December Health Awareness: SAD

Physicians Health Network Health & Awareness Articles

 

Beating Seasonal Affective Disorder

Winter is cold, long, and dark. This lack of light can have a profound impact on our health. We often use the expression “winter blues” to refer to the familiar dip in mood and energy that comes with these cold, long nights. Mental Health Counselor Karla Willis is familiar with the profound changes in health some of us experience when the seasons change. She says, “When the winter season depresses our mood, energy, and enjoyment with life we call it Seasonal Affective Disorder, or SAD for short.”
Approximately four to six percent of the population experience SAD and the incidence varies with latitude. For example, about one percent of residents in Florida are diagnosed with SAD compared to nine percent in Alaska. Women are at a greater risk than men and teens and young adults are at greater risk than older adults. SAD starts in the fall as the days shorten, and symptoms peak in the winter. “It’s important to remember that Seasonal Affective Disorder is a type of depression. In fact, individuals with a history of depression are at greater risk for SAD,” said Willis.
Behind the scenes, our eyes do more than just provide us with vision. They send messages on special tracts of nerves to various structures in the brain regarding the time of day and the time of year. These messages are based on the type and amount of light stimulating the eyes. Some of these brain structures, such as the hypothalamus, the pituitary gland, and the pineal gland, govern neurotransmitters and hormones that control hunger, energy levels, sleep, and other important functions. The lack of abundant, full-spectrum sunlight in the winter results in less stimulation to these key brain structures and can impair the natural rhythms of hunger, energy, mood, and much more.
Levels of serotonin, a neurotransmitter that influences mood and appetite, are lowered in the brains of SAD sufferers. According to Willis, “A decrease in serotonin levels is shared by SAD sufferers and those individuals with other types of depression.” Melatonin, which influences, among other things, sleep, your body’s clock, and immunity, is produced excessively during SAD. These alternations in brain chemistry result in the characteristic symptoms of SAD which are:

● Decreased energy levels
● Increased sleep
● Increased appetite often with carbohydrate cravings
● Decreased ability to concentrate
● Social Withdrawal

A diagnosis of SAD is made by matching symptoms with the changing seasons; especially if the symptoms repeat for two years consecutively. “Multiple treatments can be effective for relieving the symptoms of SAD. A mental health professional can help patients decide which treatment or combination of treatments will benefit them,” said Willis.
Light therapy is a common and effective treatment for SAD. This treatment is based on the recognition that a lack of full-spectrum light stimulating the eyes leads to the symptoms of SAD. Light therapy involves looking towards, but not directly at, a special light-box for about 30 minutes every morning. These light boxes are very bright but not as bright a sunny day. Measured in lux, a unit of brightness, a typical light-box used to treat SAD produces 10,000 lux. Outdoors on a sunny day may be around 100,000 lux. Medications, often the same drugs used for other forms of depression, are also used to treat SAD. Particularly drugs known as selective serotonin uptake inhibitors which boost those diminished serotonin levels. Cognitive behavioral therapy, which involves identifying negative thoughts and cultivating positive thoughts and healthful behaviors, can be as effective as light therapy in the treatment of SAD. In fact, there is some evidence that cognitive behavioral therapy can help, not only with the current winter symptoms but with future winters as well. Willis says, “Cognitive behavioral therapy can give SAD sufferers tools that will help them minimize the impact of SAD year after year.” Other treatments that may be beneficial for SAD are vitamin D supplementation, herbal supplements, and exercise. It’s important to note that some of these treatments can take three to four weeks before symptoms begin to improve.
“Mental health professionals recognize SAD as a type of depression and we want to spread the word that it should be taken just as seriously,” said Willis. If you feel you are suffering from SAD contact your mental health provider or primary care physician.

Sources:
https://www.nimh.nih.gov/health/topics/seasonal-affective-disorder/index.shtml

Rohan, K. J., Mahon, J. N., Evans, M., Ho, S.-Y., Meyerhoff, J., Postolache, T. T., & Vacek, P. M. (2015). Randomized Trial of Cognitive-Behavioral Therapy Versus Light Therapy for Seasonal Affective Disorder: Acute Outcomes. American Journal of Psychiatry, 172(9), 862–869. doi:10.1176/appi.ajp.2015.14101293

Rohan, K. J., Meyerhoff, J., Ho, S.-Y., Evans, M., Postolache, T. T., & Vacek, P. M. (2016). Outcomes One and Two Winters Following Cognitive-Behavioral Therapy or Light Therapy for Seasonal Affective Disorder. American Journal of Psychiatry, 173(3), 244–251. doi:10.1176/appi.ajp.2015.15060773