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Am I Blue... or just "S.A.D.?"
by Daniel B. Pearson, III, M.D.
Many people notice they are more down and blue during the winter
months. We often associate these feelings with the coming on of the holidays in December,
feeling badly about all the "hype" of how happy we "ought" to be and
how we "should" treasure our memories of our childhood and families. In fact,
many are disappointed and feel guilty about not being happy at the holiday time and about
not having ideal childhood memories of this time of the year. But is this disappointment
and grief over past holidays the only reason so many are blue in the Winter? A significant
number of people actually are not just "blue" during the winter, but are
DEPRESSED every winter. These people may have a form of depression known as SEASONAL
AFFECTIVE DISORDER, (S.A.D.). This form of depression often recurs each winter to one
degree or another, and typically starts to develop about the same time in the Fall.
S.A.D. can be just as severe and serious as other forms of Major
Depression. It usually lasts much of the winter and does not begin to get better until in
the late winter or early spring. This form of depression has been shown to be related to
the relative length of the day and night. The shorter the day and the longer the night,
the more depressed the suffers of S.A.D. get. When this occurs to people living in the
northern hemisphere, the holiday blues sometimes coincide with Seasonal Affective
Disorder, confusing the picture as to which condition is present. In contrast, in the
southern hemisphere, people who are blue about the built up expectations of the holidays
are down and blue in December, but people with S.A.D. are depressed in the southern
winter, in July!
People who have S.A.D. often had such patterns early in their life.
It is much more prevalent in women than men, as much as 4 or 5 to 1. One study which
looked at twins with one having S.A.D. showed that about half of the other twins also had
the disorder, suggesting a genetic component to the disorder.
Seasonal Affective Disorder appears to be intimately related to the
"chronobiologic cycles", our internal timers that control our circadian rhythms.
When the days start getting shorter, the amount of light reaching our eyes is less than in
summer. This also results in changes in the amount of a hormone released by a part of the
brain, the pineal gland. This hormone, melatonin, seems to be intimately involved in the
timing of other rhythmic cycles in our bodies. Similar rhythms are seen in other animals
including animals which hibernate, migrate and have estrous cycles. By artifically giving
more light during certain times of the day, these cycles can be influenced. This forms the
basis of one of the forms of treatment for S.A.D., treatment with bright light,
"Phototherapy". Though S.A.D. often responds to other forms of treatment for
depression, it also may show significant improvement with the bright lights. How bright is
bright? Ordinary room light may have an intensity of 200 to 700 lux. The intensity of
light necessary for the treatment of S.A.D. is on the order of from 3,500 to 10,000 lux.
For comparison, a bright noon sky may be about 100,000 lux, and a cloudy day, a third of
that. When phototherapy is effective, it often starts working in about two weeks.
Other symptoms of depresssion sometimes seen along with S.A.D. are
similar to symptoms of "Atypical Depression", but with a seasonal relationship.
Some of these include increased sleeping during the winter, increased appetite and weight
gain in the winter and decreased energy, also in the winter.
If you or someone you know suffer of this or other forms of
depression, please seek the help of a trained professional.
Copyright 1995 by Daniel Pearson, M.D. All rights reserved. For more
articles by Dr. Pearson, visit http://www.cybercouch.com.
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