By Dr. Roscoe Van Camp, MD at Seward Community Health Center-
Symptoms of Seasonal Affective Disorder (SAD) usually appear during the colder months of fall and winter, when there is less exposure to sunlight during the day. Depression symptoms can be mild to moderate, but can become severe. Those who work long hours inside office buildings with few windows may experience symptoms all year, and some individuals may note changes in mood during long stretches of cloudy weather.
Symptoms include fatigue, lack of interest in normal activities, social withdrawal, craving foods high in carbohydrates, and weight gain. You may not experience every symptom. For example, your energy level may be normal while carbohydrate craving may be extreme. Occasionally a symptom is opposite the norm, such as weight loss as opposed to weight gain. In a small number of cases, annual relapse occurs in the summer instead of the fall and winter, possibly in response to high heat and humidity. During this period, the disorder is more likely to be characterized by insomnia, decreased appetite, weight loss, and agitation or anxiety.
How does SAD Develop?
SAD has been linked to a biochemical imbalance in the brain prompted by shorter daylight hours and a lack of sunlight in winter. Just as sunlight affects the seasonal activities of animals, SAD may be an effect of this seasonal light variation in humans. As seasons change, people experience a shift in their biological internal clock or circadian rhythm which can cause their daily schedule to be out of step.
Melatonin, a sleep-related hormone, has also been associated with SAD. This hormone, which has been linked to depression, is produced at increased levels in the dark. When the days are shorter and darker, more melatonin is produced.
Research has proven bright light makes a difference to the brain chemistry, although the exact means by which sufferers are affected is not yet known. Bright sun light is 100,000 lux, cloudy daylight is 5,000 lux, while indoor lighting is less than 500 lux. Some evidence suggests that the farther someone lives from the equator, the more likely they are to develop SAD. Approximately 25 percent of the population at the middle-to- northern latitudes of the U.S. experience winter doldrums, a sub-clinical level of SAD. These people notice the return of SAD-like symptoms each winter, but are able to accomplish their daily responsibilities. The most difficult months for SAD sufferers seem to be January and February. Younger adults and women are thought to be at higher risk for developing symptoms. Although SAD may begin at
any age, the typical age of onset is between 18 and 30 years.
Increased alcohol use is a common pattern in the winter months for many Alaskans because of decreased employment and recreational opportunities. It does not cause SAD, but can make symptoms much worse. Alcohol does not help prevent or treat SAD.
How is SAD treated?
Increased exposure to sunlight and exercise can improve symptoms of SAD. This can be achieved by a long walk outside or arranging your home or office so that you are exposed to a window during the day. Exposure to yellow sun at some point during mid-day is the best way to combat SAD. Sun light and exercise can control symptoms over half the time.
In addition to sunlight, light therapy (phototherapy) has proven an effective treatment option. Research has proven bright light makes a difference to the brain chemistry. This form of therapy involves exposure to very bright light (10,000 lux light box 20 inches from the face) between 30 and 90 minutes a day during the winter months. These light-therapy sessions are best used during the morning hours. Light exposure must occur with the eyes open for retinal absorption.
UV rays are not a source of phototherapy. Therefore tanning beds, which can cause injury to the skin and eye, are
not an effective source of light therapy.
Additional relief has been found with psychotherapy sessions, and in some cases prescription of antidepressants.
If you have felt down in the winter previously, increasing your exercise and light exposure as winter approaches can help. If you needed antidepressant medication in the past, it is preferred to stay on this medication all year. As soon as you recognize a pattern of increasing depression, get help. Treatment is usually effective and can greatly improve your health.
There are no supplements that have been shown to improve SAD. Healthy whole food nutritious diets supply all the nutrients and vitamins needed for most individuals. If you do not eat vitamin D rich foods, taking vitamin D supplements is reasonable in Alaska for bone health.
If you feel you are suffering from SAD, it is important to seek the help of a trained medical professional. Seasonal Affective Disorder can be misdiagnosed as hypothyroidism, hypoglycemia, infectious mononucleosis, and other viral infections, so proper evaluation is necessary. For some people, SAD may be confused with a more serious condition like severe depression or bipolar disorder.
If you feel your depression is severe or if you are experiencing suicidal thoughts, consult your doctor immediately regarding treatment options or seek help at the Emergency Department. You can also call the SeaView 24 Hour Crisis Line at (907) 362-1843. There are no blood tests to confirm the presence of SAD. However, a trained clinician can diagnose the symptoms and suggest therapy options. SAD treatment can usually be of great benefit to relieve suffering and improve your health.