by Patricia O. Quinn, M.D.
Everyone experiences "ups" and "downs" in their lives but when the "down" times last for more than a few weeks and you have difficulty functioning in your daily life, maybe something else is going on. Perhaps Seasonal Affective Disorder (S.A.D.) is affecting you.
S.A.D. is a condition of chronic depression in response to changes in environmental lighting and climate and should not be confused with "holidays blues" or the "winter blahs", which last only a short time and can be easily overcome with a change in routine or an exciting activity that can take your mind off of the situation. S.A.D. consists of recurrent depressions lasting several months each winter with periods of feeling better in the spring and summer months.
Most patients with S.A.D. are women (83%) whose onset of illness typically occurs in the second or third decade. Many of these women report a deterioration in mood with a reduction of environmental light for any reason -- a spell of cloudy weather even in the summer or a move to a poorly lit office. One woman was nicknamed "Lights" because she would always go around turning on all of the lights wherever she was.
In the 1980's several studies were done on people with S.A.D. Dr. Rosenthal and his coworkers at N.I.H. described a form of S.A.D. where fall / winter depressions alternate with non-depressed periods in the spring / summer. In the Washington, D.C. area, it was found that the depression usually begins in October or November and subsides in March or April. The depressive symptoms last an average of 5.1 months. This pattern will vary in more northern regions with depressive symptoms starting earlier and lasting longer.
Depression symptoms are frequently mild to moderate but some may be severe. These symptoms may not respond to antidepressants in the typical fashion. I recall one adolescent boy I saw that I thought had S.A.D. I arranged for a trial of light therapy for him. Four days later I received a call from his mother saying that her son was no better but that she was doing great! At that time she was under the care of a psychiatrist for depression and taking three different antidepressants without positive results. Within four days of light treatment she was feeling much better.
Other symptoms of S.A.D. include: oversleeping, overeating, craving carbohydrates in the fall and winter; a pattern of weight gain in the winter; and a loss of interest in work, sex, and social activities. Some women become irritable and over 50% report PMS mood changes which are worse in winter.
Criteria has been developed to formally establish a diagnosis of S.A.D. These include:
- At least one episode of major depression
- Recurrent fall / winter depressions at least two of which occur during successive years separated by non-depressed periods
- No other psychological or medical condition that can account for the symptoms and
- No other psychiatric illnesses
The treatment for S.A.D. is fairly simple. An increase in the amount of sunlight you are exposed to each day! In winter that means spending more time outdoors each day, migrating to a more southern location, increasing the amount of light by bright light therapy. Patients usually respond within 4 days of treatment and relapse within 4 days of stopping.
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