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The Fall and Winter Blues

Seasonal Affective Disorder

Imagine this: On the first day of winter, the sun rises at 11:23 a.m. and sets at 3:29 p.m. These days of brief sunlight – assuming the sun is visible at all and not covered by clouds – last for several months. How would you cope?

By Tom Cory, PH.D.

In Iceland, daylight hours swing from one extreme to the other. Winter daylight hours are almost nonexistent. Icelanders, however, keep their Christmas lights up until April. They use more candles per capita than just about any country in the world. They have a three week food festival in February and many other festivals throughout the winter. Even the smallest fishing villages have outdoor swimming pools, hot tubs and sports halls.
Studies have found that in Iceland, the prevalence of seasonal affective disorder and seasonal changes in anxiety and depression to be unexpectedly low. But yet despite their efforts, seasonal affective disorder still exists.
Thankfully, sunlight in the Southeast is plentiful. However, many people in the Southeast, and throughout the world, struggle with changes in mood and energy levels as daylight hours change from season to season. Decreased daylight hours can bring on fall and winter seasonal affective disorder (SAD), a form of depression that occurs at the same time each year.
Most people with SAD experience symptoms of depression and low energy that typically start in the fall and continue into the winter months. According to the American Psychiatric Association, to be diagnosed with SAD an individual must have depression and other symptoms for two consecutive years during the same season, the symptoms must improve with a change of seasons, and there must not be any other explanation for these symptoms.
As with any emotional disorder, SAD ranges in severity from mild to severe and can include periods of almost manic mood elevation. SAD is typically more prevalent in women, although men tend to have more severe symptoms when they develop it. SAD seems to run in families and in the fall to winter, it appears to be caused by prolonged periods without sunlight.
According to the Centers for Disease Control and Prevention, approximately 20 percent of Americans suffer from periodic episodes of SAD. Interestingly, while the likelihood of an individual developing SAD increases with the distance they live from the equator, studies indicate that individuals living in the South are far from immune to SAD.
With relatively little experience with prolonged periods of lack of sunlight, Southerners may be more prone to develop SAD during “relatively” short periods of bad weather than their northern counterparts. For example, September 2009 was considerably cloudier and wetter in the Southeast and many mental health providers noted an increase in the number of clients they were seeing with depression.
SAD is more than being moody or a little blue. Those suffering from SAD often report problems with sleep and appetite, feelings of constant fatigue, difficulty concentrating, feelings of worthlessness and overwhelming feelings of sadness or grief. Frequently, SAD sufferers also complain of somatic (relating to the body) symptoms, such as headaches and stomach aches. It is important to note, that social withdrawal is a frequent and serious indicator of SAD.
Interestingly, the specific causes of SAD remain unknown. It is possible that reduced levels of sunlight, characteristic of fall and winter, may disrupt the body’s internal clock. Researchers at the Mayo Clinic believe that it may be this disruption of the circadian rhythm – the body’s internal clock that determines when you should be asleep or awake – that causes depression characteristic of SAD.
Reduced sunlight has also been shown to disrupt the hormone melatonin, which affects the sleep cycle, and serotonin, a brain chemical that affects mood. Either or both of these affects might lead to the depressive symptoms characteristic of SAD.
Light therapy is a common treatment for a variety of conditions, from auto-immune disorders like psoriasis and eczema, to wound healing, to depression and seasonal affective disorder, to circadian rhythm sleep disorders
SAD should be taken seriously. In its more severe forms, symptoms of SAD can mirror those of a major depressive episode and can seriously disrupt a person’s daily functioning. SAD can lead not only to social withdrawal, but also to substance abuse, school problems and even suicidal thoughts. While there is no known preventive, psychologists and physicians recommend the following:
• Make your environment sunnier and brighter. Consider purchasing lamps with bulbs that mimic sunlight.
• Get outside as much as possible. Even on overcast days, you may benefit from small amounts of sunlight that filter through the clouds.
• Exercise. Studies suggest that moderate exercise helps alleviate the symptoms of SAD.
• Socialize. Make an effort to be around other people.
• Follow the sun. Consider a winter vacation to a sunnier climate.
If you suspect that you have a pattern of SAD in your life, it can help in the diagnosis if you keep a diary of symptoms, patterns of depression and information about any major stressors or life changes you may be experiencing. Your physician may suggest treatment with an antidepressant. Since these medications may take several weeks to produce therapeutic results, the earlier you seek treatment the better.
Light therapy, also called phototherapy, has been shown to be an effective treatment for many people suffering from SAD. Patients sit several feet from a special light therapy box and are exposed to a bright light for several minutes. Light therapy is widely used in Scandinavian countries and does appear to be helpful. Be sure you discuss this option with your doctor or mental health provider before purchasing a light therapy box.
Psychotherapy is another option that may help SAD. Even though evidence indicates that SAD is a brain chemistry issue, a therapist can help you identify behaviors and thinking patterns that are adding to distress. In addition, a mental health provider can help you learn more effective ways of handling stress and help you maintain the motivation to take a positive, proactive approach to symptoms.
If you or someone you love struggles with SAD, the earlier preventative steps are taken, the better. If symptoms persist, consult with a physician or a mental health provider such as a psychiatrist or psychologist.
 Tom Cory has lived in Chattanooga for 35 years. He is a graduate of the College of William and Mary and Miami University where he received his Ph.D. in Clinical Psychology. Today he practices clinical psychology specializing in interpersonal and marital therapy.

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