Departments
Health Matters
|
Week of 13 November 1998 |
Vol. II, No. 14 |
Health Matters
Seasonal affective disorder: more than just the winter blues
Now that winter is almost here, I have less energy and feel like napping all the time. Do I have seasonal affective disorder?
Seasonal affective disorder, commonly known as SAD, is a form of clinical depression caused by the lack of bright light in the fall and winter months. The disorder is characterized by profound depression, sleep difficulties, overeating, lethargy, and poor concentration. SAD is seen in only 5 to 10 percent of the population, while the winter blues are more common.
According to Janet Osterman, M.D., medical director of the Out-patient Psychiatry Clinic at Boston Medical Center and assistant professor of psychiatry at Boston University School of Medicine, there are two types of seasonal affective disorder: depressed and bipolar.
Depressed SAD occurs in a person who has a normal mood until the days get shorter, when depression sets in. The onset of this form of the disorder typically occurs from early October to mid-November and lasts until mid-February to mid-April, when the daylight hours begin to lengthen.
Osterman says that almost anyone can be affected by seasonal affective disorder, including children. It is estimated that 14 percent of the U.S. population notice a seasonal change in their behavior and that 6 percent are so seriously influenced by the dark days of winter that their personal lives and work suffer dramatically. Since more women than men have depressive orders, they are more likely to suffer from SAD. The disorder is not based on any socioeconomic, cultural, or class factor; however, 50 percent of SAD sufferers have a first-degree relative (i.e., a parent or sibling) with a mood disorder.
Depressed SAD is commonly treated by phototherapy, exposure to bright, artificial light. Osterman says that sitting in front of bright light for two to three hours a day is generally sufficient for reducing SAD symptoms. The light must be at least 2,500 lux (a technical measurement of brightness), which is about 200 times brighter than conventional lighting. "Natural light from the sun is not sufficient to reduce SAD symptoms," says Osterman. "The amount of light needed is based on duration, and there simply is not enough daylight in the autumn and winter months."
Patients with depressed SAD are also treated with antidepressant medications, which, Osterman says, can be very effective.
The other form of SAD is called bipolar seasonal affective disorder. Bipolar is the term currently used for manic depressive disorder. In this form of SAD, sufferers are depressed during the winter months and hypomanic in the summer. That is, during the summer their mood becomes euphoric, and they talk too much, exhibit impulsive behavior, get easily distracted, and have an inflated sense of self-esteem. Bipolar SAD is treated with mood stabilizers such as lithium.
A distinction must be made between seasonal affective disorder and the normal blues that people often experience in the winter. "Those people with the normal blues may have a lower mood, but they are functional and have good days; they know they are not sick," says Osterman. "On the other hand, those with SAD find no pleasure in anything they do and often can't function at home or at work. SAD sufferers never have a good day."
Osterman says that since SAD is biologically oriented, the disorder does not simply go away. People with SAD have symptoms year after year. "With proper timing," she says, "treatment can help people avoid symptoms. Thus, if symptoms typically appear in mid-October, treatment should begin in early October."
Exercise is a good antidote to the winter blues. While many forms of exercise take place outdoors, indoor activities like riding a stationary bike or using a Stairmaster can help to reduce the ups-and-downs that accompany the cold winter months.
"Health Matters" is written in cooperation with staff members of Boston Medical Center. For more information on seasonal affective disorder or other health matters, call 638-6767.