Does the Change of Seasons Make you SAD?
by Terre Seuss
As the days grow shorter, and both the temperatures and leaves begin to fall, many people also experience seasonal changes affecting their mood and ability to function. For millions of people, the coming of the winter months is more than a dreadful anticipation of cold weather, short days and the inability to enjoy the outdoor activities of summer.
What is SAD?
Many people feel mildly depressed during the winter. Many experience some of the more serious symptoms of clinical depression. Far more serious than daily ups and downs, and occasional blues, clinical depression visits its victims with disturbances in sleep (too much, or too little), changes in appetite, lack of energy, feelings of hopelessness and helplessness, inability to concentrate and painful thinking, often including thoughts of suicide. Seasonal Affective Disorder, or SAD as it is commonly referred to, shares many of these symptoms. SAD describes people who have these clinical depressions only in the fall and winter seasons, but during the summer feel normal.
The most common symptoms of SAD include:
Extreme fatigue and lack of energy Increased need for sleep and sleeping much more than usual Carbohydrate craving and increased appetite Weight gain The symptoms of SAD are often misdiagnosed as clinical because of the many shared characteristics. However, the key factor in diagnosing SAD is it's seasonal reappearance. Many physicians use a the criteria of two episodes of fall or winter onset depression in a three year period as a guide toward diagnosing SAD. The diagnosis of Seasonal Affective Disorder should only be made after an evaluation by a psychiatrist, psychologist or social worker. Self-diagnosis can be harmful, as it is easy to misinterpret symptoms and their severity. Self-diagnosis can also keep a patient from seeking appropriate medical attention.
What causes SAD?
Though no definite causes of Seasonal Affective Disorder have been identified, several theories have been offered. Many believe that the winter season causes changes in the brain chemistry, specifically serotonin and dopamine production and balance. One of the characteristics of SAD, the strong craving for foods high in carbohydrates, gives credence to this theory, since these foods increase levels of serotonin in the brain. Many professionals credit a disturbance in the "biological clock" of the brain, that regulates hormones, sleep and mood. It is believed that the shorter days and lack of bright sunlight and the ability to be outside contribute these disturbances. In Florida for example, less than 1% of people are believed to suffer from winter depression, whereas 10% or more suffer from SAD in Alaska.
Is SAD treatable?
The good news is that Seasonal Affective Disorder is treatable! Exciting research is finding that many patients with SAD improve with exposure to bright artificial light, commonly called light therapy, or photo therapy. Exercise and diet are also critical elements of treatment.
Recommended light therapy systems consist of a set of fluorescent bulbs installed in a box with a diffusing screen. Patients are instructed to sit in front of the light box for a prescribed amount of time, with the lights on and their eyes open. It's not necessary, nor recommended that patients look directly at the lights. Treatment sessions can be as short as 15 minutes, or as long as 3 hours, once or twice a day. What appears to be critical is that the intensity of the light is comparable to natural sunlight shortly after sunrise or before sunset. It is also believed that the best results are achieved by patients who do their light therapy immediately upon rising in the morning. Some patients find additional benefits in giving themselves an additional treatment in the early evening hours. There are very few side effects from light therapy. Some people who are extremely sensitive to light, may experience some redness, mimicking a sunburn type reaction. Changing the distance between themselves and the lightbox, or using a sunscreen or sunblock can help. This won't affect the therapy, as the benefits of light therapy come from the light entering the eyes. A few patients report eye irritation. Using eye drops, or sitting farther from the light box usually relieves this side effect. Occasionally, some patients experience nausea, but this is usually mild and eventually disappears after repeated treatment. Though a physician's order, or prescription is not required by the Food and Drug Administration for light therapy, it is best to work with a physician to determine your individual needs. It is important to have a physician supervise your light therapy. Patients with certain physical conditions are not advised to use light therapy. It is not recommended that individuals build their own light boxes. Output must be carefully calibrated for the proper treatment value. The danger of creating heat or electrical hazard is also possible. Currently, a commercially manufactured light box can be purchased for approximately $300-500, with new models coming out each year.
Diet, Exercise and Medication
Regular exercise, combined with good sleep hygiene and good nutrition are also valuable treatment options. Daily, light exercise, such as a brisk walk is more valuable than sporadic heavy workouts. It is believed that the daily light routine helps the body maintain a healthy body clock, and assists the body in maintaining higher levels of serotonin. Experts caution against exercising in the late evening hours, as this may adversely affect the body's natural winding down mechanism before bed and can cause fragmented sleep. New studies are indicating that SAD patients can benefit from increasing their intake of foods high in carbohydrates and proteins. Carbohydrates increase serotonin levels in the brain, as well as give added energy. The important thing about diet is to keep it balanced. Several medications have been found to be effective in battling SAD. Most particularly medications in the SSRI family such as Prozac and Zoloft. Most importantly, anyone experiencing significant symptoms of clinical depression should be assessed by their family doctor. Some physical problems can show up as depression. A family doctor can also make a referral to a psychiatrist who is aware of SAD and other forms of clinical depression. All forms of depression are treatable. If you suspect you, or someone you love is suffering from SAD, or another form of clinical depression, tell them there's help out there! It does get better!