Seasonal Affective Disorder: The Winter Blues
The days are getting shorter and the nights, longer. Thanksgiving has passed and Christmas is just around the corner. For many, tis the season of depression. Seasonal Affective Disorder (SAD) is a type of depression that comes and goes with seasons. It most commonly begins in the late fall and early winter and goes away during the spring and summer.
SAD, also known as the “winter blues”, affects about 5% of the U.S. population.
· 4 out of 5 people with SAD are women
· The main age of onset is between 20 and 30 years of age, however symptoms can appear earlier
· The further one is from the equator, the more at risk they are for seasonal depression
· People with a history of other types of depression are more likely to develop SAD
The symptoms of SAD and depression are overlapping. It can sometimes be hard to distinguish between them. Depression symptoms include:
· Feeling depressed most of the day, nearly every day (feelings of misery, guilt, loss of self-esteem, despair, and apathy)
· Feeling hopeless or worthless
· Having low energy
· Losing interest in activities you once enjoyed
· Having problems with sleep
· Changes in your appetite or weight
· Feeling sluggish or agitated
· Having difficulty concentrating
· Irritability and desire to avoid social contact
· Loss of libido and decreased interest in physical contact
· Thoughts of death or suicide
SAD symptoms may also include:
· Carbohydrate craving
· Increased appetite
· Excessive sleepiness
· Weight gain
· Social withdrawal
The causes of SAD are unknown, but research has found some biological clues: People with SAD
· may have trouble regulating one of the key chemical messengers involved in mood, serotonin
· may overproduce the hormone melatonin, which regulates sleep by causing drowsiness
· may produce less Vitamin D, which is believed to play a role in serotonin activity
Treatment of SAD
Medication: There are anti-depressant medications that can be used to treat SAD. Talk to your healthcare provider about the best option for you.
Vitamin D supplement: Vitamin D deficiency can be diagnosed with a blood test and be treated with Vitamin D supplements.
Light Therapy: The idea behind light therapy is to replace the diminished sunshine of the fall and winter months using daily exposure to bright, artificial light. Symptoms of SAD may be relieved by sitting in front of a light box first thing in the morning, on a daily basis, from the early fall until spring.
Most typically, light boxes filter out the ultraviolet rays and require 20-60 minutes of exposure to 10,000 lux of cool-white fluorescent light, an amount that is about 20 times greater than ordinary indoor lighting. Commercial light box instructions should give the distance at which 10,000 lux is achieved, typically 16 to 31 inches.
During bright light therapy, you can engage in any activity, such as reading, eating, watching television, or working on a computer.
Side effects of bright light therapy include: eye strain, headache, agitation, anxiety, light sensitivity, fatigue, and nausea.
Dawn simulation: This is a form of light therapy that is administered during the final hours of sleep, but uses less intense white light than bright light therapy. Exposure begins in the early morning before you awaken, using a device that emits a low level of light, that gradually increases to room light level (approximately 250 lux) over a period of 30 to 90 minutes. Termination of exposure is timed to coincide with your normal wake-up time.
Psychotherapy: Cognitive behavioral therapy (CBT) is a type of psychotherapy that is effective for SAD. CBT-SAD relies on identifying negative thoughts and replacing them with more positive thoughts, along with a technique called behavioral activation. Behavioral activation seeks to help you identify activities that are engaging and pleasurable, whether indoors or outdoors, to improve coping with winter.
Engage in the following activities throughout the SAD season:
· Daily walks outside, even on cloudy days
· Aerobic exercise
· Enhanced indoor lighting with regular lamps and fixtures
Sleep hygiene is also important for treating SAD:
· Create a regular light-dark (day-night) cycle
· Minimize light exposure, especially blue light from computer monitors and televisions, in the late evening
· Sleep only as much as you need to feel rested and then get out of bed
· Avoid forcing sleep
· Exercise regularly for at least 20 minutes, preferably 4 to 5 hours before bedtime
· Avoid caffeinated beverages after lunch
· Avoid alcohol near bedtime
· Avoid smoking, especially in the evening
· Do not go to bed hungry
· Deal with your worries before bedtime