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 months)

 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 or Advanced.

For most patients, light therapy is the most natural and safe treatment for SAD, as well as the most cost-effective.

Disclaimer: Information contained on this site should not be construed as medical advice. Product statements have not been evaluated by the U.S. Food and Drug administration. The products we offer are not intended to diagnose, treat, cure, or prevent any disease. If you have a medical condition, consult your health care practitioner.

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since 1995
Seasonal Affective Disorder (S.A.D.)
since 1995
Seasonal Affective Disorder (S.A.D.)