INTRODUCTION
Many people develop depression in the late fall or winter, and improve on their own in the late spring or summer. Until recently, this was often ignored or not recognized as having a seasonal pattern. Now, however, thanks to increased public awareness, many people who had suffered with these problems in the past are now being helped. There are several treatments available now, including treatment using a special "light box".
Problems during the winter can be from two different causes. First, there are depressive symptoms related to psychological or social factors. This includes reactions to the holidays such as loneliness or family conflicts, or a response to other changes in one's lifestyle (such as a landscaper who might be unemployed each winter, or someone getting less exercise during the winter). Even though there may be a "cause" for these symptoms, working with a professional is often helpful.
In this article we will focus on the second type of Winter Blues, which is related to the shortening of daylight in the winter. Many people often blame other factors for their mood, when it may actually be related to light changes. In its more severe form it is known as "Seasonal Affective Disorder" or "SAD". This syndrome effects about 6% of the population, with an additional 14% of people having a milder form. In other words, one in five Americans suffers with some type of decreased functioning, sadness, or other problems, as the season changes to winter.
Recent research has shown that SAD also effects children and adolescents, possibly with almost 50% of children having some changes in mood or behavior associated with wintertime.
CHARACTERISTICS
SAD is a set of symptoms which recur in a seasonal pattern (usually late fall or winter), and also improve in a seasonal pattern (usually in the spring). People may also have a less severe form of the illness, with milder symptoms ("The Winter Blues"). These symptoms vary from person to person, but most commonly include some of the following:
Common Symptoms of The Winter Blues:
- tiredness or decreased energy
- isolation and withdrawal
- apathy
- decreased interest in activities or hobbies, decreased libido
- change in weight or appetite (usually increased)
- problems concentrating at work, school or home
- lower self-esteem, guilt feelings
- sleep problems (sleeping either more or less, or disturbed sleep)
- feelings that life is not worth living
Children with SAD or the Winter Blues may show very different symptoms, such as: behavior problems, change in energy level, changes in contact with friends, irritability, or problems with grades or school performance. These can be in addition to some of the adult symptoms, or may occur alone.
People often don't realize they have SAD, or they blame the symptoms on other causes, such as laziness, medical problems, social problems etc. This is why it is important for a professional with experience in this area to do an evaluation to determine the cause(s) of the problems.
SAD occurs about four times more often in women than in men, and about 50% of women with this disorder have premenstrual problems which worsen in winter. SAD symptoms typically start in late September, October or November and usually begin to improve in March, April or May. January and February are often the most difficult months. The average length of depression is about five months but varies a lot. Depression in general, and SAD specifically, sometimes runs in families.
PHOTOTHERAPY
Light therapy or "Phototherapy" (photo = light) is a relatively new treatment for SAD or its milder forms.
Typically, someone sits one and a half feet away from a "light box" (a special set of fluorescent lights) for about a half hour each morning. The timing, duration and distance of the lights vary from person to person and should be determined by a knowledgeable professional, and is sometimes adjusted as treatment continues.
While the person is in front of the light they don't have to look directly into the light, and may do things such as read, write, or have breakfast. Many people feel a dramatic improvement in mood within three to four days. The morning light treatments continue throughout the winter, since one often develops problems again if they stop treatments too early in the season.
HOW AND WHY?
How Phototherapy works, and why people get depressed in the winter, is still not clear, but research indicates some probable answers. All living things have internal "biological clocks" which regulate many things such as eating, hormones, menstrual cycles, mating, activity level, and sleep. This biological clock gets "set" by outside factors. One important influence on our internal clocks is the duration, timing, and intensity of sunlight, which changes according to the season. Unfortunately society and its obligations don't necessarily change as well. The time we have to wake up each morning usually stays the same, but our body's clock changes as the time of sunrise changes. This causes a mismatch between our lifestyle schedule and our body's clock (which changes with the seasons). It is this mismatch that can cause mood changes in some people. Also, many animals increase their sleep and slow down their activity levels in the winter, such as a bear hibernating. Some believe SAD depression is similar, being a type of slowing-down.
Phototherapy basically works by using a light box to imitate summer light patterns during the winter. Research shows that giving light treatments in the morning are more effective than in the afternoon or evening. This is probably because morning light is better at resetting our internal clocks. It has also been shown that the intensity of light is very important. The light source must be fairly bright (about the intensity of outdoor sunshine) for it to have an effect.
CONCLUSION
The Winter Blues and SAD are problems that many people have (one in five, if not more), yet they often go unrecognized and untreated. Luckily, more and more people are becoming aware of these problems and are dramatically improving their lives by getting the proper treatment. Even if SAD or Winter Blues turns out not to be the problem, it is important that symptoms of tiredness, irritability, sleep or appetite changes, loss of interest, or other symptoms mentioned above, are not ignored. If these symptoms develop, a professional evaluation may be indicated. These problems can have many different causes, and can be helped with the right treatment.
the Society for Light and Biological Rhythms : A web site with useful resources for further information about SAD and other Biological Rhythms.
The SunBox® Company: a company which sells light boxes, the site also has useful information about SAD and light therapy (get a discount if you contact Dr. Steve Resnick first!)