Focus On Health
SAD -- Seasonal Affective Disorder

Light at the End of the Tunnel:
   Help for Seasonal Affective Disorder
    by Laura Wisniewski

For many, the long nights of late Fall and Winter can mean curling up in front of a warm fire or taking an exhilarating nighttime walk or ski-run. But to almost 10% of Americans, the shorter days bring a darker mood…a depression called Seasonal Affective Disorder.

Symptoms: Seasonal Affective Disorder (SAD) normally affects people in the Fall and Winter and subsides in the Spring and Summer months. This type of depression can vary in intensity, from mild to severe, and is accompanied by a variety of symptoms. Normally, the symptoms of SAD include an apathetic mood, irritability, withdrawal from social interaction, fatigue, and increased sleep (sometimes by as much as 4 hours), as well as a strong carbohydrate craving with subsequent weight gain. For someone struggling with SAD, the same tasks that seemed manageable last Summer can become overwhelming as Winter approaches. People with SAD may also experience significant concentration or memory difficulties. 

Dr. Scott Waterman, Associate Professor of Psychiatry at the University of Vermont points out that SAD is an atypical depression.  The increased sleep and weight gain are similar to hibernation.  According to Waterman, it’s important to remember that seasonal depression is “by no means the most common pattern of recurrent mood disorder.  Most people have depressions come and go without clear reference to time of year.”  Waterman notes that the symptoms of depression must be sustained day after day and get progressively worse as the days shorten for SAD to be considered an accurate diagnosis.  “Plus, there must be some degree of impairment," he adds.  "You’re less able to do what you usually do.”

Although onset is generally between 20-40 years old, children and teenagers also suffer from SAD. They may not show a depressed mood, but instead act irritable, apathetic and withdrawn, struggling to get up in the morning. This is so widely thought to be the m.o. of a typical adolescent, that many teenagers with SAD go undiagnosed and, therefore, untreated. Yet researchers for the National Institute of Mental Health project that it may affect 3-4% of school aged children and recommend early intervention in childhood cases of SAD.

"You don’t feel sad," says Sam, a sophomore at CVU High School. "You’re just not up to your fullest." He continued, "You can’t go as far as normal. You’re in a general bad mood. It’s hard because you have to have a good attitude to make it through a day of school." After years of struggling through the winter, Sam realized that he was experiencing Seasonal Affective Disorder only last year. "My mom suggested I might have it since other people in my family do," he explained. According to the research, SAD does tend to be hereditary.

Treatment: Until the pioneering research of Dr. Norman Rosenthal in the 1980’s, Seasonal Affective Disorder wasn’t recognized as a condition. Here in Vermont, people suffering from SAD simply gritted their teeth and suffered through the long, dark winter. Now they can address the disorder.

Light therapy is emerging as one important treatment for this condition. Numerous studies have shown many people respond to daily use of a light box, a special full-spectrum, high intensity light. Lorilee Schoenbeck, N.D , a naturopathic physician with practices in Middlebury and Shelburne., finds that "wattage, rather than full spectrum" is important. She has her SAD patients put lights in any dark corners in their homes and increase the wattage of those lights. Research is also looking at dawn simulators, which gradually increase artificial light intensity in the early morning hours. Negative ion therapy has also had some good results.  Waterman suggests that light therapy may be most effective when used in the morning. There may also be some evidence that light therapy works on other types of depression as well

Schoenbeck has found the herb St. John’s Wort to be very successful for SAD. It has very few side effects and its primary side effect—light sensitivity—is not an issue in the winter. There are stronger anti-depressant drugs available including 5HTP and serotonin re-uptake inhibitors. "These drugs are great when they’re necessary, but should only be used under the supervision of a licensed provider," says Schoenbeck, who adds "and they’re not the first step in treatment."

Both Schoenbeck and Kris Karge, MSW, a psychotherapist and Hinesburg resident, stress the importance of diagnosing and treating Seasonal Affective Disorder early, even before the clocks turn back in late October. "People should acknowledge their symptoms and seek help if they need it," recommends Karge, who works with adults and adolescents. "People stop exercising and stop doing in the winter. But there are things you can do for yourself." She emphasizes the need for exercise (which increases mood-elevating endorphins) and the importance of going outdoors for at least a little while every day. Karge also recommends psychotherapy in addition to self-help approaches.

"there's no reason to think that the therapies which treat other types of mood disorder won't be successful with this," says Waterman.  For him, these include anti-depressant medication and psychotherapy, particulary cognitive behavioral therapy and interpersonal psychotherapy.

Common recommendations also include the suggestion that people with SAD not take on extra stresses during the winter months. That may seem as unrealistic as wintering in Tahiti to people dealing with the extra demands of winter holidays, shoveling snow and paying heating bills. People with SAD may be able to modify their response to stress, though. Mind-body approaches like Yoga, Tai Ch’i and meditation can often help change the physiological and psychological responses to unavoidable stress.

Typically, people with SAD crave carbohydrates in the late Fall and Winter. Carbohydrates increase serotonin levels in the brain and adequate serotonin is necessary for a stable mood. But people with SAD can gain as much as 20 pounds in the winter while excess carbohydrates can upset blood sugar balance and prevent adequate intake of other nutrients. Schoenbeck emphasizes the need for protein. Karge stresses as many fresh fruits and vegetables as possible. B-complex vitamins are critical for mood, but as Schoenbeck states, "no vitamin or mineral is going to cure Seasonal Affective Disorder.

"Whether it's a seasonal pattern or not, if you have a problem enjoying life ... or just getting through life, it's important to seek an evaluation," says Dr. Waterman.  "If people paid as much attention to the overall topic and problem of mood disorder as they do to Seasonal Affective Disorder, we might all be better off," he emphasizes. He also points out that the peak month for suicides is not November or December, but May.

And what about Sam?

Sam feels it’s helped to know he has SAD.  He says he never would have thought about trying to get more light. He adds, "It’s nice to know it’s not some deep emotional problem … knowing that it doesn’t have anything to do with something you’re doing wrong."

Sam’s message to others with SAD? "Winter’s not that long of a season," he said.  For those suffering from SAD, it's something that's probably good to remember as we approach the shortest day of the year.

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Lou Colasanti, Editor & Laura Wisniewski, Associate Editor
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