By Tom Millard
Special to the Herald
---- — Norman Rosenthal has written extensively in the area of Seasonal Affective Disorder (SAD).
His most recent book, “The Winter Blues” (fourth edition) is an excellent summary of the research on SAD. According to Rosenthal, about 9 percent of the adult population in our northern latitude experience symptoms of SAD compared to only about 1.5 percent of people in Florida.
He stated that one of three people in Scandinavian countries may have SAD. Symptoms often begin at adolescence; thus, many people with SAD have pleasant childhood memories of winter. The research shows that the hormone melatonin, which increases during nighttime hours, may be critical in those who have SAD.
Rosenthal encourages us to notice that if we have repeated symptoms during the winter months, especially during December, January and February; although symptoms may occur as early as October. Although changes in your mood during the winter months may be indicative of SAD, it may also be a medical problem such as hypoglycemia, viruses such as Epstein-Barr or hypothyroidism. Therefore, if you have these symptoms you should consult with your physician.
In one study, participants had experienced an average of 13 winters with seasonal symptoms without receiving treatment. Depression is more than just sadness. Symptoms often begin with physical problems such as fatigue, loss of energy, lowered sex drive, increase or decrease in appetite, and increased need for sleep. Also, cognitive problems such as trouble with memory and concentration, and difficulty making decisions can occur.
Depression also includes emotional components such as sadness and irritability, problems such as difficulty enjoying life, feelings of worthlessness and inappropriate guilt, as well as suicidal thoughts or attempts. It is not uncommon to have an increase in cravings for simple carbohydrates and experience significant weight gain. Women may also have more difficulty with premenstrual dysphoric disorder during the winter months.
Studies have also shown that children and adolescents may experience the winter blues or SAD. One reason that children who experience behavioral difficulties during the fall and winter months is not only because of school stress, but also because of the shortening days. It is also possible that people have trouble during winter holidays due to the lessening of daylight hours.
Rosenthal and others have done extensive research in the area of light therapy. The results indicated that if used correctly, light therapy can be effective in the treatment of SAD. It is extremely important to discuss with a medical provider if you might be a candidate for light therapy, and identify the requirements for safe and effective uses of the lights. Rosenthal stated that if used properly the light therapy might show benefits within two to four days, although he suggested giving the light two weeks to see if it is effective. He also suggested not purchasing a light if it does not come with a 30-day money-back guarantee.
He has suggested light boxes that range in price from $100 to $250. Physician referrals may result in discounts. Many insurance companies do not pay for the light, but contact your insurance company for possible benefits.
Rosenthal identified that taking a two-week vacation to a warm climate in January may be helpful in reducing symptoms for a brief period of time in SAD sufferers. Diet and exercise have also been found to be beneficial for individuals with SAD.
As mentioned previously, individuals with seasonal problems tend to crave carbohydrates. Carbohydrates have been found to boost serotonin levels in people with SAD; resulting in a temporary boost in feelings of energy and calm. However, the effects are very short-lived and the following crash and increased hunger levels that these foods produce are followed by the need to reach again for simple carbs.
This results in a yo-yo effect in mood, energy and weight gain. This increase in weight results in physical health problems, and could potentially leave us feeing worse about ourselves; possibly exacerbating depression. Rosenthal and most health experts recommend staying away from sugar and white flour, and instead eating foods high in protein as well as fruits and vegetables. It is important to be mindful of Rosenthal’s research as we are more likely to eat these foods during periods of stress.
Rosenthal reports the benefits of meditation on keeping stress levels down which prevents stress eating. Meditation, guided breathing, and yoga can help to live more in the moment; thus decreasing stress. Rosenthal also encouraged people with SAD to consistently exercise. While at least 20 minutes of intense aerobic exercise is ideal, he advises to pick exercises that are enjoyable. Whenever possible, it is beneficial to bundle up on sunny winter days, take a walk outside, and enjoy the beautiful winter scenery. Celebrating with friends and family, telling stories, and giving gifts can also be helpful in coping with the winter blues.
Rosenthal indicated that antidepressant medication may be an option in the treatment of SAD. He reported that in June 2006, the FDA approved Welbutrin XL as a preventative medication for people who have a history of SAD.
In the study, the medication was administered in the fall prior to developing the symptoms. The results indicated that nearly 50 percent of the participants did not develop SAD the following winter. Rosenthal found that some people with SAD were able to discontinue the medication in the springtime, while others needed to be on the medication yearly. He indicated that there are a variety of medications that may be useful in the treatment of SAD.
It is important to consult with a physician who has experience in treating people with SAD to find the appropriate course of treatment. Rosenthal recommends the use of the antidepressants when the depression is moderate to severe, and when light therapy alone is found to be insufficient. Individuals who take St. John’s Wort should be very cautious when using light therapy, as it can increase an individual’s sensitivity to sunlight. He recommends several websites including cet.org, pubmed.org, and sltbr.org for further information on SAD.
Tom Millard is a psychologist with Cornerstone Wellness Center in Clinton.