Seasonal affective disorder (SAD) otherwise known as winter blues or winter depression (or summer blues or summer depression for those living in warmer climates) is not a unique mood disorder according to the DSM-IV but a “specifier of Major Depression.” It is a relatively common condition, now believed to affect 6% of the population. Its symptoms consist of depressed mood, excessive tiredness, lethargy, sleeping too much or too little, eating too much, failure to find pleasure in things that one usually finds pleasurable, and feeling “blah” or lead-like, withdrawing from friends and family and problems with concentration. It occurs most commonly in Northern climates, beginning shortly after the start of daylight savings time, sometimes in October or November and lasts about four to five months. The lack of sunshine, shorter days and frigid temperatures contributes to people sequestering themselves inside leading to feelingsof depression in some people. In the springtime when we turn the clock forwards once again, the days get longer, the sun shines brighter and the first flowers of spring begin to bloom, people who suffer from this condition will admit to feeling a lifting of their spirits and moods.
According to the DSM-IV “SAD” is characterized by a “full remission at a characteristic time of the year,” specifically the depression will typically lift in the spring, and “seasonal major depressive episodes substantially outnumbers the non-seasonal major depressive episodes that may have occurred over the individual’s lifetime.” While the symptoms of depressed mood abate during the warmer months, the people who suffer from this disorder often live in dread throughout the summer as well as they know they will soon have to face another difficult winter and they are always trying to find solutions to their disorder, regardless of the season.
If this pattern of depressed mood occurs to you in a seasonal pattern, you may be suffering from seasonal affective disorder. One of the key features of this disorder, specifically the sleep problems that may result, is due to the disruption of the circadian rhythm cycle that lack of sunshine can evoke. This lack of sleep or excessive sleepiness can lead to day-time irritability and problems with memory, concentration and focus which can affect overall functioning and further dampen one’s mood. It is believed that outdoor light and sunshine appears to cause a change in brain chemicals leading to mood and the lack of sunshine, as we find in the winter months can actually cause a change in brain chemicals.
The good news is there are very good treatments available out there if you or someone you know suffers from SAD. For some people psychopharmacologyis the right answer, specifically your psychiatrist will prescribe a regimen of an anti-depressant, such as an SSRI or Selective Serotonin reuptake inhibitor such as Prozac, Zoloft and Paxil which have been found to be helpful. Another class of anti-depressants, specifically the Norepinephrine Dopamine reuptake inhibitor Wellbutrinin the long-acting XL version, has been proven to be very successful in the treatment of this disorder as well. The regimen will typically be started about a month before your symptoms usually begin because they take four to six weeks to reach their full effect and will continue the medications for a month after the symptoms remit for a total of about six months.
Another very effective approach to treating this disorder is light therapy or “Phototherapy,” which uses a light box that can be effective alone or combined with an anti-depressant depending on what your doctor feels is appropriate for you. Light boxes come in many shapes and sizes, and are produced by multiple manufacturers. You may want to consult with your doctor about which one is right for you, but primarily you are looking for one that is 10,000 lux, and typically uses white light which mimics outdoor light.It is placed one to two feet in front of you and most people will need to use it for thirty minutes each morning. Though initially a somewhat costly investment, ithas proven to be extremely effective tool for treating SAD and patients report that it changes the quality of their life and gives them energy and mood elevation during the winter months which before were inordinately difficult for them.
A final approach used in tandem with the above approaches is psychotherapy. Though SAD is believed to be a primarily chemical condition, psychotherapy can help one identify and change negative thoughts that arise, teach people more healthy ways to deal with stress and support patients going through this difficult time.
Dr. Shani Stein is a Psychiatrist with a private practice in Teaneck, New Jersey. She can be reached at 201-287-1400.
By Shani Stein, MD