Winter blues more than the blahs
Saturday, January 25, 2014 12:00 AM
Image courtesy mayoclinic.org
DELPHOS — Seasonal Affective Disorder (SAD) is a type of depression that is triggered by the varying seasons of the year. The most common type is called winter-onset depression, which has symptoms that usually begin in late fall or early winter and diminish by summer. A much less common type of SAD, known as summer-onset depression, begins in the late spring or early summer and goes away by winter. In either case, symptoms may start out mild and become more severe as the season progresses.
Between four and six percent of people in the United States suffer from SAD and an additional 10-20 percent experience a mild form of winter-onset SAD, which is more common in women than in men.
Mental Health and Recovery Services Board of Allen, Auglaize and Hardin Counties Associate Director Philip Atkins said SAD can be a major depressive disorder with full-blown episodes lasting four to six weeks.
“There are changes in a person’s circadian rhythm, which triggers changes in a person’s appetite, weight, sleep patterns, moods; and basically, it alters many of the body’s functions,” Atkins stated.
According to the National Institute of General Medical Science, circadian rhythms are physical, mental and behavioral changes that follow a 24-hour cycle, responding primarily to light and darkness in an organism’s environment. They are found in most living things, including animals, plants and many tiny microbes. The study of circadian rhythms is called chronobiology.
The body’s master clock controls circadian rhythms — which are not biological clocks — and consists of a group of nerve cells in the brain called the suprachiasmatic nucleus (SCN), which controls the production of melatonin, a naturally-occurring hormone that makes humans sleepy. The SCN is located in the hypothalamus, an area of the brain above where the optic nerves — which relay information from the eyes to the brain — are located. The optic nerves send information about incoming light to the SCN. The result is, when there is less light, the SCN tells the brain to make more melatonin, leading to a drowsy feeling.
Abnormal circadian rhythms have also been associated with obesity, diabetes, depression and bipolar disorder.
“It throws the whole body out of whack,” Atkins detailed. “It affects us biologically, mentally and spiritually.”
Not everyone with SAD has the same symptoms, which include:
• Sad, anxious or “empty” feelings
• Feelings of hopelessness and/or pessimism
• Feelings of guilt, worthlessness or helplessness
• Irritability, restlessness
• Loss of interest or pleasure in activities you used to enjoy
• Fatigue and decreased energy
• Difficulty concentrating, remembering details and making decisions
• Difficulty sleeping or oversleeping
• Changes in weight
• Thoughts of death or suicide
Alberta Health Services Mental Health Promoter Pam Kollross reported that people suffering from SAD have a substantially higher level of melatonin in their blood all the time.
“Physiologically, at some level, their bodies are still asleep,” Kollross explained. “It makes a lot more sense why we have poor concentration, we’re exhausted all the time or looking for things to nibble on. Melatonin is a huge part of the puzzle.”
Kollross said there are ways to combat the symptoms. She said since melatonin plays such a big role in SAD, one of the most common ways of treating the disorder is by using light (light therapy).
“We want to trick the body into thinking it is daytime and that there is more sunshine than there actually is,” Kollross said. Light therapy is one of the first line treatments for SAD, which is a treatment where a person sits a few feet from a specialized light therapy box exposing them to a bright light that mimics outdoor light. The treatment appears to cause a change in brain chemicals linked to mood. Research on the treatment is limited but it appears to be effective for most people in relieving SAD symptoms.
“The use of electronics before bed can throw off a person’s circadian rhythm because the brain is engaged,” Atkins detailed. “Turn off all light-emitting electronics 30 minutes before bedtime.”
The specific cause of SAD remains unknown and it is likely that genetics, age and the body’s natural chemistry all play a role in developing the condition. Factors that may lead to a drop in serotonin, a brain chemical (neurotransmitter) that affects mood, might also play a role in SAD. Reduced sunlight can cause a drop in serotonin that may trigger depression.
Atkins said serotonin and dopamine combine to regulate a person’s mood and help brain cells fire from one to the other. “When there is a lack of serotonin, there is broken ‘communications’ between the firing cell to the next cell,” Adkins added. “This can be due to diet, circadian rhythm, alcohol consumption, smoking or medical conditions like heart disease and thyroid problems.”
Atkins said some people with SAD benefit from an antidepressant treatment.
“Selective Serotonin Re-uptake Inhibitors (SSRI’s) prevent the firing cell from taking back the serotonin from the next cell enabling the ‘communications’ between cells to continue,” Adkins stated.
Health professionals urge people not to disregard the yearly feeling as simply a case of the “winter blues” or a seasonal funk they have to deal with alone.
People experiencing any of the listed symptoms should make an appointment as soon as possible with a family doctor or primary care provider.
Beneficial information needed for an appointment includes a record of symptoms; depression patterns, when depression starts and what seems to make it better or worse; mental or physical health problems you have; major stressors or recent life changes; and a list of all medications, including vitamins or supplements.
To help with a diagnosis, the doctor will do a thorough evaluation by asking detailed questions about mood and seasonal changes in thoughts and behavior, sleep and eating patterns, relationships, job, or other questions about your life. You may be asked to answer questions on a psychological questionnaire.
Additionally, the visit may include a physical examination to check for any underlying physical issues that could be linked to depression.
Even with an evaluation, it can be difficult to diagnose SAD since other types of depression or other mental health conditions can cause similar symptoms.
The following criteria must be met for a diagnosis of seasonal affective disorder: a person has experienced depression and other symptoms for at least two consecutive years, during the same season every year; the periods of depression have been followed by periods without depression; and there are no other explanations for the changes in mood or behavior.
“In Delphos, a group called Shelter From the Storm meets at the library for a depression recovery class each Monday night from 6:30 to 7:30,” Atkins said. “It can be very helpful to meet with others for support and ideas.”
For more information, visit mayoclinic.org/diseases-conditions/seasonal-affective-disorder/basics/definition/CON-20021047.