor Surveillance System (BRFSS) survey. The survey, which is conducted annually by the Centers for Disease Control and Prevention, included a list of questions that have been validated as a tool to measure current depression. A total of 1,754 people gave answers to those questions that met the criteria for depression.

The BRFSS data also included the date and geographic location for each of the survey’s interviews, which allowed Lobello and his colleagues to determine the latitude where the participants lived and (using U.S. Naval Observatory information) the amount of sunlight that participants were exposed to at the time of their interview.

After using several statistical models to analyze the data, the researchers found that season, latitude and sunlight exposure had no significant effect on symptoms of depression. Those findings held even after adjusting for a variety of possible confounding factors, such as age, race, gender, educational level, marital status and employment status.

“The findings cast serious doubt on major depression with seasonal variation as a legitimate psychiatric disorder,” Lobello and his colleagues write.

Limitations and implications

This study has several limitations. Most notably, participants were not diagnosed clinically — by a doctor — but only as a result of answers they gave in a phone interview. Some of the participants may not have answered those questions truthfully, particularly since admissions of depression often carry a social stigma.

It’s also possible that people with clinical depression may have not answered the phone at all.

This study is not able to prove — or disprove — that clinical depression has a seasonal variation. But, argue Lobello and his co-authors, if that variation does exist, it most likely affects only a very small subset of people.

“Depression is a recurrent illness,” they write. “Because all episodes of depression occur in some season, chance occurrence in two consecutive winters would explain some apparent seasonality. The role of chance as an explanation diminishes in cases where episodes are experienced in three or more consecutive winters. Even so, the existence of such cases would not in themselves demonstrate that changes in sunlight exposure are responsible for the depression.”

“The weight of accumulating evidence, including the evidence presented here, indicates that the burden of proof for including the seasonal variation modifier for major depression in DSM has shifted to those who would continue to do so,” they conclude.

You’ll find an abstract of the study on the Clinical Psychological Science website, but the full study is behind a paywall. The journal is published by the Association for Psychological Science.

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addiction recovery

Stand-up guy: Mark Lundholm uses humor to fight addiction

People who’ve been in recovery can recite their “rock-bottom” story, the point in their journey with addiction when they hit their lowest point ever and realized they had to turn their life around.

These tales — a staple of AA meetings — can be harrowing. Some people cry and shamefully admit their transgressions. Others recount their stories in an exhausted, dull tone. Emotions run the gamut, but hardly anyone tries to get a laugh out of their rock-bottom story.

Hardly anyone that is, except Mark Lundholm. In his shows, the comedian and recovering addict likes to use his lowest-of-the-low-point story for comic effect.

“In 1988, at my lowest point, I put a gun in my mouth and pulled the trigger,” Lundholm recounted. “The gun didn’t go off. It jammed. My first thought was, ‘I suck at everything.’ ”

Lundholm knows that some people will not see the humor in a story like that, but he believes that those who do will gain a special understanding of the desperate struggles addicted people face. He also knows that the ability to reveal the humor in life’s darkest moments is a special skill, one that he has been sharing with audiences for the last quarter century, ever since turned his back on decades of heavy drug and alcohol abuse.

“Comedy is relative to the bottom,” Lundholm said. “The lower you’ve been, the funnier the laugh has to be. Dark humor is a nice reminder that we all live on the edge of insanity.”

Professional funny guy

Lundholm, a self-described former “street guy,” had no experience in comedy before he was put on psychiatric hold and into court-ordered rehab. After getting sober, he used his natural sense of humor (“I come from a big family,” he said. “If you weren’t funny, you don’t get to talk. If you don’t talk fast, you don’t eat.”) to perform a volunteer comedy routine for inmates at San Quentin State Prison. After that, Lundholm decided the stand-up life was for him, and once he’d earned enough money at odd jobs to buy a car, he began traveling the country, doing one-nighters in any comedy club that would take him.

“I’d drive, sleep in my car, do the gig,” he said. “The routine was like drinking or doing dope. The addiction became comedy instead of meth or cocaine.”

These days, Lundholm is still addicted to comedy, though he no longer has to sleep in his car. He headlines at clubs around the country, doing routines that speak to “normies”— or people who haven’t experienced addiction — as well as people in active recovery.

“I always had the jail, addiction, recovery lane covered in comedy,” Lundholm said. “It took me a while to write ‘normy’ stuff where I could relate to a couple who just had a baby and came out to the comedy club for their first time out since they’d gotten a sitter. But I do that now. My comedy is recovery specific, but normy friendly. Anybody can go.”

That’s good to know, because Lundholm will be at the House of Comedy at the Mall of America tonight, performing with his friend and fellow recovering addict Kurtis Matthews. For the last two years, they have toured the country with their addiction-humor show “The Addicts Comedy Tour.” The show, which attracts an enthusiastic audience of people hungry for Lundholm and Matthews’ unique brand of humor, kicks off at 7 p.m.

“Most of the people who come see us are rabid because they are addicted to what feels good,” Lundholm said. “There are people who will drive five hours to see this show. In Minneapolis, we’ll have people in the audience who have driven all the way from Wisconsin, Nebraska, Michigan. They’ll probably have seen the show before. We get a ton of repeaters.”

Some of Lundholm’s fan base comes from the recovery-humor DVDs he distributes through the Hazelden Betty Ford Foundation.

“I’ve got very specific clinical DVDs,” he said. “I’ve also got comedy.”

‘Laughter inspires trust’

Though Lundholm makes a living laughing about his — and others’ — struggles with addiction, he also is clear about his serious commitment to helping people climb up from rock bottom and back into the daylight. In his mind, addition is a form of mental illness. There’s no shame in that fact, he said, but acknowledging the link inspires people to do the work that’s needed to recover.

“People who talk about ‘mental health and addiction’ are being redundant,” Lundholm said. “Addiction is a mental illness, period.” Just admit it and work through it, he said. Laughing at his own very real struggles with drugs and alcohol doesn’t diminish them; it just opens up the conversation and gets people talking about their own recovery. 

“Laughter inspires trust,” Lundholm said. “People will laugh hard at my shows because they trust me. I’m not making fun of anybody.” 

Lundholm might not be making fun of anybody, but that doesn’t mean that his humor is all rainbows and unicorns, either. He likes to walk the line between dark and light, exposing the brutal side of addiction with a wry smile.

“The comedy that I enjoy is a lot darker and not for everybody,” he said. “It’s PG-plus. There’s no swearing. My comedy highlights where you’re hurt and tries to help you fix it. If you don’t think I’m funny it’s because you’re broken,” he laughed. “It’s a mental health thing.”

Or maybe it’s because you’re too normy. Lundholm makes fun at the language gaps that exist between people who intimately understand addiction and those who live in the bright, shiny world without cravings and abuse.

“When normal people hear the word ‘accessory,’ ” Lundholm said, “they think ‘belts or seat-warmers on the Lexus?’ I think ‘three months.’ When normal people hear the word ‘blackout,’ they think ‘no electricity.’ I think ‘age 11.’ ”

Hopes to help others

Lundholm believes that humor has been the tool that’s allowed him to stay sober for so many years. He’s been bitterly, deeply addicted and close to death, and he’d do anything to never be back down there again. He shares his gift of humor with others in the hopes that it will keep them from going down that same road. If they do get stuck the way he did, he hopes laughter will help lift them out.

“I think that the power that be or the universe or the happy accident has allowed us to laugh at what we’re afraid of so we don’t run smack back into it,” Lundholm said. “It’s like a pothole in the road: If you hit one while you’re not paying attention you are going to damage your car. But, if I can avoid the pothole, I can tell the next person where that pothole is so they can avoid it. But if they don’t listen to me and get stuck anyway, we can laugh together about being in the pothole and figure out a way to get out.”  

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