January / February 2007 Issue

Winter Blues Q&A

by Professor Douglas George Jacobs, Harvard Medical School

Blues Versus Depression
There is a fine line between feeling sluggish and having seasonal affective disorder (SAD). Douglas George Jacobs, associate clinical professor of psychiatry at Harvard Medical School, and president/CEO of Screening for Mental Health, answers some frequently asked questions regarding SAD and winter depression. (See related article in USMS SWIMMER, January/February 2007.)

Is SAD primarily an adult condition or can it affect children?
Depression in general is not as common in children but depression can occur in children, including SAD.

Are there various levels/degrees of SAD?
Depression in general, including SAD, can vary from being mild to more severe.

Does family history play a role?
Yes, those with a family history of depression may be more susceptible to it themselves.

How do you differentiate between symptoms of SAD and a general feeling of sluggishness, or feeling as though you want to hibernate?
SAD symptoms are clearly tied to the seasons and persist through the winter months. A transient feeling of being tired, sluggish or just wanting to stay inside is not SAD.

Is SAD classified as a form of depression?
Yes, it is a subtype.

Can SAD symptoms be mistaken for another illness?
Symptoms of SAD such as feeling tired or loss of appetite or an inability to concentrate or changes in sleep can be related to a host of other disorders including hyperthyroidism or mononucleosis. The individual should have a full medical evaluation to ensure nothing else is wrong.

What makes light therapy an effective treatment for SAD?
Although light therapy has been demonstrated to be effective for a number of patients with SAD, the theoretical basis for its effectiveness is unclear.

Would you recommend a combination of therapies for SAD?
Although research is still ongoing in effective SAD treatments, there are several options to consider with your physician when trying coping with this condition.

If your symptoms are mild, increased exposure to sunlight can improve symptoms of SAD. This can include a long walk outside or arranging your home or office so that you are exposed to a window during the day. Exercise and stress management can also help.

If your depressive symptoms are severe enough to significantly affect your daily living, light therapy (phototherapy) has proven an effective treatment option. This form of therapy involves exposure to very bright light (usually from a special fluorescent lamp) between 30 and 90 minutes per day during the winter months. These light therapy sessions are best used during the morning hours. Additional relief has been found with psychotherapy sessions, and in some cases, prescription of antidepressants.

Can self-diagnosis pose a health risk?
Self-assessment tools such as screening can be helpful because they educate people about the signs and symptoms and may motivate them to seek treatment. But a diagnosis can only be made with a professional, medical opinion, and this is the safest, surest route to health and wellness.

Does stress play a role in aggravating symptoms?
Stress is always aggravating to physical and emotional illnesses.

Does caffeine play a role in aggravating symptoms?
Excessive consumption of caffeine can disrupt the body’s systems and can cause insomnia.

Are people who suffer from year-round depression more susceptible to SAD?
It is unclear if people who suffer from year-round depression are more susceptible. However, people who suffer from bipolar disorder do tend to be more susceptible.

What areas of the country have the highest occurrences of SAD?
The areas with the highest latitude and least amount of daylight hours have the highest occurrences of SAD.

Are they any foods that can aggravate symptoms?
Most physicians will recommend avoiding alcohol, which is a depressant and can make the depressive episode worse and interrupt the sleep cycle.

Do you have any stats on how many people get SAD each winter in the U.S.?
Approximately 2 to 5 percent of the general population in affected climates will experience SAD. However, in Alaska it is reported that close to 9 percent are affected.

Does sunlight exposure help combat SAD?
If your symptoms are mild, increased exposure to sunlight can improve symptoms of SAD. This can include a long walk outside or arranging your home or office so that you are exposed to a window during the day.

If your depressive symptoms are severe enough to significantly affect your daily living, light therapy (phototherapy) has been proven an effective treatment option. This form of therapy involves exposure to very bright light (usually from a special fluorescent lamp) between 30 and 90 minutes per day during the winter months. These light therapy sessions are best used during the morning hours.

Note: The information in this article is not intended as a substitute for professional or medical advice. It is not intended to provide medical advice on personal health matters. For personal medical advice, consult your healthcare provider. If you are concerned about a particular medical condition on injury, see your healthcare provider for evaluation and care.

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