Many of my patients have been to multiple doctors without getting good results. So, it’s not at all unusual for me to see a patient who has been diagnosed and treated for several different illnesses and still is miserable. That was the case with Elinor, a delightful, 80-something lady whose daughter Tracy brought her to see me one day last year.
Elinor was in an assisted-living facility. At first, she enjoyed her surroundings and the companionship of some close friends. But after a few months, Elinor began staying in bed for 10 to 12 hours at a time and then complaining about feeling tired. At mealtime, she wanted to eat only starchy foods and sweets, like mashed potatoes and cake. Although she often asked for second helpings, no amount of coaxing could convince her to eat anything else. The doctor at the assisted living diagnosed her with depression and gave her a popular antidepressant medication.
“If anything, she feels worse on the antidepressants,” Tracy told me. “She doesn’t want to read or play board games with her friends or go for rides, and she says she feels like she can’t think straight anymore. I’m really worried about her and thought you might have some ideas on how to make Mom feel better.”
What Tracy described was a common scenario: sleeping excessively yet still feeling tired, having difficulty concentrating, craving carbohydrates, and losing interest in friends and hobbies. At first glance, it did sound like Elinor was suffering from depression. But there was one key question I had to ask Tracy: “Has this ever happened to your mother before?”
She thought for a minute and then said, “She used to get really bad ‘holiday blues’ around Christmas, especially after Dad passed away, but she was fine by the time spring came.”
“Holiday blues” was all I needed to hear. Whether you live in a cold climate or not, winter can take a toll. Shorter days mean less light, and that translates into problems with circadian rhythm, the scientific name for the “clock” that runs our bodies and helps with melatonin production.
As I continued interviewing Elinor and Tracy, I discovered that before Elinor moved to the assisted living, she spent a great deal of time in the garden at her home. With Southern California’s mild winters, Elinor was able to get out in the bright winter sunlight. As days grew longer toward springtime, she was exposed to enough light to correct the situation. But there was no garden at the assisted living, so residents were confined to the building.
With that information, Elinor’s situation was beginning to make sense. She seemed to be suffering from SAD, which is treated differently from ordinary depression. I recommended she start taking vitamin D and fish oil for mood improvement, along with melatonin to improve her sleep. I also stressed to Tracy the importance of exercise, so she agreed to enroll Elinor in the assisted living’s daily walk program.
Less than a month later, Tracy called to tell me about Elinor’s progress. Not only was she much improved, but Elinor was feeling so much better that she talked the management into providing window boxes for residents to grow their own herbs and plants in their rooms.
“When it’s a little warmer, Mom plans to get everyone to start gardening outside,” Tracy reported. “She even picked out a spot in the yard where they can grow some flowers. We’ll see how that works out. But for now, it’s just great to have my mom back and raring to go!”