Winter Blues

sad-young-ladySeasonal Affective Disorder (SAD), also called or referred to as "Winter Blues" and "Hibernation Reaction," is a type of depression that commonly begins and ends, recurs, during the same time yearly for those who are affected by the symptoms. There is a tendency for the symptoms to occur as the days shorten and the sun light lessens, which means that people begin to suffer starting the beginning of the fall and ending in the spring or early summer.

Description of SAD

Seasonal Affective Disorder (SAD) is a type of depression that commonly begins and ends or recurs, during the same time of year for those who are affected by the symptoms. There is a tendency for it to become more intense as the days shorten and the sun light lessens during the beginning of the fall and it usually last into the spring or early summer. SAD has not been officially recognized as a diagnosis in spite of the many who suffer with the symptoms. It is also called or referred to as "Winter Blues" and "Hibernation Reaction."

SAD Symptoms

Those who suffer with SAD usually feel energy depleted and moody, tired, great sadness, crying spells, irritability, trouble concentrating, body aches, loss of sex drive, poor sleep, decreased activity level, and overeating, especially of carbohydrates, with associated weight gain. When the condition presents or persists into the summer, the symptoms are more commonly insomnia, poor appetite, and weight loss, in addition to irritability, difficulty concentrating, and crying spells. In severe cases, SAD can be associated with thoughts of suicide.

Causes of SAD

Researchers found that regardless of the season, the input/output of serotonin, the brain’s mood-lifting chemical is affected by the amount of sunlight on any given day. And the levels of serotonin are higher on bright days than on overcast or cloudy ones. In fact, the rate of serotonin production in the brain was directly related to the duration of bright sunlight. A sunny day increases this natural anti-depressant in the brain and a reduction of sunlight can cause a drop in the natural anti-depressant of serotonin, triggering depression.

Other causes include the decrease in sunlight, which may disrupt your body’s internal clock and lead to feelings of depression and, the seasonal change can also disrupt the balance of Melatonin levels in your body. This plays a role in sleep and mood patterns and can also trigger depression.

SAD Risk Factors

  • Being female – makes you four times more vulnerable than men, but men may have more-severe symptoms.
  • Age – is a risk factor for young people at least 23 years old, the average age of onset for winter SAD. SAD is less likely to occur in older adults.
  • Family history – shows that people are more likely to have blood relatives with SAD or another form of depression.
  • Having clinical depression or bipolar disorder – Symptoms of depression may worsen seasonally if you have one of these conditions.
  • Living far from the equator – has a greater effect negative affect probably due to the decreased sunlight during the winter and longer days during the summer months.

Treatment Options

  • Exposure to bright light - Light treatment should be used daily in the morning and evening for best results. Phototherapy is commercially available in the form of light boxes, which are used for about 30 minutes a day. The light must sufficiently brighten, approximately 25 times as bright as a normal living room light. Remember it is the quantity of the light that matters. Unfortunately, common possible side effects associated with phototherapy include irritability, insomnia, headaches, and eyestrain. Plan the use of this treatment – in the morning while taking a bath and 2 hours before bed, all with eyes closed and no shades.
  • Changing locations temporarily to a climate/place that is characterized by bright light – for example, living in Florida  can achieve similar results.
  • Antidepressants and stimulants – can be used, but those who suffer with bipolar disorder may have a manic episode.
  • Alternative methods – Exercise, is the natural leading alternative method for depressive disorders. Exercise releases endorphins that elevate mood and self-esteem, decrease stress, increase energy level, and improve sleep. Engaging in just 30-minutes of activity, 3-4 times per week can elevate your heart rate, which is greatly beneficial. Acupuncture can also be used especially if your pregnant or having difficulty with other methods. John’s Wart, an herbal supplement has been found to be a potential help for mild depression (check with your doctor first).  Pet treatment relieves stress by providing love and companionship. Research shows that animal-assisted therapy can also decrease agitation that often goes with depression. Meditation/Focused Breathing  is a stress management technique, which can be done in many ways and is used to successfully treat and prevent high blood pressure, heart disease, migraine headaches, diabetes, and arthritis. Meditation also helps to counter obsessive thinking, anxiety, depression, and hostility. With time and practice, levels of relaxation deepen and your attention becomes steadier. Melatonin is a dietary supplement in a synthetic form of a hormone occurring naturally in the body that helps regulate mood. A change in the season to less light may change the level of melatonin in your body. Taking melatonin could decrease winter-onset SAD, but more research is needed. Safety in children or with long-term use in adults has not been determined. Another option is a Dawn Simulator, which uses a timer-activated light to mimic the sunrise. This helps to stimulate the body’s clock.
  • Psychotherapy – Talk therapy should be a part of the treatment process in combination with the other listed options. Also, Dance/Movement Therapy refers to a broad range of Eastern and Western movement approaches used to promote physical, mental, emotional, and spiritual well-being.
  • Social support groups – having good relationships and social support can be an important part of maintaining a better mood during the season and lessens feelings of being alone and alienated, which are usual with depression.

Try to maintain an overall healthy lifestyle against SAD to minimize symptoms with a healthy diet consisting of lean protein, fruits, and vegetables; regular exercise; and sleep.

SAD is manageable; take charge of you mental health and talk to your primary physician, therapist, or psychiatrist because, unfortunately, there's no known way to prevent the development of seasonal affective disorder. However, if you take steps early on to manage symptoms, you may be able to prevent them from getting worse over time.

Some people find it helpful to begin treatment in late summer, August, before symptoms intensify during the fall or winter, and then continue treatment past May or June, when symptoms would normally go away. Other people need continuous treatment to prevent symptoms from returning. Don’t let the winter blues keep you down!

REFERENCES:

Seasonal Affective Disorder. (2011, September 22). Mayo Clinic. Retrieved November 10, 2014, from http://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/basics/definition/con-20021047

Seasonal Affective Disorder. (2012, December). National Alliance on Mental Illness. Retrieved November 10, 2014, from https://www.nami.org/Template.cfm?Section=By_Illness&Template=/ContentManagement/ContentDisplay.cfm&ContentID=23051

Medically reviewed by Rambod Rouhbakhsh, MD, MBA, FAAFP; American Board of Family Medicine

REFERENCES:

Golden, R.N., B.N. Gaynes, R.D. Ekstrom, et al. "The Efficacy of Light Therapy in the Treatment of Mood Disorders: A Review and Meta-analysis of the Evidence." Am J Psychiatry 162 (2005): 656-662.

Hulisz, Darrell. "Seasonal Affective Disorder." Netwellness. Case Western Reserve University. Feb. 22, 2006.

Kraft, Ulrich. Lighten Up: Seasonal affective disorder-the winter blues-can be lifted with bright light, as long as treatment if timed properly. Scientific American Mind. October 2005.

Lundt, L. "Modafinil Improves Wakefulness and Reduces Fatigue in Patients With Seasonal Affective Disorder/Winter Depression: An Open-Label Study." Sleep 26 (2003): A382.

Manber, R., R.N. Schnyer, J.J. Allen, A.J. Rush, and C.M. Blasey. "Acupuncture: A Promising Treatment for Depression During Pregnancy." J Affect Disord 83.1 Nov. 15, 2004: 89-95.

Murphy, P.K., and C.L. Wagner. "Vitamin D and Mood Disorders Among Women: An Integrative Review." J Midwifery Women's Health 53.5 Sept./Oct. 2008: 440.

Saeed, S.A. and T.J. Bruce. "Seasonal Affective Disorders." American Family Physician 57.6 (1998): 1340-1346.

McMullen, L. (2012). Seasonal affective disorder: don't let it get you down.
http://health.usnews.com/health-news/article/2012/12/03/seasonal-affective-disorder-don't-let-it-get-you-down

McPhee, S. J., & Papadakis, M. A. (2010). Current medical diagnosis & treatment (49th ed.). New York: McGraw Hill

Mental Health America (MHA)
(2013). Seasonal affective disorder (SAD). http://www.nmha.org/go/sad

Medically Reviewed by a Doctor on 1/14/2014

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by Virgil D. Wooten, MD - http://health.howstuffworks.com/mental-health/sleep/basics/how-to-fall-asleep2.htm

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Nicole Daniels

Nicole Daniels is a Licensed Clinical Marriage and Family Therapist (LCMFT), Substance Abuse Professional (SAP), AAMFT Approved Supervisor, and a Diplomat of American Association of Clinical Sexology from the American Board of Sexology. She received her Master’s degree in Counseling Psychology from Radford University and has served in the mental health field as a skilled therapist for more than 15 years.
Nicole Daniels
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