Some people appreciate the winter for the changes in scenery, pace of life and recreational opportunities. They welcome the slower pace and longer nights. Several cultures around the globe enjoy and celebrate the darkness. For some people the winter brings on periods of “cabin fever,” - at times being bored and disconcerted with the weather that keeps them cooped up inside.Yet for others, the seasonal change ushers in a form of depression called seasonal affective disorder, or SAD.
According to the American Psychiatric Association, these symptoms may indicate that a person is experiencing a condition more significant than cabin fever:
- Fatigue.
- Decreased energy.
- Lack of interest in normal activities.
- Social withdrawal.
- Craving foods high in carbohydrates.
- Weight gain.
SAD, for some people, occurs regularly each year. Symptoms can emerge in late August and worsen through fall and winter. With SAD, as opposed to a major depressive disorder, the symptoms begin to resolve in the spring.
SAD becomes problematic for people when the symptoms begin to interfere with living - they withdraw from social functions, have school or work problems, abuse alcohol and other substances or think about suicide.
What’s going on?
SAD appears to be rooted in brain chemistry that becomes out of balance by decreased sunlight. According to the Mayo Clinic, SAD reflects changes in a person’s circadian rhythms (a person’s brain and body routine).
SAD may be tied to increased melatonin, a sleep-related hormone. Darkness stimulates the body’s production of melatonin, so with the longer nights of fall and winter, melatonin levels increase, thereby increasing a person’s drive for sleep.
The drop in sunlight also triggers a reduction in serotonin levels. Serotonin is a brain and body chemical associated with regulating mood and physical comfort. The downward shift in serotonin levels can bring about depression in some people.
In 2000, the APA noted that winter-type seasonal pattern depression appears to vary with latitude and age. The higher the latitude, the higher the risk of SAD. Women comprise 60 percent to 90 percent of people who are affected, and younger people more than older.
Is it SAD or cabin fever?
The Mayo Clinic lists criteria that are helpful in recognizing SAD:
- Depression and other symptoms have been present during the winter season for a least two consecutive years.
- The periods of depression have been followed by periods without depression.
- There is no other explanation for the change in mood.
What do I do if I have SAD?
The APA recommends that people who suffer significant SAD symptoms seek help from a mental health provider. In regions of Montana where mental health services may not be readily available, a general family physician or nurse practitioner would be able to diagnose and offer treatment options.
The Mayo Clinic reports that symptoms of SAD can be managed by spending more time outdoors or sitting close to bright windows at home or at work. Light therapy is often the main treatment. Light boxes, now less expensive and more available than in the past, need to produce full-spectrum light in order to be effective. At this time, light therapy has not been approved by the Food and Drug Administration for treatment of SAD, but many have found it helpful. People who have a bipolar disorder need to know that using a light box could cause mania or recurrence of cycling moods. Discuss this treatment with your health care provider before starting.
Some people suffering from SAD benefit from medications. The FDA has approved the antidepressant Buproprion ER for the prevention of depressive episodes in people with a history of SAD. Selective serotonin re-uptake inhibitors, the type that prevent the breakdown of serotonin levels in the brain and body, have also been used to treat SAD.
Talk therapy can be helpful. Mood and behavior also contribute to the depressive symptoms. Talk therapy can help a person find healthy ways of coping with SAD and relieving stress.
The Mayo Clinic offers these tips to help manage SAD:
- Make your home sunnier and brighter. Open blinds, add skylights and trim branches that block sunlight.
- Get outdoors on sunny days. Walking helps relieve stress and improve mood.
- Get sufficient rest. Go to bed and get up at the same time every day. This helps adjust your circadian rhythm.
- Socialize.
- Take a trip. Go to sunnier locations in the winter months. Short expeditions to sunnier higher elevations can help, such as driving up into the mountains.
Whether it is cabin fever or SAD, you can minimize the effects and improve your mental and physical well-being during the cold, dark days of winter. Get more information on SAD at these Web sites:
- The National Alliance on Mental Illness: www.nami.org.
- The National Institute of Mental Health at the National Institutes of Health: www.nimh.nih.gov.
- The American Psychiatric: Association www.apa.org.
- The Mayo Clinic: www.mayoclinic.com.
John Honsky is an advanced practice registered nurse with Family Mental Health at St. Patrick Hospital and Health Sciences Center.
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