A light at the end of the tunnel
By Mitchell Strauss, M.D., obstetrician and gynecologist, Providence Columbia Women's Clinic
You'd think we'd be used to it by now. Here in the gray Northwest, dim, drizzly days are the norm from autumn until well into spring – and often beyond. We know the routine. Yet by February, even though the days are beginning to get longer, the months of sun deprivation still take their toll. We move a little slower, laugh a little less, grumble a little more.
Some extra grumpiness is normal at this time of year. But for people with seasonal affective disorder, or SAD, the effects of winter's doldrums go much deeper. SAD is a true form of depression that can affect moods and emotions seriously enough to interfere with relationships, the quality of life and the ability to function. People with SAD experience increasing feelings of irritability, sadness and listlessness that begin when autumn's days start getting shorter. They often overeat and over-sleep, a departure from most forms of depression. But the most unique distinction of SAD is its seasonality: unlike any other form of depression, SAD improves in the spring, when longer, lighter days return.
Spring can seem like a long way from February when you live in the Pacific Northwest, but you don't have to wait that long to feel better. If winter depression is affecting your quality of life, talk to your doctor about it. Several therapies are available that can make a profound difference.
For people with SAD, light therapy can be like turning on springtime. Studies show that 30 minutes of daily exposure to a 10,000-lumen light can start improving symptoms noticeably in days.
Thanks to increasing awareness of SAD, light boxes are now available everywhere – even at Costco. But not everyone understands how to use them correctly – a problem that can lead to widely varying results. If you buy a light box that projects 10,000 lumens of light for a maximum distance of two feet, and you sit six feet from it, you will not get the therapeutic dose of light intensity. Check the package for details regarding the optimal distance to position yourself from the light.
Most recommendations suggest starting with about 10 minutes of daily exposure and increasing by 10-minute intervals to 30 minutes a day. Contrary to what you may have heard in the past, you don't need to look into the light to get benefits. In fact, the ideal position for the light is over your head, so it beams down on you – like the sun. Simply let it shine on you while you eat breakfast or read the newspaper in the morning. When the light is positioned correctly, most people see a noticeable difference in energy level and other symptoms in just two or three days.
If symptoms persist after trying light therapy, ask your doctor about medications that can help. There are several antidepressants that can relieve the symptoms of seasonal depression. One antidepressant, called bupropion (the generic form of Wellbutrin), has even been shown to help prevent recurrences of SAD when taken before the seasonal onset of symptoms.
The "sunshine vitamin" is a hot topic right now. We know that people with depression generally have lower levels of vitamin D, and we know that vitamin D levels drop further in the wintertime. But the jury is still out on whether or not vitamin D supplementation can be used therapeutically to treat SAD. It may play a role, so I recommend that people discuss it with their physicians.
Exercise has been shown absolutely to decrease depression symptoms, in addition to all the other ways in which it benefits body and soul. I highly recommend it.
Counseling should be considered if you have symptoms of depression, whether they occur seasonally or otherwise. In addition to helping with issues that may be contributing to depression, most counselors are familiar with light therapy and can explain more about how to use it correctly to treat SAD.
Herbal remedies? Maybe not
While some sources, including the link at the end of this article, suggest trying St. John's wort for SAD, this herbal antidepressant is very controversial and is falling out of favor as a remedy. It can interact badly with many common medications, including antidepressants and birth control pills. It also increases sun sensitivity, with potentially serious results. Never take St. John's wort without your physician's involvement.
For most people with SAD, light therapy and/or medication will make a significant difference in lifting the heaviness of the winter months. If nothing seems to help, it's possible that the problem is something other than seasonal affective disorder. In this case, I urge you to explore your symptoms further with your physician.
For those with a milder case of the winter blahs, give some vigorous outdoor exercise a try, and hang in there – spring is on the way.
For more information
Read about one patient's experience with SAD.
Obstetrician and gynecologist Mitchell Strauss, M.D., has known several people with seasonal affective disorder, which has led to his special interest in helping patients with the condition.