Separating Yourself From SAD

By Dr. Elizabeth Orth

Rain, showers and/or snow… With these weather predictions, it is apparent that it is wintertime in Washington. In Northern states such as Washington, it can be beneficial during this time of the year to know what SAD is, what the symptoms of are, and what can be done to help with SAD.

What is SAD?

Seasonal Affective Disorder, referred to as SAD, is a type of recurrent depression that is influenced by the seasons. Symptoms are present during the same season(s), typically Fall and Winter, and absent for the remainder of the year for a least 2 years. The decrease in light, which is associated with the Fall and Winter months, is thought to affect circadian rhythm, melatonin level, serotonin level, and Vitamin D level. One or more of these changes in the body may lead to the symptoms of SAD.

What does SAD feel like?

SAD can present with a variety of symptoms. Symptoms can include: sad feelings/ low mood, fatigue, anxiety, sleep problems (trouble waking-up or falling asleep), irritability, appetite changes (such as sweet cravings), etc.

What can be done to help with SAD?

The American Family Physician Guidelines recommends [one or a combination of] the following:

1. Light Therapy (LT): For many individuals with more mild symptoms, this is a good first option. From around 12-18 inches away, shine a 10,000 LUX fluorescent white light (no UV) on yourself for at least 30 minutes daily in the early morning. I also recommend starting the light treatment before you normally start getting symptoms. Possible side effects can include eye strain, headache or skin irritation but if you are at the proper distance away from the light, use a filter and do not look directly at the light for an extended period of time, the risk of side effects goes down.

2. Cognitive Behavioral Therapy (CBT): A type of counseling that focuses on how thoughts, feelings and behaviors affect each other.

3. Antidepressant Medication: If symptoms are severe, taking a SSRI medication may be beneficial short or long term depending on the individual. If this is an option you are considering, talk with a Healthcare Professional regarding the pros and cons of being on this type of medication.

Other options that can help with SAD include:

1. Dawn Simulation: In this treatment, the light starts increasing while you are asleep and gradually increases until it gets to full brightness and it is time to wake-up. Some research showed it more effective or similar in effectiveness to Light Therapy.

2. Exercise: Both exercising 1 hour daily as well as 1 hour twice a week has been found helpful. One article showed significantly greater benefit when exercising in bright light than exercising alone. 

3. St. John’s Wort: This herbal treatment can be helpful for mild to moderate depression. You do have to be aware that this herb may interact with other medications, so it is not an option for everyone. Do not take this herb if you are pregnant. Possible side effects can include skin reaction, nausea, vomiting, diarrhea or rapid heart beat. 

Resources:

Kurlansik S and Ibay A. Seasonal Affective Disorder. American Family Physician 2012;86(11):1037-1041.

Avery D, Elder D, Bolte M, Hellekson C, Dunner D, Michael V and Prinz P. Dawn Simulation and Bright Light in the Treatment of SAD: A Controlled Study. Biological Psychiatry 2001;50:205-216.

Terman M and Terman J. Controlled Trial of Naturalistic Dawn Simulation and Negative Air Ionization for Seasonal Affective Disorder. American Journal of Psychiatry 2006;163:2126-2133.

Pinchasov B, Shurgaja A, Grischin O and Putilov A. Mood and energy regulation in seasonal and non-seasonal depression before and after midday treatment with physical exercise or bright light. Psychiatry Research 2000;94:29-42.

Leppamaki S, Partonen T and Lonnqvist J. Bright-light exposure combined with physical exercise elevated mood. Journal of Affective Disorders 2002;72:139-144.

Sarris J and Kavanagh D. Kava and St. John’s Wort: Current Evidence for Use in Mood and Anxiety Disorders. Journal of Alternative and Complementary Medicine 2009;15(8):827-236.