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Is it the 'winter blues' or is it SAD?

Post-Bulletin - 1/8/2018

Jan. 08--Feeling down this winter? You're not alone -- plenty of people get the "winter blues."

But a small part of the population also experiences SAD, or Seasonal Affective Disorder, a wintertime depression.

We talked to an expert about what it means to have SAD and what people with a clinical diagnosis can do to lift their spirits.

What is SAD?

Seasonal affective disorder, or SAD, is a subtype of recurrent depression. It's characterized by a reliable onset of mood issues that begin in the late fall and winter, and leave in the spring and summer. SAD appears in mid-November and could last through mid-February, said Dr. Craig Sawchuk, a psychologist at Mayo. "Symptomatically, you get hibernation-style symptoms," he said. "It's less sad, more 'blah.'" People may notice that in the winter, they're sleeping more than normal or craving carbs. That and a depressed mood could mean SAD.

How is SAD different from depression?

It's not uncommon for people to experience "the winter blues" -- 12 to 15 percent of people experience a decrease in activity when the days shorten. But SAD is a significant impairment in one's work, social or other activities, experienced by 1 to 3 percent of the population. The rates are a little higher in Minnesota and other northern states, Sawchuk said. The symptoms have to consistently occur during the darker months for at least two years in a row for him to consider SAD as a cause. Major depressive disorder is not linked to a specific time of year and is more likely to be correlated with stressful life events.

What causes SAD?

The actual cause of SAD is a little bit speculative, Sawchuk said. Some people may be vulnerable to circadian disruptions when they're exposed to less natural light. Serotonin or melatonin levels can also change with light exposure. It's possible to experience annual spring-and-summertime depression for the same reason -- an increase in natural light exposure could disrupt a person's circadian rhythm, Sawchuk said.

How is SAD treated?

"Level-one treatment" for patients who haven't officially been diagnosed but are experiencing a drop in mood or activity is self-care, Sawchuk said. Waking up and sleeping at the same time offsets some of the hypersomnia, while exercise and socializing are "natural antidepressants."

"Maintain a normal daily rhythm, and deliberately and personally try to stay involved," he said. "Antidepressants don't always come in pills, but in the things we do and the things we surround ourselves with."

Level-two treatment for a patient with a clinical diagnosis of SAD is a light box. These are extremely bright boxes -- 10,000 LUX, or the intensity of a very bright lamp.

The vast majority of patients respond well to the light boxes, Sawchuk said. Medication and therapy are also options for people who require more intensive treatment.

Why are light boxes the best option?

They're noninvasive, fairly inexpensive (note: white lights tend to be cheaper), and almost never produce side effects, Sawchuk said. Medication tends to have side effects. Therapy costs can add up.

How do I use a light box?

People with SAD should start using a light box about two weeks before their mood tends to decline -- "That's the strange advantage of seasonal affective disorder, you tend to have some predictability," Sawchuk said. Within an hour of waking up, put the light box within 3 to 5 feet of you and keep it on for 20 minutes to half an hour. One shouldn't stare into the light all that time, but keeping one's eyes open is encouraged. Light boxes with a lower intensity, like 5,000 LUX, are cheaper, but require more time in use to be effective. So decide -- would you rather spend an additional 30 minutes with the light box in the morning, or $20-30 more on the light box?

Some patients use their light boxes in the afternoon or evening as a mood booster as well, Sawchuk said, but there's not a lot of research into using light boxes in the afternoon. It could disrupt sleep if used too late in the day, he added.

Can't people with SAD just spend more time outside?

Being outside could be helpful, but it's not usually enough to help a clinical diagnosis, Sawchuk said. The light level on an overcast day is usually around 3,500 LUX -- not enough to effectively treat SAD in 30 minutes to an hour.

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