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Beating the Winter Blues

Give light to the darkness of seasonal sadness.

During the short winter days, many people find themselves feeling sad. You might be one of them. Whether it’s feeling extra stress around the winter holidays, or falling into the dumps once the holiday excitement is over, certain individuals find themselves having more serious mood changes throughout the entire fall and winter.  Is there really something about shorter, darker days that can leave us feeling down?

National Institutes of Health-funded researchers have been studying the “winter blues” and a more severe type of depression called seasonal affective disorder, or SAD, for more than 30 years. While they’ve learned about possible causes and treatments that seem to help most people, much about these winter-related mood shifts is still a mystery.

“Winter blues is a general term, not a medical diagnosis’” says Dr. Matthew Rudorfer, a mental health expert at the National Institutes of Health.  “It’s fairly common and more mild than serious.  It usually clears up on its own in a fairly short amount of time.”

“Seasonal affective disorder (SAD), though, is different. It’s a well-defined clinical diagnosis related to the shortening of daylight hours,” says Rudorfer. “It interferes with daily functioning over a significant period of time.”

Characteristics of Seasonal Affective Disorder

A key feature of SAD is that it follows a regular pattern, appearing each year as the seasons change and disappearing several months later, usually during spring and summer.

It should not be surprising that SAD is more common in northern parts of the United States, where winter days are darker. “In Florida, only about one percent of the population is likely to suffer from SAD, but in the northernmost parts of the U.S, about 10 percent of people in Alaska may be affected,” says Rudorfer.

SAD can lead to a doom-and-gloom outlook on life, making people feel hopeless, worthless and irritable, just as with other forms of depression. They also may lose interest in activities and hobbies they enjoyed, even spending time with friends.

“Some people say that SAD can look like a kind of hibernation,” says Rudorfer. “People with SAD tend to be withdrawn, have low energy, oversleep and put on weight. They might crave carbohydrates,” such as cake, candy, and cookies.

Shorter days seem to be one of the main triggers for SAD. Reduced sunlight in fall and winter can be disruptive to your body’s internal clock or circadian rhythm; a 24-hour “master clock” that responds to cues in your surroundings, especially light and darkness. During the day, your brain sends signals to other parts of the body to help keep you awake and ready for action. At night, a tiny gland in the brain produces a chemical called melatonin, which helps you sleep. Shortened daylight hours in winter can alter this natural rhythm and lead to SAD in certain people.  Without treatment, symptoms of SAD typically stick around until the days begin to lengthen.

The link between light and seasonal depression

National Institutes of Health researchers first recognized the link between light and seasonal depression back in the early 1980s. These scientists pioneered the use of light therapy, which has since become a standard treatment for SAD. “Light therapy is meant to replace the missing daylight hours with an artificial substitute,” says Rudorfer.

With light therapy, patients sit in front of a lightbox each morning for 30 minutes or more (based on their doctor’s recommendation). The light in the box shines much brighter than ordinary indoor lighting.

Studies have shown that light therapy relieves SAD symptoms for as many as 70 percent of patients after a few weeks of treatment. Sometimes, improvement is detected sooner. “Our research has found that patients report an improvement in depression scores after even the first administration of light,” says Dr. Teodor Postolache, who treats anxiety and mood disorders at the University of Maryland School of Medicine. “Still, a sizable proportion of patients will improve, but do not fully respond to light treatment alone.”

Once started, light therapy should continue every day well into spring. “Sitting 30 minutes or more in front of a lightbox every day can put a strain on some schedules,” says Postolache. So some people tend to stop using the lightboxes after a while. Other options have been tested, such as light-emitting visors that allow patients to move around during therapy, but results for the visors in SAD treatment haven’t been as promising as hoped, according to Postolache.

While it doesn’t work for everyone, light therapy is considered the first-line treatment for SAD. Studies show that certain antidepressant drugs can also be effective in many cases of SAD such as bupropion (Wellbutrin) which has been approved by the U.S. Food and Drug Administration for treating SAD and for preventing winter depression. Doctors sometimes prescribe other antidepressants as well.

Cognitive behavioral therapy can help

Growing evidence suggests that cognitive behavioral therapy (CBT) – a type of talk therapy – can also help patients suffering from SAD. “For the ‘cognitive’ part of CBT, we work with patients to identify negative, self-defeating thoughts they have,” says Dr. Kelly Rohan, a SAD specialist at the University of Vermont. “We try to look objectively at the thought and then reframe it into something that’s more accurate, less negative, and maybe even a little more positive. The ‘behavioral’ part of CBT tries to teach people new behaviors to engage in when they’re feeling depressed, to help them feel better.”

Behavioral changes might include having lunch with friends, going out for a walk or volunteering in the community. “We try to identify activities that are engaging and pleasurable, and we work with patients to try to schedule them into their daily routine,” says Rohan.

A preliminary study by Dr. Rohan and colleagues compared CBT to light therapy. Both were effective at relieving SAD symptoms over six weeks in the winter. Their study also found that those treated with CBT had less depression and fewer recurrences of SAD the following winter compared to people treated with light therapy.

If you’re feeling down this winter and the feelings linger for several weeks, SEARHC encourages you to talk to a healthcare provider. SAD does go away on its own, but that could take as many months as it takes for our daylight hours to significantly increase. Feeling bad every single day for five or six months is a long time, and probably unnecessary since SAD is generally treatable.

SouthEast Alaska Regional Health Consortium (SEARHC) recommends speaking to a medical or behavioral health provider by contacting your local primary care clinic or contacting the SEARHC Crisis Help Line toll-free at 1.877.294.0074. The SEARHC Help Line is available 24 hours a day, seven days a week to all residents of Southeast Alaska and staffed with a team of master’s degree level mental health therapists who will listen and provide effective, compassionate, and confidential care.

 Source: National Institutes of Health: NIH News in Health https://newsinhealth.nih.gov/2013/01/beat-winter-blues

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The SEARHC Crisis Help Line, 1.877.294.0074, is available 24 hours a day, seven days a week to residents of Southeast Alaska.