The holiday season is supposed to be jolly and joy-filled. But for people who suffer from depression or Seasonal Affective Disorder, known as SAD, the holidays can be a particularly trying time.
SAD is best known for its fall-onset pattern, in which symptoms begin in late fall when the days become shorter, and typically lasts through spring. Overcast climates and more extreme latitudes both contribute to the condition – and Whatcom County has both in spades. Some experts are skeptical that SAD is a true syndrome, but there is enough evidence of the uniqueness and prevalence of the condition that most mental health professionals support it as a truly unique entity.
For those of us who are lucky enough not to be afflicted with SAD or depression, it is important to remain sensitive to the suffering of others during the holiday season.
While many people may become a little “down” during the winter, true SAD is characterized by features of major depression, though the features may be somewhat atypical (think hibernation). SAD is more likely than typical depression to be associated with increased sleep (rather than decreased sleep), increased appetite with carbohydrate craving (rather than decreased appetite), increased weight (rather than decreased weight), irritability, interpersonal difficulties (especially rejection sensitivity), and leaden paralysis (a heavy, leaden feeling in arms or legs). Both types of depression are associated with sadness, anhedonia (loss of ability to feel joy or pleasure), and feelings of hopelessness. Some people experience these symptoms every fall and winter.
Randomized trials have demonstrated that light therapy is effective, and can be used alone for patients with mild symptoms or who choose not to take antidepressant medications. The usual dose is 10,000 lux of white fluorescent light without ultraviolet wavelengths, beginning with one 15-minute session in the early morning, increasing to 30 to 45 minutes daily. The person should be 12 to 24 inches from the source with eyes open (though it is not recommended to stare at the light). It may take four to six weeks to see a response, although some patients improve within days. Therapy is continued until sufficient daily light exposure is available, usually from springtime sunlight. Premature discontinuation of light therapy can cause relapse. Some people with recurrent SAD begin light therapy every autumn and continue through to spring.
Bright or “happy lights” can be bought from many commercial outlets. It is important when buying a bright light to ensure that it is strong enough – at least 2,500 lux, but preferably 10,000 lux – and that it not contain harmful ultraviolet wavelengths (like tanning lights, which can increase the risk of skin cancer).
For people with more severe symptoms, medications are usually recommended alone or in combination with bright light therapy. A number of different antidepressant medications such as buproprion (Welbutrin), fluoxetine (Prozac), or other selective serotonin reuptake inhibitors (SSRIs) can be effective in SAD. Medications can be prescribed seasonally or year-round, depending on the severity of the SAD and patient preferences.
For most types of depression, cognitive-behavioral therapy is an effective intervention. Cognitive-behavioral therapy includes a number of different elements, including cognitive restructuring (e.g., re-programming automatic negative thoughts) and developing coping mechanisms. While cognitive-behavioral therapy is generally not first-line therapy for SAD, it is reasonable for seasonally depressed people who do not choose light therapy or pharmacotherapy. In addition, even people who do not suffer from depression have found many of the techniques of cognitive-behavioral therapy to be useful for coping with life’s challenges.
If you have a tendency to feel a little down in the winter, it may be helpful to take some other simple steps to improve your mood, such as scheduling social activities throughout the season, taking seasonal vacations to sunny locales, or getting outside to exercise during the day as much as you can.
Finally, for those of us who are lucky enough not to be afflicted with SAD or depression, it is important to remain sensitive to the suffering of others during the holiday season. Many people who are lonely or depressed have a difficult time socializing or going to holiday parties, so reaching out individually to those in your network who might be vulnerable can be a simple but important gesture that can make a real difference to a person who is struggling.
And remember – the days will be getting longer very soon.
Dr. Bree Johnston is director of palliative care for PeaceHealth and president of the Whatcom County Medical Society.