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Seasonal Affective Dissorder

Thursday, January 21, 2016

Famed author, Willa Cather, once wrote, “Winter lies too long in country towns; hangs on until it is stale and shabby, old and sullen.”  Indeed winter does seem to hang on and dig in its heels for a long time in places like upstate NY.   For some people, those shortened, cold days result in the winter blues and in extreme cases a type of depression known as seasonal affective disorder (SAD).  According to the Cleveland Clinic, approximately half million people in the US suffer from winter SAD while another 10-20 percent of the population may suffer from a more mild form of winter blues.  75% of sufferers are women, and the onset generally occurs in early adulthood.  SAD can also occur in children and adolescents; however, it is rare in older adults. According the National Institutes of Health, SAD is more common in northern regions.  For example, in Florida only about 1% of the population is likely to suffer from SAD.  But in places like Alaska, about 10% of the population is affected.   Depression associated with SAD typically only lasts through the winter months and goes away the rest of the year.  Understanding the causes, symptoms, and treatments can help alleviate the suffering.

While the exact cause of SAD is not known, researchers agree that SAD is triggered by changes in the availability of sunlight.  Dr. Matthew Rudorfer, a mental health expert at the National Institute of Health, says, “Seasonal affective disorder…is a well-defined clinical diagnosis that’s related to the shortening of daylight hours. It interferes with daily functioning over a significant period of time.”  One theory is that decreased exposure to sunlight disturbs our internal biological clock that regulates mood, sleep, and hormones.  Others suggest that the limited light causes an imbalance of feel good brain chemicals in our brain called neurotransmitters.  Whatever the exact cause, the symptoms are clear.

SAD symptoms typically occur at the same time each year and usually start in the fall, get worse in the winter, and end in spring.  This is more than the winter blues or cabin fever.  It is depression that interferes with personal relationships, work, and interests.  The most common symptoms of SAD are:  enduring sadness, anxiety, irritability, loss of interest in usual activities, withdrawal from social activities, inability to concentrate, extreme fatigue and lack of energy, increased need for sleep, and a craving for carbohydrates, and accompanying weight gain.  

The best treatment for SAD will be a combination of therapies and self-care habits.  Because SAD is associated with lack of light, the first line of defense is to add light to your day.  This can be done by getting outside more (even on a cloudy day), sitting by a window on a regular basis, or sitting in front of a light therapy box.  Light therapy is delivered by a device that contains white fluorescent light tubes covered with a plastic screen to block ultraviolet rays.  The patient does not look into the light but reads or eats while sitting in front of the device at a distance of 2-3 feet. This is usually done for 15- 30 minutes per day in the morning for the entirety of the winter.   Most people tolerate light therapy well; however, some patients should not use a light box.  For example, patients with diabetes, retinopathy, or on certain medications may experience damage to the retina of the eye.  Furthermore, bright light therapy can cause mood changes which could be dangerous for patients with mood disorders.  All individuals should seek guidance from their physician before initiating light therapy.   

In addition to getting more light, there are several things you can do on a daily basis to alleviate the symptoms.  The American Psychological Association recommends these tips to manage seasonal affective disorder:

Experience as much daylight as possible.  Keep the curtains open, sit by the window or get out for a walk during daylight hours.  Consider taking up a winter sport such as snowshoeing, cross- country skiing, or winter hiking.

Eat healthy.  Comfort foods are tasty but they are often loaded with fats, carbs, and calories.  Reach for healthy foods like beans, veggies, fruits, nuts, and whole grains.  They will give you sustained energy and don’t spike your blood sugar (causing a crash afterwards.)

Be social.  Spend time with family and friends.  Talking and laughing elevate the mood.  

Move.  Schedule in exercise and pleasant social activities.  Avoid hibernating in front of a screen.  

Seek professional help.  If you are feeling blue this winter and it lasts for several weeks, talk to a health care provider.  He or she may recommend light therapy, an antidepressant, or talk therapy.  If symptoms become severe and you or someone you know are having thoughts of suicide, call 911 or go to the nearest emergency room.  

For more information about seasonal affective disorder, go the National Institutes for Health at https://newsinhealth.nih.gov/issue/jan2013/feature1 or the Cleveland Clinic at http://my.clevelandclinic.org/services/neurological_institute/center-for-behavioral-health/disease-conditions/hic-seasonal-depression.  

Lorraine Wichtowski is a community health educator at Noyes Health in Dansville.  If you have questions or suggestions for future articles she can be reached at lwichtowski@noyeshealth.org or 585-335-4327.  

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