'Tis the Season

For those with seasonal affective disorder, winter is the time for sunshine in a box



Dreary February days may leave us all a bit mopey, hunkering in our beds or slogging through our chores. But for some people, the period from mid-October to mid-April can be a six-month downer, caused by a condition known as seasonal affective disorder (SAD).

"It's a winter disease," says Teresa Cutts, Ph.D., a clinical health psychologist, affiliated with the University of Tennessee Health Science Center and with Methodist Health-care, who has counseled people with SAD. "I liken it to a bear hibernating. But we're humans so we have to keep functioning."

A variant or sub-type of major depression that's associated with shortened daylight hours, SAD reduces the body's level of serotonin, a neurotransmitter that affects appetite and mood. "People with SAD can't access their serotonin at an optimum level," explains Cutts. "As a result, they're fatigued, they want to sleep all the time. They withdraw socially. They crave carbohydrates, especially comfort foods like ice cream, cookies, bread, chocolates." They also experience a mild to moderate depression that, if left untreated, can worsen.

Diagnosing SAD isn't always easy because other types of depression can mimic it. Mental health specialists use three criteria for determining if a patient has SAD: The person has experienced depression for at least two consecutive years during the fall and winter months; the depression ends with spring's arrival; and nothing else has caused the changes in the person's mood or behavior.

The age of SAD onset is the late 20s and early 30s, and the disorder is more common in women, says Cutts. "If you've had SAD before, you want to be very aware of that period from [fall to spring]. Don't 'self-medicate' with carbohydrates. They might give you a serotonin rush, but in the long run they worsen the problem." Instead, she says, eat fruits and green vegetables, get out and exercise, or if the weather's too miserable, use a treadmill inside. Take a trip. Do things that give you pleasure.

A critical period, she says, is in early to mid-April, especially for individuals who not only have SAD but a recurrent or chronic depression as well. "They'll start climbing out of that funk," says Cutts, "because their energy level is returning but their mood level is still not resolved. So during that two-week window, they're at risk. That's when SAD can be serious, when it overlays or has developed into a major depression. For most people, however, it's typically more like 'the blahs.'"

Antidepressants can help SAD's symptoms, but Cutts leans toward behavioral therapy, the most common of which comes in the form of a light box. We all know how a sunny day can lift our spirits, and Hippocrates, the father of modern medicine, recommended exposure to sun-light for any number of maladies. So it only makes sense that light boxes bring relief to SAD sufferers.

"Full-spectrum" light boxes contain elements that emit all wavelengths of light, including ultraviolet (UV) rays. Other type boxes emit only non-UV white light. With the box mounted upright to a wall or slanted downward towards a table, the patient sits near it for a prescribed length of time, from 15 minutes to several hours. When using the box for extended periods, patients are advised to apply a sunscreen and to discuss other precautions with an ophthalmologist.

Light boxes range in price from $200 to $500 and can also be rented from health-care supply companies. Cutts suggests learning more about them through the American Psychiatric Association or the American Psychological Association. "These organizations have recommendations for what works and what doesn't," she says. "Some light boxes are knock-offs and not properly configured. And it's best to have some supervision by a health practitioner to be sure you're using them properly."

Finally, for those with SAD, Cutts advises awareness and common sense. "Know that if it rains all day, your mood is going to be low. And that's not the best time to make major decisions. But know too that SAD will pass. It's cyclical, so it always does." M

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