Doc Talk: Shorter days can trigger seasonal affective disorder

11/26/2013 5:29 AM

08/08/2014 10:19 AM

Many people feel down in the dumps or not like themselves during the winter. This may be a sign of a serious medical problem commonly referred to as seasonal affective disorder, or SAD. Psychiatrists classify SAD as major depression with seasonal pattern, which means that the person tends to experience episodes of depression during the fall or winter.

A striking example of this comes from Scandinavia, where the suicide rate doubles during the winter when there is less light, temperatures are lower, and the incidence of depression increases. Scientists have reported that blood levels of omega-3 fatty acids tend to be lower in some populations during in the winter, which could correlate with the increased rates of depression. Other studies have shown that people with SAD have decreased metabolic activity in parts of the brain known as the orbital frontal cortex and the left inferior parietal lobe, both of which affect mood.

Symptoms of SAD can include:

• Feeling “low” or sad
• Lacking interest in usual activities
• Having trouble falling or staying asleep
• Loss of appetite
• Poor concentration
• Social withdrawal
• Loss of energy
• Feelings of anxiety
• Feelings of guilt, hopelessness or worthlessness.

Causes of SAD

The exact cause of SAD is not fully understood. It’s believed that genetics, age and the body’s natural chemical makeup all play a role in the condition. Factors may include:

• Biological clock (circadian rhythm). The reduced level of sunlight in the fall and winter may disrupt the body’s internal clock, which signals sleep and alertness. This disruption of the circadian rhythm may lead to feelings of depression.
• Serotonin levels. Reduced sunlight can cause a drop in serotonin, a brain chemical that affects mood and is implicated in depression.
• Melatonin levels. The change in season can disrupt the balance of the natural hormone melatonin, which plays a role in sleep patterns and mood.

When to see a doctor

It’s normal to have some days when you feel down. But if you feel down for several days at a time and you can’t seem to get motivated to do activities you normally enjoy, see your doctor, particularly if you notice that your sleep patterns and appetite have changed or if you feel hopeless, think about suicide, or find yourself using alcohol or drugs to cope.

Symptoms may start out mild and become more severe as the season progresses.

Sometimes the depression resolves after the holiday or when sunlight levels increase, but some cases of SAD may require long-term or preventive treatment.

If your doctor determines you are suffering from SAD, then treatment options can consist of one or more of the following:

1. Light therapy. Also called phototherapy, bright light therapy has been shown to be effective to treat or prevent SAD. It involves spending 30 minutes a day in front of a lamp that mimics outdoor light. It appears to cause a change in brain chemicals linked to mood. The lamps can be purchased through several different companies, and you should speak to your doctor to determine if this is an appropriate treatment for you.

2. Antidepressant medication. Some people with seasonal affective disorder benefit from antidepressant treatment, especially if symptoms are severe. Your doctor may recommend starting treatment with an antidepressant before your symptoms typically begin each year. He or she may also recommend that you continue to take antidepressant medication beyond the time your symptoms normally resolve.

3. Psychotherapy. Psychotherapy can help you identify and change negative thoughts and behaviors that may be making you feel worse. You can also learn healthy ways to cope with seasonal affective disorder and manage stress.

Don’t brush off that yearly feeling as simply a case of the winter blues or a something you have to tough out on your own. Help is available to keep your mood and motivation steady throughout the year.

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