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November / December 2008 Issue

Readers Ask:
Good News for SAD Swimmers

Q- I sometimes feel mildly depressed, but only during the winter months. I’ve heard about seasonal affective disorder, and sometimes worry that I may have it. What can I do to avoid it and/or treat it?

A- Joe Weber, M.Ed. President and Director of Sport Psychology at MINDSPORT mental training systems, and Johanna Marie McShane, PhD, of the South End Rowing Club in San Francisco and offer advice for swimmers with Seasonal Affective Disorder (SAD).

Weber’s Response
First, let’s define Seasonal Affective Disorder, often referred to as SAD (Affective is another term for mood).  SAD is a type of depression caused by a biochemical imbalance due to the shortening of daylight hours and decreased sunlight in winter.  Severity ranges from mild (referred to as sub-syndromal) to severe (clinical).  Though not listed as a separate mood disorder in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders), SAD is listed as a ‘specifier’ or component of major depressive disorders.  Despite this classification, SAD can dramatically impair daily life activities.  

While the cause of SAD is unknown, there are some hypotheses as to its origin:
  1. Circadian Rhythm – decreased sunlight could disturb an individual’s circadian rhythm, the physiological process that regulates your body’s internal clock.  Thus, triggering depression.
  2. Melatonin – The body’s production of Melatonin usually increases during long winter nights.  Melatonin is a sleep-related hormone that has been linked to depression.
  3. Serotinin – Reduced sunlight can cause a decrease in Serotonin, a natural brain chemical or neurotransmitter that affects mood and could lead to depression.
Second, since SAD is a seasonal disorder, usually, the symptoms occur around the same time every year.  A diagnosis can be made after 2 or more consecutive winters where symptoms are exhibited.  Estimated prevalence of SAD in the United States population is approximately 4-6% with rates of 1.5% in Florida and 9% in the northern US.  There are an additional 10-20% of the US population who experience mild symptoms (sub-syndromal).  SAD is extremely rare in those living with 30 degrees of the Equator where daylight hours are long.  SAD may begin at any age, but often the onset occurs between the ages of 18-30.  The risk of SAD appears to decrease with age.

SAD is a form of depression with similar symptoms to those who suffer from mild to severe depression.  Most commonly, a person will experience symptoms during late fall or early winter.  These symptoms can include; depression, hopelessness, anxiety, irritability, loss of energy, concentration difficulties, loss of sex drive, social withdrawal, disruption of normal sleep patterns, increase or decrease in appetite/ weight, a craving for carbohydrates, inability to tolerate stress, and loss of interest in previously enjoyable activities.  Many sufferers develop a weakened immune system making them more susceptible to illnesses.  

Third, treatments are varied and include SSRI drugs, psychotherapy, and light therapy.  Light therapy has been shown to be effective in up to 85% of diagnosed cases though the mechanism for its effectiveness is unknown.  Light therapy consists of exposure to very bright light (10 times the intensity of ordinary domestic light) for up to four hours per day.  Light therapy utilizes a fluorescent light, rather than incandescent which at a high intensity could cause retinal damage.   Just as a point of interest, domestic lighting emits an intensity of 200-500 lux, while light therapy exposes a client to 2,500 lux.  A bright summer day is approximately 100,000 lux!

So to answer your question on how to avoid SAD, try the following tips:
  1. Exercise Daily – exercise can increase certain neurotransmitters that elevate mood.  Plus, exercise outdoors will increase your exposure to sunlight!
  2. Sun Exposure – get outdoors, participate in outdoor activities and open the shades in your house.
  3. Shift Expectations – You get what you expect!  Many people live up to the labels they receive.  You can change your world and your physiology by changing your attitude, perceptions and expectations.
* If symptoms persist or are severe, contact your physician.

Joe Weber, M.Ed. is the President and Director of Sport Psychology at MINDSPORT mental training systems.  MINDSPORT provides mental training for amateur, elite and professional athletes.  Joe has consulted with collegiate and nationally-ranked athletes, elite coaches and professional teams while authoring numerous Sport Psychology articles for sport magazines. Joe specializes in performance enhancement and injury management. Joe is a member of the International Society for Sport Psychology.

McShane’s Response

What is SAD?

Seasonal Affective Disorder (SAD) is a term for feelings of depression that coincide with the onset of the autumn and winter months (although in rare cases the depression commences when the spring and summer months arrive). There is no known cause for SAD.

Think of SAD as a point on a continuum. Everyone experiences “blue” or “down” moods at some points. This is not uncommon. And many people feel “happier” or more energetic in the spring and summer months when the weather is often easier to deal with and better for outdoor activities like swimming. But some people experience depressed mood that significantly interferes with their lives, and in some cases incapacitates them. SAD is not so much an exact diagnostic point (as might be a bacterial infection, for instance, where you assess for the presence of a particular bacteria and you either find it or not), but an indication of the extent to which the depression is affecting someone’s life.

What are the warning signs?
Warning signs include: fatigue or loss of energy, change in appetite or weight, “blue” mood that doesn’t go away, feeling “sad” or “empty,” decreased interest or pleasure in activities, decreased sex drive, withdrawing from people, difficulty sleeping or sleeping too much, decrease in ability to concentrate, feelings of “worthlessness.”

What can I do to help?
There is no know prevention for SAD, but there are some things you can do to help. Since the depression inherent in SAD is in part light related (in North America there is much less sunlight in the autumn and winter months), some people respond to “light therapy.” You can buy lights that simulate sunlight, but be advised that neither this type of therapy nor the lights on the market are regulated by any government body.

For mild cases of SAD I recommend people try to spend as much time outdoors (in true sunlight) as possible. Obviously this is easier to accomplish if you winter in Florida than in Maine, but every bit of sunlight can help. Also, maintaining regular sleep and eating patterns is important. For swimmers who find the winter months too cold to be in the water as much I recommend adding in or choosing other sports for these seasons so they can continue to exercise and not lose fitness. It’s crucial that people don’t become isolated: if you swim year-round, make sure you keep doing that, not only for the fitness, but for the social contact; if you don’t swim year-round, find something else where there are other people to interact with. A hallmark of depression of is someone’s tendency to become withdrawn and isolated, which only tends to make the situation worse. Psychotherapy can be beneficial, often to help with developing a “coping plan” or strategies to deal with the SAD. In some cases medication can be valuable, and there are many options for which medications might be the best choice and how long someone might take any of them.

The important thing to watch for is how intensely you feel depressed and the extent to which this depression is affecting your life. If you notice your depressed mood is becoming more frequent and/or more intense, or it is significantly difficult to pursue and accomplish daily activities it would be a good idea to consult with a medical professional.  

Johanna Marie McShane, PhD
South End Rowing Club, San Francisco, California