Fall has fallen upon us, and while that brings with it some wonderful seasonal treats –apples, cider donuts, colorful foliage, football — it also means shorter days, longer nights, the advent of winter and, for many, the risk of seasonal affective disorder, or SAD.
SAD is both similar to and different from other forms of depression, and no one knows that better than Dr. Norman Rosenthal, who “discovered” the medical condition after he noticed its effects on himself. Rosenthal, clinical professor of psychiatry at Georgetown University School of Medicine and author of “Winter Blues: Everything You Need to Know to Beat Seasonal Affective Disorder,” came to the U.S. from his native South Africa in 1976 to complete his psychiatry residency in New York City. “For the first time, I experienced marked seasonal changes in myself,” he says. “I slowed down, was less productive, felt less creative. When summer came, I wondered what that fuss was all about.”
Rosenthal went on to study circadian rhythms and mood, and he discovered how melatonin, a hormone made in the pineal gland that regulates sleep-wake cycles, can be suppressed by lack of daylight. “Melatonin is important in multiple species. Animals use this as a guide to where they are in the year, for breeding and gestation regulation,” he says. The pineal gland was thought to be vestigial in humans until he surmised it might be active in people, too. “We exposed a subject [with SAD] to bright artificial light, and it brought him out of it,” he says. “So now we had one interesting finding, but we needed more to make a story out of it.”
After a newspaper reporter wrote a syndicated article about Rosenthal’s quest, thousands of people with similar seasonal depression responded. “We sent them a questionnaire, and I realized I had a clear syndrome in hand,” he says. He first described SAD in a journal article in the Archives of General Psychiatry in 1984, based on this group of people. Since then, SAD has been found to exist in many parts of the world and in both the Northern and Southern hemispheres.
[Read: Emotional But Don’t Know Why? Meet the Other Seasonal Affective Disorder.]
SAD Is Major Depression
“Without my own experience, I would not have been primed to believe in this syndrome, and there still is some skepticism,” Rosenthal says. Yet people with SAD do in fact have major depression, he says, citing one study out of Scandinavia that compared SAD with nonseasonal depression. Those with SAD actually had more symptoms than nonseasonal subjects. “So it can be just as severe. It just happens to be seasonal,” he says.
SAD, and its milder variant, the ” winter blues,” describe two points in a spectrum of severity, he says. “Some people have no documented seasonal changes, others are fully disabled, so it is a big spectrum, probably a continuous spectrum, like light is a spectrum,” he says. “We pick elements of that spectrum that are relevant to us, and in an analogous way, we pick from the spectrum of seasonality.”
For some, symptoms are so serious they should be treated by a doctor, while others simply muddle through the depths of winter. “But that still represents a significant deficit in productivity,” he says. “You are not doing your best, you have no zest for the party, the luster has been shaved off of your life. I think those people should treat themselves to live life fully.”
[See: Am I Just Sad — or Actually Depressed?]
Seeing the Light
For many, the first line of treatment is light therapy. “About now, if my patients tell me they are feeling tired, I say, ‘Have you gotten out the light box yet?'” says Carol Landau, clinical professor of psychiatry and human behavior and medicine at Brown University’s Alpert Medical School. Exposing oneself to extremely bright light of 10,000 lux for 20 to 30 minutes a day has proven effective in relieving the symptoms of SAD. But don’t settle for something less powerful and expect the same results. “A 100-watt lightbulb won’t do it,” Landau says “You want to get a safe, reliable device that has been clinically tested and validated at 10,000 lux,” she warns. Though the light is intense, you don’t look directly at it. “It is great to read by it while it is on,” she says.
And it works fast, Rosenthal says: “What is special is people with SAD respond in days, if not hours, to light therapy, where non-SAD patients need treatment for weeks with antidepressants before they are effective.” Light therapy, in fact, is increasingly being shown to help nonseasonal depression as well. “One study found light was just as good as Prozac,” Rosenthal says. It has also been effective in treating bipolar and prenatal depression.
[Read: Mental Health Experts Recommend Their Favorite Depression Books.]
There are other ways to combat SAD as well. Perhaps 10 percent of patients need medication, Landau says. “Only bupropion is approved [for SAD], but an SSRI still might be added, then tapered off” as spring approached, she says. She also recommends getting enough exercise, eating fewer carbs, managing stress and checking for vitamin D deficiency.
SAD can respond to talk therapy like cognitive behavioral therapy as well. “It helps with understanding of the condition,” Rosenthal says. “If you understand that you need to get out of bed and turn on the lights and keep active, knowing that will give you lot of leverage.” Starting antidepressants in the late summer to preempt the disorder may be helpful for extreme cases.
But this time of year, light is the best thing to shine on SAD. “A big error people make is thinking that their depression is nonseasonal and won’t benefit from light,” Rosenthal says. “The wonderful thing is you can add it to virtually any other medication with no combined side effects.”
More from U.S. News
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Am I Just Sad — or Actually Depressed?
Is Seasonal Affective Disorder Different From Depression? originally appeared on usnews.com
