Healthy Edge
SAD Rises with the Declining Sun
Feeling down now that the days are shorter? Are you craving sweets and starches? Have a "brain fog," sleep excessively, feel lethargic? These are common seasonal affective disorder (SAD) symptoms. Seniors with SAD who spend long hours inside may be worsening their symptoms.
Seasonal affective disorder (SAD), sometimes called the Winter Blues, is not actually the blues at all. The "Diagnostic and Statistical Manual of Mental Disorders" - the psychiatrists' gold standard when it comes to diagnosing mental conditions - classifies SAD as a subtype of clinical depression in which major depressive episodes coincide cyclically with decreased daylight in autumn and winter. The worst months for most SAD sufferers are January and February.
Onset of a depressive episode may be gradual or sudden. An episode occurs when five of the nine following clinical depression symptoms are sustained for more than two weeks:
- Down mood
- Disinterest in loved activities
- Weight changes (SAD usually brings a weight gain)
- Sleep disturbances (SAD usually leads to excessive sleeping)
- Restlessness or psychomotor retardation
- Fatigue
- Feeling worthless or guilty
- Loss of focus
- Suicidal thinking/behavior (yes, some severe SAD sufferers have a high suicide risk)
Up to 35 percent of those with SAD require at least one SAD-related hospitalization. This condition can also adversely affect daily living. If left untreated, SAD may lead to alcohol or drug abuse, social withdrawal, or other problems at work or home. A small subset of sufferers also experience manic episodes in the spring and summer, sometimes referred to as reverse SAD. Individuals with these types of mood swings may have a bipolar disorder.
While more prevalent in the Northern regions (about 9.5 percent of Alaskans experience SAD), full-blown SAD affects one to two of every 100 Floridians. The vast majority of American SAD sufferers are women; yet, men with SAD may represent the most severe cases.
Studies suggest that in 29 percent to 69 percent of cases, patients with SAD were genetically predisposed. If you have SAD, you probably experienced your first episode in your mid-20s or 30s.
Even though diagnosis is tricky, the American Psychiatric Association (APA) has developed strict criteria for identifying SAD:
The patient's depressive episodes must occur during a particular season.
Recovery from SAD episodes must also follow a seasonal pattern.
The patient must have had at least two seasonal depressive episodes in consecutive years without overlapping non-seasonal episodes.
Seasonal depressive episodes must outnumber non-seasonal episodes.
People with subsyndromal SAD (more than 14 percent of Americans) or mild SAD may have difficulty getting diagnosed. Still, it's important for Seniors to visit their doctors if they have SAD symptoms. Other conditions such as hypothyroidism or mononucleosis can masquerade as SAD, and should at least be ruled out.
Whether they're mild or severe, SAD symptoms can be managed with a variety of therapies.
If you feel mildly affected by SAD, the APA suggests that you first try pumping up your outdoor activities during daylight hours - at least 30 minutes daily. If you can't do that, hang out by a window.
If you are depressed, your doctor can direct you to other more intensive therapies, most of which have virtually no side effects. Your doctor may recommend one therapy or a combination. Some of the more common clinically-proven SAD treatments are the following:
Bright light therapy. With your eyes open, you sit in front of a full-spectrum light lamp at doses of 2,500-10,000 lux for 30-90 minutes per day during the winter months. When you talk to your doctor about this option, know that certain meds can make you light-sensitive. Let your doctor know what you take, and don't forget to tell him or her about your dietary supplements as well! Also, late-night bright-light therapy may reduce your ability to fall asleep.
Dawn simulation and negative-air ionization. These two therapies require less work on your part than bright-light therapy, and studies show that they are as effective. While you are fast asleep, the dawn simulator and the air ionizer turn on automatically in the early morning. Kinda reminds me of "The Elves and the Shoemaker" fairytale.
Antidepressants. There are several pharmaceutical options for those with SAD. For instance, Wellbutrin XL is effective against more severe SAD. It was the first FDA-approved medication for preventing SAD in patients with a history of the illness. Other antidepressants your doctor may recommend are sertraline (e.g., Zoloft), fluoxetine (e.g., Prozac), and paroxetine (e.g., Paxil). Your doctor may suggest that you don't need to take these meds year-round - just start before your symptoms begin and then end slightly past the time they dissipate. However, please note that these therapies are sometimes accompanied by side effects.
The APA also stresses that psychotherapy is another highly effective way to manage SAD.
I recently read a quote by Dr. Karen Steinberg, a psychologist at the University of Connecticut Health Center, and it rings so true when it comes to mental wellness: "Denying, covering up, or ignoring your feelings just adds to the strain."
For more information about SAD and SSAD (subsyndromal seasonal affective disorder), visit the Seasonal Affective Disorder Association Web site at www.sada.org.uk/whatis.htm or Mental Health America at www.nmha.org/go/sad. Mental Health America's toll-free number is 1-800-969-6642.
Kendra Siler-Marsiglio, Ph.D. is the Director of the Rural Health Partnership at WellFlorida Council.