Have The Winter Blues Got You Down?

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By Julia Samton MD

It’s only January and already most of the country has seen record freezing temperatures and grey skies. Many people chalk up feeling blue in winter as simply a fact of cold weather and lack of sunshine. But foru to six percent of people may have a winter depression, which is clinically referred to as Seasonal Affective Disorder. Another 10 to 20 percent may have mild SAD. SAD is four times more common in women than in men. Although some children and teenagers get SAD, it usually doesn't start in people younger than age 20. Your chance of getting SAD goes down as you get older. SAD is also more common the farther north you go. For example, it's seven times more common in Washington State than in Florida. As a neuro-psychiatrist in Manhattan, I treat patients in my practice who display and express mood changes once September rolls around.

Symptoms

In most cases, seasonal affective disorder symptoms appear during late fall or early winter and go away during the sunnier days of spring and summer. However, some people with the opposite pattern have symptoms that begin in spring or summer. In either case, symptoms may start out mild and become more severe as the season progresses.”

The following are symptoms to look for to see if you are suffering from SAD

*Depression

*Hopelessness

*Anxiety

*Loss of energy

*Heavy, "leaden" feeling in the arms or legs

*Social withdrawal

*Oversleeping

*Loss of interest in activities you once enjoyed
*Appetite changes, especially a craving for foods high in carbohydrates

*Weight gain

*Difficulty concentrating
 

How is SAD treated?

Many people with SAD will find that their symptoms respond to a very specific treatment called bright light therapy. For people who are not severely depressed and are unable—or unwilling—to use antidepressant medications, light therapy may be the best initial treatment option.

Light therapy consists of regular, daily exposure to a “light box,” which artificially simulates high-intensity sunlight. Practically, this means that a person will spend approximately 30 minutes sitting in front of this device shortly after they awaken in the morning. If patients do not improve, a second exposure of 20 to 30 minutes may be added in the early afternoon. Treatment usually continues from the time of year that a person’s symptoms begin, such as in fall, on a daily basis throughout the winter months. Because light boxes are created to provide a specific type of light, they are expensive and may not be covered by insurance. Unfortunately, having lots of lamps in one’s house and spending extra time outside is not as effective as this more expensive treatment.

Side effects of light therapy are uncommon and usually reversible when the intensity of light therapy is decreased. The most commonly experienced side effects include irritability, eyestrain, headaches, nausea and fatigue.

Scientific studies have shown light therapy to be very effective when compared to placebo and as effective as antidepressants in many cases of non-severe SAD. Light therapy may also work faster than antidepressants for some people with notable effects beginning within a few days of starting treatment. Other people may find that it takes a few weeks for light therapy to work, which can also be the case for most people who take antidepressant medications. Although not explicitly recommended, some people may elect for treatment with both light therapy and antidepressant medications. The combination of these treatments may be synergistic and a more robust way to address the symptoms of SAD.

In my practice, I have found that antidepressant medications have been useful in treating people with SAD. Of the antidepressants, fluoxetine (Prozac) and bupropion (Wellbutrin) have been studied in the treatment of SAD and shown to be effective. The U.S. Food and Drug Administration (FDA) has approved these medications for treatment of major depressive disorder. I do caution, though, that if you’re considering treatment with an antidepressant medication, you should discuss the benefits and risks with your doctor.

People with a predisposition to bipolar disorder should be more cautious in approaching treatment for SAD and depression in general. Light therapy, like antidepressant therapy, has been associated with increased risk of experiencing a manic episode. The specifics of this are beyond the scope of this review and again, should be discussed with your doctor.

Finally, a healthy lifestyle, including regular exercise, a good diet and a strong social network, is also likely to help you cope with SAD.

Dr. Julia Samton is Board Certified in Psychiatry and Neurology. Her unique training gives her the expertise to treat a diverse range of mood disorders. Her specialties include attention deficit disorder (ADHD), depression, anxiety, and other conditions related to psychological stress. Through an individualized combination of psychopharmacology, psychotherapy, and behavioral counseling, Dr. Samton is dedicated to helping her patients lead more satisfying lives. At Manhattan Neuropsychiatric, Dr. Samton also provides neuropsychological testing to diagnose and treat ADHD, guide career selection, and help optimize professional and academic achievement. Please visit http://www.jsamtonmd.com/