When the 'blues' just won't go away
Doctors say seasonal depression is more common than most know
By Mary Loden, Of the News-Tribune
The bustle of the holidays is long over and the cold and gray of winter is taking its toll on mental health. While some can attribute their feelings to typical cabin fever or the winter blues, others experience a deeper lethargy and feelings of depression called seasonal affective disorder (SAD).
SAD is a cyclic, seasonal condition in which signs and symptoms usually come back and go away at the same times every year. Usually, the symptoms appear during late fall or early winter and go away during the warmer, sunnier days of spring and summer.
Experts say that SAD commonly begins in young adulthood and it's uncommon in people younger than 20. Some studies show that it's diagnosed more often in women, but that men may have more severe symptoms. However, data about how common SAD is and who is most likely to develop the condition are lacking.
“It's not just that you get a little bit down,” said PA Ashlea Schaumburg at Hancock County Memorial Hospital. “It's fairly common in the winter to be less active and slow down. The difference is you see mood swings, such as irritability, and sleeping more than usual. I've noticed a person's ability to cope with things is a lot less - what they blow off in the summer is a major issue now.”
Schaumburg, who has worked with psychiatric patients at Broadlawns Medical Center in Des Moines and at the Mayo Clinic in Rochester, Minn., said SAD is characterized by having dysphoria, or loss of pleasure, in the fall and winter or excessive euphoria in the spring and summer. In either case, problems may start out mild and become more severe as the season progresses.
“Seasonal affective disorder is not its own special diagnosis, but a way to describe people with depression, according to the Diagnostic and Statistical Manuel of Mental Disorders from the American Psychiatric Association,” said Natalie Hillman Alsop, Ph.D., clinical psychologist with Mercy Clinics and adjunct professor at Waldorf College. “There is a lot of conflicting information. It's a depressive episode during a particular season, the winter blues.”
Some of the conflicting research into the causes of SAD has researchers suspecting the longer nights of winter cause a disruption of a person's circadian rhythm. This rhythm is the physiological process that helps regulate a body's internal clock - letting a person know when to sleep or wake - and disruption of this natural body clock may cause depression.
Other researchers suspect that SAD may be tied to melatonin, a sleep-related hormone that, in turn, has been linked to depression. The body's production of melatonin usually increases during the long nights of winter.
Still, other research theorizes that SAD is caused by a lack of serotonin, a natural brain chemical that affects mood and reduced sunlight can cause a drop in serotonin.
“The actual mechanism is not clear,” Schaumburg said. “They are always investigations into mental illness.”
“In order to qualify as SAD, (the symptoms must occur) two seasons in a row,” Alsop said. “It is different from basic depression.”
“The biggie is if you withdraw from activities, you're not interested in the day's routine, if you have disturbed appetite or sleep patterns - a major change in what's typical - you Šneed to get further evaluated,” Alsop said.
Schaumburg said that treatment of SAD depends on the severity. Treatment often involves exposure to bright light early in the morning and sometimes a special UV light is required. “Some research has also seen tanning beds just as effective,” Schaumburg said. “Homeopathic medicine, I'm not a big proponent of them, but when you have something like light that works I would definitely go for that over medication any day.”
Alsop said that although special lamps can be purchased without a doctor's prescription, and insurance coverage varies, she still believes phototherapy should be done under a doctor's guidance.
For people who don't respond to phototherapy (sunlight or manufactured light) antidepressants may be necessary.
Whether light therapy or antidepressants may be recommended there is one sure way of feeling better. “Exercise will stimulate the serotonin and endorphins,” Schaumburg said. “I'm a firm believer in that. It's almost like taking an antidepressant.”
Although SAD may be cyclical, it is still depression - and depression hurts. Alsop said, “Get it evaluated and get back on the right track.”
(Information for this article was also obtained from the Mayo Clinic at www.mayoclinic.com.)
Story created Feb 15, 2008 - 11:15:06 CST.
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