1. In New Hampshire, Anthem Blue Cross and Blue Shield is a trade name of Anthem Health Plans, Inc., an independent licensee of the Blue Cross and Blue Shield Association ® Registered marks of the Blue Cross and Blue Shield Association. Life and disability products are underwritten by Anthem Life Insurance Company. ® "MyHealth@Anthem" is a registered mark of Anthem Insurance Companies, Inc. Depression: The Winter Blues? Chasing the Winter Blues Away Richard P. Lafleur MD, FACP Medical Director Anthem Blue Cross in NH January 13 th, 2011

2. In New Hampshire, Anthem Blue Cross and Blue Shield is a trade name of Anthem Health Plans, Inc., an independent licensee of the Blue Cross and Blue Shield Association ® Registered marks of the Blue Cross and Blue Shield Association. Life and disability products are underwritten by Anthem Life Insurance Company. ® "MyHealth@Anthem" is a registered mark of Anthem Insurance Companies, Inc. Agenda Prevalence Definition Difference of Depression and SAD(Seasonal affective disorder) Effects Treatment Prevention

3. In New Hampshire, Anthem Blue Cross and Blue Shield is a trade name of Anthem Health Plans, Inc., an independent licensee of the Blue Cross and Blue Shield Association ® Registered marks of the Blue Cross and Blue Shield Association. Life and disability products are underwritten by Anthem Life Insurance Company. ® "MyHealth@Anthem" is a registered mark of Anthem Insurance Companies, Inc. Prevalence http://www.cdc.gov/Features/dsDepression/http://www.cdc.gov/Features/dsDepression/ -accessed 1/5/11 Depression affects 1 in 10 U.S. Adults

4. In New Hampshire, Anthem Blue Cross and Blue Shield is a trade name of Anthem Health Plans, Inc., an independent licensee of the Blue Cross and Blue Shield Association ® Registered marks of the Blue Cross and Blue Shield Association. Life and disability products are underwritten by Anthem Life Insurance Company. ® "MyHealth@Anthem" is a registered mark of Anthem Insurance Companies, Inc. State Specific Distribution http://www.cdc.gov/Features/dsDepression/-http://www.cdc.gov/Features/dsDepression/- accessed 1/5/11

5. In New Hampshire, Anthem Blue Cross and Blue Shield is a trade name of Anthem Health Plans, Inc., an independent licensee of the Blue Cross and Blue Shield Association ® Registered marks of the Blue Cross and Blue Shield Association. Life and disability products are underwritten by Anthem Life Insurance Company. ® "MyHealth@Anthem" is a registered mark of Anthem Insurance Companies, Inc. Who is Affected More often meeting Criteria Persons 45-64 years of age Women Blacks, Hispanics, non-Hispanic persons of other races or multiple races Previously married Individuals unable to work or unemployed Alcohol Use

6. In New Hampshire, Anthem Blue Cross and Blue Shield is a trade name of Anthem Health Plans, Inc., an independent licensee of the Blue Cross and Blue Shield Association ® Registered marks of the Blue Cross and Blue Shield Association. Life and disability products are underwritten by Anthem Life Insurance Company. ® "MyHealth@Anthem" is a registered mark of Anthem Insurance Companies, Inc. What is depression? Major Depression Feelings of Sadness Interferes with daily life Interferes with normal functioning Causes pain for the individual Cognitive issues Interferes with normal relationships http://www.cdc.gov/Features/dsDepression/-http://www.cdc.gov/Features/dsDepression/- accessed 1/5/11 http://www.mayoclinic.com/health/seasonal-affective-disorder/http://www.mayoclinic.com/health/seasonal-affective-disorder/ -accessed 1/5/11 Seasonal Affective Disorder (SAD) Feelings of sadness Occurring for 2 consecutive years During the same season every year Periods of depression followed by periods without depression No explanations for changes in mood or behavior

7. In New Hampshire, Anthem Blue Cross and Blue Shield is a trade name of Anthem Health Plans, Inc., an independent licensee of the Blue Cross and Blue Shield Association ® Registered marks of the Blue Cross and Blue Shield Association. Life and disability products are underwritten by Anthem Life Insurance Company. ® "MyHealth@Anthem" is a registered mark of Anthem Insurance Companies, Inc. Causes Usually a combination of factors but no single cause Genetics Biochemical –Serotonin –Norepinephrine –Dopamine Environmental –Physical stress Psychologic factors –Emotional stress MRI and PET scan changes in areas of the brain that affect mood, thinking, sleep, appetite and behavior consistant with neurochemicals “out of balance”

8. In New Hampshire, Anthem Blue Cross and Blue Shield is a trade name of Anthem Health Plans, Inc., an independent licensee of the Blue Cross and Blue Shield Association ® Registered marks of the Blue Cross and Blue Shield Association. Life and disability products are underwritten by Anthem Life Insurance Company. ® "MyHealth@Anthem" is a registered mark of Anthem Insurance Companies, Inc. SAD Associated Features Female Living far from Equator Family history Serotonin Levels low Melatonin levels disrupted Disruption of normal Sleep cycles (Circadian rhythm) http://www.cdc.gov/Features/dsDepression/-http://www.cdc.gov/Features/dsDepression/- accessed 1/5/11 http://www.mayoclinic.com/health/seasonal-affective-disorder/http://www.mayoclinic.com/health/seasonal-affective-disorder/ -accessed 1/5/11

9. In New Hampshire, Anthem Blue Cross and Blue Shield is a trade name of Anthem Health Plans, Inc., an independent licensee of the Blue Cross and Blue Shield Association ® Registered marks of the Blue Cross and Blue Shield Association. Life and disability products are underwritten by Anthem Life Insurance Company. ® "MyHealth@Anthem" is a registered mark of Anthem Insurance Companies, Inc. Effects of Depression Absenteeism Short term Disability Decreased Productivity Declining Health in Chronic Disease –Osteoartrhitis –Coronary Artery disease –Cancer treatment –Diabetes –Obesity Relationship problems-personal, employment

10. In New Hampshire, Anthem Blue Cross and Blue Shield is a trade name of Anthem Health Plans, Inc., an independent licensee of the Blue Cross and Blue Shield Association ® Registered marks of the Blue Cross and Blue Shield Association. Life and disability products are underwritten by Anthem Life Insurance Company. ® "MyHealth@Anthem" is a registered mark of Anthem Insurance Companies, Inc. Treatment Standard Accepted treatment Medication –Serotonin – fluoxetine, sertraline, citalopram –Serotonin and Norepinephrine combinations-Venalfaxine, duloxetine Psycho therapy Light therapy (more effective for SAD) Electroconvulsive therapy (shock therapy-ECT) for severe cases http://www.cdc.gov/Features/dsDepression/-http://www.cdc.gov/Features/dsDepression/- accessed 1/5/11 http://www.mayoclinic.com/health/seasonal-affective-disorder/http://www.mayoclinic.com/health/seasonal-affective-disorder/ -accessed 1/5/11

11. In New Hampshire, Anthem Blue Cross and Blue Shield is a trade name of Anthem Health Plans, Inc., an independent licensee of the Blue Cross and Blue Shield Association ® Registered marks of the Blue Cross and Blue Shield Association. Life and disability products are underwritten by Anthem Life Insurance Company. ® "MyHealth@Anthem" is a registered mark of Anthem Insurance Companies, Inc. Treatment (cont) Less studied but frequently advocated (may have role in prevention ) Exercise Diet –Healthy eating –Supplements- Melatonin St. Johns Wart (may interact with other drugs) Omega – 3 fatty acids –Cold water fish, salmon, amkeral –Flaxseed –Soybean –Canola oils http://www.cdc.gov/Features/dsDepression/-http://www.cdc.gov/Features/dsDepression/- accessed 1/5/11 http://www.mayoclinic.com/health/seasonal-affective-disorder/http://www.mayoclinic.com/health/seasonal-affective-disorder/ -accessed 1/5/11

12. In New Hampshire, Anthem Blue Cross and Blue Shield is a trade name of Anthem Health Plans, Inc., an independent licensee of the Blue Cross and Blue Shield Association ® Registered marks of the Blue Cross and Blue Shield Association. Life and disability products are underwritten by Anthem Life Insurance Company. ® "MyHealth@Anthem" is a registered mark of Anthem Insurance Companies, Inc. Prevention There is no known way to prevent depression or SAD Therapies which may help symptoms- Prevention? –Exercise Improved depression symptom scores Community based Intervention Programs have shown decreased depression score in older adults –Supplements-as noted previously –Mind-Body therapies Acupuncture Yoga Meditation Guided Imagery Massage therapy http://www.mayoclinic.com/health/seasonal-affective-disorder/http://www.mayoclinic.com/health/seasonal-affective-disorder/ -accessed 1/5/11

13. In New Hampshire, Anthem Blue Cross and Blue Shield is a trade name of Anthem Health Plans, Inc., an independent licensee of the Blue Cross and Blue Shield Association ® Registered marks of the Blue Cross and Blue Shield Association. Life and disability products are underwritten by Anthem Life Insurance Company. ® "MyHealth@Anthem" is a registered mark of Anthem Insurance Companies, Inc. What can you do Recognize Medical Evaluation Encourage Healthy behaviors Reduce Stress/ stress management Get plenty of rest Exercise regularly Refrain from alcohol (remember alcohol is a depressant) Socialize- !! Take a trip– to a sunny environment ! Might be the best Prescription

14. In New Hampshire, Anthem Blue Cross and Blue Shield is a trade name of Anthem Health Plans, Inc., an independent licensee of the Blue Cross and Blue Shield Association ® Registered marks of the Blue Cross and Blue Shield Association. Life and disability products are underwritten by Anthem Life Insurance Company. ® "MyHealth@Anthem" is a registered mark of Anthem Insurance Companies, Inc. Questions?