The winter blues’ big brother

Seasonal Affective Disorder can have serious consequences if left untreated

Dr. Steven McNevin is the Director of Psychiatry at Health, Couselling and Disability Services.
Dr. Steven McNevin is the Director of Psychiatry at Health, Couselling and Disability Services.
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It’s that time of year again, when the weather gets colder and the days get shorter. For many people, the grey weather will bring with it some seasonal blues.

For some, feeling down in the winter is an understatement. According to the Seasonal Affective Disorder Association (SADA), an estimated two to four per cent of the northern hemisphere’s population suffers from Seasonal Affective Disorder (SAD), a type of seasonal clinical depression that’s irritating at best and debilitating at worst.

Traditional SAD sufferers experience symptoms such as decreased ability to concentrate, oversleeping, constant fatigue, weight gain, withdrawal from social contacts and depression. These symptoms usually begin during the fall, get worse during winter months and only improve at the start of spring.

According to the association, the causes of SAD aren’t known for certain. It may be related to chemical reactions and disrupted biological rhythms, psychological mechanisms and personality traits, genetic factors, or even a combination of all three.

Dr. Steven McNevin, Director of Psychiatry at Health, Counselling and Disability Services, said he has seen only a handful of true SAD cases over the years. He says, there’s a definite spike in depression patients each year around the beginning of fall and spring.

“Our bodies respond to cyclical patterns. Not only is the weather changing around these times, but this is when kids are starting school or graduating, getting new jobs. It can act like a shock to the system.”

The most common treatment for SAD is light therapy—exposure to a high-intensity light anywhere from 30 minutes to several hours each day. The treatment simulates summer days. The usual “dose” of light is 12,000 lux. An indoor light is usually 400 lux, a cloudy day is about 3,000 lux and a sunny day can be 50,000 lux or more. A light box costs $200 to $400 and has proven to be very effective in treating 60 to 70 percent of patients, according to the SADA Other treatment options include antidepressants and counselling. Many people don’t want to resort to medication, or simply don’t have the time and money to invest in a light box. McNevin said some doctors have concerns about light therapy.

“Photo therapy lights are not yet regulated devices; they are of variable quality and reliability. There are concerns of excess radiation especially from ultraviolet light,” he said.

“There is a concern, however, even in properly shielded lights, about the development of cataracts with long term use—just like anyone else out in the sun too long.

“As well persons prone to headaches especially with migraines may find the lights may make them worse.”

SAD appears more frequently in women—twice as much as in men—and more often to those under age 35.

Rates of SAD are found to be significantly higher at northern latitudes, but according to a study done at the National University Hospital in Reykjavik, Iceland seems to be an exception, despite its northern location. It’s possible that because of their geographic isolation from other cultures, Icelanders have acquired an “immunity” of sorts to winter darkness.

A study done in 2000 by the SADA found St. John’s Wort, a herbal remedy, effective in treating those SAD sufferers with mild symptoms. However, there’s debate as to the herb’s safety; it has been found to interact negatively with many over-the-counter medications.

McNevin suggested students learn as much as possible and explore treatment options.

“Knowledge is power,” he said. “There is a stigma associated with mental illness. But don’t be afraid to talk to friends and family, your don, or even join a support group.

Seasonal affective disorder

Possible causes

  • As seasons change, biological internal clocks shift, due to the changes in sunlight. This could cause our clocks to be out of step with our daily schedules.
  • Fluctuating moods are caused by the body’s chemical response to decreased sunlight. Melatonin, a hormone secreted by the pineal gland in the brain, is linked to the neurotransmitter serotonin. It is produced at increased levels in the dark and has been linked with most forms of depression. When the days are shorter and darker, the production of melatonin increases.
  • SAD may be linked to genetics. An analysis of DNA samples from patients with SAD revealed that neuropsychiatric disorders affecting mood and behaviour are associated with an uncommon mutant, malfunctioning gene.

Criteria for diagnosis

  • Patient has experienced winter depression for several years and at least two consecutive years, alternating with non-depressed periods in spring and summer.
  • The patient has no other major psychiatric disorder.
  • There are no clear-cut or recurring social or psychological reasons to account for the recurrent winter depression.

Other types of SAD

  • Sub-syndromal SAD is thought to affect anywhere from 12 to 25 percent of the population and follows the same pattern as SAD but on a much less severe level.
  • Reverse SAD (or summertime blues) follows a seasonal pattern associated with spring and the coming of summer. Symptoms, similar to SAD in severity, include agitation, loss of appetite, hyperactivity, insomnia and increased suicidal fantasies.
Source: The Canadian Mental Health Association,The Seasonal Affective Disorder Association, Jigsaw Health and Dr. Norman E. Rosenthal’s Winter Blues

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