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Health Matters: SAD

By Virginia Lester,
RN, MSN, ARNP

SAD is the acronym for a condition known as Seasonal Affective Disorder defined as recurring depression with seasonal onset and remission. It can occur as two different seasonal patterns. The most common type has also been known as “winter depression” because it begins late in the fall or early winter and remits during the summer months. It is more prevalent and lasts longer in higher northern latitudes. The other type is a spring-onset pattern, less common and is more difficult to treat.

The causes of SAD are not yet well understood, in spite of fairly intensive research. Consensus is that the decreasing daylight available in the fall and winter months triggers a depressive episode in people who are already predisposed to develop depression. However, to date, studies have not been able to establish a causal relationship between winter SAD and the decreasing daylight hours.

The distinction of SAD from other forms of depression has generated great debate among mental health specialists. Abnormal melatonin metabolism and circadian rhythm disorders have been proposed as precipitating causes, although studies have been inconsistent. There does however, appear to be a relationship between brain serotonin activity and the onset of SAD. Considerable support exists for SAD as a separate diagnostic syndrome with increased seasonal variations in mood and behavior also found in the general population. Fall-onset SAD has responded to artificial bright light therapy. Non-seasonal atypical depression does not respond to phototherapy.

Winter SAD is characterized by increased rather than decreased sleep, increased rather than decreased appetite and carbohydrate craving, marked increase in weight, irritability, interpersonal difficulties and a laden paralysis (heavy feelings in the arms and legs).

“Winter blues” is the common name of a milder form of SAD, termed subsynmdromal SAD and may be more prevalent than SAD. For thousands of years man has depended on the healing benefits of light. Physicians have long noted an increase in depressive problems related to the lack of sunlight. Socrates may have been the first to prescribe light therapy for depression. When he noticed winter blues, he recommended his patients flee to the southern coasts to soak in the sun. Today light therapy or phototherapy may be recommended as a treatment adjunct to medication for those patients who have the diagnosis of SAD.

A word of caution is stressed here. First the diagnosis must be made. If light therapy is warranted, appropriate type, instructions and monitoring should be a part of therapy. These lights can be purchased in many stores, even Costco. Before you buy be sure it is right for you. If you have questions or concerns, I will be happy to help you.

NOTE: We still have a few doses of influenza vaccine left at the clinic. The FDA has advised that immunizations be given even if it is late in the season. It is very important for all of us to have this protection this year. Please call for an appointment.

Everyone at the clinic wishes you a happy holiday season and a very happy new year.