If you’re prone to patterns of wintertime depression, head off seasonal affective disorder (SAD) with preventive measures in late summer or early fall.
By John F. Greden, MD
Is SAD a real syndrome?
Make no mistake: seasonal affective disorder (SAD) is real. SAD is best understood as a cyclical, seasonal, circadian pattern that affects people with major depressive disorder or bipolar illness who have an underlying genetic vulnerability to diminishing sunlight.
In fact, the current diagnostic label is depression “with seasonal pattern,” but SAD is a more familiar reference.
Light absorbed through the eyes influences brain levels of serotonin and melatonin, which govern mood, sleep, and daily rhythms of alertness, energy, and appetite. As the seasons change and the days become shorter (and grayer), SAD symptoms begin to affect approximately five percent of the total population. In parts of the globe with little sunlight, as many as 20 percent may be affected.
SAD symptoms typically emerge around September or October in the northern hemisphere. Every several hundred miles further away from the equator translates to an earlier week of onset.
(There is also a less common pattern of summer SAD, where longer days and more intense sunlight bring mood and energy changes that ease off in the fall.)
People with SAD experience increased fatigue and a greater desire to sleep and eat. They crave carbohydrates, gain weight, often are irritable, and complain of heavy leaden feelings in the arms and legs. SAD might be described as “hibernation in humans.”
If I’m prone to SAD, what will help?
The best approach is to stay ahead of the game by taking preventive measures in early September—or even late August if symptoms have started to appear. For example:
KEEP SLEEP CONSISTENT. Follow a regular routine, going to bed and getting up at the same time even on weekends. It’s a good idea to keep a sleep diary so you can immediately detect when you start to “oversleep.”
INVESTIGATE ‘WAKEUP LIGHTS’ or clocks that simulate sunrise, brightening gradually over a half-hour or so to rouse you from sleep as if it were a summer morning.
INCREASE EXPOSURE to natural light throughout the fall and winter. Lift your bedroom shades first thing in the morning. Sit near windows or face them when inside. Get outside daily for exercise or another outdoor activity, and don’t wear sunglasses.
CONTINUE TREATMENT with any antidepressants or other psychiatric medications you’ve previously been prescribed, or discuss starting a course of antidepressants with your doctor. Cognitive behavioral therapy for SAD has also proven effective.
What about light therapy?
Light therapy for SAD improves symptoms in approximately two out of three cases. Combining light therapy with medication treatment and psychotherapy often has the best outcome.
Formal light therapy is administered by a 10,000-lux light box (lux being a measure of brightness). This light is at least 10 times stronger than normal light bulbs.
It’s a simple process: Sit in front of the light box so that the light is on your face, but don’t stare at it. Begin with 10 to 15 minutes daily, preferably in the morning, and gradually increase to 30 to 45 minutes. If there’s no improvement in symptoms after two or three weeks, light treatment can be stopped.
Some important considerations:
SIDE EFFECTS generally are minimal: headache, eyestrain, and difficulty sleeping if used late in the day. If you are taking medications that increase your sensitivity to light or are at high risk for eye conditions such as macular degeneration, proceed only with your doctor’s OK.
COST OF LIGHT BOXES can range from $100 to $400, depending on the product. Look for devices that emit “white light” (rather than “blue light”) and filter out damaging UV light.
NEVER USE homemade light units, tanning lights or beds, or light boxes designed for skin conditions, as they are high in UV rays.
Printed as “Ask The Doctor: Act Now To Avert SAD”, Summer 2017
via Esperanza – Hope To Cope
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