Submitted by Deborah Edelen, APRN

December 4, 2017

Shorter days, grayer skies and cooler temperatures are a normal part of winter in Kentucky and are welcomed by some who enjoy curling up indoors by the fire or looking forward to playing in the snow. But to others, these annual wintery changes leave them feeling blue. If you are one of those who feel caught up in a rut that comes and goes with the winter season, you might be experiencing Seasonal Affective Disorder.

Seasonal Affective Disorder (SAD) is a type of depression characterized by recurrent episodes of depression, usually in late fall and winter. The symptoms of SAD can appear gradually or suddenly and may be mild to severe. They often dissipate as spring arrives and stay in remission through the summer months.

While the specific cause of SAD remains unknown, it has been linked to a drop in serotonin (a brain chemical that affects mood) caused by fewer daylight hours and a lack of sunlight during the winter months. The change in season can also disrupt the balance of the body’s level of melatonin, which plays a role in sleep patterns and mood. The most difficult months for SAD sufferers seem to be January and February.

Though the cause is still unknown, there are several factors that may increase the risk of SAD including:

• Female gender.
• Age between 18 and 30 years (though SAD may begin at any age).
• Family history of depression, SAD, or substance abuse.
• Personal history of depression or bipolar disorder.
• Residing in areas with long winters or frequent cloudy and overcast days.
• Living or working inside buildings with few windows or sun exposure (this may result in symptoms year-round).

Because SAD is a subtype of major depression, symptoms of both are similar and may include:

• Feeling depressed, hopeless or worthless.
• Feeling fatigued, sluggish, irritable or agitated.
• Losing interest in activities you once enjoyed or withdrawing from social activities.
• Having problems sleeping too much or not enough.
• Experiencing changes in appetite, weight or carbohydrate cravings.
• Having difficulty concentrating.
• Having frequent thoughts of death or suicide.

It is important to understand that it’s normal for everyone to have some days throughout the year when you feel down. However, feeling down for days at a time or not being able to get motivated to do activities you normally enjoy should alert you to see your health care provider. Treatment can help prevent complications, especially if SAD is diagnosed and treated early.

Treatment for SAD may include light therapy, medications and psychotherapy. Light therapy, also called phototherapy, is one of the first line treatments for fall-onset SAD. This therapy involves sitting next to a special light therapy box that mimics natural outdoor light and appears to cause a change in brain chemicals linked to mood. Research on light therapy is limited, but it appears to be effective for most people in relieving SAD symptoms.

If SAD symptoms are severe, antidepressant medications may be recommended. Some people may require treatment only during the time of year in which they experience symptoms. Others may choose year-round treatment depending on the severity of their symptoms. Keep in mind that it can take several weeks to notice full benefits from an antidepressant medication. Therefore, it may be helpful to begin treatment before symptoms would normally start in the fall or winter. Your health care provider can determine if medication is an appropriate treatment option for you.

Psychotherapy, also called talk therapy, is another option to treat SAD. Health care providers trained in psychotherapy can help you identify and change negative thoughts and behaviors, learn healthy ways to cope with SAD, and learn how to manage stress.

Some people choose to try alternative treatments to help relieve SAD symptoms. Alternative and complementary treatments may include herbal remedies, vitamin and mineral supplements, or mind-body therapiessuch as acupuncture, yoga, meditation, guided imagery and massage therapy. It is important to talk to your health care provider who can help you in choosing appropriate therapies.

Regardless of whether you have SAD or simply feel down every now and then during the fall and winter months, there are some things you can do to improve your mood.

• Make your environment sunnier and brighter. Open blinds and curtains, trim tree branches that block sunlight or add skylights to your home. Sit closer to bright windows while at home or in the office.
• Get outside. Take a long walk, eat lunch at a nearby park, or simply sit on a bench and soak up the sun. Even on cold or cloudy days, outdoor light can improve your mood especially if you spend some time outside within two hours of getting up in the morning.
• Exercise regularly. Exercise and other types of physical activity help relieve stress and anxiety, both of which can increase SAD symptoms. Being more fit can make you feel better about yourself which can also lift your mood.

Seasonal Affective Disorder can cause mild “winter blahs” or it can be very debilitating. Unfortunately, unless you are able to move to South Florida or to another year-round sunny climate, there’s no known way to prevent it. However, taking steps early to manage your symptoms may prevent them from worsening. Who knows…you might even learn to enjoy a wintery blizzard!

Debbie Edelen, APRN is an advanced practice provider at North Garrard Family Medical Center, a service of Ephraim McDowell Health.