More than the blues

First Posted: 2/12/2015

LIMA — When the days get shorter and the weather stays colder, some people begin to experience an onset of depression that is more than a simple case of the winter blues.

What many people don’t realize is a decrease in sunlight exposure during the winter months — especially in northern U.S. states — can lead to a condition called seasonal affective disorder, also known as SAD.

“Seasonal affective disorder would be defined as major depression, or significant depressive symptoms that have a seasonal onset and a seasonal remission,” said Christina DeBrosse, physician assistant of psychiatry with Behavioral Health Services at St. Rita’s Medical Center in Lima. “Typically, what it is, is people with a major depressive disorder — or even a bipolar disorder — it’s kind of a specifier to that.”

In other words, SAD is actually diagnosed as a type of depression with a seasonal pattern, or as bipolar disorder with a seasonal pattern.

“Reduced exposure to sunlight may seem to create some hormonal changes in our body that sort of shuts things down and contributes to this,” said Thomas L. Hustak, Ph.D., a clinical and forensic psychologist with Practice of Clinical Psychology, Inc., in Lima. “Reduced sunlight, a lot of times, can lead to a decreased level of serotonin in our body. And serotonin is the chemical that affects mood.”

At the same time, another chemical called melatonin tends to get increased in darkness, Hustak explained. Increased melatonin can cause lethargic and tired behavior. This combination of depressive feelings and lethargic behavior can hit hard in northern latitudes during the winter months.

Symptoms of SAD can include the following:

• Increased sleep

• Appetite increase

• Irritability

• Low energy or concentration

• Weight increase

• Thoughts of death

• Depressed mood

• Loss of interest or pleasure in most or all of activities.

“A person with major depression may have problems with feeling sad and grumpy, losing interest in their normal activities,” Hustak said. “They may crave more carbohydrates, such as bread and pasta. They gain weight. They may sleep more, but they still feel tired. They have trouble concentrating. Those are all symptoms with SAD.”

Treatment for SAD can vary, depending on whether the SAD is associated with bipolar disorder or with depression, Hustak noted. Going to a family doctor, a psychiatrist or a psychologist is a good first step in getting a proper diagnosis and a treatment plan.

“It’s very important to have a mental health person be very accurate with what their diagnosis is,” he said. “Because if you’re treating the depression, that’s treated just a little bit differently than if you’re treating the bipolar component — which means that variation of moods from being kind of hyper to very depressed. And that’s a little bit different.”

One promising SAD therapy option uses a special type of light to increase serotonin levels, Hustak explained.

“You don’t stare at the light, you sit near it within a certain distance of the light,” he said. “You can put your makeup on and maybe read, or get ready for work. And you sit there for about 20 to 30 minutes. … The theory is when you do that, they think that it makes some changes in your circadian rhythm — you know, waking and sleeping and waking and sleeping — they’re thinking that it may possibly be linked with exposure to increased levels of serotonin, maybe.”

A SAD therapy lamp should have a light intensity of 10,000 lux, he noted. For a comparison, a typical overhead light in a house is 100 lux and sunlight is 100,000 lux.

“I have seen an increase in the amount of people using light therapy,” DeBrosse said. “The lights are becoming more available now. I believe they can even be bought online.”

SSRIs — Selective Serotonin Reuptake Inhibitors — are also effective medications for treating depression-related SAD, Hustak explained. This type of antidepressant also helps balance out serotonin levels.

“Physical exercise, obviously, will also help,” he said. “Because physical exercise tends to inhibit feelings of depression, particularly when it’s added on to other forms of treatment.”

Avoiding sweets, carbohydrates and alcohol can also make a difference in SAD symptoms. Instead, try eating more foods such as fruits and vegetables, peanut butter and fish, Hustak recommended. Maintaining good sleep habits can help, too.

“Even if people do not exactly meet all of the diagnostic criteria, word for word, if somebody has symptoms that are really distressing to them — that are really interfering with their life — or they notice family members is having those, that still I think would mandate some sort of intervention,” DeBrosse said. “I’ve seen a good prognosis with (SAD). We’ve got lots of treatments available that can really be helpful.”

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