Seasonal Affective Disorder (SAD)
By M. J. Galceran, M. D.

Seasonal affective disorder is a depressive disorder occurring mainly during the winter months of December to February. It affects about 6% of the population with many more experiencing "winter blues". Although the exact cause is not clear, researchers feel the cause is related to seasonal variations in sunlight. This in turn, affects the levels of the light sensitive hormone melatonin. Other factors may include changes in body temperature and sleep patterns. Our internal clocks or circadian rhythm shifts with the change in the seasons. Our biological clocks are then out of step with our daily schedules. The changes in mood are not necessarily related to other obvious stresses. SAD tends to recur at around the same time every year, and resolve by the spring or summer. It is much more common in women and younger adults, and naturally is more prevalent in the northern latitudes. Some people who work long hours in building with few or no windows may experience similar symptoms.

Symptoms are those of depression: despair, anxiety, irritability, avoiding company, loss of feeling, loss of libido, lethargy, less creative or productive, and loss of motivation. Sleep disturbances, particularly oversleeping without feeling refreshed, and overeating with carbohydrate cravings are especially seen. Physical symptoms can also include joint aches and stomach problems. Some people experience a burst of energy and creativity as the winter months pass. If you experience two or more of these symptoms, for two or more years, you may be affected by SAD.

Treatment for SAD has typically centered on the use of light boxes. These are especially filtered fluorescent lights, used for 1 to 2 hours per day. Patients have responded very well to this therapy, with few side effects. Possible side effects include eyestrain, headache, fatigue and inability to sleep if the light is used late in the day. Recent research has found that an hour’s walk in winter sunlight was as effective and provided more therapeutic light than a light box. Although not proven, some researchers feel there is a connection with melatonin, the light sensitive hormone, which is increased during the winter months and reduced with light exposure and summer months. Tanning beds should not be used, as they are high in ultraviolet rays, which are harmful to the eyes and skin.

If photo therapy does not work, then antidepressant drugs, such as the newer class of SSRI’s (Paxil, Zoloft, Lexapro, and others), may prove effective in reducing or eliminating symptoms. Some people may need a combination of both therapies. Research has also shown that psychotherapy helps by itself or in conjunction with these other modalities.

Other suggestions for coping with SAD include educating yourself and family members concerning this disorder. Exercise regularly, preferably outdoors, or if indoors, near a window. Get as much natural light as possible; rearrange your work and home space to take advantage of windows, open up shades and drapes, arrange social outing to the outdoors. Maintain the same daily pattern of awakening and going to sleep. Dress to conserve energy and warmth. Install brighter light bulbs. Put your bedroom lights on a timer to come on ½ hour before awakening.

Before embarking on any treatment, it is important to have a full evaluation with your family physician or mental health professional. It is important to exclude other illnesses or problems, which could mimic depression. Discuss treatment options and goals of treatment with your physician.