It seems like we find out new things are bad for us all of the time and the news often seems contradictory. Alcohol is bad for us, but a little bit of red wine might be good for some people. Fried fish is bad, but take the oil out of the fish and put it in a capsule and it is good for the cholesterol. Sun exposure can cause skin cancer, but is absolutely necessary for Vitamin D production and, as it turns out, for normal brain functioning.
Sitting indoors in dark rainy weather doesn't just feel dismal, it actually has a negative affect on the neurochemistry of the brain with wide ranging effects that can last for months. In fact, sometime the effect can persist long after the seasons change back to sunny, warm weather and long days, well beyond the typical October to April, Autumn to Spring time frame.
So now we have our diet, our alcohol, and even the calendar that we have to watch out for. Fortunately, there are ways of managing this condition, known as Seasonal Affective Disorder.
Seasonal Affective Disorder does not affect everyone. However, people in latitudes that are further from the equator (Seattle is one of those) are more likely to be affected because there are fewer hours of daylight during the winter. Climate plays a significant role as well. In areas with less sunlight, the residents of the area are more likely to be affected. According to NOAA data, Seattle has sunshine 43% of the time. Compare that statistic to California Cities San Francisco, Los Angeles, San Diego at 66-76%, major desert Southwest cities 75-80%, and even Green Bay, Wisconsin (known for cold winter weather) at 54%.
Short daylight time during fall, winter and spring months and limited sunlight are predisposing factors for many to develop Seasonal Affective Disorder. However, there are factors within the individual that may predispose the person to suffering from this disorder. Some are more obvious such as underlying depression or depressed mood. Increased stress, excessive fatigue, disrupted sleep, limited outdoor activity and therefore limited exposure to the limited outdoor light that is present, uncontrolled medical illness such as diabetes, or othe medical or psychological issues.
People with Seasonal Affective Disorder are often challenging to diagnose. Their symptom patterns are frequently complicated and do not easily follow a seasonal pattern when first described because of the multiplicity of symptoms. Patients can present with any of a wide variety of concerns and they
will not always seem directly tied to the change in the season when the patient
explains the symptoms. Instead, the interconnectedness of symptoms, life stressors and coexisting problems can make diagnosis somewhat challenging. Typical presenting symptoms include mood symptoms such as: depression, crying spells, irritability, sensitivity to social circumstances and rejection, loss of sex drive. They may present with cognitive symptoms such as: trouble concentrating, memory effects. It is very common for there to be physical symptoms like: fatigue, body aches and body heaviness, decreased activity level. Sleep disturbances happen quite often such as insomnia, prolonged sleep, unrefreshing sleep. Surprisingly, there are metabolic changes like: overeating, especially of carbohydrates, with associated weight gain, and an increased rate of Metabolic Syndrome. Weight gain can affect other health conditions like diabetes and sleep apnea which can also affect sleep and fatigue.
The official diagnosis requires that there is determination of depression symptoms in a cyclical, seasonal pattern for a minimum of 2 years. Clearly, we do not wait 2 years to initiate treatment. When there is a clinical pattern, we initiate treatment and follow the patient carefully to assess for improvement.
Treatment for Seasonal Affective Disorder may include antidepressant medication, referral to a pychologist for psychotherapy, chronotherapy (managing the patient's sleep schedule), Vitamin D therapy, sleep hygiene (placinge the patient on a more appropriate and healthy sleep schedule, exercise therapy (which usually involves taking walks outdoors), and therapeutic light therapy.
Therapeutic light therapy is bright light therapy that mimics the wavelength of light not available in traditional room lights. These lights help to reset the hypothalamus to improve the dysfunction that occurs as the cause of Seasonal Affective Disorder. Typically the person needs to be exposed to the light for roughly 30 minutes per day, with the light in the periphery of his or her vision. It is safe for the eyes and has minimal side effects. Staring at the light might give a person a headache. Staring at the fluorescent tubes in your office at work might give you a headache, too. The light is mood elevating to a mild degree. A patient who has uncontrolled manic bipolar disorder might become irritable with the light. Also, because it promotes alertness, looking at it during the few hours right before bed might make it hard to go to sleep.
Seasonal Affective Disorder is common and likely significantly underdiagnosed. Simple interventions could probably be used for some of the milder cases to dramatically improved their quality of life. We could also significantly alter the course of the disease in more severe cases, if people came to medical attention.
