Pam Koenig, FNP
Publish Date: Fri, Dec 13th, 2013
Saturday December 21 marks the first day of winter this year and while some look forward to it, others dread its arrival.
For many, winter is a time to enjoy cold weather sports, the beauty of fresh snow, and 'nesting' or settling in for the cold months ahead. Winter holidays typically bring excitement and anticipation of family traditions and joy in spending time with loved ones and friends.
For others, winter becomes a struggle with the approach of freezing temperatures, blustery winds, holiday hoopla and limited daylight. Many suffer with feelings of apathy and sadness rather than excitement and pleasure. These emotions are commonly referred to as the 'winter blues'. If they become pervasive and more severe these feelings may indicate seasonal affective disorder (SAD).
SAD is a seasonal pattern of depression which begins in fall and can intensify and persist throughout the winter months. Symptoms usually begin to subside as spring approaches and days become longer and brighter. The exact causes of SAD are unknown; however, inadequate natural light, genetics and body chemistry are believed to be major contributors.
The disorder affects approximately 5% of Americans regardless of age. Women are four times more likely to develop SAD than men, but men may have more severe symptoms. Prevalence is higher in those with a family history of mood or alcohol –related disorders and in those living far from the equator. Depressive symptoms may worsen seasonally in those with a personal history of clinical depression or bipolar disorder. Research studies demonstrate a clear correlation between direct sunlight and production of melatonin and serotonin which affect the sleep-wake cycle and mood. The change in seasons from summer to fall and winter brings fewer daylight hours and less intense natural light. A good number of winter days are without any direct sunlight due to cloud-cover which allows only indirect light through a gray sky. Such limited natural sunlight may adversely affect the brain chemistry involved in sleeping and mood regulation.
Common symptoms of SAD include feeling down, blue, irritable and lonely. Loss of interest in previously pleasurable activities, social withdrawal, isolation, sleep and appetite changes, lack of energy, difficulty focusing and concentrating and apathy may become the norm of one's existence. Symptoms differ for each person and vary in intensity. Those with mild symptoms may be able to get through each day without others noticing their suffering while severe 'SAD'ness may leave one feeling emotionally and physically depleted.
Signs and symptoms of seasonal affective disorder should be taken seriously. As with other types of depression, seasonal affective disorder can get worse and lead to problems in relationships, difficulties at work, substance abuse and, in severe cases, suicidal thoughts and behaviors. Diagnosed early, SAD is easily treated and one can expect symptom relief within a relatively short time. Individualized treatment options depend upon symptom severity and may include bright light therapy (phototherapy), dawn simulation, medication and counseling.
Phototherapy involves sitting for one half-hour directly in front of a 10,000 lux light box every day to simulate natural light exposure. Antidepressant medications, such as fluoxetine, sertraline or paroxetine may benefit those with more severe or pervasive symptoms. Bupropion is FDA approved for the prevention of SAD and supplements such as melatonin, tryptophan and vitamin D may improve sleep and overall well-being. Supportive counseling or psychotherapy may help identify and change negative thoughts and behaviors while learning healthy strategies to improve stress-management and decrease SAD symptoms.
Symptom severity may ease with a well-balanced diet and regular physical activity to boost energy, decrease stress and anxiety and improve mood. Spending time outdoors on sunny days is known to positively affect brain chemistry, mood and sleep. Maximize natural sunlight in all rooms at home and work by opening curtains and blinds. Develop a relaxing routine in the evening and maintain a regular sleep schedule by going to bed and getting up at pre-determined times every day. Make extra effort to spend time with family and friends, maintain social connections, and seek stimulation, enjoyment and comfort during the dark winter days and nights.
It is normal to feel down on some days but if these feelings persist for days at a time and motivation to engage in enjoyable activities fades, see a health care provider. This is particularly important if sleep patterns and appetite have changed, feelings of hopelessness, helplessness or suicide arise, or if alcohol or drugs are used for comfort or relaxation. When SAD is diagnosed and treated early, one can return to a pleasurable and productive life sooner and severe symptoms can be prevented. As the long dark days of winter approach, it is important to look forward to the light at the end of the tunnel. SAD is time-limited and full remission of symptoms can be expected as the seasons change from winter into spring.