Question of the Week
November 1, 2004


Does the following scenario sound like someone you know?

"Maggie started off her junior year of high school with great energy. She had no trouble keeping up with her schoolwork and was involved in several after-school activities. But after the Thanksgiving break, she began to have difficulty getting through her assigned reading and had to work harder to apply herself. She couldn't concentrate in class, and after school all she wanted to do was sleep. Her grades began to drop, and she rarely felt like socializing. Even though Maggie was always punctual before, she began to have trouble getting up on time and was absent or late from school many days during the winter. At first, Maggie's parents thought she was slacking off. They were upset with her, but they figured it was just a phase - especially since her energy finally seemed to return in the spring. But when the same thing happened the following November, they took Maggie to the doctor, who diagnosed her with a type of depression called seasonal affective disorder [SAD]."

The winter months bring shorter periods of daylight and colder temperatures. Even without a diagnosed case of SAD, it may get discouraging to see the sun set before the clock strikes five; especially when those darker days are accompanied by temperatures that get closer and closer to freezing.

"Everyone feels down or sluggish sometimes. Some people may even get the 'winter blues' because it's often too chilly to go outside and they may feel restless and bored. However, some people experience a more serious mood change when the cold weather rolls around. They may feel like they can't get out of bed in the morning, have no energy, and have an increased appetite, especially for starches and sweets. They may also feel depressed and show no interest in their normal activities or in talking to their friends. Sometimes, these symptoms are quite severe. This condition is known as seasonal affective disorder (SAD) — it's 'seasonal' because the mood change happens during a certain season, and it's 'affective,' or emotional, because it causes emotional changes in a person. A less common version of SAD can occur in the summer, but SAD usually strikes in the winter months and in colder climates. In fact, you're about seven times more likely to suffer from SAD if you live in New Hampshire than if you live in Florida. You're also more likely to suffer from SAD if you're female and over the age of 20, although SAD is sometimes seen in kids and adolescents."

"In fact, you‚re about seven times more likely to suffer from SAD if you live in New Hampshire than if you live in Florida."

It's not just New Hampshire. North Dakota, South Dakota, Minnesota, Wisconsin, Michigan--if you live in a part of the country where where the temperature may not get UP to freezing for weeks on end, then you are more likely suffer from SAD; but this isn't just about the cold (though cold weather can keep people inside and away from natural light). Living in these colder climates is compounded by that fact that the northern states (from Washington to Maine--and we can't forget Alaska) also have a more significant change from long periods of daylight in the summer to short periods in the winter. Whether or not you live in an area with higher risk, SAD can affect you or someone you know. So...

What is Seasonal Affective Disorder?
"Some people suffer from symptoms of depression during the winter months, with symptoms subsiding during the spring and summer months. This may be a sign of Seasonal Affective Disorder (SAD). SAD is a mood disorder associated with depression episodes and related to seasonal variations of light."

"How common is SAD?
As many as 6 of every 100 people in the United States may have winter depression. Another 10% to 20% may experience mild SAD. SAD is more common in women than in men. Although some children and teenagers get SAD, it usually doesn't start in people younger than 20 years of age. For adults, the risk of SAD decreases as they get older. SAD is more common in northern geographic regions."

While SAD is more common is certain areas and populations, it can affect anyone.

"December 11, 2001: Patients with seasonal affective disorder (SAD) generate a biological signal of seasonal change that is absent in people who do not have SAD and that is similar to the signal used to regulate changes in mammalian seasonal behavior, according to an article in the December issue of the Archives of General Psychiatry, a journal of the American Medical Association."

In recent years, researches have been gaining more and more insight into how SAD affects the body, but it was first noticed generations before any of these researches were even born.

"SAD was first noted before 1845, but was not officially named until the early 1980's. As sunlight has affected the seasonal activities of animals (i.e., reproductive cycles and hibernation), SAD may be an effect of this seasonal light variation in humans. As seasons change, there is a shift in our 'biological internal clocks' or circadian rhythm, due partly to these changes in sunlight patterns. This can cause our biological clocks to be out of 'step'
with our daily schedules. The most difficult months for SAD sufferers are January and February, and younger persons and women are at higher risk."

As winter approaches and daylight hours become fewer, SAD becomes more of an issue.

"The problem stems from the lack of bright light in winter. Researchers have proved that bright light makes a difference to the brain chemistry, although the exact means by which sufferers are affected is not yet known. It is not a psychosomatic or imaginary illness."

It may be comforting to know that it is not all in your head.

"Researchers are still trying to pinpoint precisely what causes seasonal affective disorder. Some evidence suggests that the disorder arises from abnormalities in how the body manages its internal biological rhythms or matches those rhythms to the 24-hour day. Genetic factors may also be involved. The balance of evidence favors the idea that changes in the light part of the day-night cycle induce biochemical changes that bring on seasonal affective disorder. While several biochemical alterations have been noted, evidence shows that the hormone melatonin plays a big role. Melatonin helps control your body's internal (circadian) rhythms of body temperature, hormone secretion and sleep. It's produced in a specific area of your brain during darkness. During the low-light months of autumn and winter, people with seasonal affective disorder produce more melatonin -- enough to cause potentially debilitating symptoms of depression. But exposure to bright light can suppress the brain's production of melatonin, helping regulate your body's internal clock and reducing those symptoms. Researchers also speculate that light therapy causes changes in neurotransmitter activity in certain brain areas. Scientists are studying the effects of bright light on production of the neurotransmitters serotonin and dopamine, two chemicals that also have a role in depression."

How can bright light be used as treatment?

"As the cause is lack of bright light, the treatment is to be in bright light every day by using a lightbox or a similar bright light therapy device. (Going to a brightly-lit climate, whether skiing or somewhere hot, is indeed a cure). The preferred level of light is about as bright as a spring morning on a clear day and for most people sitting in front of a lightbox, allowing the light to reach the eyes, for between 15 and 45 minutes daily will be sufficient to alleviate the symptoms. The user does not have to stare at the light, but can watch TV or read or similar, just allowing the light to reach the eyes."

"It is important to note that no evidence indicates that tanning beds, where the eyes are generally covered and the subject's skin is exposed to light, are useful in the treatment of SAD. Furthermore, the light sources in tanning beds are relatively high in UV rays, which can be harmful to both the eyes and the skin."

In addition to light therapy, there are

"Other Therapies/Interventions:
Medication: In severe cases, physicians may prescribe a selective serontonin reuptake inhibitor (SSRI) antidepressant such as fluoxetine (Prozac), sertraline (Zaloft), or paroxetine (Paxil).... Nutrition: Careful inclusion of complex carbohydrates (fruits, grains, potatoes, etc.) can provide what is necessary to stimulate serotonin levels. ... Exercise: There is strong anecdotal evidence and a general belief among health researchers that exercise improves mood and self-esteem for a number of reasons... Counseling..."

If properly diagnosed, there is help. So, what can you do if you see what you think might be SAD in yourself or someone you know?

"When symptoms of SAD first develop, it can be confusing, both for the person with SAD and family and friends. Some parents or teachers may mistakenly think that teens with SAD are slacking off or not trying their best. If you think you're experiencing some of the symptoms of SAD, talk to a parent, guidance counselor, or other trusted adult about what you're feeling."

As with any disease or disorder, it is best to talk with your doctor and see what treatment may be best for you.

Questions of the Week:
Why should you know about SAD? Is there anything you can do to reduce your chances of being affected by SAD? How can you tell if you, or people you know, are just "in a slump," or may be dealing with SAD? Would you talk with your friends differently about what's wrong if you suspected SAD rather than "a slump"? Why or why not? If it would change your approach, how?

Please email me with any ideas or suggestions.
Note: Due to increasing amounts of SPAM sent to this account, please include "QOW" in the subject line when sending me email.

I look forward to reading what you have to say.

Health Community Coordinator
Access Excellence @ the National Health Museum

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