Seasonal Affective Disorder (SAD) HOL-emblem1-web.GIF (3556 bytes)

 


Women Suffer from SAD the Most
75% of all SAD sufferers are women. It is not only light deprivation, but also an “innate vulnerability that lead to the syndrome”. Women are more susceptible to depression over all.

How to Stay Sane During Long Winter Months
Ten steps to tame tension and get your spirit glowing brighter than 10,000 twinkle lights.

Help Your Children Cope With the Winter Blues
In January, children often feel let-down as life returns to a routine of school, homework, ordinary family life, and the winter blahs after the excitement of the holidays. Help your child with these tips.

Introduction

When I was young, I read a book written by Nehru, the first Prime Minister of India. Nehru had spent a lot of time in prison during India's struggle for independence. One particularly striking passage in his autobiography recalls Nehru sitting in the cell, a very small cubicle with no lights (probably lit with a kerosene lamp), looking at the trees outside through the tiny prison window. The prison was in north India. The trees have shed all their leaves for the winter. The days were very short. Nehru was feeling "very sad". He decides to write a letter to his only daughter which later became "Discovery of India".

I did not know at that time, nor did any psychiatrist, that what Nehru was describing was what is now known as Seasonal Affective Disorder or SAD for short. He was starved for light, one of the causes for SAD, as we shall see later. To further make things worse, he was away from his family and loved ones. And he was in solitary confinement. He did the best he could do to get out of the blues, writing to the loved ones. As we shall see later, even a small amount of light is good for light starved persons. To write, he had to be near a light source facing it (one of the treatment method for SAD). He was imagining what it is to be in a free India (imagery) and thinking of being with his daughter (close to friends and family). In his autobiography, Nehru wrote about taking walks through the woods when he was allowed, thinking about the attainment of his goal of living in a free, independent India. (These short walks in the sun also helps SAD sufferers as we shall see later.) Nehru did pretty good within the resources that was available to him to minimize the effects of SAD.

Psychiatrist have known for a long time that affective disorders are very seasonal in nature. For example, attacks of mania are more frequent in summer time than at other times of the year. The incidence of depression (or hospitalizations for depression, electroconvulsive therapy treatments, or suicides) is relatively more common in the late spring. And we all know what moon does to mental disorders!

Medical records throughout history show an increase in the incidence of 'melancholia', or depression during the winter months. In 1845, Esquirol effectively treated a patient with symptoms we now know as Seasonal Affective Disorder, by recommending that he winter in sunny Italy instead of Belgium. Later in the 19th century, an insightful ship's doctor observed that his crew became lethargic in the dark days of an arctic winter, and he treated their languor with bright artificial light (Jefferson, J.W., An early study of seasonal depression, American Journal of Psychiatry, 1986).

In spite of this early awareness, it is only in the last fifteen years that modern medicine has given a name and drawn up a specific list of symptoms for the 'winter blues' and 'winter blahs'.

In 1984 Rosenthal, published a study of patients (predominantly women) with illnesses such as hypomania and depression. (Psychiatrists call these bipolar II illnesses.) For most of the patients, these symptoms do not appear until the second and third decades of life although a number of cases in children have been reported. Rosenthal found that depressions usually begin in October or November and are characterized by hypersomnia, anergia, carbohydrate craving, and weight gain. Other symptoms include depressed mood, hopelessness, suicidal thoughts, decreased self esteem, and social withdrawal. The affected persons have a tough time getting anything done; they feel very tired and sometimes have trouble getting out of bed. Depressions usually end in early spring and are often followed by hypomania and, occasionally, mania in the spring and summer.

This disorder is called Seasonal Affective Disorder, or SAD. Seasonal, because the ailment is influenced by the seasons, affective, because it is an expression of mood, and disorder, because in all cases it brings about a change or imbalance in the body's normal way of functioning.

Symptoms of SAD

One of the most important distinguishing feature of SAD is that it is highly seasonal. SAD symptoms always start in the the autumn or early winter. The illness generally lasts for between five to seven months until spring, when the days grow significantly longer, and the symptoms disappear, leaving the sufferer perfectly healthy until the following autumn. Many of these people will also feel an increase in energy at the onset of spring.

Dr. Shila Mathew, a board certified psychiatrist at Kaiser Permanente Health system suggested that there are four classic symptoms shown by her patients who had been diagnosed as having SAD. These are:

According to Dr. Mathew, winter depressions can be very very severe in some patients. It affects the way you function and, in some cases, interfere with your personal relationships. Mood certainly changes. Some people become sadder, to the point of experiencing real grief at times. Many of them become very irritable, some become very anxious. Sometimes the irritability can lead to feelings of violence. Many feel drowsy throughout the day. They cannot get "enough of sleep". Some increases their sleep by as much as two hours or more per day. They may fall asleep early in the evening or have a tough time getting out of their bed in the morning, showing all signs of sleep deprivation.

Many experience a severe lack of energy which may manifest as inability to concentrate at work and a lack of vitality. To compensate for this lack of energy, many will go on an eating binge. Many crave foods which are high in carbohydrates. As a result of this overeating, many will put on weight during the winter months anywhere from 9 pounds to 30 pounds. Many find that they have no control on this excessive eating. (At spring and summer months, their eating habits will return to normal and most of them will lose the extra weight they have gained in winter only to gain them back in the next winter.)

Perhaps, the most important symptom of SAD is that all SAD sufferers feel depressed. They feel guilty for the lack of energy and the overeating. They sense a loss of self esteem, hopelessness and despair. Many find it hard to work. The number of "sick days" taken by the SAD sufferers in winter goes up dramatically. Many SAD sufferers will withdraw from the world and avoid social contacts.

The following symptoms are shown by some SAD sufferers; but not all.

Profile of A Typical SAD Sufferer

SAD shows no discrimination. It affects everyone without any regard to class, race or occupation. It is found in both northern and southern hemisphere. It gets worse in countries which are far from the equator where there is a substantial difference in the length of day from summer to winter.

SAD affects both sexes. But it was found to affect women more than men. Typically, the disorder starts manifesting when the patient is 20-40 years of age. It, however, had been found in some children and some older adults.

SAD may be hereditary. Many SAD sufferers come from a family where a parent or a close relative suffer from SAD.

It is estimated that ten percent of the population in the USA suffer from SAD. In U.K., Australia and Canada, doctors estimate that five percent of the population suffer from SAD. The variation between the countries may be due to the difference in awareness level of the population of the readiness of the population to seek treatment for the disorder.

Children with Seasonal Affective Disorder

Many of the SAD sufferers surveyed suggested that they were suffering from these symptoms since their childhood. Six percent of children surveyed in a Minnesota school claimed to experience extreme mood variations during the winter. One percent reported feeling depressed in winter. In a study conducted with 2267 middle and high school students in a suburb or Washington, D.C.. 3.3 percent of the responding students showed symptoms of SAD. The rate of SAD was found to be higher in post pubertal girls. The study concluded that between 1.7 percent and 5.5 percent of children between the ages 9-19 years may have SAD. They also have speculated that there is a relationship between SAD and puberty.

SAD Children (no pun intended) often suffer from fatigue and irritability, but not necessarily depression. They are generally aware that something is wrong, very often, they will blame their problem on external factors such as someone is "picking on them" Usually, these symptoms are thought to be the result of the onset of puberty or of adolescence. Keep an eye on your children to see whether they experience a seasonal decline in academic achievement, activity or mood.

Almost all children with SAD suffer the following symptoms during the autumn and/or winter months:

Some will show symptoms such as:

Keep an eye for the following tell-tale signs of the performance at school:

Children suffering from SAD may also show behavioral difficulties such as:

Children suffering from SAD is treated the same way as adults, i.e., Light Therapy.

Treatment

Bright Light Therapy

The main treatment for SAD is light therapy, specifically, bright light therapy. We have covered light treatment in depth elsewhere. Researchers at more than 15 medical centers and clinics in both the U.S. and abroad have had much success with light therapy in patients with clear histories of SAD for at least several years. Marked improvement is usually observed within a week, if not sooner. The bad part is that the symptoms usually return in about a week when the lights are withdrawn. So, to take full advantage of the benefits of the light therapy you should stick with it. Most users, therefore, maintain a consistent daily schedule beginning, as needed, in fall or winter and usually continuing until the end of April, by which time outdoor light is sufficient to maintain good mood and high energy. Some people can skip treatments for one to three days, occasionally longer, without ill effect, but most start to slump quickly when treatment is interrupted.

Please read the section on side reactions of light therapy and contraindications, before proceeding with the treatment. It is always a good idea to be under an experienced professional while undergoing the treatment.

Other treatments for SAD

Researchers have tried a number of other potential treatments for SAD; but most of them, such as taking melatonin, are not very effective. A number of treatments, which are still in the investigation phase, looks very promising.

Negative Ion Therapy

You might have seen the ionizers for air cleaning. These devices work by releasing a negative ion, a molecule that contains an extra electron. In nature, these negatively charged particles are created by the sun, wind, moving water, etc. These ions cling to the dirt, which is positively charge, and settle down, making the air cleaner like fresh air after a thunderstorm. Researchers have found that having these devices in the proximity of the SAD sufferer helps reduce the irritation and depression, while improving their energy level. This is something you can have in your bed room or near the location where you work most. It certainly cannot hurt; so, it is worth trying to see whether it helps you.

Dawn Simulation

Research was conducted at New York State psychiatric Institute to find the effect of dawn and dusk conditions on SAD. A computer was used to simulate the gradual appearance of dawn and the gradual disappearance of light in the evening characteristic of spring. (In contrast, during winter months, the light disappears or appears pretty abruptly.) It was found that when subjected to this simulated dawn, SAD sufferers reported substantial improvement, as good as following the full photo therapy. Blood tests revealed that the dawn simulation resulted in cutting off the production of melatonin and restored the circadian rhythm. When exposed to the artificial dusk simulation, the patients had good deep sleep. It almost appeared like "a pleasant hypnotic sensation". The dawn and dusk simulation has great potential in the treatment of SAD and more work is proceeding in this line.

Skin Illumination

Although an early study comparing light exposure to the eyes and to the skin found that light to the eyes has the greatest therapeutic effect for people with SAD, a recent study indicates that circadian rhythms (the body's biological clock) can be affected by light exposure to the back of the knee. (Please read the section titled "Does the Human Body Conduct Light?" for another angle on this.) While this finding will certainly lead to further research, it would be premature to draw conclusions about the potential effects of skin illumination on SAD symptoms. One problem is that exposure to ultraviolet (UV) light, given off by the sun and by tanning lamps, can lead to other health problems, such as skin cancer. People with SAD should definitely not try to "self-medicate" by exposing their skin to potentially hazardous UV illumination.

Conventional Treatments For Depression

Some SAD sufferers find that standard antidepressant medications provide relief. Separate independent studies have shown that bupropion and citaloprim, a selective serotonin reuptake inhibitor, are as effective as light therapy and so does the treatment with fluoxetine (prozac). Clinical studies are continuing on two double-blind studies of serotonin reuptake inhibitors in SAD. It will be very interesting to find if a combination of medications and light therapy is more effective than either treatment alone.

There are no studies done on the effectiveness of St. John's wort for the treatment of SAD. St. John's wort was found to be effective for mild depression; hence it is logical to suggest that it may be tried for SAD also.

Common Sense Care

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