Seasonal Affective Disorder

If you notice periods of depression that seem to accompany seasonal changes during the year, you may suffer from seasonal affective disorder (SAD). This condition is characterized by recurrent episodes of depression “ usually in late fall and winter “ alternating with periods of normal or high mood the rest of the year.

Most people with SAD are women whose illness typically begins in their twenties, although men also report SAD of similar severity and have increasingly sought treatment. SAD can also occur in children and adolescents, in which case the syndrome is first suspected by parents and teachers. Many people with SAD report at least one close relative with a psychiatric condition, most frequently a severe depressive disorder (55 percent) or alcohol abuse (34 percent).

What are the patterns of SAD?

Symptoms of winter SAD usually begin in October or November and subside in March or April. Some patients begin to slump as early as August, while others remain well until January. Regardless of the time of onset, most patients don™t feel fully back to normal until early May. Depressions are usually mild to moderate, but they can be severe. Very few patients with SAD have required hospitalization, and even fewer have been treated with electroconvulsive therapy.

The usual characteristics of recurrent winter depression include oversleeping, daytime fatigue, carbohydrate craving and weight gain, although a patient does not necessarily show these symptoms. Additionally, there are the usual features of depression, especially decreased sexual interest, lethargy, hopelessness, suicidal thoughts, lack of interest in normal activities, and social withdrawal.

Light therapy, described below, is now considered the first-line treatment intervention, and if properly dosed can produce relief within days. Antidepressants may also help, and if necessary can be used in conjunction with light.

In about 1/10th of cases, annual relapse occurs in the summer rather than winter, possibly in response to high heat and humidity. During that period, the depression is more likely to be characterized by insomnia, decreased appetite, weight loss, and agitation or anxiety. Patients with such "reverse SAD" often find relief with summer trips to cooler climates in the north. Generally, normal air conditioning is not sufficient to relieve this depression, and an antidepressant may be needed.

In still fewer cases, a patient may experience both winter and summer depressions, while feeling fine each fall and spring, around the equinoxes.

The most common characteristic of people with winter SAD is their reaction to changes in environmental light. Patients living at different latitudes note that their winter depressions are longer and more profound the farther north they live. Patients with SAD also report that their depression worsens or reappears whenever the weather is overcast at any time of the year, or if their indoor lighting is decreased.

SAD is often misdiagnosed as hypothyroidism, hypoglycemia, infectious mononucleosis, and other viral infections.

How is winter SAD treated with light?

Bright white fluorescent light has been shown to reverse the winter depressive symptoms of SAD. Early studies used expensive "full-spectrum" bulbs, but these are not especially advantageous. Bulbs with color temperatures between 3000 and 6500 degrees Kelvin all have been shown to be effective. The lower color temperatures produce "softer" white light with less visual glare, while the higher color temperatures produce a "colder" skylight hue. The lamps are encased in a box with a diffusing lens, which also filters out ultraviolet radiation. The box sits on a tabletop, preferably on a stand that raises it to eye level and above. Such an arrangement further reduces glare sensations at high intensity, and preferentially illuminates the lower half of the retina, which is rich in photoreceptors that are thought to mediate the antidepressant response. Studies show between 50% and 80% of users showing essentially complete remission of symptoms, although the treatment needs to continue throughout the difficult season in order to maintain this benefit.

There are three major dosing dimensions of light therapy, and optimum effect requires that the dose be individualized, just as for medications.

Light intensity. The treatment uses an artificial equivalent of early morning full daylight (2500 to 10,000 lux), higher than projected by normal home light fixtures (50 to 300 lux). A light box should be capable of delivering 10,000 lux at eye level, which allows downward adjustments if necessary.
Light duration. Daily sessions of 20 to 60 minutes may be needed. Since light intensity and duration interact, longer sessions will be needed at lower intensities. At 10,000 lux “ the current standard “ 30-minute sessions are most typical.
Time of Day of exposure. The antidepressant effect, many investigators think, is mediated by light™s action on the internal circadian rhythm clock. Most patients with winter depression benefit by resetting this clock earlier, which is achieved specifically with morning light exposure. Since different people have different clock phases (early types, neutral types, late types), the optimum time of light exposure can differ greatly. The Center for Environmental Therapeutics, a professional nonprofit agency, offers an on-line questionnaire on its website, www.cet.org, which can be used to calculate a recommended treatment time individually, which is then adjusted depending on response. Long sleepers may need to wake up earlier for best effect, while short sleepers can maintain their habitual sleep-wake schedule.
Side effects of light therapy are uncommon. Some patients complain of irritability, eyestrain, headaches, or nausea. Those who have histories of hypomania in spring or summer are at risk for switching states under light therapy, in which case light dose needs to be reduced. There is no evidence for long-term adverse effects, however, and disturbances experienced during the first few exposures often disappear spontaneously. As an important precaution, patients with Bipolar I disorder “ who are at risk for switching into full-blown manic episodes “ need to be on a mood-stabilizing drug while using light therapy.

What should I do if I think I have SAD?

If your symptoms are mild “ that is, if they don't interfere too much with your daily living, you may want to try light therapy as described above or experiment with adjusting the light in your surroundings with bright lamps and scheduling more time outdoors in winter.

If your depressive symptoms are severe enough to significantly affect your daily living, consult a mental health professional qualified to treat SAD. He or she can help you find the most appropriate treatment for you. To help you decide whether a clinical consultation is necessary, you can use the feedback on the Personalized Inventory for Depression and SAD at www.cet.org.



Reviewed by Michael Terman, Ph.D., Director, Winter Depression Program, New York State Psychiatric Institute

at Columbia University Medical Center. New York City (February, 2004).

 NAMI

Holiday Depression & Stress
The holiday season is a time full of joy, cheer, parties, and family gatherings. However, for many people, it is a time of self-evaluation, loneliness, reflection on past failures, and anxiety about an uncertain future.

 fact sheet index


What Causes Holiday Blues?
Many factors can cause the œholiday blues?: stress, fatigue, unrealistic expectations, over-commercialization, financial constraints, and the inability to be with one™s family and friends. The demands of shopping, parties, family reunions, and house guests also contribute to feelings of tension. People who do not become depressed may develop other stress responses, such as: headaches, excessive drinking, over-eating, and difficulty sleeping. Even more people experience post-holiday let down after January 1. This can result from disappointments during the preceding months compounded with the excess fatigue and stress.
Coping with Stress and Depression During the Holidays

Keep expectations for the holiday season manageable. Try to set realistic goals for yourself. Pace yourself. Organize your time. Make a list and prioritize the important activities. Be realistic about what you can and cannot do. Do not put entire focus on just one day (i.e., Thanksgiving Day) remember it is a season of holiday sentiment and activities can be spread out (time-wise) to lessen stress and increase enjoyment.
Remember the holiday season does not banish reasons for feeling sad or lonely; there is room for these feelings to be present, even if the person chooses not to express them.
Leave œyesteryear? in the past and look toward the future. Life brings changes. Each season is different and can be enjoyed in its own way. Don™t set yourself up in comparing today with the œgood ol™ days.?
Do something for someone else. Try volunteering some time to help others.
Enjoy activities that are free, such as driving around to look at holiday decorations; going window shopping without buying; making a snowperson with children.
Be aware that excessive drinking will only increase your feelings of depression.
Try something new. Celebrate the holidays in a new way.
Spend time with supportive and caring people. Reach out and make new friends or contact someone you have not heard from for awhile.
Save time for yourself! Recharge your batteries! Let others share responsibility of activities.
Can Environment Be a Factor?
Recent studies show that some people suffer from seasonal affective disorder (SAD) which results from fewer hours of sunlight as the days grow shorter during the winter months. Phototherapy, a treatment involving a few hours of exposure to intense light, is effective in relieving depressive symptoms in patients with SAD.

Other studies on the benefits of phototherapy found that exposure to early morning sunlight was effective in relieving seasonal depression. Recent findings, however, suggest that patients respond equally well to phototherapy whether it is scheduled in the early afternoon. This has practical applications for antidepressant treatment since it allows the use of phototherapy in the workplace as well as the home.

For More Information:
Contact you local Mental Health Association, community mental health center, or:

National Mental Health Association
2001 N. Beauregard Street, 12th Floor
Alexandria, VA 22311
Phone 703/684-7722
Fax 703/684-5968
Mental Health Resource Center 800/969-NMHA
TTY Line 800/433-5959

It's that time of year again.

I hope everyone is doing as well as can be.

I, for one, started my meds a week and a half ago. Knowing it's time and takin' care of business is the best thing for yourself!

Every year I think I will avoid SAD. This year, right up to about a few days ago, I thought I had it beaten but here it is again. I wrote elsewhere that this thing is insidious. It sneaks up on you slowly, starting in early fall when you still feel pretty good. It dogs you for a while, then it pounces. Before you realise it, you are eating cheap carbs, not just eating them, but craving them. The you feel yourself slowing down. You don't realise how much until you see that it is getting harder and harder to keep up at work, like I am doing now. I used to get a "second wind" after lunch but now all I get is depressed because I wonder where all this work is coming from, and why am I dealing with it when I am so exhausted. I also feel bad because I don't seem to have anything to say, even here when just recently I made replies to any post I could identify with. I just feel like I am losing bits and pieces of myself along the road of life. I know eventually I will have to tell my med nurse and all I will get for my trouble is another upping of my medication. This is one of my reasons I don't tie myself down to anything lengthy because it will go by the wayside too. It is at it's absolute worst around Christmas and New Year's. As soon as I can see the days lengthening, I begin to perk up a little and take a good long look at myself and see what the last 3 or 4 months have done to me. I am horrified that I get myself go so much. I might even consider a diet or something. Anyway, my bits and pieces come back and I become a whole person again..until next time. My med nurse mentioned a light box but they are expensive and the insurance won't help any. Even on EBay there are no bargains. Around here there doesn't seem to be anywhere that will rent one out. My AD's don't help, even when the dosage is raised. The only thing that helps is the return of the sun after the holidays....I'm sorry folks I'm going down for the count again

I've never been diagnosed with SAD but I know that I suffer from it. My pyschiatrist suggested doing that light therapy, so I guess they suspect that I have it. I can feel my heart sink every time the temperature drops and dread the holiday season coming up. Working night shift makes it 10 times worse. I feel like a vampire. I don't even want to see the sun anymore because it isn't the same sun of the Spring and Summer. Fall and Winter to me represent the death of everything pretty in the world. Spring is like being reborn again.

This post has been edited by pamschae: Oct 20 2006, 01:21 AM

I know exactly what you mean about the sun not being right. It casts the wrong color over the roads, the color and shadows just aren't right......It isn't in the sky in the right place, just kind of slops over the world instead of being high up there and shinning brightly. Even if the color and height are all wrong, I'm still a LOT happier on a sunny winter day.......

And if I can't lay off these chocolate hostess cupcakes that we eat to celebrate birthdays(lots of fall birthdays), I'm going to gain a ton. Already up one pound just from them......The idea was to eat ONE, not bake a big cake, but just have one cupcake, not eat the whole box and buy more and more. The rest of the year, I am a health food fanatic, eating mostly organic fresh fruits and veggies, lots of fish, grass fed organic chicken and beef, not touching much of anything processed, especially with hydrogenated oils.....sigh.....

Haven't used my light box which usually controls the cravings because I work odd hours, often getting a phone call to go to work at 5:45, be at work at 6:30, so no time for the lightbox.....besides my sleeping hubby would not appreciate me turning it on...suppose I could move the light box out of the bedroom.....but it's tooo much of an effort.......

Haven't exercised since the big bike ride........that was the last week of July......

Does anyone have any more information about what SAD looks like in children? My son is having a particularly difficult time at school right now (it is late October and we are approaching the time change). His teacher has suggested that this might be part of why he's having difficulty coping with situations at school that were not bothering him just a few weeks ago. I would appreciate any feedback/comments/links to other articles that might be helpful for me and my son's teacher. Thanks.

ok i need to post a new topic but i have to post 5 posts before i can but none of the topics are what im looking for so what am i to do but post and ask where i can post being a new member and not knowing where this special topic where i can post before i make i first 5 is

sorry but i gotta post 5. so hey im Jaymz im 17 and i am bipolar and i also have s.a.d(social anxiety disorder)

sorry dont ban me i just dont know im new here what do you expect

........

. . . . sorry again but thanx for not telling me where im supose to go to post before i am allowed, i did what i had to do

WOW, i think thats me pretty much in a nutshell (no pun intended). The last 4 weeks here have been grey and or rainy and its effected me greatly. I tried wide spectrum bulbs to no avail. It seems like the shorter the days get the more suseptable to serious bouts of depression I get. I thought I was the only person to have something like this effect me. Very nice leading articles.