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.

Schedule an appointment
Or
Learn more about Penn Primary Care

Prevent Snow Shoveling Injuries

If the start of the season is any indication, salt, shovels and snow blowers are in the forecast for most of us over the next few months. This means more risk of injury. Although cardiac-related injuries tend to be the most serious, sprains and strains, especially in the back and shoulders, are the most common injuries related to snow shoveling.

Andrew F. Kuntz, MD

“This time of the year, we tend to see many shoulder and elbow fractures due to slips and falls,” said Andrew F. Kuntz, MD, Shoulder and Elbow Surgeon at Penn Orthopaedics. “We also encounter a good number of sprains and strains directly related to snow removal.”

It is important to note that the design of the snow shovel does very little to help those with pre-existing back and shoulder problems. The length tends to be too short for most and a shovel made of steel adds significant weight that an individual must lift. Poor form can force individuals to bend and twist when shoveling heavy snow, which can lead to injuries.

The good news is there are tips that you can follow to reduce the risk of these types of injuries:

Warm-up your muscles

You should always remember that shoveling can be a very vigorous activity. If your muscles are cold and tight, you will be more susceptible to injury. Do some light exercises, stretch your lower back and hamstrings and loosen your arms, legs and shoulders before venturing outside - just as you would for any other workout.

Use proper technique

Just like weight lifting, having good technique can help you avoid injury and use your energy more efficiently. When possible, push the snow in front of you, rather than lifting and twisting. Be sure to always bend at the hips and lift with your core muscles instead of just your back and arms. Finally, keep your loads light and alternate shoveling between arms. Having good form will remove some of the stress put on your back, spine and arms.

Pace Yourself

It’s cold outside and all you want to do is get the driveway and front walk shoveled and hurry back inside your warm home, but go at your own pace. It is recommended that you shovel a small area, then give your body some time to rest before moving on to the next section. During breaks, stretch your muscles again and keep moving, so that you don’t tense up.

“It is extremely important to take your time and not to overdo it,” said Dr. Kuntz. “When there’s a big job ahead of you, take frequent breaks and remember to use proper technique to minimize your chances of injury."

Pay Attention to Your Breathing and Your Pulse

Shoveling snow is a strenuous exercise that can put undue strain on the heart. Factor in cold air, which constricts the blood vessels and increases blood pressure, and you have a dangerous combination for people with coronary artery disease or other forms of heart disease.

So before you go shovel your walkway or let a loved one shovel their own, take a few moments to review some common heart attack symptoms. If you feel soreness, pain or strain despite following these tips, it might be time to hand the shovel off to an ambitious or helpful neighbor.

Snow Shoveling Safety Tips

It didn’t take long for the first snowstorm of 2014 to hit. And, if the forecasters are correct, it surely won’t be the last of the season. While shoveling snow can prove to be a great workout, it can pose health issues if not done properly and if certain warning signs are ignored.

Put Less Pressure on your Back

Shoveling snow can be a real pain. The lower back is the most frequently injured part of the body during snow-shoveling. Musculoskeletal tissue, which supports the body’s bone structure, can become damaged by overexertion or overuse. Some tips to alleviate strain on your back.

• Pick a shovel that you feel comfortable with. Shovels that are too large or heavy will force you into unnatural body movements. Be sure to use the tool grip to enhance your leverage.
• Avoid shovels made from steel as added weight forces you to bend and twist, which could result in spinal injury.
• Rather than lifting the snow, try to push it in front of you. If you do lift, be sure to lift with your legs. Make sure you squat with your legs apart, knees bent, and back straight.
• Don’t try shoveling the biggest scoops of snow possible. Shovel in small amounts.
• Walk to where you want to dump snow. Avoid extending your arms out in order to try dumping snow far away from you. This will add extra strain to your back.

Get more helpful tips to reduce pain while shoveling.

Pace Yourself and Stay Hydrated

Although you may not feel as thirsty as you typically would in the summer, dehydration occurs quickly in cold, dry weather. Some tips on how to pace yourself and stay hydrated:

• Take frequent breaks and be sure to drink plenty of fluids.
• Try avoiding heavy meals prior to shoveling as digestion puts strain on the heart.
• Prior to shoveling it is good to warm up your muscles with light stretching.

Pay Attention to Your Breathing and Your Pulse

Shoveling snow is a strenuous exercise that can put undue strain on the heart. Factor in cold air, which constricts the blood vessels and increases blood pressure, and you have a dangerous combination for people with coronary artery disease or other forms of heart disease.

So before you go shovel your walkway or let a loved one shovel their own, take a few moments to review some heart attack symptoms.