Seasonal Affective Disorder

Depression, Featured Article, Mental Health & Sleep Center
on December 13, 2011
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SAD. Even the acronym for Seasonal Affective Disorder evokes a deep winter funk. But SAD is more than just a case of the blues.

What differentiates SAD from other forms of depression—or just the winter blues—is the link to the season’s shorter days. When winter approaches and the amount of daylight decreases, people who suffer from SAD feel withdrawn, listless and depressed to the point where they cannot function normally. Their energy levels drop off, their interpersonal relationships begin to suffer and even productivity at work or school declines.

Because SAD symptoms can mimic symptoms of other medical conditions, the Society for Light Treatment and Biological Rhythms (SLTBR) recommends getting a professional diagnosis if you suspect you have SAD. About six percent of the U.S. adult population is affected by this depressive disorder with its hallmark seasonal pattern. Women are at greater risk for suffering from SAD than men, as are people with a history of depression.

“As society gets faster and we (use) more technology, we stay inside more, and lots of people are not exposed to natural sunlight as much,” says Cynthia Kent, an integrative psychologist with the Raby Institute for Integrative Medicine in Chicago.

The good news is that there are a variety of treatments—from light therapy to mind-body techniques to prescription drugs—that offer relief to SAD sufferers.

Many experts believe light therapy is the gold standard for treating SAD, including Dr. Alfred Lewy, professor of psychiatry at the Oregon Health and Science University School of Medicine, who specializes in circadian rhythm disorders and depression. “It works on the core trigger,” he says, a delay in the body’s circadian rhythm.

Light therapy simply involves sitting in front of a light box with fluorescent bulbs and a plastic or plexiglass screen first thing each morning. “The higher intensity it is, the less amount of time you have to spend in front of it,” Kent says. For instance, if you have a 10,000 lux model light box, which costs around $150, you only have to sit in front of it for about 30 minutes at a time.

Morning light exposure shifts the body’s rhythm, a phenomenon called phase advancement—something like a jumpstart for your body clock. “If you try it, you should notice a result within five days,” says Dr. Robert Hedaya, a psychiatrist who worked on early light therapy research with the National Institutes of Health.

RELATED: Don't Be SAD

At that point, if the light therapy is not working, it may be time to increase the amount of time or the intensity of the light. Some people need to start out with an hour or more per day. And Lewy suggests switching to evening if morning therapy doesn’t seem to be working.

But if, after making adjustments, light therapy is still not working for you, there are other options. In fact, according to the National Institute of Mental Health, nearly half of people who have SAD don’t respond to light therapy alone. And the SLTBR has found that some patients do well with a combination of light therapy and drug treatment with antidepressants.  For years, there were no drugs specifically designed for the treatment of seasonal affective disorder (SAD). Some clinicians prescribed antidepressants such as paroxetine (Paxil), sertraline (Zoloft), venlafaxine (Effexor) and fluoxetine (Prozac, Sarafem), but in 2006 the U.S. Food and Drug Administration approved the antidepressant bupropion XL (Wellbutrin) for people who have recurrent episodes of SAD from year to year.  

Melatonin is another possible treatment for SAD sufferers. A few years ago, Lewy worked on a research project that found that low doses of melatonin given in the afternoon can trick the body’s clock, functioning in a similar way to morning light exposure.

Although not specifically as a treatment for SAD, Kent often advises patients to keep their mind sharp as a way of feeling better in general during the winter months. She recommends brain games and memory games to help people improve their concentration and feel less sluggish. Aromatherapy might also help, she added.

But the easiest treatment of all, with no side effects?

“The simplest thing to do is go out and get sunlight exposure as soon as you get up in the morning,” Lewy said.