November 1, 2004
Does the following scenario
sound like someone you know?
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
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, youre
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
"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
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
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.
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
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...
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