I have been treating a 37 year old woman for about six months.  She is married with three young children.  She came to me for treatment of depression and anxiety precipitated by her husband’s layoff from his lucrative job in the financial industry.  She and her husband were facing significant financial difficulties which have contributed to her depressed mood, difficulty sleeping, overeating, and feelings of hopelessness. They had been arguing in front of the kids and she was concerned how all this tension was  affecting them.

After referring her to a psychiatrist for an evaluation, she had responded quite well to her prescription for Zoloft, a medication to treat depression.  Things had been improving with her husband after he secured another banking job and they were barely arguing with each other.

However, about a month ago, my patient began to slip back into even a worse depression, not being to get out of bed in the morning and having frequent crying spells.  She told me that she has suffered from this “different” type of depression for the past two years, usually coming on during the month of December.  Her psychiatrist increased her dose of Zoloft and surmised that this “different” type of depression was Seasonal Affective Disorder or SAD.

What is SAD?

Seasonal affective disorder (SAD) is a kind of depression that occurs at a certain time of the year, usually in the winter.

Causes, incidence, and risk factors

SAD may begin during the teen years or in adulthood. Like other forms of depression, it occurs more often in women than in men.

People who live in places with long winter nights are at greater risk for SAD. A less common form of the disorder involves depression during the summer months.

Symptoms

Symptoms usually build up slowly in the late autumn and winter months. Symptoms are usually the same as with other forms of depression:

• Hopelessness
• Increased appetite with weight gain (weight loss is more common with other forms of depression)
• Increased sleep (too little sleep is more common with other forms of depression)
• Less energy and ability to concentrate
• Loss of interest in work or other activities
• Sluggish movements
• Social withdrawal
• Unhappiness and irritability

SAD can sometimes become long-term depression. Bipolar disorder or thoughts of suicide are also possible.

Signs and tests

There is no test for SAD. Your health care provider can make a diagnosis by asking about your history of symptoms.

Treatment

As with other types of depression, antidepressant medications and talk therapy can be effective.

Managing Your Depression At Home

To manage your symptoms at home:

• Get enough sleep.
• Eat a healthy diet.
• Take medicines the right way. Learn how to manage side effects.
• Learn to watch for early signs that your depression is getting worse. Have a plan if it does get worse.
• Try to exercise more often. Look for activities that make you happy.
• Practice good sleep habits.

Avoid alcohol and illegal drugs. These can make depression worse over time. They may also affect your judgment about suicide.

Nutrition Recommendations

It is important to consume a lot of foods and/or supplements with B Vitamins.  These vitamins found in chicken, meat, and eggs are improve mood symptoms and energy. Vitamin D is often very important because it too effects mood and energy.  People in the Northeast are often very low in this necessary vitamin because of limited sun exposure during the winter months.  Vitamin D can be found in yogurts, milk, and liver oil.  Tryptophan is also important because it is a building block of serotonin, a brain chemical implicated in depression.

Light Therapy

Light therapy using a special lamp with a very bright light (10,000 lux) that mimics light from the sun may also be helpful.

• Start treatment during the fall or early winter, before the symptoms of SAD begin.
• Follow your health care provider’s instructions about how to use light therapy. A common practice is to sit a couple of feet away from the light box for about 30 minutes every day. This is usually done in the early morning, to mimic sunrise.
• Keep your eyes open, but do not look straight into the light source.

Symptoms of depression should improve within 3 – 4 weeks if light therapy is going to help.

Side effects of light therapy include:

• Eye strain and headache
• Mania, less often (see: Bipolar disorder)

People who take drugs that make them more sensitive to light, such as certain psoriasis drugs, antibiotics, or antipsychotics, should avoid light therapy.

A check-up with your eye doctor is recommended before starting treatment.

With no treatment, symptoms usually get better on their own with the change of seasons. However, symptoms can improve more quickly with treatment.

The outcome is usually good with treatment. However, some people have SAD throughout their lives.

Calling your health care provider

Get help right away if you have thoughts of hurting yourself or anyone else.

My patient has greatly improved since taking her increased dose of Zoloft, working out at the gym four times a week, and continuing to see me on a weekly basis.  Moreover, she reports that using a light box every day for thirty minutes has really helped as well.

References

American Psychiatric Asosciation. Practice guideline for the treatment of patients with major depressive disorder. 3rd ed. October 2010.
Tesar GE. Psychiatry and psychology. In: Carey WD, ed. Cleveland Clinic: Current Clinical Medicine 2010. 2nd ed. Philadelphia, Pa: Saunders Elsevier; 2010:section 11.