Dark days, darker moods:
Could your winter blues be seasonal affective disorder?

Feeling down during the winter is common, but many people confuse a case of the winter blues with a more serious form of depression called seasonal affective disorder or SAD. According to experts at PinnacleCare Center of Excellence Brigham and Women’s Hospital, SAD is a type of depression that corresponds to seasonal changes in daylight. While the direct link between lack of sunlight and this condition has not yet been established, researchers theorize that it may be linked to disruption of circadian rhythms (your internal biological clock), hormones like melatonin, a sleep-related hormone tied to depression, and brain chemicals including the neurotransmitter serotonin.

Statistics gathered by the National Mental Health Disorders Association have shown that approximately ten to 20 percent of the population experiences mild SAD, while five percent or about 12 million people have a more severe form of the condition. Four times more women than men are affected by SAD, which usually has its first onset in adolescence or young adulthood. Researchers have also found more people with SAD in northern regions where the days are shorter, though challenging that finding a recent study of Russians, who endure extremely long, dark and harsh winters, found few of them suffered from this disorder.

SAD is a cyclic condition which means it appears and subsides at generally the same time each year. Physicians at New York Presbyterian Hospital, another PinnacleCare Center of Excellence and home to the Center for Light Treatment and Biological Rhythms, explain that this form of depression is often a chronic, lifelong condition, but that it usually responds well to treatment, allowing people to effectively manage their condition.

What are the symptoms of SAD?

SAD shares many symptoms with non-seasonal depression, including:

• Depressed mood or sadness
• Anxiety
• Lack of energy
• Increase in hours spent sleeping and, conversely, insomnia
• Fatigue
• Difficulty concentrating
• Irritability
• Social withdraw
• Decrease in sexual desire
• Overeating and craving sweet or starchy foods
• Significant weight gain

According to specialists at the Mayo Clinic, it is important to take SAD symptoms seriously and seek a physician’s guidance and treatment. If left untreated, serious SAD can lead to problems at school or work, substance abuse as a form of self-medicating to manage the pain of depression and even thoughts of suicide. While there is no known method for preventing this condition, some doctors suggest that once you’ve experienced an episode, you might want to consider starting whatever treatment your physician recommends before the season begins and continuing it for a period after it ends. For some people, this may lessen the severity of symptoms.

Seeing the light

Light therapy is the primary form of treatment for SAD according specialist Dr. Michael Terman, Professor, Columbia University Department of Psychiatry and Director of the Center for Light Treatment and Biological Rhythms at New York-Presbyterian Hospital. Through his research, he has determined that most effective and efficient treatment regimen is 10,000 lux of bright fluorescent light for 30 minutes on awakening delivered by a specially designed light box. The light box emits the full spectrum of fluorescent light with harmful UV rays screened out. There are some side effects, however, including headache, eyestrain, agitation, nausea and sleep disruptions for some people. Going outdoors for at least a half hour every day, even on cloudy days, is recommended in addition to light box therapy.

When choosing a light box, experts recommend that you seek one that minimizes UV exposure, has a light source above your line of vision and minimizes exposure to the blue light spectrum which has been linked to the debilitating vision condition macular degeneration.

Dr. Terman has also found two other effective treatments in his research—a dawn simulator and use of negative air ionization. “Dawn simulation and negative air ionization are two naturalistic, non-pharmaceutical environmental enhancements now verified superior to placebo and remarkably effective in the treatment of winter depression,” he notes. In his recent study, he discovered that while bright light therapy was the most effective treatment, with 57 percent of those who received it experiencing a decrease in SAD symptoms, dawn simulation brought relief to 50 percent of those who used it and negative air ionization was effective for 48 percent.

A small study also found that cognitive behavior therapy, a form of psychotherapy in which the patient and counselor pinpoint and work to change negative behaviors, also offered SAD suffers benefits. It was especially effective when combined with light therapy.

A pharmacological treatment for SAD was recently approved by the FDA. The anti-depressant Wellbutrin XL was found in clinical trials to relieve seasonal depression in 84 percent of participants. Some experts, however, including Dr. Terman, note that the study found that 78 percent of trial participants who received a placebo also reported they were not depressed by the end of the study.

Turn to PinnacleCare for help and support

When SAD strikes, PinnacleCare Members can count on their person Advocate to provide detailed information on the condition, treatments and available clinical trials. Their Advocate also helps them get quick access to the nation’s top specialists in the treatment of SAD.

“With treatment, seasonal affective disorder can be effectively managed allowing you to better enjoy your life and the opportunities that come your way all year long,” says Dr. Miles J. Varn, PinnacleCare’s Chief Medical Officer.