Experiencing the Winter Blues? How to Fight Seasonal Affective Disorder

Paula S. Barry, MD, a primary care physician at Penn Family and Internal Medicine Longwood, explains what seasonal affective disorder is and how it can be treated.

As the hours of daylight grows shorter and fall weather moves in, for some, the “winter blues” are beginning to set in.

The “winter blues”, also known as seasonal affective disorder (SAD), is defined by major depression that recurs with a seasonal onset as well as a seasonal remission. Often the seasonal onset occurs in the fall and remission follows in the spring. It can also have an onset in the spring, but this type is less common.

SAD is quite common, with some studies showing that up to 7% of the population is affected with another 10-20% affected with a milder form of SAD, called subsyndromal SAD. More women than men report being affected; this is thought to reflect the higher proportion of women who are affected with depression in general.

The fall onset of SAD is thought to be due to decreased daylight which then triggers depression in those that are susceptible. Some researchers feel that it is due to a change in circadian rhythm and of levels of serotonin and melatonin in the brain. A genetic link likely plays a role, just as in major depression and other mood disorders.

Primary features of fall onset SAD include: irritability (this often contributes to an increase in personal relationship stress), increased need for sleep, increased appetite (especially for carbohydrates which often results in weight gain), and a subjective “heavy feeling” and fatigue. These symptoms must occur daily for at least two consecutive weeks and have the typical seasonal pattern to meet official diagnosis.

The treatment of SAD differs slightly from the treatment of major depression in that light therapy, use of a specialized light box that provides 2,500-10,000 lux of light for 15-30 minutes daily, is often successful in decreasing symptoms. Many individuals report a change in symptoms after just a few days of daily light box use.

Other treatments that have been found to work well against SAD include the use of anti-depressants, such as the selective serotonin reuptake inhibitors (SSRIs) and cognitive behavior therapy, known as CBT, which is a form of psychotherapy. There does seem to be an overall improvement of symptoms as well as prevention of recurrence when CBT is combined with light therapy and/or antidepressants.

If you believe that you, or someone you know has SAD, please discuss your concerns with your physician. Other medical problems can cause similar symptoms and it is important to be fully evaluated. If you do suffer with SAD, know that the therapies mentioned above are very helpful in improving symptoms – there is no need to wait until spring to obtain help.

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