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The Chicago Blues

Seasonal Affective Disorder a far cry from clinical depression

By Jenny Allen

We’ve all been there. It’s the dead of winter. The alarm clock is blaring. We turn to the window with bleary eyes and… total darkness. A long workday lies ahead. Surely the lunch hour will offer some respite, but it’s 20 degrees out and way too cold to leave the confines of a warm office. Besides, going out to lunch is a luxury now, what with the holiday bills piling up. A quick glance at the calendar reveals that Valentine’s Day is right around the corner. Single. Again. Well, at least baseball’s only a few months away, right? But then you remember: You’re a Cubs fan.

It’s official: You’ve come down with a case of the winter blues. And you’ve got it bad. But is it SAD?

SAD refers to Seasonal Affective Disorder, a type of depression that affects nearly 20 percent of Americans, according to Dr. John Stracks, an internal medicine and integrative medicine physician at Northwestern Memorial Hospital. “SAD is depression that almost always gets worse in the winter rather than in the summer, and usually occurs in northern states. Symptoms include sleeping too much feeling lethargic and depressed, experiencing a lack of interest in normal activities, and seeing an increased appetite, especially for foods high in carbohydrates.”

Since when is gorging oneself on an extra slice of deep-dish pizza an indicator of a major depressive episode, though?

“In order for someone to be diagnosed with SAD, [the] depression needs to recur for at least two years and almost always in the winter. The difference between having the winter blues and Seasonal Affective Disorder is that one can feel occasional twinges of sadness without being considered clinically depressed,” says Stracks.

Dr. Robert Auger, a sleep specialist and psychiatrist with the Mayo Clinic adds that it’s important to recognize that “in patients with pure SAD, the only type of depression they experience is during those winter months or whichever season is problematic for them.”

According to Auger, another definitive criterion for SAD is significant interference with “social and occupational functioning,” including one’s “performance at work, relationships and enjoyment of life.”

So, what’s making some Chicagoans so SAD? And who’s more at risk?

“The exact causes of Seasonal Affective Disorder are unknown, but some think it’s related to circadian rhythm—basically the physiological mechanism that helps your body know when to sleep and when to be awake,” says Stracks.“When you’re exposed to less sunlight, the brain chemical serotonin may decrease, causing a negative effect on your mood. It’s also believed [that] the hormone melatonin, which helps you sleep, increases with lack of sun exposure and can make you feel more depressed or tired than usual.”

SAD is diagnosed more often in women than in men, but men may have symptoms that are more severe, according to a Mayo Clinic study. Those living far north or south of the equator also tend to experience more symptoms due to the decreased sunlight during the winter. Doctors believe, as with other types of depression, that those with SAD may be more likely to have blood relatives with the condition. Patients already diagnosed with clinical depression or bipolar disorder are at risk for developing SAD, as well. While doctors are unable to pinpoint exactly what causes SAD, they have locked down some very effective treatments that don’t include hibernation.

Light therapy—also known as phototherapy—mimics sunlight, which causes a biochemical change in the brain that lifts your mood. It is one of the more commonly prescribed treatments. The patient sits about an arm’s length from a specialized lamp with light bulbs emitting at the minimum, 10,000 lux, a measure of light. Ultraviolet rays are filtered out, but direct eye contact is never made with the light and is only meant to hit the eye peripherally to simulate the sun. “This is often used in conjunction with a therapist to combat depression,” Stracks says. “Light boxes can range anywhere from $40 to upwards of hundreds of dollars, so talk to your doctor to see [whether] this treatment is right for you.”

While light boxes have yet to be formally approved by the FDA for SAD treatment, Auger and teams from the University of Minnesota and Harvard University are hoping to change that.

“We’re actually doing a study to see whether blue or yellow light is more effective from the standpoint of Seasonal Affective Disorder,” says Stracks. “It could ultimately result in the first FDA approval for a light box, and if there were found to be a difference between responsiveness to the colors, it could spur a lot of other research, both with respect to SAD as well as circadian rhythm sleep disorders.”

Some people with SAD benefit from antidepressants like Prozac and Zoloft as well as psychotherapy to help them cope with the sometimes crippling symptoms. Stracks prefers to avoid prescription medications if possible, and suggests herbs and supplements like 5-HTP, SAM-e and St. John’s wort (not recommended for people on certain medications).

Also, just because Daylight Saving Time ended, it doesn’t mean that you should fall behind on personal wellness.

“I recommend people taking care of themselves, reducing stress, getting outside and exercising as much as possible,” says Stracks. “Take time for your friends, and make it a point to stay connected to those people who are important to you.”

And what better way to stay connected with friends and family than to swap the North Avenue Beach for Miami Beach? “If you can make it happen, get away to a sunny, warm location at least once during the winter months. Also, it’s important to remember that although we had a mild winter last year, SAD is influenced more by the level of sunlight than [by] the temperature outside.”

So, the next time you’re fumbling in the dark for that snooze button, remember: Daylight Saving Time starts on March 10.

Don’t forget to mark it on your calendar… along with Opening Day.

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Published in Chicago Health Winter/Spring 2013

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