The winter blues
The holidays and change of seasons can affect many people negatively. Individuals with limited support systems can dread the onset of the holidays because it makes them feel more isolated. Those who have experienced significant personal loss of loved ones often experience a renewal of grieving during the holidays. For others, the change of season and shortening of daylight cause them to feel “blue.”
Seasonal Affective Disorder (SAD), also known as winter depression, is a mood disorder in which people who have normal mental health throughout most of the year experience depression symptoms in the winter, year after year. Between 4% and 6% of people in the U.S. suffer from significant SAD. Another 10% to 20% may experience a milder form of winter-onset SAD. It is more common in women and usually starts after age 20. Fortunately, the incidence of SAD decreases as we get older. Winter-onset affective disorder is more common in northern regions such as ours.
There are specific diagnostic criteria that your doctor will use to determine if you have SAD. These criteria are:
1. You have been depressed during the same season and have gotten better when the seasons changed for at least two years in a row.
2. You have symptoms that often occur with SAD, such as being very hungry (especially craving carbohydrates), gaining weight and sleeping more than usual.
3. A close relative-a parent, brother, or sister-has had SAD.
It is important to distinguish SAD from actual depression. Symptoms of SAD tend to come back annually but also resolve at about the same time every year. The changes in mood are not necessarily related to obvious things that would make you feel stressed. Depression is not seasonal in nature and continues regardless of the time of the year. It is also important not to confuse SAD with the normal changes that we all experience in the winter when we tend to decrease activities and have lower levels of energy. Your physician should be able to separate SAD from mild depression, known as dysthymia, and from major depression.
It is not clearly understood what causes this condition. There are theories that the pineal gland of the brain is not stimulated by adequate amounts of light during the winter, leading to changes in brain chemistry. Treatment is similar to that for depression, which attempts to increase the amount of serotonin.
The treatment for seasonal affective disorder is guided by the severity of symptoms. There are many “cures” and supplements found in an Internet search, but most are not substantiated by actual research. The following are the current recommendations:
1. Your doctor may recommend light therapy. Light therapy is effective and easy to use. You notice improvement within a week, but you need to stick with it and use it every day until the season changes. There are two types of light therapy:
• Bright light treatment. For this treatment, you sit in front of a “light box” for half an hour or longer, usually in the morning. Units can be purchased online without a prescription.
• Dawn simulation. For this treatment, a dim light goes on in the morning while you sleep, and it gets brighter over time, like a sunrise.
2. For more severe symptoms, the use of antidepressants may be needed. These medicines have been shown to improve mood but need to be taken as directed and not stopped without doctor supervision. There are a number of side effects, so usually this type of medication is reserved for people with severe symptoms.
3. Psychological counseling may be offered to help you learn more about SAD and how to manage your symptoms.
4. Exercise is an important part of treatment. Being active during the daytime, especially first thing in the morning, may give you more energy and help you feel less depressed. Moderate exercise such as walking, riding a stationary bike, or swimming is a good way to get started.
5. For an individual whose winter blues is related to social circumstances or personal loss, activities such as planning travel during the holiday or winter months to southern locations (e.g., Florida, Mexico, Caribbean) and becoming involved in community volunteer activities often help bridge this difficult time of the year.
6. Avoid use of alcohol or other drugs to suppress depression symptoms.
In all cases consult with your family doctor for evaluation and treatment if you feel that you may have affective seasonal disorder or another form of depression.