Treating the Winter Blues

In my last blog we began a discussion of seasonal affective disorder or SAD.  We will pick up where we left off.

There is actually some debate in the psychiatric community whether or not SAD is actually a separate diagnosis, apart from general depression.  Those who claim it is not suggest that it is no more than a seasonal coincidence that occurs in someone with recurring episodes of depression.  As support to this idea the critics of SAD as a syndrome point to the fact that as seasons change there is a change in mood and behavior in the general population that don’t suffer from depression.

Those who argue that the winter blues is a separate syndrome note that it occurs more commonly and lasts longer the more north one travels from the equator and that it often responds well to bright light therapy (more on this to come)- something that does not happen in “regular depression”.

The symptoms of winter SAD are actually considered “atypical” signs of depression.  These include:

• Increased sleep
• Increased appetite with cravings for sweets in the afternoon
• Increases in weight
• Irritability
• Problems in dealing with others (especially being sensitive to rejection)
• A heavy feeling in the arms or legs (called leaden paralysis)

The more typical type of patient with depression has insomnia, decreased appetite, decreased libido, and weight loss.  Interestingly, the less common spring-related SAD is associated with the more usual signs of depression.

So how is SAD treated?  One very novel therapy for SAD, compared to “regular” depression is the use of light therapy.  This entails exposure to an extremely bright light for 30-45 minutes a day.  Basically the patient stays in front this bright light with their eyes open, without staring directly into the light.  Some studies seem to show that the response is better when the treatment is used in the morning.   

Another interesting type of SAD treatment is called dawn simulation.  A dawn simulator is a bedside device that simulates the rising of the sun.  Even though the eyes are closed during sleep it is believed that a small amount of light reaches the back of the retina through the eyelids stimulating cells in the eye that are responsive to light.  This sends a chemical signal to the brain telling us that it is time to wake up.  In some studies dawn simulation was nearly as successful for the treatment of SAD as bright light therapy.

The fact that both of these treatments seem to be effective strongly suggests that SAD is closely related to the body’s circadian rhythm, as we mentioned originally.

Lastly, antidepressants seem to be valuable for the treatment of winter blues.  It is likely that most of the common antidepressants will be helpful, but some of the agents that have been studied specifically in SAD include fluoxetine (Prozac) and bupropion (Wellbutrin).