Winter Blues

"What Can Make Me Feel Warm Inside When the Weather Is Cold Outside?"

Once again winter has arrived, and I'm starting to feel the usual depression coming on. I'm an HIV-positive woman who is on the far side of 50 and more than a little overweight. Throughout the winter, I find that I gain even more weight, sleep longer than usual, and end up drinking beer nightly in bed with the T.V. going nonstop. I'm lonely and tend to become very bitter at the thought of other people enjoying the most out of life.

In fact, life seems to have given me the short end of the stick. I've attempted to go out to nightclubs but end up sitting alone at the bar downing drinks until I'm plastered. When I try to think of ways to build new relationships, I can't get past how bad my past relationships have been with my hateful family, an abusive ex-boyfriend, and a few drunken, fair-weather friends. My true friends are candies, cookies, cakes, ice cream, television, and booze -- these at least make me feel warm inside when the weather outside is cold.

A Response to This Composite Case Study

When faced with HIV, people are at some point in their life are going to be confronted with depression. The reasons are simple: HIV can wear out anyone's emotional stability and depression can be a common result of this debilitating disease. Placing all other emotional issues aside and battling this disease in any way possible is the first step, but at some point one must also attempt to gain emotional balance.

Hopefully anyone with HIV is taking their medication consistently, staying connected with their medical advisers, and conducting themselves in a mature and educated manner on all new developments. This should include how medication and HIV can produce depressive effects. Having this information should provide the additional insights and educational strengths that people with HIV need to help keep themselves emotionally balanced. It is always encouraged for anyone with HIV or taking HIV medication to seek out psychological intervention when faced with depression.

HIV and depression are often coupled together, and you should see a mental health professional or social support groups if you see the signs of serious depression early on. Early signs include feeling sad, hopeless, or discouraged and having changes in appetite, weight, sleep or physical activity. If your outlook doesn't improve within two weeks, you should seek help from a mental health professional. More serious symptoms include greatly decreased levels of energy; feelings of worthlessness, hopelessness or guilt; great difficulty thinking; weight or sleep changes; and recurrent thoughts of death or suicide. If you have these more serious symptoms, you should seek out professional help immediately, such as by calling a hotline or consulting your primary care physician.

The period during and after the annual holiday season can be a difficult time for many people since it usually reactivates memories of one's past life and promotes self-evaluation for the future. Thanksgiving may bring up emotional issues when people ask themselves the question "What do I really have to be thankful for?" Christmas, Hanukkah and Kwanzaa are communal events that would naturally bring up concerns about family and friends, not just for the current season but also over the past year. New Year's Day raises issues about past regrets and future resolutions that probably won't be kept.

The darkened skies and cold weather could also naturally figure into your state of depression (a condition called Seasonal Affective Disorder or SAD). However, you have mentioned several other factors that are strong indicators for depression in general, regardless of the season. I would doubt that the issues you have mentioned would not be present in the summer. These include:

  1. Your HIV.

  2. Your age.

  3. Your statements on being overweight.

  4. Your association with alcohol as your "friend."

  5. Your placement of sugary foods as a substitute for love and a sense of belonging.

These statements bring up so many concerns within your self image and your daily structure that I could not justify attributing all your emotional problems just on the season. Having a positive outlook coupled with a strong daily structure might maintain your behavior somewhat in spite of the gloom you feel.

Still, Seasonal Affective Disorder may be contributing to your worsened state of mind during the winter months. This condition is characterized by recurrent episodes of depression in certain months of the year and alternation with periods of normal mood during the rest of the year. Usually those affected by SAD become depressed in the fall and winter and feel better during the spring and summer. The usual characteristics of recurrent winter depression include oversleeping, carbohydrate craving, and weight gain. Other symptoms include the usual features of depression, especially decreased sexual appetite, lethargy, hopelessness, suicidal thoughts, lack of interest in normal activities, and social withdrawal. Bright, fluorescent (not ordinary) light has been shown to reverse the winter depressive symptoms of SAD. Scientists believe that light therapy works by altering the levels of certain brain chemicals. Research has also shown that antidepressants such as Zoloft and Prozac may be helpful in treating SAD, and other antidepressants may also be of value.

Listed below are some steps you can take to improve your mood throughout the year.

Controlling your food intake: Substituting food for human love is a no-win situation. You need to recognize that equating sugary foods (like candies, cookies and cakes) with love is ultimately detrimental to your emotional and physical health. Supportive group therapy focusing on weight loss, in addition to advice from a medical doctor or nutritionist, would be helpful for planning and starting a consistent diet. Eating sensible foods would be a reasonable starting point that could lead to a major improvement in your life. If you only abuse your body with sugary foods during the winter months, then state this to your medical doctor for further evaluation.

Controlling your alcohol intake: Self-medicating with alcohol due to loneliness and low self worth is again another no-win situation. Considering alcohol a "friend" clearly speaks of your limited social supports and distorted judgment. I would ask you to consider Alcoholics Anonymous, other support groups, and the direct intervention of a mental health professional in the area of substance abuse. You need to become conscious of the damage to your physical health happening every day due to your uncontrolled alcohol intake. In addition to the abuse your body takes from your carbohydrate craving and lack of exercise, you should re-educate yourself on basic steps to improve your physical and emotional health, considering your HIV status.

Staying away from people who are damaging to your mental health: Loneliness is a key fact in explaining why we sometimes interact with people who are poor social companions. Now is the time to regain your focus on friends who provide you with support and to reject those who contribute to your poor self-image. Negative people must be avoided! They pull you down and affect your ability to pull yourself up. Negativity is infectious and the best medicine is to remove yourself from these individuals who are real dowers. You need to be around a supportive and empathetic circle of friends -- not the ones you described, who sound monstrous! Like any other relationship, this group of friends will take time to develop, but you can start the process now! The first step is to clean up your act and display the same personal characteristics that you would like to see, hear and feel in others. Positive-thinking people attract other positive-thinking people. Individuals steeped in negativity will be "turned off" by your uplifting thoughts and conversation; they will bring up negative conversation and attempt to pull you in. Follow the old rule: misery loves company, so don't join in! Don't become a passive audience to anyone's negative thinking -- move on.

Providing yourself with a solid daily structure: Your problems raise the question of why there is so little structure, direction, and goal-setting in your life. Since you didn't mention unemployment, I am assuming that you have a job which would account for at least 8 hours of your day. The other 8 hours before you sleep is the area that most concerns me. Drinking alcohol, eating nonstop sweets, and watching television in bed sound like a road map to the state of depression you are in. The first step for you is to structure in exercise in which you worked out with weights, do cardiovascular exercise, and possibly swim in a pool. This would provide you with a healthy choice to feel better about yourself, lose some weight, and possibly socially interact with others.

Certainly it sounds as if you would do well with any redirection from your bed. In addition eating out at health-food restaurants could help you start the process of making healthier choices in your diet. After work, consider a movie, a play, a dance performance or a sports game to help redirect you away from the isolation of your bedroom. Seek out activity groups that will help to motivate you to apply yourself consistently.

Seeking out HIV support: Participating in an HIV support group with people with whom you feel a connection could help you with facing life's HIV challenges. This is one group that should be a part of your weekly structure. In addition, an HIV support group may be able to assist you in developing more of the social network that you clearly need in your life. Health concerns and social issues can be discussed in this group, as well as past issues of shame and resentment. The holidays would naturally bring up these issues in your group and they could then be addressed and finally dealt with. Your current structure is limited, as you can have little human interaction while you remain isolated in bed plying yourself with alcohol and sugary foods.

Doing volunteer work: Finally always consider volunteering, especially but not only around holidays. There are many people who could benefit from your attention. Homeless shelters and food kitchens are always looking for volunteers to assist in servicing the needs of this forgotten population. This sense of "giving back," as well as working with others who care, may offer you the structure and direction you need to pull you through this troubling time. At this point I would suggest volunteering several nights a week rather than remaining in bed with the TV going nonstop and you stuffing yourself with candies, cookies, cakes all washed down by alcohol. This is a slow suicide!

In conclusion, please consider taking the steps to seek out medical and psychological intervention. You must remember it has taken some time for you to get to this point. Now with this insight, begin to take the small steps to change your life and open up new possibilities. In time I am sure you will greatly benefit and begin to interact with the world around you. Good luck!

J. Buzz von OrnsteinerJ. Buzz von Ornsteiner, Ph.D. is a psychologist and behavioral consultant in New York City and writes the "Psychologically Speaking" column. He is also the host of "Ask Dr. Buzz," a Body Positive-sponsored weekly call-in radio show about HIV/AIDS issues on WWRL 1600 AM at 2:30 pm on Wednesdays.