It's that time of year again when the days become shorter and winter approaches. Animals react to the changing season with changes in mood and behavior, and human beings are no exception. Most people find they eat and sleep slightly more in winter and dislike the dark mornings and short days.
As the days get shorter, some people experience a form of depression called Seasonal Affective Disorder (SAD) -- an extreme case of the "winter blues" that is relieved during the spring and summer months. Although SAD isn't totally understood, it is a real illness with sometimes severe symptoms. As seasons change, there is a shift in our "biological internal clocks" or circadian rhythms, partly in response to the changes in sunlight patterns.
This can cause our biological clocks to fall out of step with our daily schedules. For people with SAD, their bodies have a difficult time adjusting to the shortage of sunlight in the winter months. SAD symptoms are most pronounced in January and February, when the days are shortest. The typical symptoms of SAD include depression, lack of energy, increased need for sleep, a craving for sweets and weight gain.
Symptoms begin in the fall, peak in the winter and usually resolve in the spring. Some individuals experience great bursts of energy and creativity in the spring or early summer. Susceptible individuals who work in buildings without windows may experience SAD-type symptoms at any time of year. Some people with SAD have mild or occasionally severe periods of mania during the spring or summer. If the symptoms are mild, no treatment may be necessary. If they are problematic, then a mood stabilizer such as Lithium might be considered. There is a smaller group of individuals who suffer from summer depression.
About 70 to 80 percent of those with SAD are women. The most common age of onset is in one's 30s, but cases of childhood SAD have been reported and successfully treated. For every individual with full blown SAD, there are many more with milder "Winter Blues."
The incidence of SAD increases with increasing latitude up to a point, but does not continue increasing all the way to the poles. There seems to be interplay between an individual's innate vulnerability and her degree of light exposure. For instance, one person might feel fine all year in Maryland but develop SAD when she moves to Toronto. Another individual may be symptomatic in Baltimore, but have few symptoms in Miami. Some individuals who work long hours inside office buildings with few windows may experience symptoms all year round. Some very sensitive individuals may note changes in mood during long stretches of cloudy weather.
Bright fluorescent light (not ordinary household light) has been shown to reverse the winter depressive symptoms of SAD in most people. For most people with SAD, a light box is prescribed. A light box is a full-spectrum fluorescent light (with the harmful ultraviolet rays screened out) designed to provide bright light to SAD sufferers. The patient is given a schedule for sitting in front of the light for a certain period of time each day, usually in the morning. The length of time in front of the light and the brightness of the light are prescribed much like a dose of medicine.
Before embarking on a course of light treatment, it is best to have a complete psychiatric evaluation. Sometimes a medical illness or another psychiatric condition can masquerade as depression. Discuss various treatment alternatives with your doctor. Light therapy does take time, and must be done on a regular basis. Like exercise, not everyone who would benefit from it will actually do it regularly.
Your doctor will discuss the various types of light boxes or visors available. Persons with SAD generally begin with 30 to 45 minutes of treatment in the morning. Light in the evening may cause insomnia. After a week or two, the person with SAD can experiment with reducing or increasing the daily duration of treatment. The most common light source is a full spectrum fluorescent light. This fixture provides a reflecting surface behind the lights and a plastic diffusing screen in front.
The light box is placed either horizontally on a desk or table or vertically on the floor. The intensity of light from this special light source is equivalent to the amount of light exposure the person would receive from looking out a window on a sunny spring day. Side effects of phototherapy are uncommon. Some patients complain of irritability, eye strain, headaches, or mania. No evidence has been produced of long- term adverse effects, however.
Other treatments are also possible. Outdoor light, even when the sky is overcast, provides as much or more light than a light box. Research showed an improvement in SAD symptoms when individuals took a one-hour daily walk outside. Outside light is often brighter than the light boxes. Spending an hour outside each day can often produce beneficial results in some individuals. However, one cannot get early morning outside light in the winter.
Not everyone's job will allow for an hour-long outside walk. Only highly motivated people will continue their daily walk when it the rains or snows. SSRI (Selective Serotonin Reuptake Inhibitors -- Paxil, Zoloft etc.) have been shown to be effective in treating SAD. Some people prefer to take a pill because it is less time consuming than sitting in front of a light box. Some individuals need a combination of light therapy, medication, and psychotherapy. For those with winter depression and spring-summer mania, a mood stabilizer such as Lithium may be useful. 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 boost mood. Conversely, as the mood improves, craving for sweets may abate.
Psychotherapy can help the depressed individual look at her depressive assumptions and negative expectations. It can also help one identify relationship difficulties so that interpersonal mistakes might not be repeated. Research has shown that cognitive psychotherapy does help relieve depression faster and more completely than no therapy. Some individuals continue to have a certain amount of energy fluctuation with the seasons. If one is aware of this, one can plan for it and work the expected fluctuations into one's life.
These articles are not intended as Medical advice, and the author assumes no responsibility for actions taken based on the information contained in this article. If Medical advice or other expert assistance is required, the services of a competent professional should be sought.
Dr. Nancy Tice is a psychiatrist with extensive experience furnishing medical information and writing health and technology related articles. She did her medical training at The Albert Einstein College of Medicine in New York. Dr. Tice has been working online in some capacity for 21 years. She enjoys helping people online via online psychotherapy, e-mail and or chat correspondence, phone consultations and in person individual psychotherapy. Although classically trained and well versed in psychopharmacology, Dr. Tice also uses alternative treatments and natural supplements to manage issues when appropriate.
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