Tuesday, December 4, 2012/lk
By CHRISTINE VANDERWERF
Providence Hood River Memorial Hospital
Christina Malango has learned a lot in her 10-year struggle with the winter depression known as seasonal affective disorder, or SAD.
She’s learned that if you’re not getting results from your treatment, a second opinion — or a third — never hurts. She has found that some of the things that worked best for her, such as getting outside and exercising, are the things we all should be doing for our health. She’s learned that if you’ve tried multiple remedies and you still aren’t feeling right, it’s time to look deeper — something else could be going on. And finally, she has rediscovered the beauty in the changing seasons.
A lifelong Oregonian before spending two decades in sunnier climes, Malango started finding the winters harder to take after moving back to Oregon.
“I started having difficulty getting out of bed in the mornings,” she recalls. “I felt kind of flat all winter — just unmotivated and tired all the time, as though I were walking through mud.”
After her third son was born and her difficulties continued, she began to wonder if she had postpartum depression. Exploring treatment options first with her primary care provider, and then with a psychiatrist, she says, “I can’t tell you how many antidepressants we went through, but I didn’t have much of a response. We were heading into winter, and things seemed to be getting worse, not better.”
That’s when the light bulb went off: could it be SAD?
“My psychiatrist asked, ‘Have you seen depression elsewhere in your life?’ Well maybe. ‘Have winters always been hard for you?’ Well, kind of. So we started teasing apart the threads of it, and it did seem that winters had been harder than other times of the year.”
Malango’s psychiatrist recommended light therapy, a natural treatment that relieves symptoms for many people with SAD.
“I got a light box and spent 20 minutes sitting in front of it every morning, reading the paper, or taking it to work and sitting with it at my desk while I started my day,” she says, “and I noticed an improvement right away. The quick response is great when you’re feeling desperate – and there were definitely times, for me, that were very, very dark.”
Malango estimates that the light box improved her symptoms by about 30 percent — an appreciable difference, but not a cure-all.
“That’s when a friend reminded me that whenever it’s raining in Portland, it’s snowing up on Mount Hood. Up above the cloud cover, you can get out and exercise in the sun, or at least in the snow.”
For Malango, exercise was “absolutely key.” With a regular routine that included exercise, time outside, using the light box, and employing what she refers to as “the crowbar technique” to mentally pry herself out of bed in the mornings, life started to become more manageable. And yet — the clouds persisted.
When a new twist cropped up in Malango’s symptoms, a friend finally persuaded her to seek another opinion from a psychiatric nurse practitioner — a decision for which Malango will always be grateful. “She totally got it, and has saved my life,” she says.
Ultimately, they discovered an underlying medical condition that had been contributing to the depression that she had battled for a decade. Since addressing that condition, her depression has lifted.
“It’s been a huge gift, not only to clarify my diagnosis, but also to be relieved of that seasonal struggle,” Malango says. “I still have to be really careful about staying active, getting outside, taking my vitamin D and all that, especially in winter. But that’s what everybody needs to do. For me, it’s about self-care. It’s part of my responsibility to my health.”
Malango hopes that others can learn from her experiences.
“I can’t stress enough how serious depression is and how critical it is to get help for it,” she says. “We aren’t meant to live a miserable existence and just plod through life. Fortunately, there are a lot of solutions out there.”
If you experience depression during the winter months, Malango recommends getting outside every day, getting some exercise and trying a light box. Paying attention to good nutrition is important, too, she adds.
“It can be hard to eat well when you feel low, but it’s important not to skip meals or just have cereal for dinner. I found that the better I ate, the better I felt.”
Malango felt best when she followed a diet that was strong on fruits and vegetables, with enough protein to supply energy throughout the day. And while she found a little caffeine to be helpful in the morning.
“More than that was a losing proposition, leaving me irritable and jittery,” she says. “Caffeine is a poor crutch for depression. The temporary euphoria isn’t worth the ultimate crash that comes.”
Other self-care activities that were critical for Malango included spending time with friends, getting lost in good stories (books, movies, CDs) and volunteering
“Getting outside of your own head can be a real relief,” she says. “One of the best things I did during the roughest time was to help feed the homeless once a week. It made me feel useful, connected and grateful for my life.”
As Malango points out, “Every single one of these therapeutic activities is good for you anyway, has absolutely no side effects and can lead only to positive health results — so really, you’ve got nothing to lose.”
Regardless of which treatments and self-care approaches you try, Malango advises, if you don’t experience significant improvement in a reasonable amount of time — say a month or two — seek additional help.
“We don’t have to figure this out alone,” she says. “There’s a lot of expertise in SAD in the Northwest, because it’s more common where we live, and the doctors and mental health providers know a lot more about it than they did 10 years ago.”
Today, Malango no longer approaches the coming of winter with dread.
“Now I can see that these are beautiful months,” she says. “There are things happening outside all around us — from the falling of the leaves to the returning of the buds on the trees. It’s a more internal time, a time for journaling, for listening to stories on the radio, for renting movies, for hot baths, for flannel sheets and warm quilts on the bed.
“We’re lucky, as Oregonians, that we get to experience all of our seasons. Rather than resist the changes, now I embrace them.”
Christina Malango, R.N., is a phone triage nurse at Providence Medical Group-Columbia Women’s Clinic.