Friday, November 06, 2009

Seasonal Affective Disorder

Question: What is seasonal affective disorder?
Answer: Seasonal Affective Disorder (SAD) is a pattern of significant depressive symptoms that occur and then disappear with the changing of the seasons. SAD has also been called "Winter Depression" or "Winter Blues". The reason for these names is that SAD occurs when days get shorter around November and lasting until Spring.

Question: What's the difference between seasonal affective disorder and other forms of depression?
Answer: SAD is similar to other major depressions in its severity and symptoms; however, it occurs seasonally usually starting in the fall and lasting until early spring. This disorder is cyclical. SAD patients also tend to sleep and eat more compared to patients with other types of clinical depression — usually, depression patients have insomnia and loss of appetite. For some individuals, seasonal changes cause a "Reverse Seasonal Affective Disorder" where symptoms of mania, elevated mood, racing of thoughts and pressured speech can occur. In this case, Reverse Seasonal Affective Disorder stems from Bipolar Disorder. SAD can also occur in summer months.

Question: How many people are affected by this disorder each year?
Answer: SAD affects millions of individuals worldwide. The illness is more common in higher latitudes, that is locations farther north or south of the equator, because the timeline of darkness is longer.

Question: What are the symptoms of SAD?
Answer: Symptoms include many of the same symptoms of depression: sadness, anxiety, lost interest in usual activities, withdrawal from social activities and an inability to concentrate. The difference though, is that these symptoms resolve each Spring and tend to occur again in late Fall.

Question: What is the cause of Seasonal Affective Disorder?
Answer: Melatonin, a sleep-related hormone secreted by the pineal gland in the brain, has been linked to SAD. This hormone, which may cause symptoms of depression, is produced at increased levels in the dark. Therefore, when the days are shorter and darker the production of this hormone increases. A dip in Serotonin has also been associated with SAD.

Question: What kind of treatments are available?
Answer: Phototherapy or bright light therapy has been shown to suppress the brain’s secretion of melatonin. Although, there have been no research findings to definitely link this therapy with an antidepressant effect, many people respond to this treatment. The device most often used today is a bank of white fluorescent lights on a metal reflector and shield with a plastic screen.

For mild symptoms, spending time outdoors during the day or arranging homes and workplaces to receive more sunlight may be helpful. One study found that an hour’s walk in winter sunlight was as effective as two and a half hours under bright artificial light.

If phototherapy doesn't work, an antidepressant drug may prove effective in reducing or eliminating SAD symptoms.

Daily exercise has been shown to be helpful, particularly when done outdoors. For those who tend to crave sweets during the winter, eating a balanced diet may help stave off SAD.

Question: How Do I Seek Treatment for SAD?
Answer: If you have noticed a pattern to your depressive symptoms, make an appointment with your physician and bring this to his or her attention. Medical tests and exams should be up to date to rule out any other reason for depressive symptoms. Thereafter, a consult with a psychologist, social worker, psychiatrist or psychopharmacologist so that together you can formulate a treatment plan with light therapy, medication, talk therapy or a combination of them.

Seasonal Affective Disorder Association:

Society for Light Treatment

The Circadian Lighting Association:


Xmichra said...

this was a huge issue in my hometown (i lived in Yellowknife, NWT... aka nest to Santa). I remember walking to school in the pitch dark at 8am, and walking home in the pitch dark at 3pm. Not many hours of daylight, and you were either in school or at work for the majority of it. Really played alot into daily living up there.

CrackerLilo said...

My wife came from Siberia when she was 13, and her descriptions are similar to Xmichra's. She describes how the winter just got to everybody.

Coming from Florida to NYC, I *really* had a problem with this for my first couple winters, and of course I didn't understand how SAD could affect me before. I do understand better now, and know to do things like grab exercise and eat lunch outside (even if it is super-cold out).

Dr. Deb said...

I get SAD and offset it by using a bluelight and sitting in pools of sunlight when I nap or read to get the extra light!

jumpinginpuddles said...

Actually i didnt beleive in sad and when i first heard of it i went oh yeh anotehr excuse for people doing nothing over winter. Until this winter where it was colder than normal and spring has only just arrived a month late and for those few weeks whilst waiting for spring to arrive i found myself getting sadder and sadder yet immediately when we hit the 30's this week it has lifted as soon as the sun hit.

So im a sceptic no longer

David L. Henderson MD said...

Thanks for the helpful post. I do not see as many SAD patients living in Texas but I did while I was in Medical School in Ohio. In the winter, most days are overcast and it can become very depressing for many, especially those who have not lived there all their lives.

Barbara(aka Layla) said...

Thanks for this topic. I know quite a few people who have this and I feel bad for them knowing "its that time of year". I generally get depressed because of the holidays, not the seasons. Its my least favorite time of year even though I live in sunshine!

Gary R. Schor said...

Here in north central Florida, I get this in reverse order from those who live up north. Sure, summer is hot and sunny, but it's too hot for me. I have to stay inside much of the summer, not because of the cold, but because of the heat. Conversely, the fall, spring, and winter months are beautiful and outdoor activities are comfortable. Today's high will be 78, and tonight's low around 60 -- how can you get better than that?

PTC said...

What kind of effect does temperature have on people? I hate the cold!! Once winter comes and it's cold and dark out, I don't go out unless I have to. Once I'm in, I'm in for the night. I think if I was in a warmer climate though, I would be okay with going out after dark. I know that's not SAD, but something to think about. I tell everyone that I hibernate in the winter.

May Bleeker said...

Thanks for this valuable info.
I worked from home in a sunny climate and although I thought of myself as leading a healthy life, I was shocked to find I wasn't always getting the minimum of 15 minutes sunlight on my skin every day! Too busy at the computer to go out...and then the sun went down...You get caught up in life and miss the basics.

Belizegial said...

Coming from the tropics myself, I don't get affected by SAD. However, I can emphatize, especially with those who live in climates where the sun never comes out. Must be tragic.
Hang in there Dr. Deb and fellow bloggers. This too shall pass.

blogbehave said...

Some studies show as little as 20-30 minutes of sunlight daily can help. Even on a cloudy day, taking a walk or sitting in the back yard can help.

I also read that wearing dark sunglasses can shield us from some of the good. Don't know that the study was replicated. But when I'm walking, I try to take off my shades when the sun isn't in my eyes.

Awake In Rochester said...

Ah, very timely. I think that I have depression plus SAD. I was just wondering what to do about it. I see that the lamp costs a few hundred, which I don’t have. I’m trying to get help, but ran in to a blockage. (see my latest post) I’m not looking forward to this winter in the lest. I started to panic last night, and thought of running away to the south for the winter. To bad I don’t have wings. ;)

Anonymous said...

Yes, alas it is that dull and dreary time of the year in which Palm Springs beckons, but I don't have the time to go right now. I have found that upping Vitamin D helps a bit. Also, turning on the lights when I first get up makes a difference.

Rose said...

Yes this is the time of year for this.

tracy said...

What's it called (besides crazy) when one likes this time of year? i love it when it gets dark early.....

Dr. Deb said...

IT's called "You love Winter and Fall." Simple as that. I love the Fall. Despite less sun, it IS my favorite season.

tracy said...

Thanks, Dr. Deb....i was afraid maybe it was called "Vampirism"!

Child Psych said...

Hi - I included your post in a round up about SAD on my blog. You might find some of the other articles I cite to be interesting. See Mental Health Roundup: Seasonal Affective Disorder | Child Psych

Dr Vegas said...

Nice article Deb. I think I need some of those lights!