Winter Blue or a Deeper SAD?

The angles and tones of light are different.  There are ribbons of crispness in the air.  The landscape is dry and colors are draining.  I see it. I feel it. It is autumn.

Many traditions and cultures mark this season as a time of reaping, quiet, reflection, contemplation, and rest. Like other species, our bodies change as well, going through a seasonal shift in our sleep patterns, appetite and energy.  There is evidence that we experience a decrease in optimism and risk-taking, a shift that has been tracked in stock market data.

While a general quieting is common, for some this change can become distressing especially if one has a tendency toward negativity and obsessive thought patterns.  The result can be the unhappy mood and lethargy known as the “winter blues”.  For others, the blues may actually meet criteria for a variant of clinical depression known as seasonal affective disorder or SAD.

SAD symptoms must occur at least two years in a row. Typically, SAD starts in the fall and continues through the winter lifting in the spring and summer.  Symptoms include:

  • Sadness most days,
  • Hopelessness,
  • Anxiety,
  • Depressed energy and interest,
  • Feeling heavy and “leadened,”
  • Social withdrawal,
  • Difficulty concentrating,
  • Oversleeping,
  • Appetite changes especially craving carbohydrates, and
  • Weight gain.

SAD varies by latitude with rates varying from 0.4%- 2.6% in the general population and climbing towards 10% at higher latitudes. Milder “winter blues” have been estimated as high as 25% of the population in extreme latitudes. Research also indicates that there can be a seasonal worsening of symptoms for adults and children with other diagnoses including depression, bipolar diagnoses, substance abuse problems and dementia.

The causes of SAD are not completely understood.  Since rates are quite low in Iceland, despite the high latitude, there is the possibility of a genetic component.  Another theory is based on the winter drop in serotonin levels. Serotonin is a neurotransmitter that affects mood and appetite regulation. Deficient serotonin is implicated in depression.  Others claim that the changes in natural light disrupt the balance of melatonin, a hormone that affects sleep and mood. It might be that the reduction in light disrupts the internal clock, your circadian rhythms, affecting sleep and wake cycles.  Chronic disrupted sleep is known to adversely affect mood.

SAD treatment depends on severity.  If symptoms are not significant consider exercising regularly, getting outside in the natural light, exposing yourself to bright lights indoors, socializing, and practicing stress management. However, if symptoms are causing significant distress and dysfunction in your life, or if you are turning to alcohol or drugs to regularly manage your moods, it is time to see a doctor.   First you want to eliminate any other causes for mood and energy changes.  Then your medical professional will help determined if you meet the criteria for SAD.  Treatments at this time are quite standardized.

Light Therapy – This is considered the first line of treatment.  It provides mood relief for 50% to 80% of sufferers.  The great benefit of this therapy is that it starts working in 2-4 days and has few side effects.  The disadvantage is the inconvenience.  Light therapy requires a specialized light and daily sessions of 30 minutes or more. This must be continued throughout the winter as rapid relapse occurs if you stop treatment.

Medications – Given the link with deficient serotonin, the next most common treatment is the class of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). These medications lead to the same remission rates as light therapy. The advantage is the convenience of taking a medication once a day.  The disadvantage is that it may take 4-6 weeks to realize benefits and there may side effects.  Nevertheless, this is a very common and generally safe treatment.  By beginning them before the seasonal onset of symptoms, these medications can be used as a preventative.

Alternative Medications and Therapies – There are herbal remedies and supplements that are commonly used for depression.  A naturopathic doctor can help with these types of treatments.  While not a conclusive list, these could include St. John’s Wort, SAMe, melatonin (appropriately timed) and other supplements.  Acupuncture may also be helpful in the treatment of SAD.

Counseling Therapy – While many counseling therapies may work, the scientific research is focused on cognitive behavioral therapy (CBT) for the treatment of SAD.  CBT helps people understand how their minds create thoughts that can undermine them and create negative mood patterns.  Individuals learn to monitor thoughts, reframe them, and take responsibility for choosing their behaviors. Across many SAD studies, CBT has the same remission rates as light therapy and antidepressants.  In addition, one study that reevaluated participants a year later found that relapse rates were 7% of those who received only CBT, 37% of those who received only light therapy, and 5.5% of those who received both CBT and light therapy.  That is, CBT appears to have lasting effects.  The disadvantage is that it does require an initial investment in therapy and a commitment to using the techniques to change thought patterns.

BIBLIOGRAPHY

Lam, R.W. et al, “The Can-SAD Study: A Randomized Controlled Trial of the Effectiveness of Light Therapy and Fluoxetine in Patients with Winter Seasonal Affective Disorder,” The American Journal of Psychiatry, May 1, 2006; 163: 805-812.

Mayo Clinic Staff, “Seasonal Affective Disorder (SAD),  September 2011. Retrieved September 12, 2012: www.mayoclinic.com/health/seasonal-affective-disorder/DS00195.

Peiser, B., “Seasonal affective Disorder and exercise treatment: a review,” Biological Rhythem Research, February 2009, Vol. 40:1: 85-9

Rohan KJ. Coping with the seasons: A cognitive-behavioral approach to seasonal affective disorder, therapist guid, New York: Oxford University Press; 2009.

University of Rochester Medical Center (2007, January 25) “Getting SAD is More than Having the Blues,” ScienceDaily. Retrieved September 12, 2012: www.sciencedaily.com/releases/2007/01/070124143805.htm.

University of Toronto, Rotman School of Management (2011, October 11). “Fall market jitters a SAD thing: Less daylight in fall may lead to depressed markets,” ScienceDaily. Retrieved September 12, 2012: www.sciencedaily.com/releases/2011/10/111011132058.htm.

Westrin, A. and Lam, R. “Long-Term and Preventative Treatment for Seasonal Affective Disorder,” CNS Drugs, 2007, vol. 21:11: 901-909