Friday, December 09, 2016

Update on Seasonal Affective Disorder

Written by  Dr. Eva Hersh, MD

Dear Dr. Eva,

Every year, I have a big loss of energy and I want to sleep and eat more as the days get shorter. It starts in October or November. After the time change, with sunset at 5 and earlier, it gets harder and harder to get out of bed. I don’t want to deal with people even in minor normal day-to-day interactions. At work, I’m struggling to keep up even with routine stuff. A lot of people I know also seem to be feeling bad and are commenting on the shorter days. Other than migrate South for the winter, which is way beyond me financially, what can people like me who are affected by the short days do to keep our moods from falling in the fall?

Feel like Hibernating

Dear Bear,

People with your symptoms often have Seasonal Affective Disorder (SAD), a type of depression that is triggered by decreasing day length. One in every five people has some degree of SAD. It occurs in both men and women, but is more common in women.

Each person who suffers from SAD has their own personal pattern of symptoms and timing of when the symptoms start and end. Each person’s pattern repeats in a similar way every year. Most people with SAD notice feeling overly tired and low mood starting in October or November, although for some it can start as early as August or as late as December. Most people with SAD start to feel better by March or April.

SAD often is part of chronic depression: that is, a person who has some degree of depression year-round becomes more depressed and generally “slowed down” during late fall and winter. Often, though, people with SAD have no bothersome symptoms and are not aware of having depression the rest of the year. Some SAD symptoms are common in depression: low energy, decreased ability to concentrate, sad feelings, and irritability. In other ways, SAD is different from other forms of depression and is, as you said, more like hibernation: just like bears preparing for a long winter sleep, people with SAD crave carbohydrates, sleep more, and move around less. SAD can lead to more serious symptoms of depression, such as withdrawal from others, feelings of hopelessness, and loss of enjoyment in favorite activities.

Light therapy is the most recognized treatment for SAD. This does not mean turning on all the lights in the house, although that can help somewhat. Light therapy means treatment with a light source that produces 10,000 lumens. That is much more light than household lighting can produce. Fluorescent bulbs produce far more light per watt than incandescent bulbs. 10,000 lumens is the quantity of light produced by four four-foot long 40-watt fluorescent bulbs. A 10,000 lumen light source about the size of a small computer screen, containing 4 small, very high-intensity small fluorescent bulbs, can be bought in stores or online for less than $150-$200. As a low cost alternative, you also can buy two $20 shop lights and stand them up vertically against a wall for an equal although much less portable effect. Light therapy is simple: place the light source on a table and sit facing the light, about an arm’s length away, for at least 30 minutes each morning, as early as you can. Don’t stare into the light; that can damage the eyes. You can, for example, have breakfast and/or read or work on a laptop. Research has not shown any benefit from light therapy done later than noon.

If you are struggling with alertness in the mornings, start out by getting out of bed, doing light therapy, then going back to bed. That is just as effective as if you stayed up. Within two weeks you should improve enough that you may not need to go back to bed. Morning light treatment gives the brain the message that the day length is over 12 hours. This re-sets day length sensors in the hypothalamus, deep in the brain, to counteract SAD. It’s the intensity of light, not the spectrum, which is the key to treatment. Full-spectrum bulbs do not work any better than fluorescents.

There are other, easier forms of light therapy. It can be surprisingly helpful just to leave the bedroom window curtains or blinds open to make sure you get the benefit of the first light of each day. Some people find it helpful to use a “dawn” alarm clock. These clocks have light sources which light up with gradually increasing intensity. They can be a little complex to set, because you must experiment with different times for the light to start to wake you at the time you want. Getting outdoors and walking for 20 minutes between 11 and 2, the brightest part of the day, is helpful for most people who try it. Sunglasses should be avoided.

Recent research has shown that cognitive therapy and antidepressant medicine both can be as effective as light therapy, but are not any more effective than light therapy.

Because SAD and the Thanksgiving / Christmas / New Years holidays occur at the same time of year, SAD can be confused with “holiday blues,” but the two conditions are not related. A person with holiday blues has unhappy or conflicted feelings, or painful memories, about the holidays, and SAD sufferers do not. In holiday blues, there are no hibernation-like symptoms.

Managing Winter Depression/S.A.D.

  • Physical and emotional warmth and comfort are important: stay warm, wear soft comfortable clothes, get massages, and hug your friends often.
  • Light therapy: sit in front of a 10,000 lumen light box (an arm’s length away) for at least 30 continuous minutes every day as early as you can, but definitely before noon.
  • Sleep: It’s helpful to get 30-60 minutes more sleep a night than you need in summer, but sleeping more than that can worsen the problem.
  • Be careful about giving in to food cravings-gaining weight may make you feel worse.
  • Activity: Cut yourself some slack. Don’t take on extra projects now. Do less where you can do so without negative consequences.
  • Decrease your work week: during the shortest days in Dec/Jan/Feb, take a day off from work every week or two. This may help you more than taking a week off all at one time.
  • If SAD symptoms are still troublesome despite using these methods, discuss with your doctor whether you should try antidepressant medication and consider seeing a cognitive therapist for a few sessions to brainstorm about what else you can try to feel better.

Eva Hersh is a Baltimore family physician. Send your comments and questions to her by email at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .


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