Guest writer Dr. Charles Silberstein writes about SAD
(seasonal affective disorder)
Dr. Charles Silberstein is a psychiatrist at Martha’s Vineyard Hospital.
Why do I always feel blue in the winter? I don’t want to go on an antidepressant. Do light boxes really work? How do I choose one? Is there anything else that I can do?
During the first hour of every evaluation, I ask whether seasonal mood changes occur. Often the answer is “no,” or even, “I like the dark days of winter.” And often, I hear this: “Doesn’t everyone feel lower in the winter?” Well, the answer is that about 20 percent of people will experience some seasonal blues. About 6 percent of us will experience more severe mood changes, or seasonal affective disorder (SAD). The American Psychiatric Association regards SAD as a variant of major depressive disorder and bipolar disorder. SAD occurs in about 1.4 percent of people in Florida, and about 9.9 percent in Alaska. Though there is some controversy about this, there appears to be a direct relationship between latitude and incidence of SAD; women are about four times as likely to get it. Being younger, having a mood disorder, and having a family history are all factors that increase the risk.
What causes it?
The exact mechanism is unknown but it appears to be triggered by the decreased seasonal light. While cold weather, winter isolation, and underemployment no doubt contribute to the winter blues, they are not the cause of SAD. It appears that the excessive production of melatonin which occurs in dim light or darkness, as well as a different pattern of serotonin regulation, may be factors. People with SAD need much more light than others to inhibit the brain’s production of melatonin. And some people with SAD may have trouble making enough Vitamin D.
What to do?
I appreciate your preference not to go on medication. Medications all have side effects and unknown long-term consequences. While ultimately that may be necessary in more severe cases, starting with more natural treatments probably makes more sense. Here are my suggestions:
- Get a light box. Light is a powerful antidepressant. In a recent research study, light therapy was found to be as effective as Prozac at treating non-seasonal depression. If you search for “seasonal light box” at Amazon, a bunch pop up. The most important thing is that the box is 10,000 lux. Full-spectrum bulbs provide a nice light, but the important ingredient is light intensity. You will see blue and white lights. It is unclear if one is superior. Some people find the blue lights tend to be more stimulating. Beyond that, the choice is mostly stylistic. Some people want a small portable light, others might want a desk lamp. There is even a light visor that can work while people move around.
- Sit close to the light — 16 to 24 inches. There is an exponential dropoff in light intensity with distance from the light. Just think about how light fans out from its source. The closer you sit, the more intense and therefore effective the light is. Most people use it in the morning. Others use it twice a day. Some people find that it really helps evening energy when used late in the day. One word of caution: Bright light interferes with the production of melatonin — the sleep hormone. If you use it late in the day, it may interfere with sleep.
- Get your vitamin D level checked, and if it is low, take Vitamin D supplements.
- Get psychotherapy. Cognitive therapy has been studied for SAD, and it works. Other therapies have been studied for depression, and they are quite effective as well.
- Consider a negative air ionizer in your bedroom. Negatively charged particles in the sleep environment can help mood and SAD.
- Consider medication. Serotonin reuptake inhibitors like Zoloft, Celexa, Lexapro, Prozac, and a bunch of others are probably the most effective medication for SAD. Others, such as Wellbutrin and Provigil, may help as well. Medication can be safe, easy, and effective.
Here are some other suggestions that are less well studied but make common sense for anyone with the blues:
- Spend time with caring, comfortable, low-conflict friends and family. We are tribal animals, and benefit from being with others.
- Keep a neat and organized home and work space.
- Get enough sleep. (I will write about sleep in another column.)
- Exercise! Especially outdoors in daylight.
- Get enough omega-3 fatty acids in your diet. Eating fatty fish twice a week may suffice.
- Sex and love — giving and receiving — of course are also powerful and pleasurable mood enhancers.
Charles H. Silberstein, MD
Martha’s Vineyard Hospital
Oak Bluffs, Massachusetts