By John A. Patterson MD MSPH FAAFP
Does the cold, dark winter take a toll on your mood?
Many of us feel an effect on our mood this time of year. Terms such as ‘winter blues’, ‘wintertime depression’ and ‘winter-onset depression’ refer to a potentially serious form of depression called ‘seasonal affective disorder’ (abbreviated SAD) which affects people during the coldest and (most importantly) darkest, months of the year. Though most people are affected from the fall into the winter, some suffer this annual change in mood in the spring and early summer.
Common symptoms of SAD include depression, anxiety, low energy, loss of interest in previously pleasurable activities, physical symptoms such as headache, changes in appetite, weight and sleep, impaired concentration and memory, social withdrawal and isolation from friends and family. As with depression of any kind, it is important to take seriously any of the above symptoms, especially if they are a recurrent annual experience that persists for more than a few days or if they interfere significantly with work or personal life. It is especially important to seek professional help if there are any suicidal thoughts or a dependency on alcohol or other recreational drugs as a form or escape, denial or self-medication.
Although the exact cause of SAD is unknown, there are several possible contributors. A reduction in natural daylight in fall and winter can affect the body’s internal clock, causing changes in the circadian rhythms (variations in normal physiology related to time of day) and blood levels of hormones and chemicals important in mood regulation. Changes in serotonin and melatonin levels are two examples.
About 5% of Americans experience moderate to severe SAD symptoms and up to 20% experience a mild form. Women are affected by SAD more than men. People living in the far northern and far southern latitudes, farthest from the equator, where winters are darkest, are more affected. Those with a personal or family history of depression of any kind are more likely to be affected.
As with other forms of depression, self-care approaches may help SAD and are worth trying if symptoms are mild, especially if such approaches have helped in previous years. Letting more light into the home and office can help. Spending more time with supportive friends, family and pets can help. Vigorous physical exercise can help most forms of depression, including SAD. Exercising outdoors combines both these approaches. Yoga, meditation, mindfulness training, prayer, massage and acupuncture may be helpful. Ask your primary care provider (PCP) for a referral to a complementary provider in whom they have confidence. Although several herbs and supplements are promoted as having anti-depressant activity, some of them may also have adverse health effects, including interacting with medications or nutritional supplements. Always discuss such approaches with your PCP as part of your partnership to establish your own unique, individualized plan of care.
Your PCP can help you determine the cause of depression and other symptoms, provide educational resources and referrals and work with you to develop your unique plan of care. There is no diagnostic test for SAD. To establish the diagnosis of SAD and distinguish it from other forms of depression, it is necessary to document the recurrence of symptoms for at least 2 consecutive years at the same time of year. There must be depression-free intervals between periods of depression and your PCP must have ruled out other causes of depression.
If your PCP determines that your symptoms are the result of SAD, they may recommend light therapy (phototherapy), anti-depressants, mental health counseling or a combination of approaches. Phototherapy involves sitting a few feet away from a light box with bulbs that emit light simulating the daylight wavelength spectrum. Phototherapy may worsen symptoms in those with bipolar disorder and menstrual irregularities, so its use should be discussed with your PCP for maximum safety and choosing a reputable product. Tanning beds should not be used for phototherapy as their light is high in ultraviolet rays that can harm both the eyes and skin.
Anti-depressant medications used for SAD include those used for other forms of depression and should be selected by you and your PCP after a thorough review of your symptoms and medical history. Please never self-medicate by taking someone else’s anti-depressant medication. Your needs and unique medical history will determine what is best for you. Anti-depressants may take several weeks to show a beneficial effect. This is why it is important to discuss several treatment options with your PCP or mental health provider and stay in close contact with them during treatment.
Any conversation with your PCP, mental health counselor or chaplain/spiritual counselor must honestly describe the extent of the symptoms being experienced, especially if there has been any thought of self-harm or suicide. Many people, especially men, minimize the severity of such symptoms, believing they should be able to ‘snap out of it’ on their own. Mental health counseling can provide help not provided by medication alone. There are several ways to use such counseling to manage overall stress and re-train thoughts, attitudes and behaviors such that they are more mood-elevating and life-affirming.
Please remember that it is not a sign of weakness to ask for help and share the extent of your emotional anguish with a trusted friend, faith community member, PCP or mental health professional.
For further information about SAD, visit FamilyDoctor.org and MayoClinic.com.
About the Author-
Dr Patterson is past president of the Kentucky Academy of Family Physicians and is board certified in family medicine and integrative holistic medicine. He is on the family practice faculty at the University of Kentucky College of Medicine and the University of Louisville School of Medicine, Saybrook University’s School of Mind Body Medicine (San Francisco) and the Center for Mind Body Medicine (Washington, DC). He operates the Mind Body Studio in Lexington, where he offers integrative medicine consultations. He can be reached through his website at www.mindbodystudio.org.