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December 16, 2012 at 11:51 PMComments: 0 Faves: 0

Seasonal Affective Disorder: Winter Blues or Something More?

By Jeffrey VanWingen M.D. More Blogs by This Author

What a depressing time of year this can be! I drive to work in the dark, and it's dark again when I leave. I miss those long, warm, sunny days of summer, and I'm not alone in these sentiments. Many people experience a decline in their mood in the late fall and winter months, which are short on sunlight. For some, this creates significant disorder in their lives.

When the issue becomes significant along the spectrum of severity, it's known as seasonal affective disorder (SAD). This blog will bring the disorder to light (no pun intended) and offer some helpful ideas in combating the problem.

What Exactly Is Seasonal Affective Disorder?

Are seasonal affective disorder and "the winter blah's" the same thing? Not really. SAD is distinct in that it creates a significant impact on a person's life - their personal happiness, their family, their job, etc. While the problem improves in the spring, it comes around again and again each time the leaves fall off the trees and the days get shorter. Because of this impacting nature and recurrence, SAD is considered a serious mental health problem.
 
It's estimated that as much as 5% of the U.S. population experiences SAD in a given year. SAD is most common in early to middle adulthood, declining among older persons. Among the sexes, SAD tends to predominate in women, particularly during childbearing years with a 4:1 ratio. Obviously, geography plays in huge here with northern latitudes being at greater risk.  

Potential Causes

The exact cause of SAD is not known. The predominant thought is that our bodies either advance or delay the body's day-night cycle. This cycle consists of our rhythm and daily shift between daytime wakefulness and nighttime sleepiness. Other hypotheses exist that focus on the sensitivity to light on our retinas (the light-collecting sensors on the back of our eyeballs that send signals to the brain). Still, others believe that the disorder is related to dysfunctions in our neurotransmitters (primarily serotonin) or that genetics play a role. In truth, many factors likely play in. 

I Have SAD... Now What?

Help is out there to treat and prevent SAD. I's best to be proactive and catch it before the problem cycles around again. The three main forms of treatment include light therapy, cognitive behavioral therapy, and medication. 

Light Therapy

Light therapy is a popular treatment for SAD. It just makes sense that filling the deficiency that causes SAD can help. Indeed, many studies show benefit in regular doses of light and certain standards have been developed to guide treatment. White fluorescent light should be used without ultraviolet wavelengths. The light should be placed 12-18 inches away from the body for 30 minutes each morning. Eyes should be open to allow the light to hit the retina, but staring directly at the light isn't necessary. This process should be performed until well into the spring, beginning again in the early fall to prevent relapse.
 
Units typically run around $250 and can be readily found online and in pharmacies. Insurance companies may cover the cost with a doctor's prescription.

Cognitive Behavioral Therapy (CBT) 

CBT is a proven, mainstream technique utilized in the treatment of anxiety and depression.  The therapy addresses thought processes and behaviors utilizing personal insight.  Typically, sessions occur on a weekly basis.  A small study did find benefit in utilizing CBT for seasonal affective disorder. 

Medication

Pharmaceutical therapy has been shown in placebo controlled studies to help with the symptoms of SAD. Selective serotonin reuptake inhibitors (SSRI's), such as Prozac, Zoloft, or Celexa, are effective along with selective serotonin-norepinephrine reuptake inhibitors, such as Cymbalta. The downside of using these medications is that they take around four weeks to become effective and, by this time, a significant amount of the season has passed. Homeopathic preparations also offer benefits for SAD. 

Other Considerations

Decreasing sun exposure means decreased metabolism of vitamin D in our bodies. Vitamin D deficiency symptoms include a depressed, irritable mood along with fatigue and muscle aches. If you feel a decline in your mood during the winter months, get your vitamin D level checked or try supplementing 2000 IU per day.

Exercise (particularly in the morning) can also be therapeutic during the cold, low light months.  It increases norepinephrine stores which enhance energy, wakefulness, and mood.

Seasonal affective disorder is a serious, impacting problem that effects numerous people during the seasons of cold weather and low exposure to sunlight. Help is out there in the form of light therapy, talk therapy, or medication in addition to other options such as vitamin D supplementation and exercise. If you think you may have SAD, seek help and bring some enjoyment back during the bleak midwinter.

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