By J. Ron Eaker, M.D.

Virginia dragged herself into the office and slumped over in the chair. Her body language spoke volumes and her words reinforced that she was feeling poorly.

“I don’t get it.  I feel pretty normal, and then over about a week this time every year I feel like I am falling down a deep hole and can’t get out.  I sleep way more than normal, but never feel rested. I gain weight and just feel down all the time.  I’m really getting tired of being tired.”

Virginia wasn’t sad, she had SAD.

Seasonal Affective Disorder, or SAD, is a medically recognized subset of major depression that effects anywhere from 2 to 9% of the population.  It is characterized by seasonal (mostly winter) onset of depressive feelings, excessive sleeping, feelings of hopelessness and worthlessness, thoughts of suicide, loss of interest in activities, withdrawal from social interaction, appetite problems, difficulty with concentrating and making decisions, decreased sex drive and a lack of energy.

There has been a bit of controversy surrounding the diagnosis of SAD, as early on many doctors questioned whether it was a real entity or simply a manifestation of an underlying depression. Most experts now agree that it is indeed a distinct disorder but in the family of major depression characterized specifically by its episodic nature.  Most folks associate the mood changes with the winter months, but it can occur in other seasons, although much less frequently.  The key designation is a distinct change in symptoms with a change in temperature and/or light exposure (can you say Daylight Saving Time?).

There seems to be a difference in geographic occurrence with the lowest incidence in Florida (<1%) and the highest occurrence in Alaska (10%), and it also seems to affect women more than men.  Some Nordic countries like Finland have a higher incidence whereas Iceland strangely has one of the lowest rates.  Some speculate that their relative genetic isolation along with their heavy fish consumption protects the Icelanders from high rates of SAD.

Like most mood disorders, SAD exists across a spectrum.  There are some folks who notice some mild mood changes associated with the fall or winter, but not enough to disrupt their normal lifestyles. These milder variations can usually be dampened or extinguished by exercise and increased outdoor activity, particularly on sunny days, resulting in increased solar exposure. Many people are never actually diagnosed with any specific disorder but just step up their exercise almost intuitively to offset any mood changes.  Connections between human mood, as well as energy levels, and the seasons are well documented, even in healthy individuals. We  have long known that intensity of symptoms is key to a specific diagnosis.

Speaking of diagnosis, it is important to have a competent physician or psychologist evaluate you before labeling yourself.  This is critical as some symptoms of SAD are actually manifestations of bipolar disorder and other mental health issues that need to be properly diagnosed and addressed.  Not all episodic blues are SAD.

The good news is that there are effective treatments available to those correctly diagnosed.  As with most mental health issues, the first step towards successful treatment is properly identifying the problem and being open to treatment. Luckily, with the acceptance of SAD as a legitimate disorder, the stigma of being “crazy” or “weird” has lessoned and people should be more open to seeking treatment.  The benchmark of treatment is light therapy.  This approach uses a light box which emits far more lumens than a customary incandescent lamp.  A person generally sits a few feet from the light box for at least an hour a day.  The physiology behind this approach is related to a number of biochemical pathways that depend on light such as melatonin secretion by the pineal gland and serotonin production.  It’s important to know that using a light box is not simply some hocus-pocus placebo effect but actually produces measurable changes in the body of the participant.  Light therapy can also consist of exposure to sunlight, either by spending more time outside or using a computer-controlled heliostat to reflect sunlight into the windows of a home or office.

Some medications have also been proven to be helpful in treating SAD.  In particular, the family of medicines called the SSRIs (Prozac, Zoloft, etc) restore serotonin (a brain hormone) levels which seem to be affected in SAD. Another novel approach is negative air ionization, which involves releasing charged particles into the sleep environment.  It has been found effective with a 47.9% improvement if the negative ions are in sufficient quantity.  The reason for this effectiveness is less well understood, but again is tied into hormonal secretions needed to balance mood.

SAD is real and its variants are surprisingly common.  If you notice distinct changes in how you feel, especially in the winter months, talk to your doc.

This article appears in the December 2017/January 2018 issue of Augusta Family Magazine.
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