Seasonal affective disorder

When a case of the winter blues feels more like depression, you may be suffering from SAD. SAD stands for Seasonal Affective Disorder. SAD is a seasonal disruption of mood that occurs during the winter months and ceases with the beginning of spring. Symptoms usually begin in September when days begin to shorten, and last through the winter into March when the days begin to lengthen again. The symptoms of SAD usually include episodes of depression, hypersomnia, increased appetite, and weight gain. Light plays a big part in its origin and in its treatment. To better understand winter depression, think of it as four months of jet lag. The human body has hundreds of 24-hour biological rhythms all controlled by one “internal clock.” The sleep cycle is one rhythm. Body temperature is another. The brain’s production of certain chemicals, like the nighttime hormone melatonin, is another. Melatonin is a hormone produced by a gland in the brain called the pineal gland. High levels of this hormone can adversely affect our mood. Very little melatonin is secreted in daytime light and its peak production is usually at night, between 2 and 3 a.m.

Due to their longer nights, winter months cause extra production of melatonin in the body. In the summer, most of us wake up when it is light outside. The morning light decreases the levels of melatonin in the body. In winter, however, most of us force ourselves to wake up while it’s still dark outside. The darkness causes increased levels of melatonin, which cause some people to become depressed. Seasonal Affective Disorder causes many symptoms of depression. It can cause a diminished interest or enthusiasm in all, or almost all, activities. Overeating, especially of carbohydrates, leads to significant weight gain. SAD causes sleep problems such as oversleeping, but not feeling refreshed; and a feeling of lethargy or an overall sluggishness during the day, as if everything is an effort. Sufferers of SAD have difficulty coping with life as a result of these changes. They have feelings of despair, misery, anxiety, hopelessness and, in severe cases, have suicidal thoughts. SAD can lead to family problems and cause sufferers to avoid company and participation in social activities.

An estimated 10 million Americans have SAD. Women are 4 times more likely to suffer from SAD than men. The average age most people begin to suffer from SAD is 23. As a person gets older, they are less at risk of suffering from SAD. People with other depressive illnesses and people that live in the northern latitudes are also more susceptible to SAD. About 4 to 6 percent of the general population actually experience SAD, and another 10 to 20 percent experience a sublevel of the SAD symptoms, usually referred to as “winter doldrums.” People with the winter doldrums are bothered by the return of SAD-like symptoms each winter, but they remain fully functional. As Seasonal Affective Disorder became more recognized by scientists, they came up with an idea to treat it. Scientists at the National Institute of Mental Health had an idea: If people get depressed when the days get darker, why not just give them more light? They decided to treat a SAD sufferer by building a 2-foot by 4-foot metal box filled with bright fluorescent bulbs, covered with a plastic screen. They asked the patient to sit in front of it for three hours before dawn and three hours after sunset every day. Three days later the patient was out of his depression.

Since then, scientists have come further in their light therapy treatment, using brighter lights and shorter treatment times. Light therapy involves exposure to intense levels of light under controlled conditions. The recommended light therapy system consists of a 10,000 lux light box directed toward the patient at a downward slant. The patient shouldn’t stare directly at the light box, but rather engage in such activities as reading, writing, or eating meals in the light box’s light. The light therapy sessions should start with a single 10 to 15 minute session per day, gradually increasing the session length to 30 to 45 minutes. If symptoms worsen, sessions should be increased to twice a day. Some patients show an immediate benefit from light therapy, but most take two to four days to experience a sustained antidepressant response.

Patients who respond positively to the light therapy should continue treatment until adequate daily light exposure is available to them through other sources, such as springtime sun. Side effects of the light therapy has been minimal. A small percentage of patients experience headaches, eyestrain, or nausea at the beginning of treatment. These symptoms are usually mild and go away after a few days. Mild symptoms of SAD can be treated with simple measures such as keeping drapes and blinds open; sitting near windows; or turning on bright lights during cloudy days. Changing the lights in the bathroom to high output lights will wake you up and turn off the melatonin in your body. Working in bright areas also signals your body to stay American Academy of Family Physicians (March 15, 1998).

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