February 2020 As cold-weather months see a peak in depression, anxiety, and substance abuse, Evergreen Psychological Services provides help to get you through winter...and beyond. Some people call it the 'winter blahs', while others know it as 'cabin fever'. The clinical name is Seasonal Affective Disorder, or SAD, a clever - and descriptive - acronym for the feelings that accompany the condition. Virtually anyone is susceptible to it during the cold winter months we experience here in Central Indiana. Lethargy, trouble sleeping, changes in appetite, and depression are just some of the symptoms that can develop from late fall into early spring. Dr. Brett Presley, MD, a psychiatrist at Evergreen Psychological Services in Zionsville, explained that well-documented studies have shown that the less amount of daylight our brains are exposed to, the less good brain chemicals they make, such as serotonin “and when those brain chemicals get low, that can cause depressive symptoms," he said. Dr. Brett Presley, MD According to Dr. Presley, light boxes and other photo-therapies are beneficial for certain people who experience sadness in the fall and winter time. "It depends on the severity. If people just have seasonal depression, a lot of times some light therapy is enough to get them by," he said. "But if there's an underlying depression the rest of the year and it gets worse seasonally, the photo-therapy usually isn't enough to manage the symptoms.” Depression, Anxiety, and Substance Abuse There are three areas in particular that Dr. Presley says tend to spike during the cold-weather months: depression, anxiety, and substance abuse. "People are pent up inside," he said, "that obviously increases stress, which exacerbates anxiety." While the holiday season often brings on its own levels of anxiety and depression for some, Dr. Presley explained that holiday activities can also mask depression symptoms. "If the depression isn't too severe, able to kind of push and push and push, day-by-day to get everything done to get through the holidays," he said. "By the time the holidays are finally over, they're just exhausted. So, you can get that exhaustion on top of the underlying depression." Anxiety Cold weather - especially if there's snow on the ground - prohibits outdoor activity, which can lead to feelings of anxiety with no release. "If we exercise or do physical activity, it burns off that anxious energy," said Dr. Presley. "But there are a lot more barriers to doing that in the winter time. People tend to ruminate more about things when they're stuck inside with less to do." In Dr. Presley's experience, he has observed that college students are particularly prone to seasonal depression and anxiety, as the more high-pressure times of the semester tend to coincide with the cold-weather months. "We see anxiety disorders peak after the first few weeks of both semesters at school," he said. "I see young adults, 17 and up, here at Evergreen Psychological Services. We'll get a bump in our intakes of college men and women the first couple weeks after the fall semester starts and then when the spring semester starts in January." Dr. Presley said in some cases, students will start out fine at the beginning of the fall semester but start to struggle as they near the holiday break, setting them up for even more stress after the first of the year. "They're on break for a couple weeks, the depression gets worse and they have to turn right around and start brand new classes," he said. "Students who struggled from Thanksgiving on, then have to start a new semester - picking up from their worst point from the last semester - can find that transition pretty daunting.” These types of issues aren't necessarily limited to college freshmen. Indeed, as the number of class hours increase and course work becomes more demanding for upper classmen, stress and anxiety can become a problem. "It starts to impact people's level of functioning, their grades, and social relationships," said Dr. Presley. Substance Abuse Dr. Presley explained that during cold weather and the holidays, the dangers of substance abuse can be especially prevalent. "Anytime there's a peak time of the year for a mental health condition like anxiety or depression, there's also a corresponding peak in substance abuse," he said. "With the stress of the holidays and depression peaking in the winter months, there is an element of self-medicating. People may be treating anxiety with alcohol and treating depression with stimulants." He went on to say that opiate use disorders generally peak in the winter months because it tends to be one of those substances that people use in private. When people are holed up in their house, it's easier to use. Evergreen Psychological Service offers what Dr. Presley calls the "gold standard" of opiate use disorder treatment: Medically Assisted Treatment, or MAT. "It's a two-part treatment," he said. "The medical part with prescribed medication and substance use disorder therapy. Without both, long-term recovery rates are very low but with both, recovery rates are much better." Dr. Presley described the MAT process at Evergreen Psychological Services: "You see a therapist, targeting not only the substance abuse issues, but also any other coexisting mental health issues that are triggers someone could be self-medicating such as anxiety, depression, bipolar disorder, etc. The therapist works very closely with the doctor prescribing the medication.” "Initially, they'll see the prescribing doctor every week or two and they see the therapist every week. Then as they get months into recovery, the appointments space out a little bit, but they're still always engaged in ongoing therapy. That's the model that the research shows works the best." In addition to Evergreen Psychological Services' use of the MAT program for opiate use disorder, Evergreen also has the benefit of having Dr. Presley himself on staff. "I have a pretty extensive background in working with people with opiate use disorders," he said, "working at multiple clinics before joining Evergreen. I have that expertise and experience that I've brought to Evergreen." Dr. Presley also carries a special exemption license, which allows him to use medications to treat opiate disorders. Not all prescribing doctors hold that exemption license. How to Cope Short of Professional Help For short-term seasonal depression, Dr. Presley has a few suggestions that are easy to do and can get you through the colder months. "Join a gym for regular exercise. Those gyms are usually brightly lit," he said. "It's getting you out of the house, it's getting you around other people so you're not isolated. There are a lot of benefits of going to a gym.” "Bundle up and go for walks, especially if it's a sunny day. It gets your blood flowing, and gets you moving.” "Make sure you have all your curtains and blinds open in your home; every bit of light you can get into the house is better than nothing." And for stress or anxiety? "There are lots of good things like meditation, yoga, and massage therapy;” however, if you think you may have a more serious underlying mental health issue that lasts long after the winter has passed, heed the suggestion of Dr. Brett Presley and be an advocate for your own health and well-being. Evergreen Psychological Services, 1155 Parkway Dr., Suite 200 in Zionsville, is a private, full-service mental health practice that provides a variety of psychological treatments, including psychiatric evaluations, medication management, individual psychotherapy, psychological assessment, parent consultation, and more. Evergreen also provides psychological services for children and adolescents. "Whether it's an anxiety disorder, or ADHD, or spectrum issues, we treat that," said Dr. Presley. "It's very beneficial for school if a child needs extra help, or accommodations for testing, to have documented formal psychological testing. Evergreen has the staff to complete formal testing to assist students of all ages.” Contact Evergreen Psychological Services at 317-520-4650 or online at evergreenzionsville.com.