Don’t let winter get you down

The holidays are over and January was one of the grayest, rainiest month in recent memory. It’s only natural that a lot of people would feel a bit down. Shorter days mean less daylight, and that also affects mood. But for 2 to 10 percent of the population, the blues are actually clinically described as seasonal affective disorder or SAD.

SAD feels just like regular clinical depression because that’s what it actually is, said Cathy Perkins, MD, medical director of Emergency Psychiatric Services at Cape Cod Hospital.

“It is a subtype of major depression and it’s characterized the same way, with mild symptoms, moderate symptoms or severe symptoms, so there is definitely a continuum,” she said.

Dr. Perkins said the symptoms of depression include:

• Sleep disruption
• Changes in level of interest and motivation
• Changes in concentration
• Changes in appetite
• Changes in energy level
• Unexplainable guilty feelings

“Some people may have mild symptoms and they sort of muddle through,” she said. “They notice it but it doesn’t impact their functioning. If it’s something that is starting to impact somebody’s ability to function at work or socially, they might want to consider having an evaluation.”

Treatment Options

Researchers are uncertain why SAD occurs, but one theory is that less light affects serotonin and melatonin levels in the brain, Dr. Perkins said. There are a few different treatment options. Patients could take an antidepressant, begin cognitive behavioral therapy or start light therapy. Both light therapy and anti-depressants have a success rate of about 60 percent, so it might be beneficial to combine two or more treatments.

“You would probably start with one or the other and hopefully be successful,” she said. “If not you would need to add in a second or third agent.”

There are two different types of light therapy. The first one, bright light therapy, uses a light box. Patients sit in front of it for 20 to 30 minutes every morning and are exposed to between 6,000 and 10,000 lux intensity. To put that in perspective, Dr. Perkins said on a bright sunny day you would be exposed to 50,000 to 100,000 lux. On a cloudy day, you would be exposed to 1,000 to 5,000 lux. If you stay inside the house with just the regular lights on, you would get 250 to 500 lux.

When you sit in front of the light box, you sit about two feet away from it.

“It’s pretty effective,” Dr. Perkins said. “Some patients who might not want to take medication might be more amenable to this.”

The other type of light therapy involves putting a light on a timer. The light comes on gradually over a time period of 90 minutes before you want to get up. This simulates a natural sunrise and can help people feel better.

For a lot of people, SAD begins around November and ends around April, so they only need treatment for those months. The patient can then take a break and start up again about two weeks before they know the symptoms typically show up.

“When you have depression, your appetite, sleep and energy can go up or down,” Dr. Perkins said. “With the fall onset of seasonal affective disorder, the sleep usually increases and people’s appetite usually increases. They tend to crave carbohydrates so there can be some weight gain with it.”

Other Things to Consider

Conversely, there is a variant of SAD that happens in the summer that has a different constellation of symptoms. People get more irritable, sleep less and have less of an appetite. That variant isn’t as common but it is caused by an increase in light that throws some people off.

The only caution with treating seasonal affective disorder is that for the small percentage of people who have a proclivity for bi-polar disorder, the anti-depressants and light can cause them to become manic, according to Dr. Perkins.

“People need to be aware of that because if they start to feel worse, they would really have to talk to their doctor about it,” she said.

Other things that can help with seasonal affective disorder are lifestyle changes. Physical activity is really helpful in supporting people’s moods, so a walk outside every day can really help. It also has the secondary benefit of being outside getting light exposure too. Be sure to keep socially active and not become reclusive. Even if you have to force yourself to do social things, the mental health benefits will be worth it.

Finally, practice good sleep hygiene. Dr. Perkins recommends not sitting in front of a computer or screen before you go to bed. Instead give yourself some downtime to transition to sleep. Make sure you have a comfortable sleep environment that is not too hot or too noisy.

“Just make sure you are protecting your sleep, which in turn protects your mood,” she said.