Winter Depression is S.A.D.
It is estimated that 10 million people in the United States alone experience the
effects of Seasonal Affective Disorder (SAD), while another 25 million suffer
from a milder version sometimes referred to as winter depression.
Dr. Norman E. Rosenthal , of the National Institute Of Mental Health in
Bethesda, Maryland, spearheaded research in the disorder in 1980 when he
noticed patients became severely depressed in the winter but snapped out of it
in the spring. He also noticed that some patients from the North brightened
when they visited a southern climate, but experienced a relapse when they
returned home. Since then, dozens of research psychiatrists and doctors have
analyzed SAD, finding that light can influence moods, possibly because it
produces an increase in a hormone called melatonin which can cause depression
when present in large amounts. It is believed that production of this hormone
decreases when the body is exposed to sunlight.
Dr. Rosenthal describes the symptoms of SAD in his book, Winter Blues.
Typically, the symptoms last from early November, when the days become
noticeably shorter, until March, when days begin to lengthen. January and
February are the worst months for depression. Women are about four times more
susceptible to SAD than men. This may be related to hormonal differences.
What Is Seasonal Affective Disorder (SAD)?
Like water and air, light is essential to our well-being. Our body has a very
distinct 24 hour cycle. This cycle is controlled by bright light (the sun).
Shift workers, travelers crossing several time zones, people with certain sleep
disorders, often feel "out of sorts" because their daily cycle is "out of sync"
with the sun.
Studies have shown that during fall and winter about 20% of the population is
affected by specific symptoms related to changes in our sleep/wake pattern that
may include sleep problems, change in appetite or weight, lack of energy,
diminished sex drive, body aches or pains, memory loss, inability to make
decisions, problems concentrating, low self-esteem, lack of interest in or
enjoyment of activities, suicidal thoughts.
Seasonal Affective Disorder is a specific type of major depression, which
reoccurs at specific times of the year. The most common pattern is the onset of
major depression in the fall (September through November) and abating of the
symptoms in late winter to early spring (March through May). The frequency of
SAD seems to vary with geographic location. It may approach 10% of the general
population in northern New England, 5% of the population in the
Baltimore/Washington area, and less the 2% of the population of Southern
California or Florida.
About 75% of SAD sufferers are women, but Seasonal Affective Disorder affects
men and children as well. The most typical age of onset is in the twenties, but
other onsets are common such as during puberty, middle age, and old age. After
women pass through menopause the numbers in men and women become equal. Most
affected are those living in northern latitudes and in frequently overcast
areas, especially during the shortened fall and winter days.
As in the case of major depression, the diagnosis of Seasonal Affective Disorder
is a clinical one, based on the presence of specific symptoms. To meet the
criteria for a seasonal relationship, there should be at least three episodes
of mood disturbance in three separate seasons, at least two of which are
consecutive. There should be no association between the disturbance and
situation stresses, such as being unemployed with each winter.
What Causes SAD?
The primary cause of Seasonal Affective Disorder is change in sunlight exposure.
The reduction in daylight hours in the fall and winter can affect sufferers of
SAD. The most commonly accepted hypothesis for the underlying cause of SAD is
that reduced natural sunlight exposure affects the body's natural daily
rhythms, which are not fully precise and rely on the intensity of sunlight to
provide adjusting cues. These cues originate in the retina at the back of the
eye, creating signals which pass through the optic nerve to the mid-brain,
setting in motion a number of chemical changes. These changes include:
• Increase In The Neurotransmitter Serotonin, Necessary For A Sense Of Well Being.
• Regulation And Suppression Of The Hormone Melatonin, Which Is A Factor In Normal
Sleep Patterns And May Influence The Recuperative Benefits Of Sleep.
Seasonal Affective Disorder can be experienced as an isolated disorder or may be
experienced in conjunction with an existing mood disorder or chronic illness.
The tendency toward SAD or severity of the symptoms can be influenced by many
factors, such as living in a northern latitude, recent cloudy weather patterns,
family history of SAD, working in a windowless office, recent illness, or
general life stresses.
Symptoms Of SAD (In addition to suffering from depression that can last for
• Crave Carbohydrates (Starchy Foods) And Sweets And Feel Better After Eating Them
• Gain Weight
• Sleep Longer Hours But Wake Up Feeling Tired
• Lose Interest In Sex.
• Feel Overwhelmed By Insignificant Things
• Avoid Family And Friends
• Have Difficulty Thinking And Concentrating
• Feel Achy And Suffer From Frequent Infections
Brighten The Mood
According to Dr. Robert deVito, chairman of the Department of Psychiatry at
Loyola University Medical Center in Maywood, Illinois, 60% of the adult
population experiences some change in mood and behavior linked to the seasons.
But in most cases the problem is easily solved. DeVito reports an 80% recovery
rate in his patients when full-spectrum light therapy is used. Light therapy
evens out the mood swings, decreases the need for sleep, and lessens the
cravings for carbohydrates. "The full-spectrum lights give the body the
equivalent of a longer day and lift the mood considerably," deVito explains. "
Ordinary interior lights won't do," he adds. "You need light 10 times as
bright, light that imitates sunlight, without the intensity of the sun's rays."
One of the most effective methods of treatment is a device known as a "lightbox." Designed to simulate the brightness of the sun as it is in the midmorning
hours of springtime, the lightboxes trick the body into believing it is no
longer winter. The light from a lightbox may range between 2500 to 10,000 lux,
(a lux is a standard unit of measurement for light brightness). This compares
with the usual 500 to 700 lux in an ordinary well-lighted room and up to
100,000 lux outdoors on a bright day.
Portsmouth, N.H. psychotherapist Stephen Little has treated more than 250 of his
patients with lightboxes. "As opposed to anti-depressants, which can take as
long as a month to know if they are working," according to Little," light
therapy can take from one to five days and with no side effects." He said if
SAD sufferers sit in front of a lightbox for 30 minutes each morning, the light
almost instantly makes them feel better.
How Does Light Therapy Relieve SAD?
In many ways the treatment of Seasonal Affective Disorder is similar to that of
other major depressive episodes, utilizing antidepressant or mood stabilizing
medication and/or psychotherapy. In addition, the exposure to bright light has
been found to be an effective means of treating Seasonal Affective Disorder.
The individual sits in front of a bright light unit, a specialized, portable
box which houses balanced spectrum fluorescent tubes. An individual's needs for
light therapy specifies the duration of exposure and the optimal time of day.
An individual should meet periodically with their health care professional. The
dose of light therapy should be adjusted as needed.
The most successful treatments for SAD involve identifying how the change in
daylight shifts the person's daily circadian rhythms, especially in their sleep
cycle. Most people with SAD symptoms show changes in their sleep/wake patterns
and melatonin levels. Bright light is known to be a powerful regulator of
melatonin and the sleep/wake cycle. Seasonal Affective Disorder and "Winter
Blues" sufferers tend to show two common patterns in their sleep phase: Delayed
For most patients, light therapy is the most natural and safe treatment for SAD,
as well as the most cost-effective.