by Patricia O. Quinn, M.D.
Everyone experiences "ups" and "downs" in their lives but when the "down" times last for more than a few weeks and you have difficulty functioning in your daily life, maybe something else is going on. Perhaps Seasonal Affective Disorder (S.A.D.) is affecting you.
S.A.D. is a condition of chronic depression in response to changes in environmental lighting and climate and should not be confused with "holidays blues" or the "winter blahs", which last only a short time and can be easily overcome with a change in routine or an exciting activity that can take your mind off of the situation. S.A.D. consists of recurrent depressions lasting several months each winter with periods of feeling better in the spring and summer months.
Most patients with S.A.D. are women (83%) whose onset of illness typically occurs in the second or third decade. Many of these women report a deterioration in mood with a reduction of environmental light for any reason -- a spell of cloudy weather even in the summer or a move to a poorly lit office. One woman was nicknamed "Lights" because she would always go around turning on all of the lights wherever she was.
In the 1980's several studies were done on people with S.A.D. Dr. Rosenthal and his coworkers at N.I.H. described a form of S.A.D. where fall / winter depressions alternate with non-depressed periods in the spring / summer. In the Washington, D.C. area, it was found that the depression usually begins in October or November and subsides in March or April. The depressive symptoms last an average of 5.1 months. This pattern will vary in more northern regions with depressive symptoms starting earlier and lasting longer.
Depression symptoms are frequently mild to moderate but some may be severe. These symptoms may not respond to antidepressants in the typical fashion. I recall one adolescent boy I saw that I thought had S.A.D. I arranged for a trial of light therapy for him. Four days later I received a call from his mother saying that her son was no better but that she was doing great! At that time she was under the care of a psychiatrist for depression and taking three different antidepressants without positive results. Within four days of light treatment she was feeling much better.
Other symptoms of S.A.D. include: oversleeping, overeating, craving carbohydrates in the fall and winter; a pattern of weight gain in the winter; and a loss of interest in work, sex, and social activities. Some women become irritable and over 50% report PMS mood changes which are worse in winter.
Criteria has been developed to formally establish a diagnosis of S.A.D. These include:
- At least one episode of major depression
- Recurrent fall / winter depressions at least two of which occur during successive years separated by non-depressed periods
- No other psychological or medical condition that can account for the symptoms and
- No other psychiatric illnesses
The treatment for S.A.D. is fairly simple. An increase in the amount of sunlight you are exposed to each day! In winter that means spending more time outdoors each day, migrating to a more southern location, increasing the amount of light by bright light therapy. Patients usually respond within 4 days of treatment and relapse within 4 days of stopping.
Vacations to sunny places will do the trick for awhile but a relapse will be waiting upon your return. You can't turn on all of lights in the house all the time so the next best treatment is exposing yourself to very bright light for shorter periods each day. The light used for treatment is not the usual dim yellow household light source which is only 300 lux but exposure to a very bright light source of 2500 lux full spectrum florescent light called a VITA lite.
The amount of light you will need varies but your doctor should be able to get you started in treatment and work with you until an appropriate exposure time for you has been established. This may vary from 30 minutes to 3 hours either in the A.M. or P.M. depending on your symptoms.
S.A.D. does occur in children and adolescents, who also respond to light therapy. The amount of light needed in children may be much shorter than in adults. The diagnosis of S.A.D. should be considered in children whose school difficulties are most prominent in the fall/winter semesters.
As in all cases of depression, it is important to seek a diagnosis from a competent professional. Talk with your doctor about the possibility of this diagnosis if you feel that you meet the criteria. For a more in depth discussion of depression in general, you can write or call for the pamphlet: Depression: What Women Need to Know published by the National Mental Health association 1-800-969-NMHA or visit their website.
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