Deborah first noticed the symptoms three years ago. It was late October and for no apparent reason the then-39-year-old financial planner began feeling increasingly lethargic, anxious and “grumpy”. Over the next several weeks Deborah began sleeping more and gaining weight. She tried psychotherapy, which she found helpful, but it didn’t get to the root of her problem.
So when the same symptoms re-appeared last fall, Deborah, who lives in Silver Spring, Md., did some research and discovered she had all of the classic symptoms of seasonal affective disorder, or SAD, a cyclical depressive disorder that affects an estimated 10 million people in the United States.
Today, she uses a light box -- more on this later -- and makes sure to exercise several times a week. While not completely cured, most of Deborah’s symptoms have lifted.
SAD usually strikes in the fall and winter months and in colder climates, so someone living in Manhattan is much more susceptible than someone in Miami. It typically occurs between October and April, with the most difficult months being January and February. (Some people experience SAD in the summer months, but this is quite rare.)
Many of us tend to isolate in the winter months, particularly in January and February, after all of the holiday parties have ended, preferring to stay home at night and on weekends rather than brave the ice or snow.
But this behavior has serious effects for those with SAD, says Karen Waugh, a licensed clinical social worker in Columbus, Ohio.
“I tell my clients we all want to go into hibernation mode in the winter months, but it is particularly dangerous for those with seasonal affective disorder,” she says. “It makes you more isolated and feeds the already low energy and self-esteem you may have.”
According to the Diagnostic and Statistical Manual-Fourth Edition, the bible of mental health professionals, people in their 20s and 30s are at the highest risk for SAD. The disorder is of particular concern for women, since they comprise 60%-90% of all SAD sufferers.
Some common warning signs include:
• Increased sleep and fatigue
• Overeating and weight gain (craving sweets and carbohydrates)
• Depressed mood
• Loss of interest in previously enjoyable activities
• Social isolation
It’s important to note that to be diagnosed with SAD, the above symptoms must regularly occur in the fall and winter, with full remission in the spring and summer. Also, there cannot be a reasonable explanation for changes in mood and behavior, such as a recent divorce or the death of a loved one.
So, what causes SAD?
The most common explanation is the reduced sunlight during the winter months, which may disrupt the circadian rhythms that regulate the body’s internal clock. Circadian rhythms tell us when it’s time to sleep and when it’s time to wake up.
Also, there are fewer daylight hours in the winter. It often starts getting dark between 4:30 and 5 pm, owing partly to the Daylight Savings Time change each year in October.
Melatonin, a sleep-related hormone which may cause symptoms of depression, is produced at higher levels in the dark. So, when days are shorter and darker, melatonin production increases, which can make you feel depressed.
It all sounds fairly grim, right? Fortunately, there are several things you can do to combat SAD and start feeling better.
1. Light therapy (phototherapy)
This is the most common and effective treatment because these special lamps mimic the intensity of direct sunlight.
The lighting in your house is less than 100 lux (the photometric unit) and lighting in a typical office is 300 to 500 lux; direct sunlight is more than 50,000 lux. Light boxes, which are essentially a bank of white fluorescent lights or bulbs shielded by a plastic screen, usually bring 10,000 lux. Some light boxes offer more, but 10,000 is considered a beneficial amount.
Duration and timing are two other key factors. You need about 30 minutes a day with a light box, and the most important time of the day is the early morning, between 6 and 7 am – the earlier in the day you arrest the production of melatonin, the better you’ll feel.
Light boxes, which start at $180 and go up to $500, can be ordered on the Internet and come in a variety of shapes and sizes. Some are small and portable enough to fit in the shelf of your stationary bike; many weigh three to five pounds.
It’s important to not look directly at the light box, since the light can damage your eyes. You can read, use the computer, talk on the phone, or watch TV while using your light box.
In June 2006, the Food and Drug Administration approved Wellbutrin XL as the first drug to specifically treat SAD. It’s not surprising, since Wellbutrin XL works on patients with atypical depression, a form of depression in which the most common symptoms are overeating and oversleeping.
Psychiatrists like Laura Lee Anders of Chicago often prescribe Wellbutrin XL or other atypical antidepressants such as Effexor and Cymblata to her patients, in conjunction with light therapy.
“All of the seasonal affective patients I have are on a combination of light therapy and medication. Some are on medication throughout the year, and I just adjust it for the winter months,” says Anders, who says about 15 percent of her practice is comprised of SAD patients.
3. Find a therapist
Therapists who practice cognitive-behavioral therapy (CBT) or use a problem-solving approach are the most effective. CBT therapists highlight and then help modify their patients’ negative thoughts, which can often lead to harmful or self-destructive behaviors. Problem-solving therapists help their patients learn new coping skills. Both approaches look to decrease depression and anxiety.
Waugh challenges her SAD clients to engage in social activities, even when they are hesitant to do so, as a way to brighten their mood.
“The weekends are usually the hardest for people. It’s easy to lie in bed and do nothing,” she says. “I encourage my clients to force themselves to do social things. So, when friends call and ask you to go to a play or go out to dinner, do it even though you don’t want to. Afterwards, you’ll feel better and be glad that you did it.”
Twenty to 30 minutes of aerobic exercise a few times a week will help raise your spirits, boost your energy and help keep the weight off. If it’s sunny out, take advantage and go for a walk at lunch. On bad weather days, work out at the office or play indoor tennis. Invest in a stationery bike or Stairmaster.
Be aware of any changes in your diet since many people with SAD crave sugar and carbohydrates. It’s OK to cheat every now and then, just don’t make a habit of it.
5. Schedule activities and trips to look forward to
Helen Smith, a forensic psychologist in Knoxville, Tenn., has managed her SAD for the past several years by adding fluorescent lighting in her house and spending extra time outside.
But this year, she and her husband decided to do something different: take a vacation to the Florida Keys over Christmas and New Year’s.
“People don’t take vacations this time of year. They feel as if they should be with their families. And we’ve always gotten together with family this time of year, too, so this is a big deal for me,” she says. “It’s been so nice to look forward to. You can tell yourself that no matter how bad it gets, in a few weeks I’ll be able to walk along the beach.”
David Sternberg, LICSW, is a psychotherapist in private practice in Washington, DC. He offers individual, couples and group counseling. He has been featured several times in the media, most recently in The Washington Post and on 'Good Morning America' for his work on stress management at the holidays. For more information about Mr. Sternberg, please visit his website dctalktherapy.com.